College, COVID, and Eating Disorders: What You Need to Know

As I’ve talked about in depth, the transition to college away from home is challenging for most young adults. It is especially fraught for young adults with eating disorders. In that article, I provided an Eating Disorder College Readiness Checklist. The article provides guidance for parents of students entering college after a history of an eating disorder or returning to college after a diagnosis of an eating disorder. I learned the hard way. I’ve witnessed the heartbreaking reality of what can happen to students who go away before they’re ready. I may seem stringent, but we’re talking about one of the most deadly mental illnesses and this is your child’s life and future.

Someone recently asked me whether the same standards should apply in the current climate. I replied that I thought the standards should actually be more stringent given the pandemic. This has been on my mind all summer; now, I am prepared to sound the alarm.

Students with eating disorders of all types—anorexia nervosa, bulimia nervosa, binge eating disorder, and avoidant restrictive food intake disorder (ARFID)—often have a narrow range of foods they are comfortable eating. They often struggle with flexibility.

Covid Changes on College Campuses

The pandemic has thrown a wrench—really, a whole toolbox—into the college experience. Among the changes this fall, is that most dining halls have pivoted to prepackaged meals. This will be an added challenge for students with eating disorders. Students have already reported that the results are long lines as they wait for food, far fewer food choices, no option to portion their meals themselves, and no option to mix and match. These prepackaged meals may be insufficient in nutrients or energy, especially for students in recovery who have high energy needs.

Add to this the experience of students who are quarantined either due to outbreak or exposure or as required by the college upon return to campus as a preventative measure.  Most are in dorm rooms without access to a kitchen. Social media has exploded with unfortunate food stories. For example,

• Meals comprising things students cannot eat—a vegan student who gets a steak and cheese salad; a student allergic to gluten who gets a sandwich on wheat bread
• Objectively inadequate meals—one NYU student reported her dinner consisted of a granola bar, a cookie, and a lemon
• Meals with rotten food
• Meals that seem to be missing items—one student received chips and salad dressing but no salad.
• Strange combinations—a lunch consisted of watermelon and chicken salad, peanut butter, an orange, and a rice krispie treat.
• Meals never received, received several hours late, or 3 daily meals batched into one delivery at the end of the day.

These stories garnered attention. People found them laughable and criticized the colleges. However, I became worried about the impact on college students with eating disorders.

Challenges for College Students With Eating Disorders

Eating disorder recovery requires eating at regular intervals and meals sufficient to maintain recovery. Even a small negative energy balance can increase the risk of relapse in individuals with anorexia nervosa or increase the risk of binge eating for those with bulimia nervosa or binge eating disorder.

Students who are not very stable in their recovery may not be able to handle the current climate. They may not be able to seek additional food if portions are too small. People early in recovery often experience shame about hunger. It could be very triggering to receive portions that are not satisfying. Patients with eating disorders may not be able to advocate for their nutritional needs or do the problem-solving required to make sure the meals are sufficient. Finally, receiving an entire day’s worth of meals at the end of the day would be a natural trigger for those who have struggled with binge eating—or for most people!

Add to this the stress of academics and social issues and the uncertainty about the rest of the semester, and you have a perfect storm for relapse.

If you have any doubts about whether your student may be ready for college under these challenging circumstances, I strongly encourage you to consider keeping them home this semester. If there ever was a time to err on the side of caution, it is now.

The Gift of More Time

Currently, most classes are online and social options at college are significantly limited. Consider this a unique opportunity to keep them home so they have more recovery time under their belt before they have to face such eating challenges. They will not be missing much, and you can work on strengthening recovery so that when the pandemic is over they can return as a healthier student capable of embracing the full college experience. You can use my eating disorder college readiness guide—which outlines steps to prepare a student for the challenges of navigating recovery in college— to ensure they are fully prepared when the time is right.

Therapy for College Students with Eating Disorders in California

If you would like more support for a college student with an eating disorder, we can help. When they are in California, we can provide therapy. We can also help if your child lives or goes to school in a few other states. We provide in-person therapy for eating disorders in our office in Los Angeles and online to people in California. Contact us for an appointment or to learn more.