Anatomy of Care for Students With Eating Disorders

Health professionals often direct students with severe eating disorder symptoms to inpatient treatment facilities. But students with less severe symptoms often find their on-campus treatment options lacking. In many cases, these options don’t extend beyond meeting with a mental health counselor who may or may not have experience in eating disorders.

What does quality, campus-based outpatient care look like instead? Experts say it involves complementary therapies and a collaborative approach.

“Eating disorders are complex, bio-psycho-social illnesses,” says Elizabet Altunkara, director of education for the National Eating Disorders Association (NEDA). “College counseling programs need to have providers who can identify the signs of an eating disorder and a multidisciplinary team dedicated to supporting these students.”

Who’s on the treatment team: Treating an eating disorder generally involves “a combination of psychological and nutritional counseling, along with medical and psychiatric monitoring,” Altunkara continues. So a treatment team best equipped to support students in outpatient care would include a therapist, nutritionist, medical doctor and psychiatrist.

The key, adds Altunkara, “is to make sure all these professionals specialize in eating disorders.”

Other supports: Groups for students who are relapsing or in a maintenance phase also are an important layer of care.

“Eating disorders are isolating illnesses, and it is important for the person to realize that there are other people struggling with similar issues and grow connections that will support them through their recovery,” Altunkara says.

Another element of quality campus care is prevention programs that teach coping skills and “tools to resist pressures to conform to unrealistic standards of beauty and the diet culture that is promoted in our society,” says Altunkara.

(A note: While multidisciplinary, team-based care is recommended for outpatient treatment on campus, institutions with such teams vary by how long they extend services to students. Some teams may eventually refer students to off-campus providers for long-term care.)

Jade Garneau-Fournier, program director at North Palm Beach Outpatient Eating Disorders Program at Discovery Behavioral Health, previously led a university eating disorder management team and says that while campus teams have limitations, they’re “beneficial to get a student started with getting treatment.”

Why eating disorders emerge during college: College has long been considered a risky time for students with or at risk of developing eating disorders, for a variety of developmental, environmental and social factors. And research suggests that the risk is only growing: one 2022 paper based on data from the Healthy Minds Study, a large annual survey of college students, found the prevalence of eating disorder risk increased significantly between 2013 and 2021—from 15 percent to 28 percent. The same study, published in Psychiatry Research, found that young, female and Hispanic students experienced the largest jumps in risk. Overall risk increased by three percentage points during the early period of the COVID-19 pandemic alone.

Altunkara underscores that eating disorders are on the rise, and that this is part of a larger mental health crisis. NEDA’s help line saw a 107 percent increase in volume from March 2020 through the end of 2021, and the number of calls remains elevated.

How community providers help: Institutions without their own eating disorder care teams looking to better serve students on campus may choose to partner with community-based services. In this model, a college or university contracts with an outside care provider to deliver targeted services to students on campus. This can reduce costs for the college or university and ensure that students don’t have to go far to seek help. Texas Christian University, for example, plans to soon launch a program in which experts from the local Eating Recovery Center will run intensive on-campus outpatient treatment.

Eric Wood, director of counseling and mental health at Texas Christian, says that “when students are really at higher risk, you do need a specialist. And not only a specialist. You need a team.” Staffing that expert team often becomes a “matter of resources” for institutions, however, he says, and “that’s such a complex thing. So I think our way works a lot better, because if you already have [community-based] treatment centers that have an established program, they have the staffing and we have the infrastructure. And we create this win-win situation.”

More examples of comprehensive campus care:

• Dartmouth College: A Nutritional Wellness Team assesses students based on a medical evaluation with a primary care provider, a mental health assessment with a counselor and a dietary assessment with a dietitian. Students deemed appropriate for treatment by the team, based on level of need, can expect services grounded in nutrition and intuitive eating, mental health (including attention to co-occurring issues), and medicine.
• Massachusetts Institute of Technology: The Eating Concerns Team at MIT Medical includes medical providers with relevant experience, psychiatrists, nurses, nutritionists, wellness coaches and athletic trainers. There is no referral requirement. Services include early identification, assessment and ongoing management of disordered eating.
• University of California, San Diego: Students seeking treatment for eating issues through the Student Health and Well-Being Eating Disorders Program meet one-on-one with a primary care provider, psychiatrist, therapist and dietitian. Care includes individual therapy, group therapy, nutritional counseling, medication management and primary care support. Services may be spaced out, depending on a student’s level of need.
• University of Wisconsin at Madison: Students with concerns about eating and related issues complete an eating disorder assessment. The three-session assessment explores mental health and social history. Diagnosis and treatment plans are discussed, as is a treatment plan. Care is delivered by a team of group and individual counselors, psychiatrists, and medical and nutrition providers. Students are seen weekly or biweekly.

Does your college or university have a health or wellness program addressing a particular disorder or group of students that you think other higher ed institutions tend not to have and should consider modeling? Tell us about it.