Conversations to Assess College Readiness If Your Child has Suffered from an Eating Disorder

90% of eating disorders begin before the age of 20 years old. Social transitions, such as moving from middle school to high school or high school to college, often serve as catalysts for eating disorder behaviors. The transition to university can be particularly challenging as this represents a significant change to adolescents’ support structures, food availability, eating and exercise patterns and social pressures. In situations where an eating disorder has been active, this transition to university often acts as a trigger for relapse or significant recovery setbacks. An individual’s readiness for the university lifestyle needs to be carefully evaluated. In some cases, a contract with agreed upon expectations is necessary to provide boundaries for the first year. Local, university-sponsored support groups, regular appointments with the treatment team and transparency between parent and student are also helpful to protect from relapse. 

Before even considering university, it is important to establish that your loved one is well into the recovery process. The following characteristics need to be present in your child’s life and maintained for at least 6 months prior to the transition to college: 

• Able to eat regularly, adequately, spontaneously and with plenty of variety WITHOUT being prompted or supervised
• Maintain weight that is well above the minimum weight for their height 
• Not engaging in any sort of compensatory or diet behaviors such as over-exercising, purging, restricting, calorie counting, etc.
• Engaged in their own therapeutic treatment and activities to support their mental health
• Able to manage school, self-care and social demands while maintaining recovery 

After establishing the above baseline, take some time to address the topics listed below. Include your adolescent and all pertinent members of his or her treatment team. Going through these questions can help identify potential problem areas that need to be addressed before making the college transition. These questions can also serve as topics to re-address after the first quarter to see if any new thoughts or behaviors have developed for your student. 

Food Questions to Discuss  with Your Teen and Treatment Team before Deciding on University:

1. What sort of dining options are available on campus? Is there adequate variety? Is it pleasurable and inviting? Does the dining facility offer extended hours? Is it conveniently located? 
2.  Is there an option for cooking in the dorms? Is it a shared space? How might the dorm room cooking options become a roadblock between my student and eating? How might it be a support to my student’s food needs?
3. Will my child be prone to over rely on food delivery services (ie, DoorDash or Ubereats)? Are there fast food options on campus? Will access to these food options be good for my student’s recovery, or a hindrance? 
4. Who will be living with my student? Whose food behaviors will they most likely be influenced by? Will they be encouraged to approach all foods with neutrality? Or will they be bombarded with language about “good foods” and “bad foods?”

Exercise Questions to Discuss with Your Teen and Treatment Team before Deciding on University:

1. Is there 24 hour access to the gym on campus? Will my student be encouraged to exercise when sleep, rest or play might be a better option for them? 
2. What sorts of athletics is my adolescent planning to engage in? Do I know the coach and am I comfortable with how the coach discusses food, extra training, rest, and other categories of self-care? Is athletic training, academics and life-balance important to the coach? 
3. What opportunities are available for extracurricular or intramural sports? Is play and connection with others encouraged? Are there ways to build relationships and find commonalities outside of athletics?
4. Are there comfortable and safe walking options on the campus? Are there curated outdoor spaces to promote time in nature? 
5. How far apart are my student’s classes, dorm and dining facility? Is there a campus transportation system? Is my student able to manage the extended walking of a college campus and adequately feed themselves? 

Social Eating and Drinking Questions to Discuss with Your Teen and Treatment Team before Deciding on University:

1. WIll my student be involved in a fraternity or sorority? How will the eating and drinking environment promote or hinder their recovery?
2. How will they approach party environments with a variety of foods? How will they respond when alcohol is being offered?
3. In situations of overeating (such as after a party or event) are they able to listen to their hunger and fullness cues and appropriately feed themselves? Are they able to engage in overeating without compensating the next morning?
4. Is my student able to navigate their relationships in a way that is healthy and balanced? Are they able to express their preferences, desires, appetite and feelings without fear?

Diet Culture Questions to Discuss with Your Teen and Treatment Team before Deciding on University:

1. How does my student’s body compare to others their age? Will my student be pressured to diet or try to change his or her body? How will they respond to this pressure?
2. Are different body types celebrated at this campus? Are there student organizations and safe spaces that include all genders and body shapes and sizes?
3. How is thinness promoted at this campus? Is there extensive marketing around weight loss, dieting and exercising?

It is crucial to have open dialogue about these topics before transitioning to university. Make sure that you honestly evaluate your adolescents’ readiness for the freedom, spontaneity, chaos, pressure and excitement of the university setting. Approach the conversations with an openness to the possibility that university life might be postponed for a year. Being able to feed oneself regularly, adequately, flexibly and with plenty of variety is necessary if one is to thrive in the college environment. If your loved one is not quite ready to do this without your assistance, do not hesitate to wait. University postponed for a semester or a year is something one can recover from. Eating disorders, on the other hand, are much harder to shake. If you are concerned about your student or loved one, please reach out to your medical providers for the help and support you need.