Nutrition & Physical Activity
Dear For future reference,
Living with someone who has an eating disorder can be incredibly stressful. It is certain that others, similar to yourself, notice unusual eating patterns among friends, loved ones, roommates, partners, etc. that they later learned were signs of an eating disorder. Eating disorders affect people of all ages, ethnic backgrounds, and sexual orientations.
Your helping strategies depend on whether or not this is an emergency situation. If this were an emergency situation, for instance, the person is blacking out, losing significant amounts of weight, sleeping all day, and/or expressing suicidal thoughts or attempts, then do not try to deal with the situation politely or gently. Tell your resident advisor (RA), residence hall director (GA), or someone else who can help to get the assistance and support you need to intervene. If you are at Columbia on the Morningside campus, you can call Counseling and Psychological Services (CPS) at 212-854-2878 or Medical Services at 212-854-2284 for an appointment. CUMC students can contact the Mental Health Service or Medical Services at 212-305-3400. Morningside students can also use Open Communicator to make a primary care appointment. If this were an extreme emergency, you would need to call your campus's volunteer ambulance service, if there is one at your school, which should come with security. If you are at Columbia, you can call CU-EMS, Columbia University's Emergency Medical Service, at 212-854-5555.
If this were not an emergency situation, a good roommate or friend may be the best person to express concern and get her to help. You can choose to speak with your roommate directly, or you can do things that are less direct — such as place pamphlets about eating disorders around the common living areas; you can attend a seminar or workshop on eating disorders, body image, or healthy eating and invite your roommate to come with you; or, set up an appointment with a mental health provider to discuss ways to help your roommate.
If you choose to speak with your roommate directly, pick a time to talk when you are feeling calm and both of you have plenty of time. Choose a time and place where you will not be interrupted. Start off by keeping your observations away from food or her body, and on her non-appearance oriented traits — such as what a good roommate or person she is and/or how much you care about her. Focus on expressing your concern by conveying your observations about her health or behaviors. Tell her that you are worried. Make sure she knows you value her and highlight for her the qualities in her you appreciate.
If your roommate seems receptive to your thoughts, you can mention the following things in your conversation:
- What you see that makes you think there is a problem: Be specific about what you see regarding her eating, purging, exercising, or starving behaviors. Your observations, rather than evidence of wrongdoing, can be discussed gently if you focus on your concern. Stick to the issue — if she changes the subject, ask her when would be a better time to talk.
- How you feel: Use "I" statements to express your feelings about what's happening to your roommate: "I'm upset because I've noticed that you don't eat meals with us anymore," or "I'm concerned because you complain about how fat you are all the time. I think there's something wrong."
What you would like to see happen: Make sure that your goals for the conversation are attainable. Your goal is NOT to stop her from bingeing, purging, or starving. You would most likely end up in an ineffective control battle. A realistic goal is simply to open the door to talk, either now or in the future, and to encourage her to take steps to get the help she needs and deserves.
This may be a difficult conversation, and you can try to keep it from becoming an argument. For example, if you become upset, ask if you can continue the conversation at another time. Also realize that your roommate may need to hear your worry several times before she's willing to have a conversation with you about it.
Remember, regardless of her reaction, you can know that you've tried to help her. She's lucky to have you as a roomie.
Dear Weight conscious,
Feeling like life is passing you by or “putting off” your life can be a discouraging feeling for anyone. Here’s something to consider: If you lose all the weight you want to lose, what would your life look like? What would you be doing that you aren’t currently doing? Can you begin to do some of these things now? Following your heart and doing things you truly love today may help you feel better about tomorrow. And, that just might provide you with more motivation to accomplish your weight loss goals.
Now, let’s talk more about your specific question. Unfortunately, free weight loss camps are hard to come by, and may not even exist. However, if you're willing to think outside the box a little, you may be able to find a short-term physically active job that can help get you moving. For example, you could look into a program such as WWOOF, which places people who want to volunteer on organic farms with small organic farmers around the world. In addition to requiring volunteers to contribute physical labor, many of these opportunities provide one or more meals per day of healthy, farm-fresh foods for their working volunteers. And besides being a great work out, these programs offer a great opportunity for adventure!
