There’s a very thin line between eating disorders and disordered eating.
By Alison Stein
I watched Yvonne from across the room as she packed her duffel bag to go home. Actually, I had been watching her for a while. So had all the girls in my hallway. She was tiny—78 pounds stretched across a five-foot-three-inch frame. We called her Rexie—short for anorexic. We made fun of her as she walked through the dining hall, her plate heaped high with iceberg lettuce. When she refused to talk to us about her problems, we thought she was vain, self-absorbed—“Little Miss Perfect.”
But now Yvonne (not her real name) was leaving Penn in mid-semester to enter an in-patient clinic for eating disorders. As she finished throwing her half-read textbooks into a shoe crate and stuffing piles of dirty clothes into her bag, she began to talk. She had a habit of gazing directly through you as she spoke, and she would bury her hands underneath her armpits, curling her body inward, as if she feared collapsing onto the ground.
It began when she was 12, she explained. “My mother would mark down the calories I ate on a dry-erase board, which was attached by Velcro to the front of our refrigerator. Each red line was a hundred calories. I was only allowed a certain number of red lines.”
As she talked, I began to understand why she had such an unhappy relationship with food. It had always been her enemy. The lines on the dry-erase board had never really been erased.
It is a maxim in this country that you can never be too rich or too thin. One result of our obsession with thinness is that we spend more than $35 billion on dieting and diet products each year. But there are other, more sinister effects as well. More than five million Americans suffer from eating disorders, including anorexia, bulimia, and binge-eating. Eighty-one percent of 10-year-old girls are afraid of being fat, according to one survey. Fifty-three percent of 13-year-old girls are unhappy with their bodies. Eighty-five percent of adult women wake up each day “ready to do battle with their weight and size.” (Those last two statistics come from the Renfrew Center Foundation, a nonprofit organization devoted to the education, prevention, research, and treatment of eating disorders.)
In many ways, college campuses are slices of American society. They are also filled with highly competitive, achievement-oriented people—especially academically rigorous universities like Penn. The result is a sobering number of girls like Yvonne.
In a Web survey conducted last November by Penn’s Office of Health Education (OHE), more than 75 percent of all respondents said they had tried to change their body’s appearance since coming to the University, while 15 percent cited eating concerns and body image as a top personal health concern.
Four years ago, Penn conducted a survey as part of the National Eating Disorders Screening Program (NEDSP), whose goal was to identify students at large research universities who exhibited symptoms of eating disorders. The self-scoring form was distributed to a convenience sample (young women chosen from specific groups of people) of 587 female students, ages 17 to 43. The questions addressed not just issues surrounding eating disorders but also more general concerns of “feeling fat, counting calories, and exercise habits.”
Fifteen percent of the respondents showed symptoms of serious eating disorders (anorexia, bulimia, binge-eating). More than 20 percent reported that “food controls their lives and they feel guilty after eating.” Some 25-49 percent showed symptoms of “disordered eating,” indicating that they “felt terrified of being overweight, preoccupied with food and the thoughts of fat on the body,” and often dieted.
While the world is aware of eating disorders, “disordered eating” is a relatively recent term, used to describe a general preoccupation with food, weight, and dieting as well as a general dissatisfaction with one’s body. It falls in the realm between serious, full-blown eating disorders and healthy eating, and though it is not recognized or covered by health insurance, it can seriously affect a person’s quality of life. Yet much of what constitutes disordered eating is viewed merely as a habit, even a societal norm. Those who practice it are often described as “finicky eaters” or “exercise freaks.”
Mary Anne Clairmont, the nutritionist for Student Health Services, sees hundreds of Penn students who fall into that category. She describes them as the “worried well.”
“I see eating disorders at Penn, but I also see people with disordered eating,” she explains. “Being part of the ‘worried well’ takes up so much of your time and energy, and really cuts down on your general quality of life.”
I ask her what’s wrong with eating on the healthy side, whether it be cutting out sweets or restricting soda. After all, hasn’t obesity become an epidemic in this country? Aren’t we simply taking care of ourselves by trying to stay fit and healthy? Is there anything wrong with carrot sticks and a quick jog?
