Eating disorders have the highest mortality rate of all mental illnesses, but Yale University recently took the unusual step of forcing a 92-pound student to undergo treatment for an eating disorder. The issue is complicated because people with eating disorders sometimes do require an intervention, but at the same time individuals with naturally slender physiques are not necessarily unhealthy. Chan’s problem came to a head when the university threatened her with medical leave for not complying with medical requests, but her decision to fight her case in high-profile media outlets like the Huffington Post led to the decision to be overturned by Yale. The story is interesting—and surprisingly common—but it raises a very difficult issue: was Yale’s course of action right?
Five feet two inches tall and 92 pounds, New Jersey-born Frances Chan first went to her student health center after discovering a lump in her breast. It turned out to be benign, but a month later she received an email from the center regarding “a concern resulting from your recent visit.” Fearing a reversal of the decision on her cancer scare, she went to the meeting only to find that the actual concern was for her low weight. She was told she had to turn up for weekly weigh-ins, and warned that if she didn’t show up she’d be placed on medical leave.
The problem she had with this was that she’d always been skinny. She’d been effectively the same height and weight since high school, and the rest of her family members have a similar physique, despite regularly eating fattening meals like home-cooked beef noodle soup, cheesecake and cream puffs. She argued her case—that she can be both skinny and healthy—but the clinicians insisted that she gain at least two pounds. She was submitted to blood tests, urine tests and heart EKGs in addition to the weekly weighing, and also was sent to appointments with mental health professionals and nutritionists. The battery of tests revealed no problems, but the clinicians persisted in their requests.
Chan said she gave up fighting, instead setting up a weight-gain diet (with a menu that included ice-cream, chocolate, cookies and Cheetos) and eventually put on two pounds. When she went back to be weighed, the clinician told her it wasn’t enough. At that point she decided to focus on her studies and ignore what she saw as a non-issue.
Eating Disorders And College
Among college students, the rate of eating disorders is anything from 10 to 20 percent for women and up to 10 percent for men (although men are often less likely to report—or be listened to—when they have an issue). College is a particularly vulnerable time for young adults to develop an eating disorder as they attempt to stay trim in an effort to fit in and look good. Research suggests that 35 percent of ordinary dieters go on to pathological dieting. From these pathological dieters, up to a quarter go on to develop eating disorders. With the earlier fact about the high mortality rate associated with eating disorders, it’s obviously reasonable to focus on college students when looking at reducing the prevalence and impact of the conditions.
Is Yale’s Approach Right?
This is why Yale took action in the first place, and it’s undeniably a good thing to attempt to identify students at risk of an eating disorder. However, the decision to rely solely on BMI “grades” leaves students like Chan—who claims a genetic predisposition towards a low BMI—on the receiving-end of possibly unneeded attention.
Chan argues that this approach also leads to students who do have an eating disorder that doesn’t show through a low BMI being ignored when they should be targeted for intervention. Other students have pointed out that there isn’t a corresponding cut-off point for those on the high end of the BMI scale. Binge-eating disorder is an example of a serious condition that would almost always go unnoticed by these sorts of measures, and food addiction would also be missed despite being a serious and potentially damaging issue.
Colleges like Yale should do something to help students struggling with eating disorders, but that action should be more nuanced than a simple analysis of each student’s BMI. The fact that Yale overturned the decision is very promising, but hopefully this change of heart will be reflected by an overall update to the policy in the near future.