Now back to the more traditional residential weight loss programs. Some are helpful, whereas others are simply moneymaking ventures. A sound weight loss program addresses three key issues: controlling calorie intake, changing problematic food habits, and increasing physical activity. Specifically, look for the following characteristics in a weight loss program:
- The program's diet plan should meet nutritional needs, even though you are eating fewer calories. This means following guidelines like those at MyPlate.gov, which emphasize healthy and balanced eating.
- The program should stress gradual, rather than rapid, weight loss. Look for a loss of 1 to 2 pounds per week.
- The program's plan should be adaptable to habits and tastes. No rigid rituals should be required.
- The program's plan should minimize hunger and fatigue while ideally supplying at least 1500 kilocalories a day for men and 1200 for women. Any lower calorie regimens should provide either fortified foods or a vitamin and mineral supplement.
- The program doesn't have to be expensive to be helpful to you.
- The program should help reshape lifestyle and problem eating habits to make weight loss and, later, maintenance possible.
- The program should improve overall health. It should emphasize regular physical activity, proper rest, stress reduction, and other healthy lifestyle changes.
You can also make changes on your own to incorporate physical activity and healthier eating into your everyday life. Some tips are:
- Plan out your meals in advance. Be sure to include a variety of foods (like whole grains, vegetables, fruits, and lean protein) in each meal. Planning in advance will help you to avoid any impulsive, less healthy choices.
- Start a food journal. Do you frequently crave a fatty or sugary snack around the same time each day? Do you tend to skip meals, and then overeat later on? Keeping track of what you eat and how much may help you identify where you could make healthier choices.
- Slowly initiate physical activity. Try starting with a 10-15 minute walk a few times a week and gradually work your way up to 30 minutes of moderate aerobic exercise on most days.
- Work in physical activity throughout the day. Using a slightly farther away parking space, bus stop, or subway station; taking the stairs when possible; and stretching or walking around the office as a short break from work are all possibilities.
- Enlist the help of friends and family. Have a regular weeknight tennis match with a friend. Practice cooking healthy with your family.
For more tips on exercise and healthier eating, check out the Nutrition and Physical Activity section in the Go Ask Alice! archives. You may want to speak with a nutritionist (if you're at Columbia, login to Open Communicator or call x4-2284 to make an appointment); or, contact a registered dietitian in your area for a weight loss camp or program recommendation that will work for you. These providers can help you find affordable, convenient suggestions for successful weight loss.
May 17, 2012511312
November 9, 200420793
Another option that you might check into would be hiking/backpacking/bicycling trips in national parks, or other such trips sponsored by outdoorsy groups (Sierra Club, National...
Another option that you might check into would be hiking/backpacking/bicycling trips in national parks, or other such trips sponsored by outdoorsy groups (Sierra Club, National Wildlife Federation, American Wheelmen, etc., if I remember correctly). Try an on-line search for some of these websites. I'm sure some of their trips last for a couple weeks, and maybe you could do them back-to-back, or figure out something creative. I don`t know if they are cheap or not, but it's worth checking out, or contact them stating your needs and they might have further suggestions.
May 18, 200120362
Yes, both boys and men can and do suffer from eating disorders. In fact, disordered eating and eating disorders can affect anyone, regardless of gender, race, ethnicity, sexual orientation, or socioeconomic status. You raise a great question, though; all too often eating disorders in boys and men are much less talked about than in girls and women. Doctors are also less likely to diagnose males with an eating disorder compared to females and there are also fewer resources for boys and men who wish to get help with their condition.
In recent years, there has been increased attention (and research) given to this topic. Some older studies reported that around 10 percent of patients with eating disorders were men. More recent studies, however, indicate that as many as 30 percent of patients with anorexia or bulima were male, and that men accounted for 40 percent of binge eating cases.
While men and women can both experience eating disorders, men are often trying to change their physical appearance for different reasons than women, including:
- A desire to improve athletic performance.
- A history of being teased, criticized, or picked on for being overweight.
- Wanting to change a specific body part (to reduce "flab" and promote muscle definition).
- To make required weight for a specific sport (i.e., wrestling or crew).
- To be more attractive to a potential partner.
