For Liz Rene, a recent UNH alumna, it started in seventh grade with a class trip to a water park.
"For some reason I wanted to lose seven pounds [before the trip]," said Rene in a written statement. "I was never fat, but I had always played a lot of sports and was muscular. I started to cut out some food groups and restrict a bit." Rene estimates that she lost a couple pounds through dieting, but she lost more weight while sick with mononucleosis. Afterward, she could not return to her usual weight. "Once I had lost that weight it was like I couldn't allow myself to gain it back," she said. It led to a seven-year battle, with three attempts at treatment, before she made a successful recovery. Rene's story is not uncommon. According to the National Eating Disorders Association website (www.nationaleatingdisorders.org), as many as 10 million women and 1 million men are struggling with some type of eating disorder - with millions more struggling with binge eating.
College students and teenagers make up the largest group affected by eating disorders. According to the Eating Disorder Foundation, 27 percent of girls age 12 to 18 show significant eating disorder symptoms; 31 percent of college females have an eating disorder. According to a UNH counseling center survey conducted in 2001, over 25 percent of UNH student respondents reported an eating disorder or symptoms of disordered eating.
Suzanne Sonneborn, a nutrition educator at UNH's Office of Health Education and Promotion, said the number of people affected by eating disorders is probably higher than reported, since many students will not disclose personal eating habit information. This is because there tends to be secrecy and shame surrounding eating disorders. She said the percentage of students who exhibit disordered eating at some point during their years at UNH could be as high as 30-50 percent.
The feelings of shame and secrecy have presented a challenge to students and staff who are trying to reach out. "When we do education on this campus, it's a really tricky topic," Sonneborn said. "We're looking for any way to get to people."
Marie Coyle, a member of the student advocacy and awareness group Students Ending Eating Disorders (SEED) said there have been instances in the past where she was concerned a fellow student might have disordered eating, but found that reaching out was difficult.
"What can you do?" Coyle said. "What can you say to that person?"
For those suffering from an eating disorder, it is just as challenging, if not more so, to reach out and get help. "It's really scary to seek help," said Maria Larkin, an on-campus nutritionist who specializes in eating disorders. But it is not stopping some individuals with eating disorders, their supporters, or campus organizations from speaking out and trying as hard as they can to change things. For example, it was Laura Plummer's observations about the silence surrounding eating disorders that sparked her to found SEED.
"I noticed that there were some rather clandestine initiatives taking place on campus to generate awareness of eating disorders, but none as loud and in-your-face as I felt an awareness group of this nature should be," Plummer said in a written statement. "I was tired of the culture of shame and silence surrounding eating disorders and those who suffer with them."
"I think in the past couple years, especially, there have been some great strides made in bringing more awareness and attention to the problem," said Rene, who founded the counseling center support group. The phrase, "it's not about the food" is used as part of her recovery process. "From peer-education to the support group and SEED, people are becoming more active in bringing awareness to eating disorders," said Rene. "So we've got a ways to go, but at least we are heading in the right direction."
Eating disorders and their causes
There are many types of eating disorders. They include anorexia nervosa, which is restrictive eating; bulimia nervosa, which is binging then purging through methods like laxatives, excessive exercise, or vomiting; and eating disorder not otherwise specified (EDNOS), which involves a combination of symptoms of different eating disorders. People may also have disordered eating habits, which are unhealthy but do not fall under the strict criteria of a diagnosable eating disorder like anorexia or bulimia.
Linda Guttman, a psychologist at the UNH counseling center, called eating disorders "complicated" because there are many underlying issues beyond what may seem at first glance to be a problem about physical appearance. Depression and anxiety can manifest themselves through eating disorders. Also, Guttman said the person affected may have difficulty managing their feelings or have a high need for perfection in other aspects of their lives beyond just appearance.
Larkin described the eating disorder mentality as a conversation in the person's head, with one voice being the eating disorder and the other the person's true voice.
Rene experienced this herself when she started getting attention for all the weight she had lost. She said the attention was clearly negative, but the eating disorder twisted it into something positive.
"There literally is a voice in their head that, when struggling, they can't tell is different from their own voice," said Rene.
Sonneborn said many times people with eating disorders feel like the eating disorder is their friend because it relieves stress or anxiety and gives them tangible gains. This makes it more difficult for people with eating disorders to want to change their behavior. Also, length of the disordered eating is a factor.
"The longer you have the eating disorder, the stronger it becomes and the more difficult it is to overcome it," said Larkin. She said the eating disorder becomes a part of the person's identity.
Food can generate a lot of anxiety, and even get in the way of enjoying life. For example, Larkin said, people with eating disorders may not want to go out with friends because they are afraid they will have to eat in front of them. "Food is pretty scary for people with eating disorders," Larkin said.
Rene said the eating disorder's interference with her life is what ultimately sparked her to be ready to seek treatment for a third and final time.
"After seven years I was sick and tired of being sick and tired," Rene said, after describing how the things she loved had "slowly been taken away." She was not able to play sports or even drive because of health problems caused by her eating disorder.
