Connecting to resources: It’s time to talk about eating disorders

CW: In this series, I will be discussing eating disorders and their devastating effects. As someone who has an eating disorder, I try my very best to never describe specific behaviors or comparative numbers, as that can be very damaging, but the material may be upsetting nonetheless. If you decide not to read, thank you for taking care of yourself.

While at residential treatment, I was told that recovering from an eating disorder is a full-time job. Learning how to rethink and undo years of ingrained thinking is the hardest thing I have ever done. As I described in my last installment, an eating disorder is really a way of coping. So, when I stopped engaging in any disordered behaviors, my brain went into overdrive. The voice inside my head became meaner and louder, barely able to think about anything other than how much I hated how my body looked. Every time I got stressed the voice told me that I’d feel better if I got thinner, so I found it easier to engage in the behavior than sit with the feeling.

It took me a long time to want to get better. I knew the things I did to my body were objectively bad, but they didn’t feel bad. I was keeping up with my academics and athletics, and I appeared perfectly healthy. It took seven years for me to really break down. When my therapist told me I needed treatment, I became angry and defensive, but ultimately I agreed to go. I wasn’t experiencing life fully, always half-absent and busy battling voices and urges. I didn’t want to live that way anymore. The clinical term for this turning point is “readiness for change.”

Birant Akbay, doctoral practicum student at Grinnell, elaborated, “when an athlete reaches out for help, that’s a very critical period where you need to try to connect that person to help.”

I know several individuals who reached this stage at Grinnell, and I struggled to help them. We do not have adequate resources on campus. The College only provides brief goal-oriented therapy, meaning 6 to 10 sessions, and none of them specialize in eating disorders. During my search, I was unable to find an eating disorder therapist or specialist in the town of Grinnell. 

However, in addition to Akbay, the College has also brought in another doctoral practicum student, Jessica Pauley. Both provide therapy for athletes, but without the additional resources needed to support eating disorders holistically, there’s only so much they can do. Akbay said when he works with athletes at the University of Iowa, “We always include a registered dietician and team physician. That care is essential for the interdisciplinary holistic approach. I would love to be able to do that at Grinnell. I think it’d be really effective here because it’s proven to be effective in other areas, but we just don’t have that resource yet.” Beth Perlman, clinical director of Student Health and Wellness (SHAW), further elaborated, “they are cultural, medical, psychological and interpersonal, so a lot of different pieces to disordered eating treatment.”

Nevertheless, resources still do exist. One silver lining from the pandemic is that telehealth has become more readily available. Students can connect therapists who specialize in eating disorders, and dieticians in Des Moines and Iowa City, by accessing SHAW’s Virtual Care Group.

       The biggest issue may actually be the lack of information on how to access these resources. I browsed through some pamphlets in SHAW and found that most deal with alcohol use, illness and sexual health, but no information about eating disorders. Because there is so little direct information about disordered eating and behaviors, the onus of finding resources is placed on students. 

When I met with Perlman, she couldn’t give me any specific names of eating disorder specialists in town. I had to sift through the list of providers she gave me myself. Perlman told me that the College does have a registered dietician, but when I reached out, I discovered that Britt McConnell does not work with students to provide meal plans, and her expertise is in food service, not healthcare. While she can provide general nutrition information and direct students to Accessibility and Disability Resources to get accommodations in the dining hall, she does not provide the medical care necessary for wholistic treatment.

This kind of work is time-consuming and exhausting, and given all the demands put on Grinnell students, they certainly don’t have the extra time to be doing all this research. Because the desire to recover is already so nuanced and complicated, I fear that if someone wants help, the time suck of finding resources may just prevent them from getting the care they need. Additionally, while virtual care can be effective for some, disclosing the intimacies of an eating disorder (a personal and stigmatized illness) and trusting someone whom one has never met in person can also be a serious deterrent.

Nothing is more important than your wellness, so even though it might be daunting, seeking out resources is worth it. Starting at SHAW, you can check if you are medically sound. If you have been engaging in eating disorder behaviors, checking in on your health is crucial as you often won’t know there is a problem until it’s too late.

A fantastic resource in Grinnell is Libbi Hoel (libbihoelnutrition@gmail.com), a registered intuitive eating counselor who recently opened her own practice in Grinnell, though she currently only sees patients virtually. She works as a dietician, but talks with her clients about much more than food to manage recovery. Intuitive eating refers to our ability to eat according to our bodies’ needs, which can be incredibly difficult for those struggling with eating disorders. After years of malnourishment, the person suffering often doesn’t have access to interoceptive awareness. For example, this often affects hunger cues — for almost a decade, I quite literally could not tell when I was hungry or full. Navigating this is one of the many aspects that makes recovery hard, and it is why having a holistic approach to recovery is crucial.