- To look less like one's father.
In addition, it’s important to note that while women with eating disorders are often preoccupied with weight, men tend to focus more on achieving a particular body type, such as being muscular or lean. One example of this is a disorder known as megarexia, a term used to describe an individual who is obsessed with increasing his or her muscle size. Men are more likely than women to have megarexia, which also goes by the names muscle dysmorphia or bigorexia. These individuals exhibit many of the same symptoms of other more well-known eating disorders, such as a very restricted diet, preoccupation with food and body weight, and a history of low-self esteem. For more information on this disorder, check out Obsessed with building muscle in the Go Ask Alice! archives.
For further reading on how men are affected by eating disorders, try Arnold E. Anderson's book, Making Weight: Healing men’s conflicts with food, weight, shape, and appearance. If you are a Columbia student (of any gender) and feel you are suffering from disordered eating, make an appointment with the Columbia Health Eating Disorders Team.
February 27, 2012507779
Dear Needing Help,
Thank you for writing. Reaching out can be intimidating, even online. You've taken the first step towards regaining your health by admitting that you have a problem and asking for help. First of all, it is important to get support from others throughout this process. The reality is that anorexia nervosa (whose symptoms you describe perfectly) is a very complex disorder, and it will take time, energy, and the help of multiple health care professionals to untangle the components that got you into this state. Whereas last year you may have been teetering on the brink, it is now safe to say that this year you've crossed the line.
At this point, it is imperative that you see a health care provider. Some of the long term physiological effects of anorexia are irreversible, so the faster you get help, the better. Your health care provider may recommend that you start a comprehensive treatment program for eating disorders. If you are a Columbia Student, you can make an appointment at Medical Services by calling x4-2284 or by logging into Open Communicator. Let them know that this is urgent. You may choose to make an appointment with a member of the Eating Disorders Team, a multidisciplinary group of clinicians specializing in disordered eating issues among students.
If talking out loud about your problems seems daunting, you can start by simply making a list of your symptoms (as you've done here) and telling them to a counselor or doctor. Your health care provider will be able help you move forward from there. Together you will be able to work out a plan of action — whether this leads you to an in-patient treatment program, an out-patient program, or group and/or individual counseling. You can make the decision based on both your personal needs and your insurance plan. If you are not a Columbia student, you can find resources and information from the National Eating Disorders Association website and their helpline at 1.800.931.2237.
Please talk to someone soon. You're worth it!
July 27, 200721292
Dear Anyone who goes to the gym knows me,
Anorexia can be a scary word, and it takes a lot of courage to consider the fact that you may have an eating disorder. Based on your description, it sounds like your friends and family are concerned about you. Perhaps they have picked on the fact that you may be struggling with healthy versus unhealthy eating and exercise habits. Talking with a health care provider, nutritionist, or even a therapist may help you identify ways to stay strong, both physically and emotionally.
Balance is the key to healthy eating and exercise. A nutritious diet includes a variety of foods from all the major food groups, including a small amount of fat each day. Since your daily meals consist mostly of carbs, fruits, and veggies you may be missing out on important nutrients found in other food groups. Also, losing weight and skipping meals are important signs that you may not be getting enough calories for your activity level.
Sometimes, unhealthy eating and/or exercise habits can develop into a more serious problem. Anorexia is a form of disordered eating characterized by an obsession with food, weight, and body shape. According to the Mayo Clinic, some physical signs of anorexia include:
- Extreme weight loss
- Thin appearance
- Abnormal blood counts
- Fatigue, dizziness or fainting
- Dry skin, hair, or nails
- Soft, downy hair covering the body
- Absence of menstruation
- Intolerance of cold
- Irregular heart rhythms
- Low blood pressure
Despite the outward emphasis on food, the root causes of anorexia often have more to do with self-esteem and/or control over emotional issues completely unrelated to diet or exercise. For this reason, it may be helpful to talk with a therapist if you are worried about your recent weight loss and eating habits. At Columbia, there are several resources for students with concerns about healthy versus disordered eating. Medical Services has put together an Eating Disorders Team. This group is comprised of physical and mental health professionals who focus on nutrition and eating concerns. To make an appointment with a health care provider on the team, call x4-2284 or log on to Open Communicator. You can also call Counseling and Psychological Services (CPS) at x4-2878 to talk with a therapist who specializes in eating disorders. After your initial visit at CPS, you may want to consider the Eating Concerns Group. If you are off-campus, this related question, Eating disorder support resources on the Web, offers a variety of online supports.
