Students Speak On Factors Exacerbating Disordered Eating At Columbia And Barnard

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20 November, 2021

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Columbia Daily Spectator BY JULIA TONG NOVEMBER 18, 2021 Editor's note: This article deals with topics of disordered eating and eating disorders. Some of the names included have been changed to protect the anonymity of the subjects. In my first year at Columbia, my relationship with food was fractured. In hindsight, it was a combination of being away from home for the first time, school-related stress, and the pressure of beauty standards. I demanded perfection from myself, and that extended to my body. I would not eat for long periods before a massive meal in the evening, inadvertently memorize how many calories were in common foods like eggs or yogurt, cut out grains and carbs from my diet, and fixate on planning when my next meal would be. I felt a hollow, gnawing sense of guilt after a big meal left me feeling bloated. I was afraid to shower, to be forced to fully reckon with how my body looked and felt. I made sure I worked out regularly, and, late at night in my dorm room, I would step onto the scale, watching the numbers on the display flicker in the darkness, hoping it would not be "too high." Once I became hyper-aware of my eating behavior, it felt impossible to return to my eating habits from before they became disordered. Though this relationship with food was not pleasant, to say the least, I convinced myself I did not have a problem. After all, my habits did not correspond with the symptoms I understood to be characteristic of eating disorders such as anorexia nervosa or bulimia nervosa. What I did not know in my first year, however, was that my symptoms were surprisingly common; they were recognized as unhealthy behaviors by professionals and there were many other people on campus who felt the same. It took years before I realized I was suffering from disordered eating, and found out that treatment—and recovery—was possible. Through spoken interviews and a campus-wide survey, students provided insight into the presence of disordered eating on campus. I found that the behaviors associated with disordered eating stem from a diverse range of factors, including diet culture, academic stress, prohibitive expenses, a lack of autonomy in dining halls, and the inaccessibility of treatment. These factors are exacerbated by a campus environment in which disordered eating and eating disorders remain profoundly stigmatized, yet alarmingly normalized; of the seven people interviewed for the piece, five requested to remain anonymous. About disordered eating The urgency of addressing disordered eating habits seems to be particularly pressing at Columbia, where both disordered eating and eating disorders are prevalent but not commonly spoken about. In a survey conducted by Spectator that was sent to the general student body, 80 percent of the 434 respondents reported preoccupation with food, body image, or weight. Behaviors connected with disordered eating were particularly prevalent; 74.3 percent experienced body dysmorphia or related negative body image issues, 72.6 percent reported feeling shame or guilt after eating, and 67.7 percent skipped meals in order to control their food intake. However, only about 25 percent of respondents reported having a formal eating disorder diagnosis. Meanwhile, many responses indicated that they knew others who have struggled with maintaining healthy eating habits, or have thought that disordered eating is pervasive on campus. As a term, "disordered eating" is challenging to define. Eating disorders such as anorexia nervosa, bulimia nervosa, and binge-eating disorder have clearly defined criteria according to the Diagnostic and Statistical Manual of Mental Disorders. However, because disordered eating encompasses a wide range of highly individualized behaviors, it lacks a similarly definite set of criteria and the possibility of diagnosis. Brianna Mariotti, a master's student at the Institute of Human Nutrition, has personal experience with bulimia nervosa and disordered eating patterns, which has informed her approach to nutrition. Mariotti defines healthy eating as "intuitive eating," a term coined by Evelyn Tribole and Elyse Resch, which emphasizes listening to bodily cues over prescribed diets, food plans, or other weight control measures. Intuitive eating habits include responding to fullness cues and not restricting foods or food groups. Eating habits thus form a spectrum with intuitive eating and a diagnosed eating disorder at opposite ends. Disordered eating occupies the space in between, covering eating habits that are not intuitive but do not fit the specific diagnoses of an eating disorder. "I think disordered eating is anything that goes hand in hand with behaviors that are in some way restrictive or can be eating beyond satiety," Mariotti said. "If we use intuitive eating as the normal—which I don't think is really normal in our environment—then anything that strays away from intuitive eating [would qualify]." The line between disordered eating and a diagnosable eating disorder is incredibly fine and often porous. However, the highly individual and often unspecified nature of disordered eating habits means that simply recognizing that one has unhealthy eating habits—a step necessary to understanding those habits and finding professional help—can be difficult. Those who experience disordered eating may think their habits are not severe enough to seek treatment. Left unchecked, however, these habits have the potential to escalate into diagnosable eating disorders. "I didn't have an eating disorder until I did," Mariotti said. "People don't realize what behaviors [they] are engaging in that could actually put them at risk." Early intervention—particularly when disruptive eating habits initially begin to manifest—is particularly important in both alleviating the mental stress of disordered eating and preventing habits from becoming more severe, according to Mariotti. "If something is negative in someone's life, especially when it comes to foods and restrictions, then that is enough to seek treatment and to consider what and why they're engaging [in] those behaviors," Mariotti said. "Getting to the threshold of an ED [eating disorder] is the last thing that you want. So I think the intervention needs to be way before that." Dining halls Mariotti stressed that environmental conditions are a major factor in the development of disordered eating. As the primary food source for students on campus, the dining halls control the structure of many students' eating patterns. Dr. Lisa Ranzenhofer, an assistant professor of clinical psychology in psychiatry at Columbia University Irving Medical Center, said colleges should ideally provide a wide range of options and healthy eating messaging within dining halls to combat the development of disordered eating habits. "In general, availability of a wide range of food options may be a key component of fostering a healthy eating environment, which of course is likely to be a particular challenge with the constraints of the pandemic," Razenhofer wrote in an email. "A healthy eating environment can also include healthy messaging about food and eating, for example, not labeling foods as 'good' or 'bad,' and providing resources for students who struggle … as Columbia offers." For some students, the wide and healthy selection of food in dining halls allows them to make nutritious choices. Two respondents praised John Jay for having "nutritious and varied" food options, while also allowing students to self-serve and control their own portions. Although a few students felt that the dining halls helped their eating habits, many do not feel that their needs are met through campus dining. Crowding in dining halls remains a top concern for students, with 61.7 percent of survey respondents reporting that this issue had disrupted their eating habits. Of the students surveyed, 66.8 percent cited irregular hours as a problem and 57.6 percent skipped meals due to scheduling problems or other dining hall issues. While Columbia Dining implemented eco-containers for free when indoor dining resumed, the 50 cent charge for compostable containers, which was imposed to encourage students to use reusable containers to cut down on waste, negatively affected 46.5 percent of respondents. These issues make it difficult to maintain a consistent eating pattern, which, Mariotti noted, is a critical factor in developing disordered eating habits. "If you are now in an environment where you don't have the choice to have a regular eating schedule, to eat the foods that you want, to eat balanced meals, or you feel like you have to eat everything at once, that leads to negative feelings or perceptions down the road," she said. Furthermore, many students are affected by the anxiety of being in a packed environment, especially given concerns around the lack of COVID-19 safety in dining halls. Zach Martin, GS '22, has medical conditions that put him at an especially high risk of COVID-19. Going to the dining halls, where crowding eliminates the possibility of social distancing, poses serious obstacles to establishing healthy, regular eating habits. "The anxiety that comes around not having structured intake of food, and having to try and manage that stuff on your own, is really, really challenging," Martin said. "Then you add the anxiety of being present in the dining hall situation where now we're in this quasi post-pandemic world where the university is happy to put everyone together." At Barnard, frustrations grew over the calorie counts written on menus, small portion sizes, and high costs charged for meals, which some considered triggers for their disordered eating habits. Survey respondents described the portion sizes given at Diana and Hewitt as "miniscule," "ridiculously small," "abysmal," and "smaller … than CU dining." One student responded, "[M]y nutritionist that I go to for my eating disorder has commented on it and said the portion size was too small." In a post from Barnard Class of 2022's Facebook page, one student posted a picture