When Numbers Trigger
Her family never knew.
They never knew that for years, she thought getting dizzy when she stood up was normal.
They never knew that every day she was restricting what she ate and that calorie counting consumed her almost every thought.
They never knew her high school experience was burdened by the eating disorder that was taking a toll on her body and mind.
And they never knew that when she finally decided enough was enough, she tackled recovery almost completely alone.
They never knew, and at the time, that’s exactly what Bri Arey wanted.
Arey, now a senior at UNC, is open about her struggle with an eating disorder in high school and her relapse during her sophomore year of college. She is currently a co-chair of Embody Carolina, an organization with around 40 active members, whose purpose is to train students to be eating disorder allies and to promote body positivity on campus.
“It was a really isolating experience,” Arey said. “Eating disorders are just so personal, and they’re so secretive, and it can be so easy for families to just have no idea.”
About 25 percent of men and women in college suffer from a clinical eating disorder, according to data collected and analyzed by the University of Michigan in 2014. And that statistic does not consider those who suffer from more general disordered eating, meaning their eating habits are unhealthy and dangerous, but they don’t meet the clinical definition of an eating disorder.
No specific data has been collected regarding the number of UNC students with eating disorders. But campus health professionals estimate the data to be about the same as the Michigan study.
And for the eating disorder community, 2016 will be a crucial year with the Food and Drug Administration enacting a new law, “Food Labeling: Nutrition Labeling of Standard Menu Items in Restaurants and Similar Retail Food Establishments.”
The new federal regulation will require all buffet-style restaurants and dining facilities to clearly show calorie counts next to all food items. The law’s goal is to promote health and reduce the obesity rate in the United States, but many professionals say the effects are much more complicated.
Advocates argue that calorie labeling can be triggering for those at-risk of eating disorders or in recovery, and having numbers so explicitly stated does not take their needs into consideration.
“People who suffer from anorexia think about food 90 to 100 percent of the time. For bulimics, it’s 70 to 90 percent,” Arey said. “It’s so difficult to always be thinking about your next meal, how you’re going to avoid it if you’re restricting, (or) for bulimics, thinking about their next binge.
“It’s literally constant.”
Sophia Al-banna is a second year master’s student in the UNC School of Global Public Health. She is enrolled in a dual program earning a master’s in public health and a registered dietician degree.
Her voice is calm at the onset. But as she discusses the new FDA policy, her speech quickens, more opinionated and passionate. As a public health student, she sees both sides of the issue. She understands that the new law is trying to reduce obesity rates, but she’s worried about the potential negative effects for individuals with eating disorders.
“I really believe the majority of people looking at calories on college campuses are those with disordered eating or those at risk or at the top of the slippery slope,” Al-banna said. “The wide room for interpretation of that label may subconsciously lead to pathologic behavior.”
And while eating disorder rates on college campuses are higher than the general population, obesity rates are significantly lower, she said.
According to Al-banna, the real problem is who the law is targeting. The majority of buffet-style dining facilities exist on college campuses, but the college population is not at risk for obesity, compared to the rest of the country.
“Honestly, the people who are gaining your freshman fifteen, that is not from the dining hall,” she said. “It’s from the frat party drinking and the late-night Insomnia Cookies and your late-night delivery food. Let’s get real here.”
If Al-banna were to design her ideal nutrition display, she would avoid caloric values and numbers all together, instead labeling things as “high in fiber,” “high in protein” or “no sugar added.”
“Displaying macro-nutrients is very helpful,” she said. “I think giving food a numerical value is really unfair when you don’t know where the calories are coming from.”
Years later, Arey reflects on her original eating disorder in high school. She speaks with confidence, her voice clear and steady as she describes the day she knew things had to change.
She said she didn’t have a choice. If she didn’t do something, her eating disorder would eventually have killed her.
“I started having heart palpitations. My hair was falling out. I lost my period for about a year and a half, and that was terrifying,” she said. “I remember going to bed one night and thinking, if I don’t change something, I’m going to die. And that wasn’t part of my plan.”
Arey said she confided in a few friends and researched eating disorders on her own. Approaching recovery without a strong support system isn’t something she advocates, and it’s the rare person who can successfully combat mental illness alone. Gradually, she pulled herself into a more positive state.
“Once you start recovering, I think you start to get a glimpse at what life is like without an eating disorder, and it was really motivating for me.”
But during the winter of her sophomore year at UNC, Arey was one of the many people who relapsed after her initial recovery.
It was the middle of winter. She had returned from class, and after not eating enough, the blistering cold was unbearable. Her roommates asked her to go to dinner: a simple question that stung more than the terrible weather.
“I remember just literally pulling the covers over my head and thinking I can’t do anything,” said Arey. “It was just like I wanted to stay in that spot, and I think that just speaks to how consuming eating disorders are.”
