When the pandemic struck midway through the second semester of her sophomore year at college, 19-year-old Jane flew thousands of miles home to California and found herself almost entirely without the activities or responsibilities that she’d devoted herself to before.
“I went home, and all of a sudden, I had nothing going on,” said Jane, (whose name has been changed), recalling how the extracurricular, social, and academic routines once familiar to her had quickly dissolved.
What Jane did discover at home, however, was an unprecedented excess of time. And this unplanned, unprogrammed time turned out to be fertile ground for the type of strict eating and exercising she’d long considered but never acted on.
“I had always been in my head like, ‘One day, I’m just gonna do it,’” she said. “One day, I’m just gonna do all the things — work out super regularly, eat in a very concerted and controlled and deliberate way.”
“Something in me decided that the time to go for it and the way to go for it was during the pandemic right there and then,” she added.
Over the course of her initial months in quarantine, Jane began following a rigid exercise program and a very strict diet, which she now recognizes as “objectively an insufficient amount for my body.”
Jane’s regime on exercise and eating intensified to an unhealthy level, but at the time, she shut out many of her concerns about her behavior, even as it increasingly chipped away at not only her physical health but also her larger sense of self.
It is becoming clear that while young college students were less likely to contract the most serious symptoms of the Covid-19 virus, they were far from immune to the secondary stressors of the pandemic.
“I masqueraded under some false notion that it was fine and I was fine, and became honestly so hungry I didn’t know I was hungry and didn’t know that over the course of a year I had lost much of my personality and ability to feel,” Jane said. A year indeed passed before Jane received a formal diagnosis for her eating disorder and was able to begin addressing the extent of the psychological burden it had put on her.
As Jane began to address her issues, researchers around the country started to investigate the increasingly evident link between the onset of the pandemic and a wave of new and exacerbated disordered eating around the country.
Since the first lockdown, crisis lines and clinicians across the country have reported being overwhelmed by an influx of eating disorder cases. As early as July, 2020, one survey determined that, since the pandemic, symptoms had worsened among over 60% of respondents in the US with anorexia nervosa and 30% with bulimia nervosa and binge-eating disorder. In January, 2021, The National Eating Disorder Association announced an over 40% increase in demand for its online and phone services since the previous January.
It is becoming clear that while young college students like Jane were less likely to contract the most serious symptoms of the Covid-19 virus, they were far from immune to the secondary stressors of the pandemic. Prior to the pandemic, experts estimated that the rate of eating disorders among college students may have already been beyond the national average — up to 20% for female and 10% for male students.
And while experts continue to consider how the pandemic has affected eating disorders in college students specifically, the disruption to routine and social restrictions stand to be some of the most critical factors: Eating disorders can manifest in response to stress or uncertainty, and many college students — accustomed to spending their time in classes and dorms among peers — were rapidly uprooted and pushed into isolation.
Still, the common challenges that students encountered beginning last March — isolation, family dynamics, academic adjustments — no doubt unfolded and influenced their relationships to food and their bodies in a myriad of different ways. Now, over a year since quarantine forced them to navigate unexpected and extreme shifts in their daily life, they are anticipating another major transition — this time, back to “normal.”
This summer, as students who struggled with eating disorders this past year prepare for the next, some welcome the return to school with new hindsight and sense of maturity, while others are contending with the uncertainty of adjusting to a novel lifestyle once again.
For 22-year-old Lucy Fetterman, the initial transition from school into quarantine last March was one of the first serious challenges they faced following treatment from their eating disorder.
After an almost decade-long battle with their eating disorder, Lucy decided to enter an inpatient eating disorder program in 2018 — the summer before freshman year at Swarthmore College. “I just came to a point where I looked at myself in the mirror one day and was like, ‘Is this how I want to spend my 20s? Is this how I want to go through the rest of my life?’” they recalled. “I saw myself choosing my eating disorder and disordered activities over my friends and family.”
Lucy, now entering their senior year, said the last few years have been a constant process of learning to find neutrality, and even joy, in food and eating. But the pandemic was an obstacle that they never could have predicted, nor prepared for. While Lucy traditionally relied on a certain amount of cushion time to ready their mindset before a transition, taking that space was no longer an option. When classes turned remote, they flew to California to stay with a friend for the initial months, finding that navigating a new routine and doing so in someone else’s home was particularly difficult.
“Not only eating but all of my habits kind of shifted,” Lucy said. “Especially if I’m not sleeping regularly, and I’m really stressed, I’ll wake up in the morning, and it’ll be hard to just commit to that first meal and eat it.”
