College is a time of transition – for many students, it’s the first time they’re living on their own, and they’re now responsible for taking care of themselves. Mental health is becoming a larger part of the conversation for college students, but one issue often goes overlooked – eating disorders.

“The amount of people with disordered eating is vast on college campuses, and invisible,” said Dr. Ellen Rome, the Head of the Center for Adolescent Medicine at Cleveland Clinic Children’s Hospital.

“Just off the top of my head. I have five friends that I could name right now that all have eating disorders,” said Ryan Leflar, a junior at Kent State. “So it’s pretty rampant, you know?”

According to the National Eating Disorders Association, 32% of female-identifying college students and 25% of male-identifying college students suffer from an eating disorder. It’s estimated that over 40% of freshmen struggle with disordered eating behaviors during their first year of school.

“It started for me in college because I went to school and I just was surrounded by very pretty people and a lot of stress,” said Emily Dioguardo, a junior at the University of Pittsburgh.

Eating disorders on college campuses are often normalized as part of college living – skipping breakfast before an early class because you woke up late, forgoing meals before going out, or having “sleep for dinner.”

“You could say somebody might have food preoccupation, or negative body image, or an unhealthy relationship with food,” said Dr. Maria Rago, President of the National Association of Anorexia Nervosa and Associated Disorders. “You don’t have to have even a full blown eating disorder in order for eating and body image issues to greatly affect your quality of life.”

The transition to college can be more challenging for students than they realize – with so many big changes happening at once, it can put students in a fragile state.

“It’s a time where people do have a lot on their minds,” said Dr. Rago. “They’re trying to make new friends, they’re trying to manage a heavy workload at school, they might be managing missing homes, financial issues.”

“It’s a time of change, and an eating disorder can be a coping strategy. It’s somebody trying to avoid freshman 15, or COVID 15,” said Dr. Rome. “Or, they underestimate how huge their campus is and how much energy it takes to just walk around campus. All of these create a perfect storm for disordered eating.”

The COVID-19 pandemic has also created extra barriers for students to get access to food.

“Being on campus in isolation or with less food access, or meals that are getting delivered, but may not be things that that person needs,” said Dr. Rome. “So the challenges of 2020 have just escalated the underlying baseline problems.”

Students who live both on and off campus have to deal with barriers to getting food amid the pandemic.

“It’s hard to take the bus during a pandemic so I could never buy the proper groceries,” said Dioguardo. “So it was just a lot of snacking and not eating meals and then not wanting to eat too much because I snacked.”

Eating disorders can have adverse effects on every part of your life. Beyond the physical effects, they can also take a toll on your social life and academic performance.

“You may be having eating disorder thoughts 24 seven, that doesn’t allow a lot of other room in the brain for studying. So the wheel spinning that happens from disordered eating thoughts shouldn’t be underestimated as crowding out regular academic thoughts,” said Dr. Rome.

“Especially now,” said Leflar, “If I go too long without eating or like, if I don’t eat till later in the day, it’s hard to get my day started, it’s hard to get motivated.”

Experts say that although you might not have a diagnosed eating disorder, negative thoughts about your eating habits and body image are clues that you could be struggling.

“It’s this really, really uncomfortable dichotomy of wanting to talk about it because you know, so many people feel it and not being able to because it’s taboo,” said Dioguardo.

It’s easy for students to think that their disordered eating behaviors are normal or even healthy – but those unhealthy thoughts and practices can consume you quickly.

“But what really matters is like, Are you happy? How depressed are you? How anxious are you? And how preoccupied with food, weight and body image are you,” said Dr. Rago. “What percentage of your time do you spend on that, thinking about that and obsessing about it and being upset?”

Dr. Rago said be mindful of your friends’ behaviors too, as making sure everyone feels comfortable eating can go a long way.

“I’ll try to do what I wanted people to tell me for the five months that I was starving,” said Dioguardo. “No one ever said it. I almost needed to express it to other people so they could validate that it was okay to eat when I wanted to eat and it was okay not to work out.”

“People sometimes need permission,” said Dr. Rago. “They feel scared. And they don’t want to do the wrong thing. And they don’t want to be too fat. And so they get kind of paralyzed. And for you to come in and be like, hey, let’s make sure we get dinner, what are we doing? Then it’s like a relief. Everyone’s like, Oh, good, we get to eat dinner.”

Taking the step to get help for you or someone you care about can be challenging, but Dr. Rome said that difficult conversation could end up saving a life.

“If anyone’s worried about your or your friends’ disordered eating,” said Dr. Rome, “take that seriously. Odds are, it’s an unrecognized problem.”

Maddy Haberberger is a TV2 reporter. Contact her at [email protected].