Back-to-School: Top 5 Ways to Tackle Your Eating Disorder Freshman Year

It’s just about that time of year. As students ready themselves for college orientation and the first week of classes, a common concern is, “Will I gain the freshman 15?” Students heading off to college this fall, and sometimes their families, may worry that the stress of leaving home together, with the all-you-can-eat meal plans and the late night eating common among US college students, may lead to increases in weight.

For young people with eating disorders and their parents who worry about them, the concerns are different.

Eating disorders, including anorexia and bulimia nervosa, are potentially life-threatening conditions that generally develop during adolescence and young adulthood. In anorexia nervosa, low weight and failure to maintain minimally normal weight are the core features. Eating patterns include severe food restriction and may include excessive exercise and/or self-induced vomiting that aim to compensate for caloric consumption. Bulimia nervosa is characterized by a cycle of overly restrictive eating which results in a cycle of binge eating and purging (by self-induced vomiting, laxative or diuretic abuse, or excessive exercise).

When eating disorders begin in high school, patients may work with a team of professionals to improve nutritional choices and eating patterns and, in the case of anorexia nervosa, to normalize weight. Concerned parents may have struggled to find pediatricians, nutritionists and therapists who demonstrate the ability to work well with their teen and to work well with each other to help their affected high school student improve his/her psychological and physical health.

Going off to college is stressful enough. What should a rising freshman and his/her parents consider as the summer comes to an end? Here are 5 ways to build on what’s been successful and keep sneaky eating disorder symptoms from returning or worsening:

1. Establish a treatment plan before you start school.

School life is busy once you’ve moved into your dorm and started classes. Have a plan and discuss it in advance. Most students will need to establish a new team, and this may take a bit of work to set-up. Call the school’s student health service to learn about their services. Ask hometown clinicians whether they know anyone in the vicinity of the school. Know ahead of time whether continued meetings with your home team may be possible. Is school close enough to home? Does your home therapist have an established practice of delivering treatment online, via tele- or video-conference?

2. Don’t be afraid to work with your school’s student health service.

Their offices are right on campus and they’re there to help you transition successfully to school. Many schools have developed wonderful, supportive teams with specific expertise in conditions that affect college students like eating disorders. Sessions are generally covered by the health insurance plans available through your school, but check whether access to student health requires an active decision to sign on for the school’s preferred insurance plan, or whether various insurance plans are accepted. Check on session limitations, as some schools cover only a limited number of sessions annually. If the allowable session numbers are too few, don’t convince yourself that you won’t need more than 10 sessions in a year! Instead, inquire about off-campus therapists with whom the school has worked closely (and successfully) before.

3. Think about housing and meal plan options and how they will or won’t work for you.

If you tend to isolate yourself and look for reasons to skip meals, you may not want to sign up for a dorm with cook-for-yourself options. Go for the meal plan instead! If you are worried about binge eating at the buffet, make plans with your therapist or nutritionist about how best to portion meals. What are three healthy and tasty options for lunch? The wrap station, the sandwich bar, and the soup and salad counter? Consider practicing eating cafeteria style meals in your hometown before leaving for school. This will give you a chance to evaluate how it goes with your current treatment team and family, and to be able to plan well for possible setbacks.

Decide whether having a roommate will keep you honest about eating your daily meals and snacks. Are you someone who may want to hide your eating from a roommate? If so, you may want to select a single room. If, on the other hand, having a roommate might help you to work on eating socially and minimizing body checking or other disordered behaviors, you may want to live with others.

4. Pick an exercise plan that’s right for you.

Going to the gym at school can be a way to socialize and take good care of yourself, unless you’re prone to overdoing it. Talk to your therapist about whether and how to exercise when you’re at school. Also consider how your activity level might change by virtue of being at school. Will you be headed to a city where you’re likely to walk a lot? This should be factored in to your plan to stay well.

5. Talk to your parents.

Believe it or not, your parents care about you and want to hear how it is going. Don’t just rely on short texts or status updates on Facebook or Instagram. Pick up the phone and give them a call. Or Facetime with them so they can see you and maybe even get a glimpse of your dorm room. Tell them how it’s going, even if you haven’t figured everything out yet.

A great deal is brand new when you first get to college, including the people. Speak with your therapist about whether and how to talk about your history with new friends and roommates. You may also want to call your home therapist from time-to-time. Clinicians who know you are probably curious about how you’re doing, and would welcome a call. Call the person who is most likely to help get you, or keep you, on track.

You may have the magical idea that the eating disorder won’t follow you to school and that you will no longer have to pay attention to its tricky ways. There’s no such thing as magic, I’m afraid, but there are ways to be smart, and successful at staying healthy.

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Evelyn Attia, MD

I am a psychiatrist at Columbia and Weill Cornell Medical Centers and have spent the last 30+ years working to improve our understanding of eating disorders and develop effective treatments.


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