Back-to-School Time and Eating Disorders


Contributor: Staff at Timberline Knolls Residential Treatment Center

For many students, back-to-school season is a time of hope, excitement, and optimism. For others, though, returning to the classroom is a stressful experience that can put their mental and physical health at risk.

For high school and college students who are at risk for eating disorders, or who are working to maintain their recovery from eating disorders, the start of the school year can be particularly problematic.

The beginning of the 2021-2022 school year may present an even greater challenge than usual, as many schools are resuming in-person learning for the first time in more than a year after being fully online due to COVID-19 concerns.

The Risk for High School Students

Eating disorders can occur at any age. Typically, though, symptoms of more common eating disorders such as anorexia, bulimia, and binge-eating disorder first appear during adolescence and young adulthood.

According to the National Institute of Mental Health (NIMH), eating disorders affect about 2.7% of adolescents ages 13-17. The rate is much higher among girls than among boys. About 3.8% of adolescent girls and 1.5% of adolescent boys struggle with eating disorders [1].

Elevated stress levels, being bullied or otherwise harassed, persistent exposure to unrealistic body standards, and a sense of loss of control have all been identified as potential risk factors for eating disorders. Unfortunately, stress, bullying, body shaming, and loss of control are far from uncommon experiences among high school students.

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Compounding the problem, many high school students do not have appropriate access to counseling or other mental health services.

An August 17, 2021, article on The Journalist’s Resource website noted that, on average, U.S. schools employ one school psychologist for every 1,211 students. In some states, writer Denise-Marie Ordway reports, the ratio of students to school psychologists is higher than 10,000:1. These statistics far exceed the recommendation of the National Association of School Psychologists, which has called for a minimum of one school psychologist per 500 students [2].

Ordway’s article also notes that although the American School Counselor Association recommends that schools have one counselor for every 250 students, the national average is one counselor for every 424 students [3].

Unique Challenges on College Campuses

For college students, the uncertainties of the start of a new school year may be exacerbated by having to adjust to a new environment.

For many first-year college students, the start of school may be the first time they’ve ever lived with anyone other than family members. For students who are returning to school, there may be a period of adjustment as they reacclimate themselves to either living alone or cohabitating with peers.

In many cases, college students are also attempting to manage a much more demanding academic workload than they had in high school, and they may also be feeling added financial and career-related pressure to perform at a high level.

In a 2010 study that was published in the Alabama Counseling Association Journal, authors Virginia L. Shelton and Karena T. Valkyrie found that elevated stress among college students increased the likelihood that they would experience a desire for thinness, express higher levels of body dissatisfaction, and develop symptoms of bulimia [4].

But social stress and academic pressure aren’t the only factors that can put college students at risk for developing an eating disorder.

In an article on the website of the Child Mind Institute, Dr. Douglas Bunnell is quoted as identifying round-the-clock availability of food and the threat it poses to students’ self-control as factors that can prompt a student to engage in disordered eating habits.

“The freedom to eat at different times, a range of eating options available whenever — it’s not a good environment for people who are at risk for eating disorders,” Dr. Bunnell said in the article [5]. He added that this can be especially challenging for students who are at risk for bulimia.

The Ongoing Impact of the COVID-19 Pandemic

For high school or college students who are returning to school to start the 2021-2022 academic year, the stresses and pressures of this experience are likely to be exacerbated by the ongoing COVID-19 pandemic.

For example, a meta-analysis of research into COVID-related symptoms of anxiety and depression among young people indicates that the prevalence of both disorders has risen significantly during the pandemic.

This report, which was published online August 9, 2021, by the journal JAMA Pediatrics, involved a review of 29 studies of more than 80,000 children and adolescents. Among the results noted by the authors:

  • Globally, about 25% of young people have had an increase in symptoms of depressive disorders during the pandemic.
  • About 20% of young people throughout the world have developed elevated symptoms of anxiety during the pandemic.
  • Symptoms of both depression and anxiety throughout the pandemic have been higher among girls than among boys [6].

Mask for Pandemic

When students who are already experiencing increased symptoms of anxiety or depression while continuing to deal with the impact of a global pandemic are confronted with the stress and pressure of a new school year, their risk for engaging in disordered eating habits and other maladaptive coping behaviors may increase.

According to Alana Otto, M.D., MPH, who has studied the impact of the COVID-19 pandemic on adolescents, young people who have eating disorders or are at risk for developing eating disorders have been hit hard by this ongoing global health crisis.

“During the pandemic, the absence of routine, disruptions in daily activities, and a sense of a loss of control are all possible contributing factors,” Otto said in a July 7, 2021, article on the University of Michigan Health Lab website. “For many adolescents, when everything feels out of control, the one thing they feel they can control is their eating [7].”


  1. U.S. Department of Health and Human Services. (n.d.). Eating disorders. National Institute of Mental Health.
  2. Ordway, D.-M. (2021, August 30). Students wrestled with depression, eating disorders amid COVID-19. The Journalist’s Resource.
  3. Ordway, D.-M. (2021, August 30). Students wrestled with depression, eating disorders amid COVID-19. The Journalist’s Resource.
  4. Shelton, V. L., & Valkyrie, K. T. (2010). College Student Stress: A Predictor of Eating Disorder Precursor Behaviors. Alabama Counseling Association Journal.
  5. Jacobson, R. (2021, May 18). College Students and Eating Disorders: Why the first years away from home are a perfect storm for anorexia and bulimia
  6. Racine, N. (2021, August 9). Global Prevalence of Depressive and Anxiety Symptoms in Children and Adolescents During COVID-19: A Meta-analysis

7. Mostafavi, B. (2021, July 7). Study: Hospitalizations for eating disorders spike among adolescents during covid. University of Michigan.

About Timberline Knolls

Timberline Knolls BannerAt Timberline Knolls Residential Treatment Center, located outside of Chicago, Illinois, we provide specialized care for women and girls who are living with mental health disorders. Our private facility offers female-only treatment programs for eating disorders, addiction, and a range of mental health conditions. We work closely with each person to develop treatment goals to maximize strengths while focusing on individual needs. Our treatment team understands that each woman has unique needs and that she must play a role in her journey to wellness.

The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published on September 8, 2021. Published on
Reviewed & Approved on September 8, 2021 by Jacquelyn Ekern, MS, LPC