‘An act of resistance’: How UBC students grapple with eating disorders amid little institutional support

Content warning: This article contains mentions of eating disorders.

For those lucky enough to have stayed with their parents through the early months of the pandemic, quarantine is remembered as a period of indulgence — of baking banana bread, concocting whipped coffees and staying home from the gym. For me, it was a time of sickness, but not from COVID-19.

My plans for senior year and first year were completely upended, sending me on a desperate search for control. I felt trapped, not just physically within the four walls of my house but within the confines of an illness that made me both think obsessively about food and deprive myself of it.

Having abundant time to make choices about food and to notice even the most minute changes to my body quickly unearthed disordered eating habits and body dysmorphia, both of which I always had under the surface, but had previously been drowned out by the fullness of pre-COVID-19 life. Behind closed doors and with no distractions to keep them at bay, they fermented and festered.

While a deadly virus raged in the outside world, a pandemic was happening in my own body.

I told no one and tried my best to hide it from my family, which only isolated me further from the only social support I could access. Even as I returned to campus this fall and socialized with more people in a week than I had in all of last year, the loneliness never subsided. I was still all alone with my disorder — or at least it felt that way.

Awareness of eating disorders has experienced a surge in recent years, largely due to efforts by activists, survivors and schools to bring this mental illness into public consciousness. But as the psychiatric disorder with the highest mortality rate, it is still often misunderstood, its dangers understated and its victims dismissed.

I am not alone

Jennie can’t remember a time when she wasn’t comparing her body to her peers. By the time she was ten years old, she already thought of food as ‘good or bad.’

Jennie is a UBC alumna and asked to remain anonymous as she hasn’t told everyone in her life about her eating disorder.

As Jennie moved up in the school system, her relationship with food and body image got progressively worse.

In high school, she begged her parents to send her to a weight loss clinic, where she lost weight rapidly, just as they had advertised. But no matter how much weight she lost, it didn’t make her feel better about her body. Jennie was eventually kicked out of the clinic for not losing enough weight, and that’s “where the cycle of eating disorder behavior stemmed from.”

Bernice Hong, a second year, has a similar story.

When Hong was in high school, she wanted to lose weight, so she adopted a healthier diet and was doing so sustainably. But after a classmate made a negative comment about food to her, dieting quickly devolved into disordered eating habits like calorie counting.

“I started understanding what calories were and I had the mindset of ‘the less the better,’” Hong said. “But I would pass it off as healthy eating. I was in denial.”

Hong’s friends and family grew concerned, and halfway through high school, she committed to recovering. However, much like most recovery journeys, it has not been a linear one, and the risk of relapse is always omnipresent.

Jennie, unlike Hong, didn’t talk about her eating disorder until she was in university. At UBC, Jennie found a community she was able to open up to and in which talking about mental health issues was accepted.

“On campus, you hear way more conversations about mental health, especially from students and student leaders,” Jennie said. “I felt like I had more language for it and I started reading about [eating disorders].”

Dr. Carl Birmingham, a professor and researcher in the faculty of medicine, noted that the transition to university can expose young people to a great risk of developing an eating disorder because of new sources of stress and unpredictable schedules.

“People don’t get to eat what they want, they get to eat what they can,” Birmingham said. “They don’t plan, they just react. And reactive eating isn’t good.”

The impacts of an eating disorder are not neatly contained within mealtimes; they bleed into nearly every aspect of life.

For me, thoughts about food and weight were all-consuming — they concocted a loud, cacophonous background track that played on repeat in my head without respite, making it hard to rationally process anything else.

For me, thoughts about food and weight were all-consuming — they concocted a loud, cacophonous background track that played on repeat in my head without respite, making it hard to rationally process anything else.

Exam season and the onslaught of academic stress it brought sometimes triggered Jennie’s symptoms even during periods when she thought she had them under control. Without the language, diagnosis or support system, requesting accommodations posed a daunting challenge.

For Jennie, the kindness and flexibility that professors offered made a world of difference. She said that the type of no-questions-asked extensions and exemptions that professors sometimes gave were “wonderful.”

Aside from trying to keep up with school, the pressure to socialize in university can also facilitate exposure to triggering influences. Recovering from an eating disorder often requires insulating yourself from negative attitudes towards body image and food, which becomes difficult when you interact with so many people.

For Jennie, this was especially true.

Jennie joined a sorority in her second year and found that some aspects of Greek life gave rise to body image issues.

“​​While I really valued a lot of the really wonderful women I got to meet through in a sorority, I really detested a lot of parts of it,” Jennie said.

Jennie said that there existed an invisible hierarchy whenever their sorority interacted with men from fraternity houses; it would become apparent when men were only interested in talking to women who looked a certain way.

Sororities would also prioritize certain girls to be in promotional photos, which only highlighted the underlying sizeism that persisted despite individual efforts made by sorority members to be inclusive and body positive.

Engaging in student leadership was also a double-edged sword for Jennie’s recovery. While it boosted her confidence and shifted her sense of self-worth away from her body, being a public figure on campus meant receiving unwarranted comments.

“People that you don’t even know, when you put yourself out there, feel entitled to ... comment on your body,” Jennie said.

While Jennie felt it would’ve helped a lot of people, she never spoke publicly about her eating disorder because she worried that people would look at her differently and only focus on her body, “[which was] a very troubling idea for someone who already thinks a whole lot, and too much, about their own body.”

When the pandemic started, Jennie found it much harder to manage her eating disorder due to a general state of being “down about the world” and isolation from her support networks.

“It hadn’t been that bad for many many years since before I came to university,” Jennie said.

However, it was also the intensity of this experience that prompted Jennie to finally go to counselling.