"I couldn't sleep at night, I couldn't hang out with my friends out of fear of having to eat or drink in front of them," she said. "I wasn't living at all, I was simply existing…I knew I needed help, and I wanted it, because I couldn't live like that anymore."
Treatment and Recovery
When a person enters treatment and recovery, mindset and readiness can have a significant impact on the effectiveness of treatment.
Rene describes her recovery in three stages because she made three attempts at recovery before she was finally successful. The first two times she said she did not want to go through treatment.
"The first time I went to treatment I didn't think I had a problem," she said. "I didn't think I had to go and I definitely didn't want to go. I was still in the denial stage. I really had to hit rock bottom before I could get well."
Guttman stressed the importance of the person's mindset while in the recovery process.
"People need to do this when they're ready," she said, provided the person's health is not in immediate danger. "We try to work hard to start where the student wants to start." Larkin said progress is slower with those who are not fully ready to address their eating concern. However, she said, just talking to a professional can help students dealing with eating concerns, even if they are not yet ready to take action, because it can "plant seeds" in their mind.
Studies have shown the best strategy for treatment involves a team of a physician, a nutritionist and a therapist. Aspects of treatment include reconstructing thoughts about food, analyzing triggers of the eating disorder and examining potential origins of the eating disorder. Treatment also encourages the affected person to get in touch with their thoughts, perceptions of the self, and feelings of hunger and satisfaction. Treatment strategies and recovery time vary widely depending on many factors such as the severity of the disorder and the person's relationships.
After treatment, some people may have relapses and cope with their eating disorder for the rest of their lives. Others, like Rene, recover fully.
"I can honestly say today food is not an issue for me," said Rene. "I just want to send a message of hope that recovery is possible and it does happen…but you've gotta work for it." Sonneborn said people who are worried a friend may have an eating disorder need to be patient because the affected person may not yet be ready to seek treatment.
"You have to really hang in there," she said. "It's difficult to reach people."
She recommended approaching the person one-on-one in private, since groups could be frightening or come off as an attack. If the person wants to seek help, she recommended showing support by helping make an appointment and going with him or her to the appointment if you are willing. "Be supportive without being judgmental," said Rene. "Let the people you are worried about know that you care about them, and that you are there for whatever they need."
Sidebar: Linda Guttman, a psychologist at the Counseling Center, called eating disorders "rampant" among the college population. Of all people who visited the counseling center last year, 8 percent had some form of an eating concern. One in four college women struggle with some type of eating disorder, and college students, along with teenagers, make up the largest group affected by eating disorders. While there is no one defining cause of this age-specific prevalence, there are many possible reasons.
"College campuses are a breeding ground for eating disorders," said Liz Rene, a recent UNH alumna, who won her seven-year battle with anorexia. "For the first time many people are on their own without parental supervision…It is extremely easy to get away with restricting, binging and purging or over-exercising in college if that's what you are trying to do." Suzanne Sonneborn, a nutrition educator at the Office of Health Education and Promotion, said the competitive nature of college plays a large role. Guttman also said eating disorders can be about competition with peers, even if it is a competition that exists in the individual mind rather that in reality. In the larger picture, Sonneborn said the media can be a huge influence when it comes to eating disorders. Because American media is transmitted across cultures, she said, incidences of eating disorders are on the rise in cultures and ethnicities that typically value curvier figures.
"We're bombarded with messages of thinness," she said. "I have to believe [the rise in eating disorders] is a reflection of our culture right now. We're so body-conscious." "I can't pick up anything or turn on anything without being infuriated within thirty seconds," said senior Vanessa Romanoff, a member of Students Ending Eating Disorders, about how the media portrays the "typical" body type. Guttman pointed out the catch-22 of body image in our society. She said we live in a culture that promotes eating processed food while simultaneously sending the message to stay thin.
Info Bar: Resources on campus
Health Services 862-2856 Health services offers physical exams, diagnosis, and medical care for those with eating concerns.
Office of Health Education and Promotion (OHEP) 862-3823 OHEP offers body image and eating disorder education throughout the year. A list of upcoming events, including events in recognition of National Eating Disorder Awareness Week (Feb. 24-Mar. 1) can be found at http://www.unh.edu/health-services/events/index.html. OHEP also offers resources and support for those coping with eating concerns and friends of those with eating concerns. There is a resource library available as well. Appointments can be made with Maria Larkin, a nutritionist who specializes in eating concerns, through OHEP.
Counseling Center 862-2090 The counseling center offers initial assessment, short term individual therapy, group therapy, medication, and referrals to outside specialists.
Students Ending Eating Disorders (SEED) MUB 203, Wednesdays 6-7
SEED is a student advocacy and awareness group, but it is not a support group. The members focus on events and programming to promote positive perceptions of the self. Upcoming events include a Real Beauty Fashion Show and the publication of the third issue of their 'zine "Fed Up," which features various media about self-esteem and positive body image.
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