It was so difficult to not think about her next meal. Her next bite. Her next calorie.
“Sitting in class, I would plan out my meals on a Post-it instead of taking notes. It’s so difficult to get away from that. Even to explain it to people,” Arey said.
That’s the reason members of Embody Carolina fear calorie counts in the dining hall would act as a trigger.
The new law is a federal regulation, and as a result Carolina Dining Services is unable to reject calorie labeling. But Kelli Wood, a registered dietitian at Carolina Dining Services, said the organization does support the new law and CDS has to first think of the greater campus population.
“We support the goal of the menu labeling law,” she said. “The law was passed with the simple goal of reducing obesity and improving the health of Americans by providing information to consumers. We already provide nutrition information for the foods we serve, we have made calorie and nutrition information available in various ways to help students make informed choices, including both online and point of service.”
The law, which goes into effect Dec. 1, 2016, requires dining halls to post calories on menu boards and other menu signage. Before, nutrition information was only located on the TV screens above each serving area and available online.
Wood said while she understands the apprehension, CDS must consider the needs of all customers, and the system cannot be tailored specifically for those with disordered eating.
“We believe the availability of calorie and other nutrition information for the foods and beverages we serve often can be beneficial,” she said. “For students with eating disorders, our registered dietitians are available to provide individual counseling and assist students with adopting healthier eating habits.”
Christine Peat, a clinician at UNC’s Center of Excellence for Eating Disorders, said the response to the law is going to depend on an individual’s background and health experience.
“It’s really hard to have laws like this because it’s not going to be a one size fits all. It’s not going to be bad for everybody, and it’s not going to be good for everybody. I think that the challenge is really finding a balance between those two,” Peat said. “It’s that really rigid fixation on numbers that I think eating disorder clinicians are often concerned about.”
Arey said especially during her relapse, calorie-counting played a huge role in her cycle of disordered eating.
“I remember things felt so out of my control. I couldn’t control my grades. I couldn’t control what was going on around me, but I could control the number. I could control my intake. That number on the screen starts feeling like your identity, and I could control that. I think that’s a big reason why I focused on that.”
One day, Arey’s friend Allie Minnich confronted her during a meal, took her phone and deleted her calorie-counting app. Arey said at that point, letting someone else take control was the best thing that could have happened. For so long, she was controlled by her own destructive thoughts.
“Your eating disorder sort of becomes this voice in your head,” she said. “I was talking about it with my parents one time. They asked me why I allowed myself to do this, and I said, ‘I didn’t think I had a choice. I didn’t think I deserved the food.’ That’s how eating disorders consume you.”
If calorie counting were the answer to healthy eating, Antonia Hartley, a clinical nutrition specialist at UNC Campus Health, said she would be out of a job.
She understands the objective of the law. The effects of the obesity epidemic are widespread and detrimental, but as an expert in nutrition, she said numbers and vague labels are not the answer.
“What I see coming through my door is people looking for a better relationship with food and a better relationship with their bodies, and I haven’t found that one can find a better relationship with food through numbers.”
She said that in general, she would never tell a patient to lose weight through counting calories. While it might work for some, on a college campus, it’s simply not appropriate.
Hartley said an alarming statistic, collected by UNC Campus Health, is that 4 percent of UNC students eat the daily recommended amount of fruits and vegetables. She said that if she were to recommend counting calories, there would be even less focus on food groups and servings, which need to be prioritized.
“I always tell my clients that numbers, whether it’s calories or whether it’s weight, is like a hammer,” she said. “It can be a tool, but it can also be a deadly weapon.”
But Hartley said she’s not surprised by the law. It wasn’t enacted by nutrition specialists. It was enacted by politicians.
“The government is always two steps behind, to be completely honest.”
Al-banna said one of the most problematic things is that the majority of people looking at the calorie count will be the ones at risks, the people who shouldn’t be scrutinizing the numbers.
“Most people with eating disorders or disordered eating are happy the calories are there,” she said. “But it’s not how mealtime should be. It should be ‘I’m going to eat this because it’s good for my body not because I have to meet this certain number’.”
As Arey speaks about her past, it’s clear she is conscious of self-care. When a memory begins to trigger negative emotions, she takes a moment to collect her thoughts and express them in a healthy manner. Just as she takes care of herself, she hopes to be an advocate and protect others from potential triggers.
While the Embody community has raised awareness and created a safe space for many, it’s policies like the new FDA law that continue to push eating disorders out of the public health conversation, she said.
“We hear so much about the obesity epidemic, and it should be talked about, but I don’t think people realize how big of a population the eating disorder community is,” Arey said.
“It feels very overlooked and like it’s not a priority.”