The return home for the holidays after the first semester at college is often the first time you’ve spent significant time with your young adult since they moved away. Maybe your college student looks a little thinner to you. Or maybe they are not eating the foods they used to eat before they left for college. Or maybe they have a newfound interest in working out.
Might this be a symptom of a new (or the return of an old) eating disorder? Or might it just be new healthy habits? The distinction can be difficult. Eating disorders can often mask as healthy behaviors and fly under the radar screen. So read on to learn what to look for and what to do if you suspect an eating disorder has taken hold of your college student.
College Mental Health Challenges
We’ve written previously about the immense challenges of the transition to college. College is a time of vast transition and development. Young adults’ identities are coalescing around their peers and they are forming their own values, which may be different than those of their family of origin.
It’s also a time when mental health problems, including eating disorders, are likely to emerge for the first time. The median age-of-onset of eating disorders occurs from age 18 to 21 years (Hudson et al., 2007; Ward et al., 2019). A recent study found that among undergraduate students in the United States, the prevalence of eating disorder risk rose from 15% in 2013 to 28% in 2020/2021 (Daly and Costigan, 2022).
No young adult is immune; eating disorders affect people of all genders, races, ethnicities, sexual orientations, and socioeconomic statuses. Eating disorders often occur alongside other mental health disorders including depression and anxiety. They carry a risk for significant medical consequences and have the second highest mortality rate of all mental health disorders.
Eating Disorder Warning Signs
Some potential warning signs to watch for in your young adult:
- Appears to have lost weight
- Makes excuses to avoid eating meals with you or exhibits high anxiety around meals
- Rejects foods that were previously enjoyed
- Avoids eating whole groups of foods (i.e. starches, desserts, or condiments)
- Frequently looks at their body in the mirror or weighs themselves
- Goes to the restroom and/or showers right after meals
- Talks about their intentions to “be healthier” or lose weight (even if they have gained weight at college)
- Expresses an obsession with healthy eating
- Exhibits an increased preoccupation with exercise or is distressed when unable to exercise
- Exhibits significantly different eating from when they last lived at home
- Misses menstrual period if in menstruating body
- Displays low mood or energy levels
- Large quantities of food going missing (could indicate binge eating)
How to Respond
If your young adult has gained weight in college and is upset about it, this is a great opportunity to de-pathologize it and educate them that adult bodies are supposed to continue gaining weight— even after reaching adult height—until at least about age 21. Dieting and intentional weight loss can—for those who are genetically predisposed—trigger an eating disorder so should be discouraged in favor of body acceptance.
If you are not sure whether their behaviors warrant further attention, one strategy is to try to provide one of their favorite (more indulgent) foods and see if they are willing to eat it. People with eating disorders will often be inflexible around these kinds of challenges. If your young adult will eat foods that might be scary for a person with an eating disorder, that’s a good sign that they still have flexibility. If they balk at eating that food, that is more concerning.
You can talk to them and express concern about what you are noticing. If they deny having an eating disorder but it doesn’t match what you are seeing, I wouldn’t stop there. In fact, defensiveness might be a red flag. I would keep trying to eat with them and gather more information. Your parental instincts are important and can be trusted. Having further conversations—using a nonjudgmental stance—is important. People with eating disorders often experience shame and are frequently unaware of the severity of the illness. Drawing attention to it without increasing shame is important. No one knows your child as well as you do and no one will be as protective of them as you. Parents can be integral parts of their young adults’ recovery and setting the stage for your involvement in these early conversations can be vital.
Taking them to their childhood pediatrician while they are home for a weight check and vitals—including orthostatic vitals—can be a good safety measure. You can also have them assessed by an eating disorder professional—either a therapist or dietitian—while they are home. Keep in mind that if this provider recommends intensive treatment or they don’t return immediately to school, this is a warning to heed.
If you identify a problem, I suggest—at a minimum— setting them up with a treatment team at their school. Keep in mind that most colleges do not have the staff to provide ongoing treatment for all of their students’ mental health needs and will refer them to providers in the community. Many providers may have waiting lists so helping your young adult do the initial legwork can be helpful. I also suggest asking your young adult to sign a release of information so their treatment team members can contact you in case your young adult needs more support or a higher level of care.
Learn more about eating disorders in teens and young adults by reviewing our webpage about FBT and Families Empowered and Supporting Treatment of Eating Disorders (F.E.A.S.T).
If there is a newly emerged eating disorder, you can also consider whether they should even go right back to school, or alternatively take some time off for treatment. Quite frequently, people with eating disorders need more support than can be provided by just weekly therapy and dietary sessions and may need a more comprehensive program that includes support at mealtimes. An effective alternative to higher levels of care is Family-Based Treatment, in which parents provide meal support. You might want to consider having your young adult take a semester off and live with you so that you can support their eating and recovery.
We suggest 6 months of stable recovery before a young adult goes to college and also having a college contract in place.
Learn more about our virtual and in-office eating disorder therapy services for college students in California.
Daly M, Costigan E. Trends in eating disorder risk among U.S. college students, 2013-2021. Psychiatry Res. 2022 Nov;317:114882. doi: 10.1016/j.psychres.2022.114882. Epub 2022 Oct 2. PMID: 36228436.
J.I. Hudson, E. Hiripi, H.G. Pope Jr, R.C Kessler, The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication Biol. Psychiatry, 61 (3) (2007), pp. 348-358
Z.J. Ward, P. Rodriguez, D.R. Wright, S.B. Austin, M.W. Long, Estimation of eating disorders prevalence by age and associations with mortality in a simulated nationally representative US cohort, JAMA Netw. Open, 2 (10) (2019), Article e1912925