of a burrito bowl from Diana: two small scoops of meat and rice that didn't fill the bottom of the rectangular plastic container, with a sprinkling of cut tomato and a garnish of black beans. The meal totaled less than nine ounces of food as weighed on her baking scale. "I find it hard to feed myself adequately at Barnard dining halls, as the portions are too small and the calorie counts control how much food I give myself," one survey respondent wrote. "In general, eating at Barnard dining halls is awful for people with eating disorders." For Jane, the calorie counts listed on the dining hall menus have been a central factor in making her recovery from an eating disorder more difficult. "A lot of my experience in the dining halls is eating the same things over and over again because I'm too afraid to go back to the Barnard dining halls and see the calorie content of everything, or get the same things over and over again," she said. "Even though I stopped calorie counting a really long time ago, it's very difficult for me to turn this off in my mind." I've felt these frustrations firsthand. One day this semester when I was too busy to cook, I picked up a quick lunch from the Diana Center Cafe at Barnard for the first time in a little over a year, as I had switched to Barnard's lowest meal plan, the 400-point commuter plan, to preserve my health and sanity. This planned five-minute stop escalated into nearly half an hour of chaos as I navigated the crowds, ears pounding with music and noise, staring at calorie counts flashing on the menu screens overhead. I felt overwhelmed, stressed, and exhausted. It was only when I got outside that I fully realized what had happened. The dining hall had triggered my old behaviors; I had completely reentered my disordered eating mindset. The experience made me reluctant to return to the dining halls. According to Mariotti, the lack of autonomy in food preparation and portion sizes prevents students from selecting food based on their individual dietary and energy needs and may shame students out of asking for larger portions that they need. Furthermore, it renders intuitive eating⁠—listening to the body's natural signals of fullness⁠—impossible, hindering the development of healthy eating patterns. Though Mariotti believes that calorie counting can be helpful for certain populations⁠—for instance, a person who may need to gain weight for health reasons⁠—she remains unconvinced of their utility for "vulnerable" populations on college campuses. She claims that posting calorie counts places an emphasis on weight, rather than more holistic labeling that emphasizes the nutrient content of food. "Having calories on a menu without any context, without any education, without establishing neutrality of what those calories mean, can be unproductive. … I think it can be a trigger," Mariotti said. "For some people, it can become this game of math in your head all day. It's like, 'look, I had this serving, this many calories. Well, now I can't have this,' even if it was something that you really wanted, and something that your body was telling you would be good for you." In the past, Chartwells, the dining service provider for Barnard Dining, has claimed that they are legally mandated to make calorie counts visible on menu signage. Since 2018, the New York City Department of Health and Mental Hygiene has required calorie count signage in establishments serving "restaurant-type food" that are "part of a chain with 15 or more locations in the United States doing business under the same name and selling substantially the same menu items." These definitions make it unclear whether this rule applies to dining halls operated by Chartwells, which may not operate under the same name or sell exactly the same menu items at each location. Students have also felt unsupported by the lack of accommodation from and communication with Chartwells' administration. One student claimed they raised concerns about the calorie counts in Barnard dining halls and was "laughed at" by Chartwells leadership. Grace, a student with autism, said she has sought accommodation from Chartwells for sensory issues related to eating certain foods. After Grace's Center for Accessibility Resources and Disability Services coordinator connected her with a Chartwells dietitian, she claims that the dietitian failed to respond to her emails before scheduling an appointment outside of her stated availability due to class. When the day of the appointment came, Grace was not informed of where the appointment would be, despite multiple emails and calls. When she was finally brought to the closed Hewitt dining hall, she felt unheard by the dietitian as well as Edward Mitchell, Barnard Dining's campus executive chef. "It was made clear to me during that meeting that there would be no accommodations made, that they did not feel that it was necessary. And what they kept repeating to me—both of them, over and over—was 'this is not a restaurant, we are not catering to people's individual orders,'" Grace said. "I have not been back to the Hewitt dining hall since. It was just an