Body image and food issues are prevalent on campus, as adolescence and early adulthood are two peak times for the onset of these problems. Arising from a combination of emotional, psychological, and social conditions which include:
- poor self-image
- difficult family relationships
- challenges in personal relationships
- cultural pressures to be thin and/or extremely fit
90% of reported cases are female, and there is a significant increase in eating disorders in males. People may use food, weight, exercise, purging, dieting, and/or the abuse of laxatives, diuretics, or steroids to exert control over their lives, handle stress, and avoid or minimize feelings of failure, depression or anxiety. Some people have a distorted sense of their body image. This is called dysmorphia, characterized by the person thinking/believing they are shaped differently than they truly are. The socio-cultural pressure to conform to unrealistic and unhealthy standards of weight and size, and even fitness level, encourage destructive dieting and body image problems, both of which are associated with and are precursors to eating disorders.
Eating Disorders have the highest mortality rate of any psychiatric illness. There is often denial and shame present, making it difficult for sufferers to know there is a serious problem and to reach out for help.
How Do I Know There’s a Problem?
Signs and Symptoms
- Body dissatisfaction
- Increase in statements about body size, style or level of fitness
- Preoccupation with a specific body site (face, nose, abdomen) shape or size
- Complaints may be specific or general statements referencing “ugliness” or “unacceptability
- These thoughts may dominate the individual’s life focus and energy.
- The distorted beliefs may dictate your friend’s choice
- Rapid weight loss
- Erratic weight fluctuations
- Wearing very oversized clothes
- Frequently talking about being/feeling fat
- Eating secretly
- Barely eating
- Pretending to eat or other “food games”
- Eating excessively
- Stealing money (to buy food)
- Stealing food
- Exercising excessively
- Avoiding social gatherings or situations where food is served
- Spending a lot of time in the bathroom, especially after meals
- Hiding/hoarding food
- Abusing diet pills, laxatives, diuretics, illegal drugs, steroids
- Mood changes
- Food and body image issues may lead your friend to lose focus on other things
- Your friend may feel out of control
- She may “go into hiding”
- It may be stressful for you to eat or work out with this person
- You may feel worried, even out of control yourself
- You may feel like nothing you say is helpful, even when your focus is to be non-judgmental
- You may be the support your friend needs to avoid the dangers of an eating disorder
Supportive Questions to Ask Your Friend:
- What is the problem?
- What are you doing about it?
- What do you think needs to be done next?
- How can I help?
Eating Disorder Descriptions:
Anorexia Nervosa: characterized by severe restriction of food intake resulting in significant weight loss, and may or may not include purging behaviors, such as vomiting, use of diet pills or laxatives, and/or excessive exercise. Characteristics of those suffering from anorexia may include the following: intense fear of fat, distorted body image, preoccupation with diet/calories/weight/exercise, depression and mood disturbances, and loss of self-esteem. Physical effects may include malnutrition, loss of hair, muscle cramps, dehydration, dizziness and fainting, kidney impairment, cessation of menstruation, infertility, altered brain function, cardiac irregularities, and in the most severe cases (10-15%), death.
Bulimia Nervosa: known as the “binge-purge” syndrome in which the person feels compelled to consume large quantities of food in a relatively short period of time, and feels out of control. The binges are usually followed by purging, in the form of self-induced vomiting, or abuse of laxatives, diet pills, and/or diuretics, excessive exercise, or fasting. People with bulimia may be of normal weight, underweight, or slightly above average body weight. Specific medical complications arising from bulimia include tooth and gum decay caused by frequent vomiting of stomach acid, gastrointestinal disturbances, swollen glands, scarring on the back of the hand or fingers, dehydration, dry or cracked lips, dizziness and fainting, low potassium levels, kidney impairment, esophageal hemorrhaging, electrolyte imbalances, cognitive disturbances, cardiac irregularities, and in the most severe cases, death.
Binge-Eating Disorder: a condition in which persons overeat, not in response to hunger but in response to compulsive feelings driving them to eat. This problem is similar to bulimia, but does not involve purging behaviors. Compulsive overeating may be a way of dealing with difficult emotions or painful life situations as the eating may numb uncomfortable feelings. The behavior can become habitual, like an addiction. Weight problems including obesity may result from binge-eating, and persons who compulsively over-eat generally also chronically diet. Dieting itself sets one up for overeating as it creates emotional and physiological deprivation, which can lead to overeating. Dieting also lowers one’s metabolic rate and increases normal levels of fat storage in the body, both of which contribute to slower weight loss and more rapid weight gain. “Yo-yo dieting,” or frequent substantial increases and decreases in weight, create significant health risks.