During the course of the pandemic, eating disorders in Canada spiked as treatment centres saw a significant increase of patient intake, particularly adolescents.

Birmingham attributed the uptick to the “tremendous stress and isolation” that people were experiencing.

“People we see that have eating disorders, many of them have gotten worse. There’s just so much stress on them, they can’t see their friends, they can’t go out,” Birmingham said. “Even people who have been well for 10 years or 20 years, we see [they] are now ill again.”

Disordered eating, disordered treatment

When I realized that I had an eating disorder, I went to UBC Counselling, who referred me to UBC Student Health Services, who referred me to UBC Psychiatry, who referred me to a practice that specialized in eating disorders. I’m still on the waitlist.

The whole process took more than six months, during which my condition continued to detrate. Having to lock myself in the closet so my family couldn’t hear my therapy calls certainly didn’t expedite the process.

I considered telling my friends, some of whom also exhibited disordered eating symptoms. But because eating disorders are inherently competitive, those who most understood what I was going through also felt like the worst people to tell.

A large part of why I wanted to dig deeper into eating disorders at UBC is because I wanted to know if this dysfunctional system was the only source of recourse for people like me, who had no one else to talk to.

I found that aside from Student Health Services and UBC Counselling, neither of which are equipped to professionally treat eating disorders, UBC Student Recovery Community has a new peer support program focused on eating disorder recovery.

Jennifer Doyle, a program analyst at UBC and lead of the peer support group, emphasized the importance of peer support, which could be more accessible than clinical treatments that sometimes require a diagnosis.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), a scale used to classify and diagnose patients, used to require that patients have a “body weight less than 85% of what is expected” to receive a diagnosis of anorexia nervosa.

The criteria for anorexia was revised to allow diagnosis of individuals who are at a “significantly low weight” in order to grant more physician discretion. Atypical anorexia, which is when an individual presents the same symptoms as those with anorexia nervosa but don’t fall into underweight categories, was also added to the DSM-5 in 2013.

However, physicians still often look at weight criteria as a means of diagnosis. This means that many people with larger bodies and higher weights are often barred from a diagnosis and thus treatment — even if they suffer the same symptoms.

“It’s difficult when your eating disorder doesn’t necessarily match the expectations you have of what it should look like,” Jennie said.

“If you have a bump on your arm, everyone knows [that]. But when you have an eating disorder, what do they see that they can understand?” Birmingham questioned. “This makes getting better much worse, if no one even thinks there’s something wrong with you and yet you feel so depressed and anxious, it’s hard to get help.”

However, even if someone does overcome these barriers and seeks help, Birmingham claimed that “there’s very little help around.” He said that the provincial eating disorder program faced cutbacks due to funds being prioritized for COVID-19 relief.

Even as the BC government recently announced new funding for eating disorder programs, Birmingham pointed out that the programs aren’t “set up in a way that people could use them” because they often require patients to take time off of school and work.

Birmingham said that UBC should bring back the eating disorder program he led under the department of psychiatry, which was cut more than ten years ago. He also suggested that researchers with lived experiences of an eating disorder should be recruited to conduct research with the department of psychiatry.

For those with eating disorders, Birmingham recommended going to Student Health Services and searching for local recovery programs and non-profit organizations. For those looking to support friends and family who have an eating disorder, he said it’s best to “try to just listen” without judgement.

Data about eating disorders among UBC students is not publicly available, but Noorjean Hassam, the chief student health officer, speculated that most eating disorders are not merely about nutritional illiteracy or body image.

“It’s a way bigger problem than what one campus can manage,” Hassam said. “I think we have to hit it at all different points in order to tackle it as a problem that I see as a societal problem.”

What made the biggest positive impact on Jennie’s recovery, according to her, was the work student leaders did to normalize conversations surrounding mental health and faculty who understood that “students’ lives don’t begin and end in the classroom.”

“I feel like when your peers are the ones who speak up about these issues, it really makes a big impact,” Jennie said.

Jennie said that she had to seek out resources for herself, which proved to be a good learning experience, but not an accessible one. Hong also said that UBC could do a better job of outreach.

Even with the institutional support that was available, Jennie felt that she didn’t take full advantage of it because she wasn’t ready to confront the fact that she had an eating disorder, partially due to stereotypical messaging about what someone with conditions like anorexia is supposed to look and act like.

Hong felt that it was hard to find the resources UBC has.

“What I do think they could do better is advocating for it or posting about it or just something to make it known that they do have resources,” Hong said.

Hassam said that one of the things on her agenda was ensuring that students have knowledge of available resources, but she thinks that it’s “more than just the knowledge.”

“You need to get that information at the time that you need it, and then you need the kind of comfort and safety to access those services,” Hassam said. “So there’s just many layers we need to work on.”

A rocky path towards recovery

Having a toxic relationship with food feels inescapable because it’s not a relationship you can ever leave. At least three times every day, I am forced to confront my disorder head-on and tune out the voice in my head that tells me to fear food.

However, hearing the stories of Hong and Jennie, I realize how much each of our journeys overlap and that makes me feel less alone. Knowing that we, and many more students, are all survivors of this ruthless illness fills me with hope.

Eating disorders thrive in secrecy and breed behind closed doors. Talking about this for the first time on a public platform feels like putting all my personal relationships and reputation in jeopardy. But it’s an act of active resistance against an illness that has held my body and mind hostage for the past two years.

Standing up to an eating disorder can look like telling a friend, going to counselling and giving yourself unconditional permission to fuel your body so it can function the way it’s designed to.

Most of all, it requires knowing that your body is not the enemy, the disorder is.