Hoel, Perlman and other counselors at SHAW are great resources not only for those struggling with eating disorders, but also for friends of those with eating disorders. Both Hoel and Perlman individually offered to do over-the-phone consultations to talk through options to help a friend in need.

Indeed, most people are unsure of how to support friends who are struggling with eating disorders. All of the professionals I spoke with emphasized approaching the situation without judgment. Perlman recommended, “first sharing concern, sharing your observations. My approach is doing that through a direct behavioral observation. I think that’s a non-judgmental way to start a conversation. That might look like, ‘I noticed that you haven’t been coming with us to the Dining Hall lately. I just wanted to see if everything was okay.’”

After sharing your concerns, you can then see if the person struggling is open to connecting to resources with you. Offer to go to SHAW with them or call Hoel together. This is really all you can do as a friend. Perhaps the hardest part of supporting someone with an eating disorder is accepting the fact that you cannot force them to get help. Trying to stop them from engaging in behaviors isn’t your job. Your job is to be a support and connect them with resources. This is difficult, I know, but Akbay assured me that not policing their behavior doesn’t mean you are doing nothing. 

“As long as we’re opening the door and letting people know that, ‘I’m available should you wish to come to me,’ that’s doing something,” Akbay said. “That’s actually doing a lot because there’s a hope that then the client would feel that this is a safe person I can talk to as a non-judgmental space that I can enter into when I’m ready.”

Eating disorders aren’t rational, and if someone is not ready for change, they just need a friend. When we come at someone with an accusatory statement, that will likely only push them away. But by instead showing others your support, hopefully the person struggling will become ready for change on their own.

All of this conversation, however, highlights to me that we need more clinical resources, but it also shows people to learn how to have conversations about these topics. Sports teams are mandated to partake in training to learn about safe drinking and active bystanderism, and Student Athlete Mentors receive suicide prevention training. We need similar mandatory training to learn how to talk about eating disorders.

Additionally, there needs to be better access to food. My dietician was appalled to learn I went six hours between meals, but when we have three meal swipes a day, that becomes the norm, especially since we are not allowed to take food out of the Dining Hall. Jokes are often made about athletes taking multiple sandwiches, but they do that because they need the calories, and they have to get most of their food in one sitting. Would it be so hard to allow students to take a snack with them to go? The Global Café and the Spencer Grill are the only other food options on campus, but the prices make many students feel that they would rather go without food than pay for an expensive snack. Better access to food is just one way that the College could take a preventative approach. 

Much more can be done to catch disordered tendencies before they become an eating disorder. The level of perfectionism it takes to balance a Grinnell course load, even without a job, sport or extracurricular activity, promotes controlling behaviors that can fuel eating disorders. Students are managing living away from home and being in charge of their own food for the first time. We are creating the perfect environment for eating disorders to flourish, and that means we also need to provide adequate resources to combat them, only starting with a registered dietician.

In my interviews, athletes shared that they are provided with little to no guidance on how to properly fuel their bodies. When I spoke with one student in a strength-based sport, he told me, “I feel like because everybody’s trying to either gain or lose weight. We need to help each other figure that out — what to eat. Bigger programs [at other colleges] have nutritionists and stuff, which is totally different than here. Here, we have zero direction, really.” So I’ll emphasize again — we need basic resources to learn how to fuel our bodies.

Coaches also need training. Often, an athlete’s performance actually increases when first engaging in disordered behaviors, and even though this performance eventually tapers off, it can make it difficult for coaches to believe that someone is really struggling. Coaches that emphasize an athlete’s performance over the individual person often fuel eating disorders. Therefore, coaches need to know the role they play in both eating disorder development and recovery, and they must be given the tools to support their athletes, especially because coaches are often the first person that people go to when worried about a teammate. We need policies to ensure that coaches connect athletes with the proper resources when a teammate notifies them of someone in need. My interviews led me to believe that sometimes coaches do not act. This is unacceptable.

Campus-wide, we need more dialogue. We need to talk about eating disorders and fatphobia at New Student Orientation, we need pamphlets at SHAW and training for students and coaches. The College knows this is an issue — in fact, Perlman said she plans to develop a multidisciplinary task force — but they need the push from students to make combatting this issue a priority. If you or a friend is struggling, please let the College know what they can do to support you. Your desire for support is not unreasonable, it is simply human. 

I hope that if you or someone you love is struggling this series has given you some tools and courage to begin speaking on this issue. No one person can do it alone, and I promise you the journey to recover, to live each day fully, is worth it. 

Editor’s note: This article has been updated to accurately reflect Britt McConnell’s ability to meet with students in her position as the college’s consultant dietician. Updated March 6th, 2023, 2:02 p.m.