You've already taken a brave first step just by considering the fact that your eating and exercise habits might not be healthy. By talking with a health professional about your concerns, you can gather the support you need to keep running strong.
The world of eating disorders is complex; many individuals may have unhealthy behaviors or tendencies related to eating that do not fit neatly into diagnostic categories. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), published by the American Psychiatric Association and universally used in diagnosing eating disorders, bulimia includes both binging and purging, which is mostly likely what your professor was referencing. By contrast, sufferers of anorexia nervosa attempt to lose weight by inducing starvation, often coupled with rigorous exercise, and may also attempt to accelerate weight loss by vomiting, taking laxatives, and/or using diuretics.
It seems that your behavior may be a conglomerate of a few different eating disorder tendencies. Even though not everyone fits neatly into a specific diagnosis, this does not mean that health consequences associated with bulimia or anorexia will be absent. Repeated, self-induced vomiting packs a serious punch in terms of health risks.
In terms of your birth control pills, typically five to six hours is long enough for the pill to absorb into a woman's system. But keep in mind that frequent purging is highly stressful for your body, and is likely to disrupt normal bodily response to birth control pills or other medications, possibly including digestion and metabolism of birth control pills. Your contraceptive method will be most effective if you are successfully managing other medical conditions, such as eating disorder tendencies, with your health care provider's knowledge and support.
Some risks that may occur regularly and/or immediately following episodic vomiting include:
- Fatigue, which may become chronic or persistent.
- Sore throat.
- Tooth decay and/or tooth pain.
- Puffiness in cheeks and strained or broken blood vessels underneath eyes.
More serious health consequences of frequent purging include:
- Constant electrolyte imbalance as a result of frequent vomiting can overly stress the heart, leading to irregular heartbeats and possible heart failure.
- Inflammation and possible rupture of the esophagus.
- Chronic constipation and/or irregular bowel movements.
- Developing ulcers or pancreatic disease.
While there is a clear physiological component to purging, there is undeniably also a psychological component that is driving your actions. It may be useful for you to explore this issue more. If you are a Columbia student on the Morningside campus, you can make an appointment with a professional on the eating disorders team in either Counseling and Psychological Services or Medical Services. For counseling, you can make an appointment by calling 212-854-2878; for a medical appointment, you can call 212-854-2284 or log on to Open Communicator. For students on the CUMC campus, you can make an appointment with the Mental Health Service or Medical Services by calling 212-305-3400. Outside Columbia, some starting points are the National Institute of Mental Health's page on Eating Disorders, the National Association of Anorexia Nervosa and Associated Disorders (ANAD), and the National Eating Disorders Association, all with loads of information on how to approach this issue on a personal and medical level.
Eating disorders are complex and confusing; asking questions about the impact that purging can have on your health can be a great first step on the path toward managing and recovering from any type of disordered eating. Good luck along the way,
Regardless of the time of day you eat it, ice cream wouldn't make it on any top ten healthy foods list. However, if your body is able to deal with the high doses of sugar and fat first thing in the morning, which many adults cannot, there might not be reason to toss out the ice cream scoop just yet.
The most important thing is to eat something within the first few hours after waking up in order to get your metabolism going and refuel your body after not eating for several hours. The fat in ice cream may help you stay full longer, and it contains a lot of calcium, which your body needs for healthy bones and other important functions.
Sound too good to be true? It might be… if you did it every day. Like many other things in life, too much of a good thing may not always be the best for you. Ice cream is high in calories and saturated fats, which is why it's a supplement to, rather than a basic staple, of a healthy diet.