No, she says calmly, there’s nothing wrong with healthy eating. But healthy eating becomes disordered eating when it turns into a distressing occupation rather than a comfortable, relaxed, natural life choice.
“The ‘worried-well’ can [develop] a full-blown eating disorder,” she warns. “And unfortunately, the ‘worried well’ have become a societal norm. It can be really hard to help these students— because disordered eating is actually what we’ve come to expect socially.”
The waiting room at Penn’s Counseling and Psychological Services (CAPS) is a small, sparsely decorated office space on the third floor of the former Mellon Bank Building at 36th and Walnut streets. Huge bulletin boards hang on every wall, covered with postings for various support groups and group-counseling sessions. When I showed up unannounced one morning last spring, almost every chair in the waiting room was taken. The students sat awkwardly in their seats, burying themselves in their DPs or flipping through their day planners to avoid looking around the room, as I waited for the frazzled receptionist to have a free moment. Finally, she did. I asked her who I could talk to about eating concerns and disorders. “That’s easy,” she answered. “Dr. Margaret Fichter.”
Fichter has been a staff psychologist at CAPS for over 12 years, but has worked in University counseling since 1975. Eating disorders and disordered eating are her specialty; she serves as coordinator of eating-disorders evaluation and treatment, as therapist for the anorexia/bulimia group, and as team coordinator and therapist for the Penn Support Team for Eating Concerns, which last year treated 80 students.
A week later, having made an appointment, I sat down in her office. She greeted me with a manila folder full of literature—some of it written by her—and a sheet with the names of half a dozen other people at Penn who work with disordered eating. She also showed me a screening form that any student who comes to CAPS must fill out before seeing a therapist. One question asks: “Are you concerned about diet, weight, or level of exercise?” The answers, on a scale of one to five, indicate the severity of their concerns; Fichter considers three or higher a warning sign. Sixty-seven percent of the students who have filled out the form fall into that category.
“Disordered eating involves depending on skipping dessert to feel good about yourself and in control of your life,” Fichter explained as we settled into her office. “I am basically opposed to dieting because the restrictions of most diets create feelings of deprivation, which can lead to obsessive cravings for ‘forbidden foods.’ Penn students are so preoccupied with ‘healthy’ eating that it just backfires—and then they binge on calorie-dense comfort foods. And these feelings of deprivation can lead to binge eating and/or vomiting.”
Disordered eating is harmful, she explained, because it is inextricably linked to eating disorders. As long as disordered eating remains the social norm, an environment for a full-blown eating disorder exists. Although the causes of eating disorders are complex, dieting is frequently a trigger for an eating disorder: according to the NEDSP, 20-25 percent of dieters develop partial or full-syndrome eating disorders.
Yet many Penn students still diet, and some claim that it’s hard to find a person who is not on a diet.
“It’s extremely scary for me that the basic foundation of life among my friends has become dieting,” says a senior in the College who prefers to remain anonymous. “While the people I know don’t technically have eating disorders, they obsess and are completely consumed by thoughts of food. They are constantly talking about and comparing their diets.”
Penn students also find that their eating becomes a kind of competition—with others as well as with themselves. Eating becomes the ability to display self-control.
Susan Villari, director of the Office of Student Health and the Office of Health Education, points to the “extreme level of competition on Penn’s campus,” and adds: “Eventually, what is there left to compete with? The body becomes the last domain for competition. The part that’s saddest for me is how the preoccupation with dieting and exercising takes a toll on the quality of life for students at Penn. In a community that is so talented and gifted, there is extreme psychic deprivation in this preoccupation with thoughts of food and exercising.”
This past January, a group of five College seniors were planning to take their spring break in Mexico. They had just finished their finals, and having put on a bit of “winter weight,” they decided that they would try to lose as many pounds as they could before they had to don bathing suits. One student decided to refrain from all carbohydrates for the next two months before his spring vacation. He hoped to make his body as “cut” and as “thin” as possible in such a short amount of time. Banished were gum, soda, the sugar in his coffee—even fruit.