awful, humiliating experience trying to talk to this person." Due to the lack of accommodations, her disordered eating has worsened to the point where she is considering leaving the University. Food insecurity Food insecurity, which is a major factor affecting food access on campus, is particularly tied to disordered eating habits. A recent article in the Journal of Nutrition Education and Behavior studied 533 college students in the United States and found that "food insecurity was consistently linked with [disordered eating behaviors]" that may be "associated with worse health outcomes among vulnerable college students." In an email citing the book "Intuitive Eating" by Dr. Evelyn Tribole and Dr. Elyse Resch, Mariotti writes that "food insecurity poses a challenge to 'feeling your fullness' by creating a sense of urgency or general need to bypass satiety cues in order to eat enough or more than enough while the food is there because there is uncertainty around when the next meal may come. Restriction and rigid rules can also fuel this sort of behavior." As a low-income student on campus, Martin felt the consequences of what Mariotti describes as a "scarcity mindset around food." He noted that the pressure to get enough food during the limited time he had in dining halls perpetuated his "natural binge cycle." "The dining hall situation forces you to do that. As a low-income student, you're like, 'Okay, I don't know if I'm going to be able to buy the amount of food that I need to make it through the day and have decent energy levels.' So you take advantage of the one meal you have where it's as much as you can eat." On campus resources Resources are available on campus for students who are dealing with disordered eating behavior, as Columbia and Barnard both offer services to treat disordered eating and eating disorders. Columbia students can schedule appointments through Columbia Health Services to meet with a psychologist on the eating disorder team. Similarly, Barnard students can schedule a consultation with a member of Barnard's eating disorder team by calling Primary Care or the Rosemary Furman Counseling Center. However, for students who have already looked for professional help for their disordered eating, opinions remain divided on the efficacy of campus resources. Some students found campus resources to be essential and useful in their treatment. In their response to the survey, one Barnard student said that the "extensive support" they received through Furman, Primary Care, and the Dean's Office "saved [their] life." To other students, group workshops through both Furman and Columbia's Counseling and Psychological Services were particularly useful, providing a uniquely understanding space to talk openly about their eating habits and body issues. "I went to a body positivity group workshop through CPS and it was actually fantastic," one survey respondent wrote. "Having a group of other people my age talking about their body image issues and EDs was so comforting and I felt safe to express myself. It gave me the courage to pursue individual therapy." However, other students felt that the process to get help through CPS or Furman was drawn out, difficult to access, and at times, emotionally stressful—these students claimed they faced long wait times, a lack of sufficient support, and unsupportive providers. Some students felt that the short-term nature of both Furman and CPS' treatment program was a particular barrier to those who felt overwhelmed by financial commitments for treatment or a lack of guidance throughout the referral process. One survey respondent did not realize that they would be limited to 10 sessions with a resident psychiatrist at the time, and felt uncomfortable navigating the referral process as a first-year. They said that the lack of support following their time at Furman was overwhelming. "It was scary and it felt like I was facing my disorder on my own and [I] didn't quite know what to do," the student wrote in her response to Spectator's survey. Furthermore, intake calls, which triage students by asking about their disordered eating behaviors in order to set up an appointment with a professional, can be particularly difficult. Mariotti noted that those calls were "a huge barrier," as many people reaching out for help may not be ready or equipped to talk about their disordered eating habits. Mary, a Barnard student, recalled the "very triggering" and emotionally taxing intake call she had with a nurse at Furman, in which she had to recount all of her eating habits and patterns. After Mary was asked to disclose her weight, she informed the nurse that she did not weigh herself as she found it triggering, and that the nurse then commented on her weight. "She was like, 'well, you're actually very normal for your weight.' And then she counted out for me how much per inch a woman should around be weighing," Mary recalled. "And I was like, I really don't need to hear another mathematical explanation of where I should be weight-wise because that's the thing that's going to stick with me." Mary was further frustrated by the