If you're choosing ice cream first thing in the morning because you love that it's sweet, creamy, and cold, you may want to try some low-fat yogurt instead. It's like ice cream but not as high in fat, calories, or sugar. All the while, it still provides you with ample amounts of calcium. If you don't mind warming up, you could also try oatmeal sweetened with a touch of brown sugar, cinnamon, or honey and stir in some chopped up fruit for more flavor. Making the oatmeal with milk instead of water can help you feel full longer and provide essential vitamins and minerals, including calcium. If it's just your sweet tooth you're looking to satisfy, you could try switching to granola with fruit and yogurt, toast with jam or fruit spreads, or lightly sweetened cereal with milk.
Combining these foods with the occasional bowl of ice cream in the morning will help to ensure that you're eating a healthy and balanced diet overall. Of course, it's also important to eat well throughout the day, which means including plenty of fruits and vegetables, lean meats, and low-fat dairy products in other meals. For more tips on healthy eating, check out the related Q&As below.
Dear Hopelessly hungry,
It's true that some students put on weight when they first come to college, however this is not a universal event, nor a foregone conclusion. For many first year students, it's their first time away from home, making choices about what to eat, how much, and how often. On top of this, many college students eat in cafeterias, where meal options are abundant and portion control can be a daunting task. Students may also be facing new challenges and situations that lead them to eat for reasons other than hunger — such as coping with stress, loneliness, or even hanging out and having fun late at night with friends.
You can, however, make good food choices. Here are some general tips for finding healthier options:
- Choose baked or grilled foods over fried foods
- Choose water, milk, or fortified soy milk over sodas
- Buy groceries if possible: you can better plan your meals, or at least have healthy snacks on hand when you get hungry during late-night chats or study sessions
- Try to control portion size: ask for a smaller amount, or remember you can come back for seconds if your dining hall is self-serve
- Have fruit for dessert (and grab an extra piece to snack on later)
- Vary your entrée selections: try to have chicken, fish, other meat, vegetarian, and pasta once or twice a week each
- Avoid cream-based soups and sauces
- Moderation is key: pizza, burgers, or ice cream once in a while are fine; just don't make them your key food groups
All in all, you want to aim for a varied diet with enough whole grains, lean protein, and fruits and vegetables and minimal fatty and sugary foods. For more tips about working in healthier foods, check out the Optimal Nutrition section of the Go Ask Alice! archive, learn more about the tools from Columbia's Get Balanced initiative, or visit Choosemyplate.gov. You can also call your school's health service and make an appointment with, or get a referral for, a nutritionist to create an appropriate food plan for your individual needs. At Columbia, use Open Communicator or call x4-2284 to make an appointment.
There are often different culprits outside of the dining hall. During the first year at college, some students consume much more alcohol than in the past. Although there is no fat in alcohol, calories from alcohol are unusual in that they can't be stored or converted to energy for later use. Meaning that calories from alcohol are used first by the body, while calories from food that would otherwise be burned are stored, potentially contributing to weight gain.
Additionally, many first-year students might not think about exercising or may have trouble finding the time. Eating balanced meals and participating in regular physical activity are both major factors in losing or maintaining weight. If your concern is avoiding weight gain, keep physical activity in mind as a key ingredient. It may help to work out with a friend or schedule your exercise — Columbia students, faculty, and alumni can connect with CU Move to access tools and support for choosing strategies that support being physically active.
Gaining a few pounds may feel like the worst thing that can happen to you; however, it's important to learn how to take care of yourself, stay healthy, listen to your body, and eat because you're hungry — not because you don't want to study, you just got in a fight with your roommate, or you think you might have flunked a test. Check out the related questions and tips below to think about what you can do to maintain a healthy eating routine, and have a great first year.
Eat varied and well-balanced meals at your school's eateries. Besides what you choose to eat, watch how much you eat as well, because calories count and can add up quickly.
