It started with a juice cleanse — three days, 18 bottles of juice, $135 — three-and a-half pounds lost. “That was living hell, but I’ll go to Nekter, do the five-day one next,” says USC sophomore Sarah.
Sarah’s eating disorder began last spring when all of her new friends were chatting about the “freshman 15” they had put on. With plans to rush a sorority their next semester, many of them became increasingly fixated on how to lose weight. They used tactics like juice cleansing, meant to boost wellness, as intense diets. They were not well.
“Honestly, I never would have thought twice about the weight I’d put on. It wasn’t even that much, definitely not 15 pounds. But I could not escape the conversations.” Soon, Sarah’s new friendships revolved around skipping meals together, trying odd new diet fads like sport, and shopping for smaller sizes.
According to USC’s Engemann Health Center, eating disorders have the highest mortality rates of any mental disorder, including depression. Serious health consequences like low blood pressure, abnormally slow heart rates and osteoporosis can develop from these disorders.
The National Eating Disorder Association’s latest report says that 10 to 20 percent of college women and 4 to 10 percent of college men have been diagnosed with an eating disorder. Statistics from Engemann show that during the 2017-2018 academic year, the center treated 164 patients for anorexia or bulimia. But these numbers are thin. They only include students who willingly went to Engemann and were deemed statistically “underweight” or students who self-reported having disordered eating.
The strong influence of Greek life, fitness fads, and Hollywood-induced aesthetics perpetuate a culture of disordered eating and unhealthy body image on our campus. Social media reinforces the pressure to look picture-perfect at every turn.
Sarah says that eating disorder culture quickly infiltrated her life and her friendships: “[Weight loss] dominated our friendship. I liked these girls and finally felt like I had made good friends, so it was hard to opt out of things or change the topic.”
As bikini season approached, these five girls leapt from diet to diet — they replaced meals with QuickTrim, the Kardashians’ diet pills. They cut out gluten for weeks at a time. They binged on laxatives before parties, formals and events.
“One of the girls even started smoking to curb her appetite,” Sarah says. “We were all encouraging each other.” The group had formed a tight bond, reinforcing each other’s unhealthy behavior. When she returned home for summer break, her parents noticed her hollow cheeks and bulging bones immediately. She had lost 19 pounds that semester.
“My dad sat me down the day after I came home. I’ll never forget that feeling. It was humiliating — sitting in my childhood bedroom having him question me on if I knew how to feed myself, and why I was doing this. … His face was so sad and concerned.”
This conversation prompted a harsh awakening for Sarah. Her parents sent her to an eating disorder specialist that summer. She gained back over 10 pounds. “I look back at my weight and my decisions and I am disgusted.”
Sarah was able to experiment with serious dieting and escape unscathed. But the scope of eating disorders in college students runs deep.
Dr. Patty Pinanong, a physician on Engemann’s eating disorder team, says students feel shame acknowledging that they are struggling with an eating disorder. College culture does not promote students coming forward to talk about their struggles with eating or body image.
“(Eating disorders) often include a loss of control. People don’t want to share that shame and embarrassment,” Pinanong says. In our aesthetic-driven society, it is difficult to admit to caring about appearance and body image.
“People don’t want to say they did something extra to look the way they do, to be fit.”
Engemann only offers short-term counseling to students with eating disorders, but the staff will continue with case management until the student is settled at their next level of care (outside therapy, outpatient, rehab). Pinanong says that the eating disorder team encourages weekly weigh-ins and check-ins after short-term therapy ends because the potential for relapse is so high.
Engemann offers a group therapy, Peace with Food, once a week.The staff does outreach with USC athletes to ensure that their mental and physical orientation around food is healthy, but they are seeking to expand outreach on eating disorders and address the scope of the problem in spheres like Greek Life and with new students.
Rachel’s eating disorder began long before she got to USC. She has lived with chronic anorexia since age 8. At 10 years old she was hospitalized for two weeks in a psychiatric ward. She has been through peaks and nadirs in her battle with eating — jumping from rehab to rehab across the country — but the aesthetic-dominated worlds of USC and Los Angeles pose challenges in her fight against anorexia.
“Imagine going to class. You’re trying to listen to your teacher, but you’re thinking what did I eat for breakfast? What should I eat for lunch? Should I eat lunch? Should I skip it? Should I go to the gym? How many steps have I walked today?”
This is the harsh mental reality of someone struggling with an eating disorder.
“It’s not just a lifestyle choice,” Pinanong says of eating disorders. “Scientists say there is a genetic link. They are wired in your brain.”
College poses unique pressures for those struggling with an eating disorder — academic stressors, newfound independence, increased peer pressure.
“The hardest thing is when you’re already thinking all of these things and someone says, ‘Oh my god this has so many carbs,’” Rachel says.
An article in the digital magazine Highline notes that Americans spend more on dieting each year than they do on video games or movies. Forty-five percent of adults say they’re preoccupied with their weight —an 11-point rise since 1990. Nearly half of 3- to 6-year-old girls say they worry about being fat.
Disordered eating is something deeply rooted in American culture and it thrives here at USC.
“I know more people at USC that have some type of disordered eating than people who don’t,” says Lucas, a senior.
Lucas grew up in the heart of Los Angeles and developed a severe eating disorder at age 15. Sipping black coffee in the Village, he says it is easy to be in denial about an eating disorder in LA.
“It’s hard to find the line between the culture where you live and abnormality,” he says. In LA, people drink kale smoothies for dinner and fast for days at a time. “People normalize eating disorders here. We bond about having been anorexic. It feels like everyone has been through it. It’s normalized. It’s almost glorified.”
Lucas relapsed when he transferred to USC his sophomore year. He quickly fell into a group of transfer students who became fast friends through counting calories, excessively working out and shedding pounds.
“We would all talk behind each other’s back about how unhealthy the others were, but to their face we would say, ‘Oh you look so good.’”
The group would starve themselves for days before big events. Lucas reached rock bottom at Coachella 2016. “When I look back at those photos I’m terrified of my body and what I was capable of.”
Lucas says that his eating disorder was fueled, in part, by the normalcy of these disorders among gay men.
“Aesthetics are prioritized even more in the gay community,” he says. “And eating is something you can control, no matter how hard other aspects of life are going. … I think Greek life also has a lot to do with the toxicity of USC — everyone needs to be this tall, thin, perfect blond person.”
A new disorder has now emerged: orthorexia. The Journal of Clean Eating defines orthorexia as an obsession with clean eating, proper nutrition, restrictive eating patterns and strict avoidance of foods considered “impure.”
“The trend has shifted from obsessing over not eating to obsessing over what you eat,” Rachel says.
Pinanong says that the communication and culture surrounding eating disorders at USC must change.
“We’re here for the health of our students. We want to change the culture and have people feel safe,” she says. In particular, students should feel comfortable speaking up when they see peers engaging in unhealthy conversations or behavior. “We want referrals from friends, from the community at large. It is important for people to step in and step up if they see this budding problem.”
The students who spoke to us for this story asked to be identified only by first name. Sarah asked that we not use her true first name.
Photos by Candy Win