time it took to schedule an appointment; she said that she was not able to meet with the dietitian until about five weeks after she had initially emailed them asking for an appointment. Martin was also particularly concerned about the long wait times at CPS, especially given the potential physical damage that can be a consequence of disordered eating. "You're talking about the amount of damage that you could do to your body in three weeks' time. If you're severely, severely undereating, and you're undergoing the stress of midterms or finals and all of your other extracurriculars and still trying to function, it can be extremely detrimental to health in a very short period of time," he said. Barnard's dietitians, Dr. Kathleen Niegocki and Dr. M.J. Murphy, were unavailable for a 15-minute phone interview until January to comment. Campus culture The drivers of disordered eating on campus, however, extend far beyond the dining halls. Students spoke about the broader campus culture, which centers on the difficulty of academics, pressure for perfection, and beauty standards, as a major disrupter to their eating patterns. For Jane, the "coffee-centric, academically rigorous lifestyle that comes with attending Columbia," that puts pressure on students to be "perfect in every single way," resulted in unhealthy eating habits such as skipped meals. "[The] practice of placing your academic success over your own bodily needs is very much a common thing [at Columbia], and it should be dissected more, because it can very quickly delve into disordered eating," Jane said. Other students also felt this pressure to concentrate on academics over wellness. Elise Barnes, BC '22, felt what she called a "pressure to prioritize schoolwork above literally everything else," including her health. Returning to campus study spaces, which she associates with late nights and stress, has led her to restrict her food intake "under the guise of self-control and productivity." The Anxiety and Depression Association of America notes that disordered eating habits are closely tied to stress, anxiety, and depression—all of which are prevalent among Columbia students. The 2020 Columbia Student Well-Being Survey, for instance, found that 25 percent of Columbia students surveyed reported symptoms of moderate to severe anxiety, as well as depression. Many students noted that disordered eating habits have become increasingly normalized among the student population and are exacerbated by the lack of self-care on campus. One survey respondent noted that it is "so commonplace to discuss things relating to healthy/unhealthy food and exercising"—such as comments about how "they need to go for a run after eating that pizza slice"—that those discussions are impossible to avoid. Two other students pointed at signs near elevators saying "burn calories, take the stairs" as a small, yet emblematic, signal of the broader fixation on calories and weight that promotes diet culture on campus. Unhealthy eating habits are also closely tied to the pressure to maintain a thin body to match societal beauty standards—what one survey respondent described as the "unspoken need to subscribe to thinness"—which can spark disordered eating habits and body dysmorphia. These attitudes are particularly present on Barnard's campus. One student surveyed noted how "triggering" the prevalence of language associated with disordered eating habits is on campus. For instance, she said, phrases like "I'm not going to eat today" or "I'm so fat" are "far too normalized" on campus. As Barnard students, Jane and Mary have both observed how the prevalence of disordered eating habits on campus reflects broader societal pressures on women to appear thin at the expense of their health. Mary stressed that the constant cultural conditioning, especially through media, that portrays "an image that everybody should be incredibly skinny" lays the groundwork for a disordered eating mindset well before students arrive on a college campus. To Jane, controlling food intake is a method for those in female bodies to regain autonomy in a society that routinely denies them that through unrealistically high expectations. "Women and people born in female bodies—at least in their adolescence—are pressured so much to put effort into their appearance that, in a world where everything is crumbling around them, and where there is so much that they still can't really do freely, one of the few things you can really control is how the world sees you and how the world perceives you," Jane said. However, the cultural conditioning that creates both disordered eating and unrealistic body standards is not limited to women. According to the 2020 Columbia Student Well-Being Survey, 14 percent of men, and 21 percent of transgender/gender non-binary people were positively screened for a possible eating disorder—in comparison to 24 percent of women. The National Eating Disorders Association further notes that about one in three people diagnosed with an eating disorder is male. Although subclinical disordered eating behaviors—such as binging, purging, or fasting for