“The people I am surrounded by at Penn, including myself, are used to excelling at everything we do,” he explained. “So I thought to myself, ‘If I can excel at school, why can’t I excel at my body? Why can’t I refrain from carbohydrates?’ It’s all about making yourself better. If I work half as hard on my body as I do on my school work, I’ll have an amazing body.”
“People who develop eating disorders tend to have personality characteristics that are extremely perfectionist and achievement-oriented,” explains Fichter. “They base their self-esteem on external measures—getting A’s, being the president of their class or the fastest runner. They tend to be black-and-white in the way they perceive things: If they’re not the best, they’re the worst. This includes their perceptions of their own bodies.”
This is not a new phenomenon. Back in the late 1970s, Amy Albert C’81 knew a number of young women at Penn who used eating as a way to challenge themselves and compete with one another.
“One friend counted out the number of Rice Chex, maybe 15 or so, that she allowed herself each day—and that was pretty much the sum of what she ate,” says Albert, now senior editor at Fine Cooking magazine. “We were doing rigorous work all day long. We were using all our manpower and our brainpower—so of course we were hungry. But it was not okay to be hungry. Hunger was something else we had to work hard at to control.
One of her dorm-mates was “clearly uncomfortable with the act of eating,” she recalls. “She was really attractive and she had a great boyfriend, but she thought she was ‘blimpy.’ And I have very clear memories of her eating her food with this really uncomfortable look on her face. She poked at it with her spoon and put it in her mouth with this kind of sour expression—as though this was something she shouldn’t be doing.”
Many of Albert’s friends were obsessed with thinness, and some of them made her feel that she should curb her own appetite. (She weighed about 125 pounds then, about a dozen pounds more than she now carries on her five-foot-three-inch frame.) “They pressured me into going on Weight Watchers with them,” she says. “There was so much status connected to conforming to a fashionable body type: small, upturned breasts and the kind of boyish hips that look great in guy’s Levi’s. To this day I’m not sure that I really was overweight then. But I sure as hell felt like it.”
While the vast majority of students with eating disorders are women, 5-10 percent are male, according to a recent article in Men’s Health magazine. Three years ago, Mike Rogan W’00 conducted a survey in which he found that six percent of men admitted that “the degree of their muscle makes them anxious, nervous, or tense.”
“It is not just a female issue,” said Rogan. “Men suffer from disordered eating as well. Wrestlers lose weight quickly and drastically, and men go on the Atkins diet to bulk up.” He wishes that more men would speak out about the problem and get involved with solving it.
“I think this is a tremendous problem for all students, both men and women,” agrees Fichter. “Men present behaviors of disordered eating as well. Many students are devoting too much of their time to perfecting their bodies.”
The high-pressure atmosphere at Penn can trigger patterns of disordered eating. But many students arrive on campus already preoccupied with their body image and eating habits. Students’ perspectives about their bodies, as well as any dieting habits, are often shaped years before they begin college. According to a study conducted by the Council on Weight and Size Discrimination, over 80 percent of 10-year-old girls have dieted.
“We have to start sooner than college,” explains Fichter. “Attitudes about how we expect people to look need to change. We are living in an age where everything can be perfected. We have braces, SAT tutoring, and private batting coaches for Little Leaguers. The goal of achieving perfection gets applied to people’s bodies, starting at an extremely young age. Combating unrealistic cultural pressures about body image begins at home with parents.”
“Parents need to be really careful about the feedback they give their children about their bodies,” adds Villari. “Parents who are perpetual dieters or have restricted food in the house need to realize that their intelligent kids are picking up on these messages from a very early age. They should place more emphasis on academic performance and quality-of-life at college and less on physical appearance.”
Rhoda Kreiner is director of the American Anorexia and Bulimia Association of Philadelphia, which works with parents to help young people combat eating disorders and disordered eating.
“There are parents who come in and tell us they can take care of their own child,” explains Kreiner. “That is wrong. They need to involve a professional who is educated about eating disorders. Parents feel extremely guilty, especially fathers. Fathers are fixers, and for a father who cannot ‘fix’ his daughter, it is an absolute blow. Parents whose child is battling eating disorders feel extremely frustrated and angry—but mostly helpless.”