Dr. Rachel Rodgers, director of the Applied Psychology Program for Eating and Appearance Research (APPEAR) at Northeastern University, emphasized how tied one’s social environment can be to food and potential disordered eating. So while abandoning the dorms could have been restorative for some people’s relationships with food, the change left others feeling unsettled — particularly without a familiar sense of independence or social support.
Being forced to leave the dorms kicked off a series of stressors for many college students uprooted by the pandemic. While Jane attributes her eating disorder to a desire to prove that she could “exercise discipline in the most rigid of ways,” her family environment in quarantine was a contributing factor. Her extreme restriction and exercise were partly a response to the fact that those behaviors had never been the norm for her mother: “There was some element of me wanting to say, ‘Yes, I can do this version of adult life that you don’t do,’” Jane explained.
Having dealt with Obsessive Compulsive Disorder for years, Jane also grappled with contamination anxiety around Covid-19, tracking surfaces she touched or changing out of clothes she had worn outside. Dr. Rodgers says that disordered eating can stem from not only body size or shape concerns but also health concerns, which were rampant during the pandemic. “It’s really hard when the very things that, for you, were obsessive, are now being prescribed by the CDC,” Jane said of her OCD.
Meanwhile, quarantine arrived for Lucy at a moment of transition in terms of not only eating disorder recovery, but also gender identity. “I spent so much of my time thinking about food and my body in really negative ways that I just didn’t have any time for exploration,” they explained. “So, following treatment, one thing that I started exploring was gender, and that was something that came up for me when I was asking myself, ‘What does it mean to be in my body and express myself?’”
Dr. Rodgers confirmed that LGBTQ+ people tend to suffer from higher rates of eating disorders. “It’s hypothesized for a number of reasons — because of the multiple marginalized identities, because perhaps of the differences in appearance ideals in certain subcultures, as well as potentially other types of appearance-based discrimination,” she said.
Dr. Rodgers stressed the importance of an intersectional lens when it comes to eating disorders, recognizing that her field also needs to dismantle false stereotypes that exclude people of color. Attention to the relationship between eating disorders and food insecurity is growing, as well, particularly in light of the pandemic, which pushed many into new economic uncertainty.
Lucy and Jane both highlighted their positions of privilege in receiving treatment, being White or having access to good healthcare. “If I had not known what it is to have good therapy or what it is to assemble a team [of clinicians],” Jane said, “I cannot imagine how I would get help.”
Sarah remembers having always had a “toxic relationship” with food — “especially being a female athlete,” she added.
A soccer player at Clark University, Sarah (whose name has been changed), believes that food and body concerns are common among athletes, including some of her fellow teammates: “We want to eat a lot because we’re running so much, but then are we going to get fat? What is that going to do on our bodies? Are we going to get too muscular? Or are we going to lose muscle?” she shared of constant anxieties around size, shape, and fitness.
Starting college in the fall of 2019, Sarah hoped to find stability in her engagement with food and exercise, recognizing that doing so had improved her mental health in the past. But a pattern of restricting her eating to lose weight, followed by overeating from intense hunger, is what she calls a “vicious cycle” — one that the onset of the pandemic triggered in an especially intense way.
Isolated at home, Sarah did not have access to her usual training resources, including coaches, soccer practices, and lifting sessions. “There were things cut out of my life that usually would help me stay in a positive mental state that I didn’t get because of the pandemic, which then in return affected how I was treating my body,” she said.
Her inability to access the gym or field indeed generated a wave of questions about how her body could change: “I was like, I’m not doing enough. My body isn’t doing enough. I feel fat. I feel like I’m not exhausting my body.” Particularly in the first months of quarantine, Sarah denied herself food to compensate for a perceived lack of exercise.
Dr. Rachel Rodgers confirmed that athletes can be a very vulnerable group when it comes to eating disorders, especially in sports with an aesthetic or weight-related component. “One can imagine that the disruptions to training related to the pandemic might also have had implications not only for their education in the college context, but also for their professional ambitions and their sense of identity,” she added. “If you’re a college athlete, except you’re not because everyone’s at home, then that could be a very distressing situation.”
As she struggled between prolonged periods of restriction and binge eating, Sarah began to think broadly about her future in terms of food and sports: “This kind of opened my eyes to, ‘What is my relationship with my body? And what is my relationship with food going to look like after I play my last soccer game?’” she said. “Because soccer can’t make me feel like it’s okay to eat. Soccer can’t make me feel like I actually have something going for me and that I am somebody.”