weight loss—are almost as prevalent in men as they are in women, awareness of eating disorders in men has remained low, a consequence of what the NEDA refers to as a "double stigma"; the association of eating disorders with women, and the stigma around getting psychological help for men. As a former competitive bodybuilder and powerlifter who worked as a coach in a gym, Martin is particularly cognizant of how men also "internalize" unrealistic body images. Muscular cultural icons such as Arnold Schwarzenegger or Sylvester Stallone create unattainably high standards that men connect their self-worth to. To Martin, these "hypermasculine" expectations feed into an environment where men are pressured to not discuss their emotions and feelings, ultimately perpetuating an environment where they feel compelled to stay silent about their eating problems. "People aren't vocal about their struggles. I've seen so many guys who clearly have a diagnosable eating disorder, but they found a way to channel it into disordered eating, in a way to make progress in the gym or whatever. But often, it's a way to find an excuse to perpetuate the same behavior." The silence men face in connection with eating habits is further reflected in Spectator's survey, where the majority of respondents providing detailed answers in open-ended questions were women, despite the relatively high prominence of disordered eating habits among men as well. Though numerous environmental factors on campus can affect eating habits, it is clear that many of the primary drivers of disordered eating are society-wide issues that become magnified on college campuses. These are deep-rooted expectations that prescribe how bodies should look; condition the way society talks about eating, food, and body image; and manifest themselves in how the campus community approaches diet culture and healthy eating. A way forward In my first year at Columbia, I thought my relationship with food was permanently fractured. But with the help of peers, close friends, and education, I was able to put it back together, step-by-step, bit-by-bit. Far too often, those who experience disordered eating and eating disorders may feel isolated. However, as Mariotti stressed, those behaviors are a result of pervasive and unavoidable environmental pressures—a busy work schedule resulting in a skipped meal, an offhand comment about weight that triggers restrictive eating—that affect everyone in the campus community. "Although intuitive eating is the ideal, at least in my opinion, it's actually very difficult and it's something that has to take a lot of work to get to," she said. "And I think that most people would lie somewhere on the nonintuitive eating side of things, which is perfectly natural because we have environmental cues that will shape how we eat." As many surveyed students voiced, a more open discussion around food can lessen some of the outside pressures that can exacerbate unhealthy eating habits and remove the stigma from seeking help. It was only after hearing others speak openly about their own experiences that I finally realized I had an unhealthy relationship with food. Being aware of disordered eating behaviors was an important step toward recovering a healthier approach to food I thought I had lost. I realized, then, that taking the emphasis away from an individualized experience also raises the possibility of a more open, community-oriented approach to promoting healthier relationships with food. Despite the stigmatizing and isolating nature of disordered eating, some students have found spaces on campus that provide support and understanding against outside pressures. For some, this was a meeting with other students in Furman or CPS support groups. For others, it was a tight-knit group of friends, some who were also recovering from eating disorders, who also did not subscribe to diet culture. For Martin, it was the barbell club he helped found—a community that is particularly attuned to recognizing disordered eating habits—and is dedicated to creating a healthier dining environment. Mariotti is optimistic about the more open attitudes she has seen among her cohort in her nutrition program, in comparison to the weight-oriented curriculum: "We want to avoid creating restrictive mindsets. We want people to feel a sense of autonomy around food." For Martin, this openness to speaking about disordered eating habits is key towards building a community and environment that is open and willing to engage with unhealthy eating habits. "It's hard to talk about these things, but the conversations need to be had," Martin said. "Not only can you change your own life, but you can have the opportunity to catch and impact someone who is really really struggling and struggling alone." Staff writer Julia Tong can be contacted at [email protected]. Follow Spectator on Twitter @ColumbiaSpec. Founded in 1877, the Columbia Daily Spectator is the independent undergraduate newspaper of Columbia University, serving thousands of readers in Morningside Heights, West Harlem, and beyond. Read more at columbiaspectator.com and donate here.