Body Image Concerns

Last updated: 12/22/2022

Many young people have concerns about diet, weight, and attractiveness. These concerns can lead to unhealthy preoccupations with body weight and eating; affecting self-esteem, well-being, and vitality. When preoccupations become serious, they can lead to significant health problems.

Eating problems fall within a broad spectrum of eating-related feelings, attitudes, and behaviors and can be painful and frightening. The first step to overcoming an eating problem is acknowledging that you have a problem. Often this can be the most difficult step. An important aspect of this is realizing that eating behaviors and distressed feelings are impacting your food choices and other aspects of your life.

Common eating disorders

Anorexia nervosa—often simply called anorexia—is a potentially life-threatening eating disorder characterized by an abnormally low body weight, intense fear of gaining weight, and a distorted perception of weight or shape. People with anorexia use extreme efforts to control their weight and shape, which often significantly interferes with their health and life activities.

People with anorexia excessively limit calories or use other methods to lose weight, such as excessive exercise, using laxatives or diet aids, or vomiting after eating. Efforts to reduce weight, even when underweight, can cause severe health problems, sometimes to the point of deadly self-starvation.

Anorexia affects three to four percent of college students, with the prevalence highest among young women. 

Bulimia nervosa—commonly called bulimia—is a serious, potentially life-threatening eating disorder. People with bulimia have episodes of bingeing and purging that involve feeling a lack of control over eating. Many people with bulimia also restrict their eating during the day, which often leads to more binge eating and purging.

During these episodes, they typically eat a large amount of food in a short time, and then try to rid the extra calories in an unhealthy way. Because of guilt, shame, and an intense fear of weight gain from overeating, they may force vomiting (purging bulimia), exercise too much, or use other methods, such as laxatives, to get rid of calories (non-purging bulimia). People with bulimia are preoccupied with their weight and body shape, and may judge themselves severely and harshly for perceived flaws.

Bulimia affects three to four percent of college students, with the prevalence highest among young women. 

People with binge-eating disorder regularly eat too much food (binge) and feel a lack of control over eating. They may eat quickly or eat more food than intended, even when not hungry, and may continue eating even long after being uncomfortably full.

After a binge, they may feel guilty, disgusted, or ashamed of the amount of food eaten. But unlike someone with bulimia or anorexia, those with binge-eating disorder don't try to compensate for this behavior with excessive exercise or purging. Instead, embarrassment can lead to eating alone to hiding bingeing. A new round of bingeing usually occurs at least once a week.

Getting Help

After recognizing a problem, the next step is to talk with professionals experienced in helping students who struggle with eating problems. Schedule an appointment with Counseling and Psychological Services to talk with one of our providers.


What treatment may look like

The Eating Disorders (ED) team at Columbia Health comprises medical providers and mental health practitioners, such as physicians, nurse practitioners, nurses, nutritionists, social workers, and psychologists. Members of the ED team work closely together to provide appropriate assessment of and treatment for students with a range of eating, weight, and body image concerns. The team then reviews initial assessments and make recommendations for treatment and level of care will be provided to the student.

Treatment can comprise many elements, including nutritional counseling, education, individual or group counseling, and medical monitoring. Proven approaches can effectively prevent, reduce, or stop troublesome behaviors while helping to develop new, positive ways of coping with underlying feelings.

Students receiving care at Columbia Health may be provided with short-term individual psychotherapy, group counseling, nutrition counseling, and medical monitoring. The team will continue to assess a student's progress over time and make recommendations based on the student's engagement in treatment and level of functioning.



For consultation or additional information, contact Annette Santiago-España, psychologist and clinical team leader of the Eating Disorders team at 212-854-2878.