Eating Disorders in university students: A snapshot of the prevalence, recognition and ways to seek
Eating Disorders in University Students: A snapshot of the prevalence, recognition and ways to seek help
Do you have any food rules, such as not consuming carbohydrates or not eating after 7 pm?
Do you feel pressured to spend hours in the gym and get into shape?
Do you compare your appearance with your peers or catch yourself looking at your reflection in shop windows?
If yes, you are not alone! Many young people, particularly university students, engage in disordered eating attitudes and behaviours and find it difficult to maintain a healthy relationship with food and their bodies.
My name is Başak İnce Çağlar and I have a PhD in Clinical Psychology. My research and clinical work mainly focus on body dissatisfaction and eating disorders. While I was working as a therapist in a private clinical setting and a research assistant at university, I observed that the majority of young people have difficulty in coping with the sociocultural pressure of appearance ideals, and engage in at least some level of eating disorder behaviours, which in turn negatively affect their physical, psychological and social well-being.
Thus, for my PhD project, I focused on identifying and reducing eating disorder symptoms and behaviours among university students, which is why I have chosen to write about this topic for today’s blog in honour of Eating Disorders Awareness Week.
Prevalence of eating disorders among young adults
Eating disorders are serious psychiatric illnesses “characterised by a persistent disturbance of eating or eating-related behaviour that results in the altered consumption or absorption of food and that significantly impairs physical health or psychosocial functioning”. No single cause for eating disorders has been identified, though biological, developmental, psychological, and sociocultural factors can play a role.
Although eating disorders can occur at any time throughout life, the incidence of eating disorders reaches the highest level during the transition to university. Starting university is generally considered to be exciting, however, some people find this transition period stressful. Separation from home and family, increased autonomy, social and financial changes, new academic responsibilities, identity pursuit and exploration, can all be challenging. These new challenges are likely to increase the risk of the development of eating disorders.
In addition to these challenges, most university students frequently use social networking sites (e.g., Instagram, Pinterest, Tumblr) and mobile weight-related self-monitoring applications (e.g., MyFitnessPal, Runkeeper) which are associated with increased risk of body dissatisfaction and eating disorders. Moreover, a longitudinal study found that dieting, body dissatisfaction, internalisation of appearance ideals, self-objectification, and experience of unpleasant emotions in the first year of university can predict the development and/or maintenance of eating disorders.
Extensive evidence demonstrates a high prevalence of eating disorder behaviours among university students, and low levels of help-seeking behaviour. For instance, a study reported that more than 25% of university students engage in unhealthy weight control behaviours at least once per week. More recently, another study on over 70,000 students showed that one-fifth of college and university students screened positive for an eating disorder. Eating disorder behaviours and symptoms bring extra challenges to students, such as impairment in academic success, social isolation, decreased quality of life and increased comorbid medical and psychiatric conditions.
Recognition and Seeking help
Despite the high prevalence, severity and negative consequences of eating disorder behaviours, only about 3% of university students receive treatment. Many young people do not seek help due to the following growing reasons: lack of self-recognition, shame, failure to perceive the severity, lack of support and encouragement, denial of the problem, fear of stigmatisation, lack of mental health literacy, high treatment costs, low levels of motivation, normalisation of diet culture among peers, and using eating disorders behaviours as coping mechanisms.
As there is no single factor causing eating disorders, related attitudes and behaviours do not appear in one form. However, there are several common symptoms and warning signs that can help us to identify a problem that requires help:
Strict dietary rules (e.g., “I am not going to eat any chocolate”, “I cannot consume 1,200 calories in a day”, “I can only eat vegetables”)
Excessive exercise (e.g., skipping classes or missing social events to go to the gym, exercising in unsafe or inappropriate places and even in the case of injury, feeling stressed or irritated when cannot exercise, exercising to compensate for eating)
Body & weight checking (e.g., frequent weighing, measuring body parts, pinching or squeezing flesh, and seeking assurance from others about appearance)
Body & weight avoidance (e.g., wearing baggy clothes and avoiding being weighed, looking in the mirror, taking or looking at photos, and clothes shopping)
Body & weight comparison (e.g., comparing appearance with peers, celebrities, or people around them, and comparing previous and current photos)
Engaging in “fat talk” (e.g., “Summer is coming. Are you sure you want to eat this?”, “Does this t-shirt make me look fat? ”, “If you work hard enough, you can look like a supermodel”)
Eating disorders are treatable illnesses and several evidence-based treatment methods are available, but it is generally quite difficult for someone to recover without professional support. Seeking help may not be easy due to individual barriers (e.g., shame, lack of motivation, underrecognition of need) and structural barriers (e.g., long waiting lists, high treatment costs, travel distance etc.), but getting help as early as possible is crucial for increasing the chances of a full recovery.
If you are experiencing eating disorder symptoms or know someone who is struggling, here are some steps and resources I can recommend:
Talk to someone you trust for support
Make an appointment with your GP to discuss how you’re feeling and get a referral for assessment or treatment from a specialist eating disorder service
Reach out to your university’s counselling centre to learn about available support on campus
Have a look at the resources on Beat’s website, which is the UK’s eating disorder charity, or guides on FREED’s website, which is a service designed for giving youth rapid access to tailored and evidence-based treatment.
Despite increased advocacy and awareness in the community, there are still myths, stereotypes and misunderstandings around eating disorders that we need to fight against. Fortunately, many researchers, clinicians and organisations are providing resources for understanding, preventing and treating eating disorders.
While still evolving, several face-to-face and virtual interventions are available to help young people to reject diet culture, challenge their unhealthy eating attitudes and behaviours, build self-esteem, get involved in the body positivity movement, and gain social media literacy and intuitive eating skills.