Rethinking the Freshman 15

Haley Hogan, a recent Yale graduate who has suffered from anorexia, got used to seeing nutrition facts displayed at New York chain restaurants when she took a semester off last fall. But when she returned to Yale in the spring, she was shocked to find cards detailing calorie information all over her residential dining hall. "They're very triggering if you're in recovery from an eating disorder," Hogan says of calorie counts. "I felt almost violated that Yale had done this."

With more than 30 percent of college students falling into the American College Health Association's obese or overweight categories, Yale is not the only school trying to help students make smart food choices. But experts say the emphasis on calorie counts can backfire and lead to disordered eating, even among students with no history of food issues.

Dr. Richard Kreipe, a specialist in adolescent medicine whose research centers on eating disorders, says that while he has seen fewer cases of classic eating disorders like restrictive anorexia nervosa and bulimia nervosa in the past several years, the number of patients with eating disorders not otherwise specified (EDNOS) has "almost doubled" nationally in the midst of America's obesity epidemic. (An EDNOS, also called disordered eating, is an eating disorder that doesn't meet the strict diagnostic criteria for a full-blown eating disorder, but may include drastic weight loss, caloric restriction, binging, and purging.) Since 2000, the number of college students dieting, vomiting, or taking laxatives to lose weight has jumped from about 28 to 38 percent, according to the American College Health Association's annual surveys. Well-balanced caloric intake, with regular meals and physical activity—not dieting—is the best way to avoid obesity, says Kreipe, a professor at the University of Rochester Medical Center. That's why, in his view, calorie information doesn't benefit students. "Nutrition is not a simple thing that can be distilled down into a label," he says. "There's a tendency for people to overinterpret what a specific number means."

Last fall, Harvard removed cards with calorie information from dining halls. Writing about the decision on his blog, Ted Mayer, executive director of Harvard's dining services, noted that his staff needed to address "the challenge a quiet and surprisingly large contingent of our community faces with eating disorders." The dining staff now makes the information available on the Internet and at kiosks in the dining halls.

Going away to college makes all students vulnerable to weight gain and disordered eating, often at the same time. Students tend to experience a loss of structure when they go from high school to college. Studies have found that college students are less likely to eat breakfast or regular meals, and snack foods account for many often-unrecognized calories. All-you-can-eat dining halls and easy access to alcohol also make college students more susceptible to weight gain. At the same time, anxiety about gaining the "freshman 15" can trigger disordered eating—often well beyond the freshman year. Kreipe says that in a new setting surrounded by new people, college students are more likely to develop body-image issues, which can also lead to disordered eating.

Even overweight students, the prime targets of obesity-awareness programs, may get the wrong message. In a recent study, Dianne Neumark-Sztainer, a professor at the University of Minnesota School of Public Health, found that about 40 percent of overweight college-age women and roughly 20 percent of overweight college-age men engaged in disordered eating behaviors in an attempt to get thin. "People are concerned about the fat kids being fat and the thin kids having anorexia," she says. "But people aren't concerned about the disordered eating among the overweight kids." For under- and overweight people alike, eating disorders can lead to a host of health issues, including electrolyte imbalances, fertility problems, impaired brain development, bone loss, and, in severe cases, death. The study also showed that disordered eating behavior leads to further weight gain over time.