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University Professors: Helping a Student Overcome an Eating Disorder, Part 1

What you can do

Published February 11, 2010.

The college dance professor saw all the signs. One of her students was becoming thinner and thinner as the semester progressed. The other girls told the professor that their friend avoided mealtimes and often made excuses for skipping events where food was served. While the teacher suspected an eating disorder, she didn’t know what to do. Acutely aware that she lacked the expertise to handle this illness, she left the girl alone, hoping she would improve.

The scenario above may be far too common, given the extremely sensitive nature of any discussion about eating disorders. In fact, professors who are uncertain or unaware of their university’s policy for confronting students about such issues may choose to step back and hope the situation resolves itself. In interviews with college dance teachers across the country, DT encountered a range of policies and attitudes regarding what faculty should do when they suspect a student has an eating disorder. It’s up to you to work within your department or university guidelines to determine the best approach for your students. But remember: what’s most important is that dancers get the help they need, so that they can return to class healthy and ready to learn.

The Basics
In the simplest terms, an eating disorder is an illness that causes people to adopt unhealthy eating habits. The two main eating disorders are anorexia nervosa, characterized by an intense fear of becoming fat that results in extreme restriction of food, and bulimia nervosa, characterized by episodes of binge eating that are often followed by vomiting, laxative abuse or excessive exercising. These disorders often coexist with a flawed body image—individuals may continue to be dissatisfied with their appearance even after having lost a significant amount of weight.

The College Factor
While there are no known statistics for eating disorders in college dancers, the National Eating Disorders Association does note that numbers are higher for athletes, with the risks increasing in sports that emphasize appearance, focus on the individual and in which the participant has been training since childhood—all conditions that mirror collegiate dance.

Sarah McCalister, an assistant professor of dance at Valdosta State University in Valdosta, Georgia, presented a study at the 2005 International Association of Dance Medicine and Science conference in Stockholm linking depression with disordered eating (negative attitude toward eating) in two college dance populations. “Sometimes the academic and social pressures at college, mixed with the pressures of the dance world, can cause anxiety or depression, root causes of eating disorders,” she explains.

A number of other factors can also contribute to the likelihood that dancers at this level will develop body image issues. For instance, college may be the first time a student is living away from home. “Without daily parental guidance and support, an already tenuous situation can worsen,” McCalister says.

Additionally, a dancer who was at the top of the class in her hometown might find herself in a very different situation when she gets to college. “A grade A dancer at a small studio might not be the best dancer or academic student in college,” says Sondra Kronberg, MS, RD, CDN, a clinical nutrition therapist specializing in eating disorders who is the executive director of NEDA. This sense of insecurity, coupled with the fact that dancers tend to be perfectionists, can lead to a student feeling that she needs to lose weight in order to be more competitive within the department.

“Making a successful transition to college, where you have to sever old ties, recreate new ones and reestablish yourself, is a major tax on the sense of self,” Kronberg says. “College can overwhelm with all the choices it presents—time management, relationships, food—and people with eating disorders generally feel overwhelmed and out of control to begin with.” Thus, if a student’s coping mechanism for dealing with a lack of control is to manipulate food, then the illness may flare up.

What’s Your Role?
It’s well documented that people who suffer from anorexia or bulimia will have a higher chance for recovery with early detection, diagnosis and treatment. The role of an educator is crucial here. According to NEDA, an instructor should not attempt to serve as a diagnostician or a therapist, but should provide understanding, nonjudgmental support and direct the student to therapeutic and medical resources.

With the exception of extreme cases, it can be difficult to distinguish between an eating disorder, diagnosed by a medical professional based upon specific criteria, and disordered eating, an unhealthy attitude towards eating. In our thin-obsessed culture, many females have disordered eating or some sort of negative relationship with food, so how can you tell when an unhealthy attitude has become dangerous? The issue is further complicated by federally and state-mandated privacy laws that protect the privacy of anyone over 18. Thus, parents cannot be contacted about a college student’s well-being without his or her consent. The university’s legal department should be able to tell you more about these laws and how they affect you and your dancers.