Obesity: or being over-weight, is not an eating disorder, but, rather, is a size. People who are large may be healthy and fit. One’s normal, healthy body size may be any weight, depending largely on one’s genetics.
Orthorexia: can be construed as healthy nutritional practices “on steroids”. At first glance tightly controlled “eating healthy approaches” may not seem to be problematic. However, if a person becomes rigid in food choices and practices rituals involving their food, the healthy intention may be a slippery slope to problem eating. Orthorexics are often defensive and self-righteous because many of their beliefs and behaviors are founded in healthy practice. Orthorexia is a good plan put to extremes.
Emotional Eating: the practice of eating when stressed, sad, angry, or bored. It is not biological hunger. It may occur in social situations with the distractions of interaction. Research shows that this practice can be a significant source of extra calories, resulting in becoming overweight or even, obese. Frequently, emotional eating is practiced when the individual wants something else, like companionship or meaningful relating. It may be resorted to as a distraction from an unsavory task (writing a paper or studying for an exam). The antidote to emotional eating is mindful eating where the individual makes healthy choices, monitors portion sizes, and practices awareness during meals. Emotional eating may be supported if the person watches TV, plays video games, or reads during the meal.
What is compulsivity?
A compulsive voice might say: “I have to do it!” Usually there is a sense of urgency. Feeling like there is no other choice is typical. These responses are a reaction to some type of trigger: an event, an interaction, feeling hungry, angry, lonely, or tired, or helpless, or are a result of a traumatic experience. The cycle includes a triggering experience, which induces feelings of stress, followed by binge eating to relieve unwanted feelings, resulting in feeling guilt, leading to an increase in resolution to stop overeating and to diet. Compulsivity is a loss of control. There is a significant emotional component to compulsive overeating. Your friend may think and /or feel that he /she “deserves” a reward or comfort. Reaching for food may be a habit; an automatic response. Most of us can control what food is available to us. We can “manage” to get food. It is a dependable resource. Maybe we learned of its availability and effectiveness in soothing us early in childhood where eating patterns are formed. Foods do impact brain function and may, indeed, make us feel better for a discrete amount of time.
Rationale for compulsive eating:
• Using food as a reward
• Using food as a distraction or comfort; an attempt to manage hidden issues
• Eating when not hungry
• Feeling that you can’t stop eating once you start
• Sneaking food
• Hiding or stashing food
• Eating instead of addressing feelings of sadness, boredom, anxious, or anger
• Excess body size may serve as protection from further physical/sexual abuse
Compulsive overeating, uncontrollable eating, is followed by feelings of shame or guilt. Inevitably it results in weight gain.
Signs and symptoms of compulsive eating
• Eating large amounts of food even if you don’t intend to
• Consuming food at a rapid pace
• A lack of awareness during the process of overeating
• Grazing” behaviors; eating throughout the day
• Avoidance of eating with others
• Physical symptoms of bloating, heartburn, fatigue, abdominal discomfort
• Feeling depressed, ashamed, or guilty after consuming large amounts of food
• Mood is based on perception of controlling food
• Cyclic dieting in an attempt to stop the behavior and or to control weight gain
• History of weight fluctuations
• Withdrawing from activities because of embarrassment about weight
• Attempting multiple diets frequently
• Attributing disappointments and failures to weight and size
• Awareness of abnormal eating patterns
• Weight is life’s focus, spending excessive amounts of time and thought devoted to food
Reasons to intervene
• Yo Yo dieting is physically harmful.
• Being overweight is potentially unhealthy: heart ailments, high cholesterol diabetes, kidney disease, arthritis, bone deterioration, sleep disturbance, high blood pressure, stroke, constipation, lack of fitness, fatigue, mobility problems
• Overweight people are often stereotyped as lazy, prompting prejudicial treatment.
• Relying on food is an ineffective means of dealing with feelings.
• Caring support is often the key necessary for making healthy changes.
• May provide your friend the encouragement to identify more effective coping strategies.
• Assisting your friend to become more mindful, rather than trapped in habitual reactions, contributes to a happier, healthier, more fulfilling life-style.
Eating in the Light of the Moon by Anita Johnston
Boundaries: Where You End and I Begin by Anne Katherine
Bodylove by Rita Freedman
When Food is Love by Geneen Roth
Breaking Free from Compulsive Eating by Geneen Roth
It’s Not About Food by Normandi and Roark
Mindful Eating 101: A Guide to Healthy Eating in College & Beyond
by Susan Albers
Foods are neutral. Food is fuel. Amounts and frequency of eating certain foods can impact body size but there are no “bad” foods.
Compulsive eating is treatable with counseling and therapy and in some cases, with psychotropic medications. Statistics reflect that approximately 80% of suffers seeking professional support experience significant reduction in symptoms, with many recovering completely.