- Low- or nonfat yogurt with fresh fruit or cold cereal
- Cold cereal (especially whole grain varieties) with skim milk
- Hot cereal (such as oatmeal)
- Waffles with fruit
- Whole grain toast
- A sandwich — choose lean meats (such as fresh roasted turkey, roast beef, or ham), grilled or fresh veggies, and low- or nonfat cheeses; top with whole wheat, rye, or whole grain breads; spread on some mustard rather than mayo or other dressing (unless low- or nonfat is available)
- A salad — include beans, peas, grains, and sweet potatoes (if offered), as well as a variety of fresh veggies (including different types of lettuce, if available) and fruits; choose low-fat dressings and get them on the side
- Soup — choose broth-based rather than cream-based
- Pasta — stick with tomato-based rather than cream-based sauces, and try to get them on the side
- A meat entree — choose baked, broiled, steamed, stewed, or roasted skinless and de-fatted meats
- Vary your entree selection — meat once a week, fish once or twice a week, pasta once or twice a week, chicken once or twice a week, and vegetarian once a week
- Steamed veggies
- Salad or soup (see above for hints)
November 16, 200120388
This is in response to First-Year Fifteen Can it be avoided?. I just want the reader (and others at Columbia) to know that when I was at CU, I...
This is in response to First-Year Fifteen Can it be avoided?. I just want the reader (and others at Columbia) to know that when I was at CU, I visited the nutritionist and found the experience to be incredibly helpful. I'm not sure if the same nutritionist is still there (this was several years ago), but she was kind, non-judgmental, and full of good advice.
Dear New to the City,
Welcome to New York City, one of the greatest cities for walking, running, and many other indoor and outdoor physical activities. Yes, the Alice! Health Promotion, part of Columbia Health, manages CU Move, a physical activity initiative open to all Columbia students, faculty, alumni, and staff. CU Move encourages members of the Columbia community to engage in active lives that include regular physical activity. The program provides participants with motivation and incentives to be active throughout the year. Actually, CU Move encourages all types of exercise, not just running. You can participate whether you like to work out alone or in a group. One of the goals of the program is to encourage members to exercise at least 100 minutes per week.
To join register for the e-mail list online at CU Move. You'll also program features, inspirational reasons to participate, and links to other physical activity resources.
CU Move has some outstanding features, including:
- Motivational messages — receive inspirational emails that will help you stick to your regular exercise program through messages tailored to your specific level of activity
- Incentives and prizes — stay active and receive rewards, including limited-edition fitness gear, music gift cards, and other fun and inspirational incentives.
- Campus events — interact with campus fitness experts, learn how to improve your fitness level, and get free giveaways
- Community events calendar — link to a variety of physical activities across the city
Participating in CU Move is a great way for both runners and other exercise enthusiasts to set goals and track fitness progress over time. The program will also provide opportunities for you to connect with other fitness-related programs on campus, such as Dodge Fitness Center and other special campus and community events.
So, whether you are an avid exerciser or just beginning to think about starting a regular exercise program, we'd love to CU Move!
Dear Where's my hair?
You can expect to normally lose between 100-200 strands of hair each day. If your hair is coming out by the handfuls however, you do have cause to worry and should see a physician for a complete medical workup. A large loss of hair can indicate more serious bodily malfunctions. Stress can also be implicated as a cause of hair loss, and if things have been extra stressful for you lately, you might want to see a counselor to help you reduce your stress levels.
If your hair loss is more moderate, you are right that your nutrition and diet have a lot to do with it. Zinc is an important mineral for your hair, and a deficiency would probably show up as excessive hair loss, lack of sheen, and difficulty with control. The Recommended Dietary Allowance (RDA) for zinc in adult men is 11 mg, and for adult women the RDA is 8 mg. A zinc supplement might help you here, but consult your health provider before starting one. Zinc is found naturally in beans, seeds and nuts, legumes, milk, and wheat bran and germ. Also, in terms of your vegetarianism, you might very well be taking in insufficient levels of vitamin B-12. This is somewhat common among vegetarians, and the results of a deficiency include dandruff, scaling, and hair loss. Most of the naturally occurring B-12 is in animal products, but can also be found in nutritional yeast and sometimes in fermented soy products (i.e. tempeh). For adult women, the RDA for B-12 is 2.4 mcg. For adult men, the RDA is 2.4 mcg. Read Vegetarian — B-12 deficient for more information on vegetarians and B-12 deficiencies.
If updates to your eating plan don't seem to help, perhaps a visit with your health care provider is the next step. S/he can run some tests to check for a number of other possible options. If you are a Columbia student, you may consider a visit with a Registered Dietitian. Never fear, hope is not lost. Happy eating and a speedy solution to your concerns.