Your first step should be to find out if there is already a policy in place for dealing with eating disorders in students. If there is not, work with other faculty, university administrators and your college’s counseling service to develop such a policy. Here are a few courses of action you may want to keep in mind:

-Approach students directly, if necessary. Carol N. Iwasaki, professor and chair of the Department of Ballet at the University of Utah in Salt Lake City, admits that speaking to students about health issues can be difficult. “We feel that every individual is entitled to privacy and should feel free to come to class without the faculty probing into her personal life,” she says. “On the other hand, we will not sit by if we are worried about a student’s health.”
All undergraduate students studying ballet at UU are required to record their height and weight when they join the department. “This gives us a baseline to consult if we suspect that there has been a significant weight loss or gain,” says Iwasaki. Then, if faculty members do become concerned about a student’s health, they bring up the issue at one of their weekly faculty meetings.

“We determine the best candidate to speak with the student. It’s very important that the teacher be someone with whom the student feels at ease,” Iwasaki says. “That teacher would express her concerns, ask the dancer how she is doing and invite the student to share her feelings.”

-Work closely with the university’s counseling service. If you’re concerned that by approaching a student, you’ll exacerbate the situation, try going directly to the college’s counseling center. “The first thing I would do is contact university counseling and other appropriate offices to find out what to do,” says Karen Potter, associate professor and director of dance in the Department of Theater and Dance at Case Western Reserve University in Cleveland, Ohio. “[This is] an extremely delicate situation that should be handled by medical professionals.”

You can take the process one step further by coordinating a buddy system with the counseling center, so that students feel comfortable going there.

“[Counselors] would emphasize to all the students that they are looking out for their health, well-being and future,” McCalister says. “To educate the students, the counseling center would discuss and distribute information about the signs and symptoms and short- and long-term effects of eating disorders and disordered eating.” (For more on educating students about eating disorders and proper nutrition, see Part 2 of this story in next month’s DT.)

-Consider restricting participation in classes, rehearsals and performances. Sarah Lawrence College in Bronxville, New York, requires every dancer to sign a waiver called the “Dance Student Participation Agreement.” This form gives the dance faculty the right to limit activity and/or deny a student access to the dance program if he or she exhibits behavior considered to be harmful or dangerous to his or her health or well-being. The document states that in such a case, the student must undergo a full health assessment—which includes a body mass index test—the results of which the dance faculty can access. A committee of health services staff, dance faculty and other parties deemed appropriate then makes a recommendation of acceptable activities.

“This form came out of a situation with a student we were very concerned about several years ago,” says Sara Rudner, director of Sarah Lawrence’s dance program. “It was difficult to help her without a road map. But now, with a signed form from every student, we are empowered to help, if necessary. We don’t have to watch a terrible situation unfold, feeling unable to help.”

If students resist help, Rudner reminds them about the form that they signed. “I tell them that I value them and want them to continue to participate in the dance department. I remind them that dance is about building a healthy body and that we have all shapes and sizes here,” she says. “We recommend that they go to treatment that would include testing and counseling.”

Similarly, if students at UU refuse to seek treatment, they are not allowed to continue taking dance classes. “We don’t have to know what is taking place in counseling, just that it is taking place,” says Iwasaki. Then, the student can return to class as long as his or her health provider has deemed it safe to resume dancing.

-Listen to other students’ concerns. Iwasaki, McCalister and Rudner all say that a peer will often detect a problem before the faculty does. “It is often the student’s friends who come to us and say that they are worried,” says Rudner. “They might say, ‘Why aren’t you helping her?’ Generally, we are already concerned about the person in question.”

Peers are actually in the best position to notice changes in eating behaviors and attitudes, adds McCalister, “because they spend so much time with each other at meals, in study sessions and just hanging around.” If a student is concerned about a peer, McCalister explains, she can inform the faculty coordinator anonymously or in a personal meeting. Then, after consulting with the school’s legal department, the faculty coordinator can decide whether to keep the information confidential or share it with other faculty members in the program, so everyone is alert to the red flags.

Despite the complexities of eating disorders and the delicate psychological make-up of those who suffer from them, it is crucial that appropriate treatment is received as soon as possible. Educators are on the front line with their students and therefore in a good position to identify a problem and monitor a student’s behavior and attitude. The stakes are too high for the fictional dancer in the first paragraph and real people just like her. Whether through formal policies or persuasive discussions, make sure help is on the way. DT

Susan Eisner Eley is a freelance writer based in New York City and a former editor of Dance Teacher.

Originally published inDance Teacher, April 2006