Amado Hall in Irvine Auditorium was packed for the final event of “Body Talks: Challenging Body Image in Today’s Society,” a full-day conference last spring. The annual conference was sponsored by GUIDE—Guidance for Understanding Body Image and Eating—a body-image peer-education group that promotes the celebration of all body types by challenging societal notions of a particular idea of beauty. (Next year’s national GUIDE conference will be held at Penn February 28-March 1.)
“We have to break away from the shame and hiding associated with body image,” said Ophira Edut, the keynote speaker and author of Body Outlaws: Young Women Write About Body Image and Identity. “In general, we don’t like to talk about struggle in our lives. It’s a rejection of what’s considered a feminine way of communicating. We are defined by our bodies, but at the same time we are still separating from them, feeling critical of them.”
Communication on this touchy subject is, in some ways, easier said than done. While a wide range of treatment services are available throughout the University, disordered eating and body image continue to be subjects which students feel uncomfortable discussing.
When Susan Villari first came to Penn in 1987, she started an all-female student group—“Food, Sex, and You”—which discussed issues of body image. While the group was designed for “healthy” women, many of its members still felt that their bodies weren’t “good enough,” which they knew was not a healthy attitude. The group disbanded in 1991.
“There is a need for more discussion groups on campus, ones that aren’t deemed ‘therapeutic’ and don’t carry that stigma and shame,” she says. “Penn students would benefit from more public debates on what it means to be ‘healthy,’ and specifically how the issues of body image, food, and disordered eating transcend race, ethnicity, gender, class, and sexual orientation.”
Dr. Judith Rodin CW’66, Penn’s president and a professor of psychology, has a scholarly background in disordered eating and body image. In her book Body Traps, she examines the need for society to reshape its attitudes towards women’s beauty. As an administrator, Rodin feels that Penn can play a large role in combating messages of negative body image.
“Through education, we can promote social change on campus,” she says in a brief e-mail interview. “We can use vast resources and expertise here to offer various perspectives, engage in meaningful dialogue, and use vast networks of services to support and educate our community. I disagree with the premise that society is unlikely to change, but believe that change on this and other campuses is necessary.”
Sometimes the best thing a student can do is get away from the mirror that is Penn. For one College senior, who had been on diets since she was 14, it took a term abroad on a community farm in Costa Rica to gain a healthy perspective toward food.
“I had struggled for years with different diet and exercise regimens,” she explains. “I have been an Atkins supporter; I have counted calories. But living in Costa Rica, I was able to regain my perspective on food and eating. I discovered the joy of food. My whole experience was about appreciating the food we had—eating it, growing it, preparing it, and cooking it.”
Though she acknowledges that it’s hard to hold on to that perspective at Penn, she maintains that “we really do need to change our perspective from a fear of fat to an appreciation of health.”
Unfortunately, most weight-watching Americans don’t have that opportunity to see food outside a dieter’s perspective. Yvonne, my freshman hall-mate, was away a semester as well, but her experience at the in-patient clinic was a far cry from Costa Rica. Almost two years after I watched her pack up her duffel bag to return home, I ran into her at the library. She still looked tiny, though perhaps a bit less so. And she still held her hands tightly under her armpits. But I could tell something was different. At first, I didn’t know what it was. Then suddenly I realized that she was staring at me, right into my eyes as she spoke. And she was smiling.
“For the first time in so many years, I finally feel like I am thinking about the right things, devoting my time each day to things that are important to me, like my friends and my classes,” she said. “I look back and realize how much time my dieting took away from me. Like everyone else, I still sometimes have a ‘fat day.’ But when ‘fat thoughts’ creep up on me, I know they are just red flags that something else is going on in my life.
“I feel lucky to have gotten a chance to take time out of my life to recover from an eating disorder,” she added. “I am slowly reclaiming myself in a disordered social structure.”
Alison Stein C’03 is a senior English major (with a minor in African studies) from Hamden, Connecticut.