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Nutrition Students Are at High Risk of Eating Disorders

The field is finding its way to a curriculum that centers student well-being.

By Lydia King

Those in the nutrition field are not guaranteed a healthy relationship with food. In fact, a 2017 study published by the Journal of the Academy of Nutrition and Dietetics surveyed 636 American dietitians on their eating and exercise habits. It found that 12.5% were at high risk for an eating disorder. Interestingly, similar trends are observed among nutrition students. In 2023, Budhiwianto et al conducted a systematic review that focused on nutrition students worldwide. The results were striking: from 4 to 32% were at high risk for eating disorders.

Working nutritionists and faculty acknowledge that there must be a change in the way nutritionists are trained. Nutrition programs must take into account the frequency of eating disorders and structure the curriculum in a way that promotes student well-being. This process of curriculum change must be interdisciplinary, to address both the strengths and gaps in nutrition pedagogy.

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Shifting the Focus from Body to Well-being

First, it’s important to understand why nutrition students may be more at risk for eating disorders. Much of this phenomenon stems from our society’s restrictive view of ideal body image. In their review of nutrition students’ eating habits, Budhiwianto links this phenomenon to internalized fat phobia. They specifically point out that nutritionists’ appearances can be linked with credibility. There may be the false belief that a nutritionist should know how to achieve what is seen as the “ideal” body type. If curricula focus on the quantification of food without also pushing back on unhealthy body standards, a nutrition student may fall into disordered eating habits. 

Unfortunately, many nutrition programs still don’t address these risk factors. Part of this lag can be traced back to a disciplinary split between dietetics and psychiatry. Nutritionists can study and diagnose disordered eating, but the term “eating disorder” is specific to a psychiatrist’s diagnosis. Perhaps because of this, the topic of disordered eating can be skirted over in training.

“You know the thing about dietetics training – they don’t teach you about disordered eating,” notes Ms. Brittany Rose Verras, Associate Director of Nutrition Services at Emory. “They’ll talk through all this stuff, but we don’t get exposure to it in a way that’s meaningful… If you do get more exposure, it’s because you intentionally sought out a clinical placement at an eating disorder clinic, [or got training] through a certificate program or continued education.”

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When Verras started her role at Emory, she had little background on disordered eating treatment, especially because she has never struggled with disordered eating. However, students frequently come to her about their disordered eating. 

Through training from her mentor, she was able to learn how to help them effectively. However, the same mentorship is not guaranteed to everyone. This lack of guidance is significant, especially because it also has negative consequences on the well-being of nutrition students. If nutrition students aren’t taught about disordered eating in a meaningful way, they won’t be able to effectively identify disordered eating in themselves.

Verras also noted how her job could make her feel scrutinized. “People are a little hesitant that I’m gonna be the food police when I’m around; they want to hide their food.” While this has not affected the way Verras thinks about her eating, these expectations could have detrimental effects on another nutritionist’s self-image. The assumption that a nutritionist must have a rigid eating regimen may affect a nutritionist’s ability to make food choices without guilt.  These presumptions from peers might be something that nutritionists will always face. However, there are practical changes that could offer them the tools to maintain a positive relationship with their food. Dr. Long Wang, Department Chair of Nutrition at the University of the Pacific, believes that this requires a shift in the way that training is administered.

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Reframing Training: Competency-Based Learning and Mental Health Support

At the University of the Pacific, the emphasis is placed on competency-based assessment. Wang noted that this is a direction that many nutrition programs are taking. While students may spend less time memorizing minutiae, they are tested on actual skills that they will need to succeed in the workforce. He believes that this decreases the stress of nutrition students, who may have previously felt the pressure to succeed on extremely difficult tests. 

Secondly, Wang noted that nutrition programs must also have a foundation in sound content. He emphasized that health should be taught as a client’s ability to live fully, not their physical appearance. Nutrition students must be taught that continually. 

Finally, Wang described the necessity of attending to students’ mental health needs. He was aware that some students had experience with eating disorders, and he expressed the importance of them getting access to counseling services. Wang also expressed that proper care entailed an understanding of provider roles. He pointed out the difference between the role of a counselor and a nutritionist. 

The Intersection of Nutrition and Psychiatry

Some people might liken a psychiatry student in need of therapy to a nutrition student in need of eating disorder treatment. However, Wang made it clear that this was an imperfect comparison. He emphasized that a nutrition student in need of eating disorder treatment also needs a therapist, not just a nutritionist. The nutritionist can then come in and support the recovery process, but they don’t necessarily start it. While Wang described this as a simple distinction, others might not agree. The lines between the role of the nutritionist and counselor are not as clear-cut as they might seem. 

“You’re supposed to kind of stay in your lane, so you don’t end up messing it up because both of those practices are really, science-based,” described Verras. “But a lot of times in the conversations in my office, there’s lots of crying. There’s lots of self-deprecation.” 

It’s clear that eating habits are intrinsically linked with general mental well-being. As Wang noted, nutrition programs must create environments that are conducive to student wellness: through lower-stress assessments, access to care, and body-positive teaching. However, Verras brings in another important point. Nutrition students must also be taught to examine the blurry boundaries between nutrition and mental health, the parts of nutrition where emotion can leak in. It reminds them that they come to the nutrition field with their perceptions of food and physical activity. Perhaps the key to promoting nutritionist well-being is simply this: an acknowledgment of shared humanity.