Because eating disorders are behavioral patterns, which are a result of unresolved emotional conflicts, the conflicts need to be addressed and ultimately resolved or neutralized in order for the sufferer to develop a healthy relationship with food and body image. Compulsive eating is a serious condition and should be addressed with appropriately trained professionals. Medical care, nutritional counseling, and talk therapy are standard modalities of treatment.
While cultural stereotypes may suggest that an individual who compulsively over eats, simply lacks self-control and is naturally lazy, there is no substantiation for this bias. The emotional reactions of guilt, shame, self-loathing and depression may curtail the energy and attention of the sufferer and may be interpreted as lack of intention.
Like other addictive behaviors, an addiction to food serves as an effective means to avoid feelings that are difficult to confront and to resolve. It is a “detour” that works to a certain degree. It is reinforcing because it does distract the individual from attending to the uncomfortable source of the unwanted feelings.
Guidelines for supporting a friend
While we know that, ultimately, we cannot exercise control over the behavior of
another person, when there are indicators that a friend may be at risk, you do have power over your choices. You can offer support. That may be sitting up late and talking; it may be inviting the friend to have a meal with you; it may be assisting in finding a therapist or making a phone call home. You have a better chance of success if you are informed about available resources as well as having listened well and cared enough to have observed the reality of your friend’s situation.
There is no way to gauge how the friend will respond to your offer of support. It is worth a risk of your friend becoming upset, to demonstrate your willingness to help. Your efforts and expressions of encouragement and concern may be crucial to your friend’s wellbeing. You do not have to wait to have “proof” of a full-blown eating disorder to express concern.
What you can do and how you can do it
• Choose a private place and an un-hurried time.
• Reflect understanding and concern. Empathy is necessary.
• Stay open to the perceptions of your friend even if they are different than your own.
• Talk about what you have observed. “I noticed that you have eaten that whole bag of chips.” “I heard you getting the bag of cookies last night after we went to dinner” “I worried when I noticed that you ate the whole extra-large pizza.
• Phrase comments in neutral tones. “I’m worried that you aren’t happy.”
• Mention concerns other than food and body.
• Share information about resources.
• Avoid arguing with your friend.
• Accept your limitations.
• Exercise patience.
• Refuse to become “the food police”.
• Avoid discussing appearance.
Based on materials from:
The Eating Disorder Sourcebook
by Carolyn Costin, M.A., M.Ed., MFC
Excessive or Compulsive Exercise
Excessive or Compulsive Exercise: can be viewed as another healthy practice gone badly. It is unsafe. A student who makes multiple visits to an exercise facility in one day, who spends over one hour more than five days per week working out, who looks thin or gaunt, may be over exercising. A student who will miss class or a social engagement but not miss their work out, even if they are ill or injured, may have difficulty managing exercise appropriately. A compulsive exerciser often experiences light-headedness or dizziness. They may feel weak during workouts or at other times. Frequently, excessive exercise is accompanied by food restriction behaviors. This individual requires “re-training” of their relationship with exercise. They can be shown that exercise is about strength and fitness not about weight loss.
Diet Pills : support the obsessive pursuit of thinness, or so many people believe. They are common and easily obtained. Both prescription and over the counter pills are one of the most unhealthy and potentially dangerous ways to attempt to manage weight. Many of these substances are highly addictive. The individual can become dependent on the diet pills. These substances act as stimulants to the central nervous system and can have serious and even fatal side effects. Complications include: diarrhea, vomiting, headaches, dizziness, anxiety, irritability, and insomnia, even seizures, cardiac arrest, and stroke.
Laxative Abuse : occurs with the frequent or consistent reliance on laxatives to get rid of calories, to lose weight, or feel thinner or “empty”. It can result in a variety of health complications .It is a myth that laxatives are effective for weight loss. In actuality, laxative abuse causes loss of water, minerals, electrolytes, and fiber. This weight returns when the body re-hydrates. Recovering from the cycle of laxative abuse is complicated, requiring medical and emotional support. Health consequences can include: dependency on the stimulant, dehydration, tremors, weakness, blurry vision, kidney damage, electrolyte imbalances, mineral loss Results can manifest as liver damage, Irritable Bowel Syndrome, and/or improper functioning of vital organs.
Pica : is a relatively rare condition characterized by eating non-nutritive substances (paper, ice or dirt). A nutritional deficiency of zinc or iron may trigger the unusual cravings. The practice may be an indication of malnutrition. Pica can be a habituated carry-over from childhood or can be a practice by adults who crave a certain texture in their mouths. Pica can result in complications such as malnutrition, lead toxicity (if paint is ingested), infection (if contaminated soil or animal waste is ingested), abdominal or intestinal obstruction.