For Lucy Fetterman, the pandemic also highlighted the difficulties, as well as the importance of building a lifelong relationship to exercise outside of school. Once on the volleyball team at Swarthmore College, Lucy says that the long-term effects of their eating disorder still caused them to be sick and injured in the transition to college athletics — they’ve never been able to complete a full season.
“What does working out look like when I’m on my own? And how do I reckon with competitive athletics in my body as I am?” Lucy asked themselves while navigating fitness in quarantine.
A major part of their eating disorder recovery has involved repairing their approach to movement — a process that is both challenging and exciting, especially as their body changes over the course of treatment. Having grown up receiving messages from coaches and athletics at large that athletes must look and move in a certain way, they continue to remind themselves that fatness and fitness need not correlate.
“What does it mean to show up to the gym and, again, be fatter than a lot of the people there and still be grounded in my mission and what I want to do and my belonging in that space?” they said of their effort to disentangle the ideas of having fat and feeling good in their body.
As they continue their journey with movement, Lucy is preparing for a recently-approved fall pre-season at a gym whose space feels especially promising.
The gym’s motto? “If you have a body, you’re an athlete.”
In a year marked by little personal interaction, it may come as no surprise that a mental illness infamous for being difficult to identify and diagnose could fly under the radar.
Asked whether the pandemic made it challenging for those with eating disorders to seek and receive help, Dr. Rodgers said the answer is easy: “Yes, because [eating disorders] are difficult to detect. Yes, because people often delay before reaching out for help. Yes, because even when they have, it can sometimes take people a while to identify what that assistance and help would look like.”
Even though Jane had been in therapy since the beginning of the pandemic, she came to realize that the help she was getting wasn’t solving the problem it needed to — the problem that she didn’t want to admit she had. Her longtime therapist had been approaching her eating disorder as a manifestation of her Obsessive Compulsive Disorder, and, after a year, the treatment method clearly wasn’t working.
“I had to turn this point where I was like, I am going to do the thing — the hard thing,” she said of her decision to change therapists and treatment approaches. “You have to decide that you’re going to fight [the disorder] in a real way, because you can fake fight for a long time.”
Now, as the upcoming school year approaches and students plan to move on campus, a new set of barriers to recovery may be surfacing — the imminent shift in social environment, food environment, and support systems among them.
Still, Jane said that she is entering this next semester with a renewed sense of maturity and confidence in her ability to thrive independently. Being away from school over the last year actually helped eliminate some of her college-related anxieties. Off campus, she didn’t worry as much about missing out socially, helping her recognize that the people or parties that once stressed her out are less worth her energy.
But, as pandemic restrictions begin to taper off, Dr. Rodgers has noticed a new type of anxiety related to eating disorders and the ‘return to normal:’ “People [are describing] something akin to the effect of the high school reunion or the going home for spring break after two semesters of college,” she explained. The thought of re-entering old social spaces prompts some to agonize over how they’ve changed since the pandemic and the impression they will now have on others.
For Lucy, the prospect of returning to campus this fall can feel terrifying. “I’m scared, and there’s a lot of uncertainty,” Lucy said. “But the big thing that I’m trying to lean into this summer is controlling the things that I can control.” As they think about the upcoming volleyball season, they are focusing on being patient with themselves, as well as offering support to younger members of the team.
Sarah said that facing the ongoing challenges of the past year has similarly motivated her to be kinder to herself. Already, she finds herself choosing time with friends over gym sessions that she prioritized before and through much of the pandemic.
But while she’s excited for the upcoming soccer season, Sarah recognizes that getting back into a regular practice routine can bring with it many pressures around body size and fitness. “You’re so much harder on your body in the sense that if you go in and one practice you were a little more winded than usual, you’re like, ‘Do I need to lose weight?’ Or you’re constantly thinking about, ‘Does my body look good in the uniform? Do I look fat compared to my teammates? Do I look in shape?’” she explained.
Anxious to test her more compassionate attitude toward her body on the soccer field, Sarah thinks that repurposing team meetings or bonding sessions to discuss nutrition and body image could help support her and her teammates. But, she added, these mental health resources should also extend off the field, so that all students at Clark have the opportunity to attend webinars or listen to podcasts and “take what they need from them.”
For all three students — Jane, Lucy, and Sarah — the new academic year catches them as they continue striving toward new ways to practice body appreciation and acceptance — whether by trying to be more socially carefree, setting a strong example for their younger peers, or taking more rest days.
For college students similarly working toward recovery, or still in the darkest stages of their disorder, Dr. Rodgers said, “If we’re on campus in September, it’s because you have a body that allows you to live through a pandemic. Celebrate that.”