Problem at the Plate

At Duke and other elite institutions, where a be-the-best environment exacerbates cultural pressures to be thin and beautiful, one of the most common problems students run into is maintaining a healthy attitude about their bodies.

Last year, of the nearly 1,700 students who sought assistance through Duke’s Counseling & Psychological Services (CAPS), more than 600 had worries about their relationship with food or their body image. More than two hundred students were referred to professionals in the community or to specialized care at the Duke Hospital Center for Eating Disorders.

Recent research has shown that eating disorders such as anorexia and bulimia have genetic components, but factors such as stress and upheaval can tip those who are predisposed to eating disorders toward potentially life-threatening behaviors. Students worried about fitting in or stressed over a bad grade on an exam may begin dieting or fasting as a way of regaining control or shielding themselves from the pain of disappointment.

“Clinical eating disorders are complex issues made up of biological, cultural, and psychological factors,” says Nancy Zucker A.H.C. ’00, director of the Center for Eating Disorders. “For those individuals entering into college with the biological and psychological vulnerabilities already in place, the cultural pressures and standards on high achievement at all costs at Duke can put them at higher risk for the development of a clinical eating disorder such as anorexia or bulimia.”

CAPS offers a limited scope of services that includes eating disorder assessment and treatment of milder forms of body image or food-related distress. In the most severe cases, students have taken a medical leave in order to engage in full-time treatment. Comprehensive care that includes mental health, nutritional support, and management by a physician is imperative in such instances because of the complexity of the issues and physical risk factors. According to the National Eating Disorders Association, anorexia has the highest premature fatality rate of any mental illness.

One of the ongoing challenges of treating men and women with such a multidimensional disorder is reintroducing them to the cultural milieu. When students who have received intensive treatment for eating disorders return to campus, the same pressures that contributed to their disorder are still there—putting them at high risk for relapse.

“We’re trying to encourage everyone in the Duke community to think about how we all contribute to cultural norms related to beauty, success, relationships, or expressions of vulnerability, because eating disorders affect everyone,” says CAPS’ Eating Disorders coordinator Paula Scatoloni. “Eating disorders are not simply about food, fat, and dieting. They are a reflection of our deeper hungers—love, validation, acceptance, connection—how we seek support, and the degree to which we feel our friends and community will be there for us if we show our deficits.”

—Bridget Booher