Training student groups of eating disorders

An essential aspect of outreach is training student groups like resident assistants
(RAs) and health educators. RAs, in particular, are oft en on the front
lines in recognizing and responding to problems. Our training program
reviews the defi nitions of eating disorders and warning signs of possible eating
problems, clarifi es gray areas like how to tell when irregular eating or exercise
becomes a problem, and off ers a list of factors to consider when deciding how
to respond.
We defi ne the formal eating disorders from the DSM-IV and discuss disordered
eating. Behavior becomes problematic, we explain, when there is no
fl exibility in eating or in exercise rules or patterns. For example, one student
realized he had a problem when he couldn’t eat a piece of his own birthday
cake. When someone has the fl u and worries all day because she can’t work
out, that’s an indicator that “normal” behaviors have become compulsive.
Warning signs of possible eating diffi culties are discussed in terms of food,
body, and social behaviors. We indicate that some of these behaviors are common
and may have nothing to do with an eating disorder, although they may
mask problems and are good markers for further investigation.
We also teach that food-related behaviors that involve the elimination of a
whole food group, like being vegetarian or vegan, or claims of lactose intolerance
or food allergies may signal problems. Another warning sign is frequent
use of appetite suppressors like gum, hard or gummy candies, diet sodas,
coff ee, or cigarettes. Also worrisome are students who express fears or false
beliefs about food—for example, that one dessert can make you fat—or who
never eat in public.
A further point we make is that body obsessions can indicate a problem.
People who are overly preoccupied with their bodies or parts of their bodies
may be struggling with an eating disorder. Th ey can spend hours getting
dressed to fi nd an outfi t in which they don’t “look fat.” Another indicator is
compulsive exercise—for example, going to the gym when they’re sick, or running
in a blizzard. Social behaviors that may predict eating problems include avoiding plans involving meals or canceling at the last minute (they ate “bad
food” that day and it shows). Sudden abstinence from alcohol because of the
“empty calories” warrants further questioning. Obviously, always going to the
bathroom aft er meals can also indicate eating problems.
Once a student at risk has been identifi ed through outreach, a number of
factors should be considered in deciding how to approach the student:
Is there evidence of health problems? Does she feel dizzy, faint, or
weak? If there are many indicators of ill health, a physical evaluation
may be mandated.
How disturbed are the behaviors? A student leaving vomit in jars
around her suite may require a more urgent response than someone
whose purges are hidden.
How much insight does he have? Interventions with someone who
denies everything will be diff erent than with someone who can talk
about his struggles.
What, if anything, has been tried already? Th e fi rst intervention, if not
a dire situation, is usually gentle and inviting—expressing concern
or recommending student support services like counseling or health
service. However, if the person has been approached many times but
continues to demonstrate problems, more directive approaches may
be indicated.
What is the eff ect of this person’s behavior on the community? People
who are ups