The prevalence of eating disorders is an increasing concern for college students. Research shows that up to 17% of female college students and 4% of male students exhibit signs of an eating disorder. The impact of an eating disorder can be felt in all aspects of a college student’s life. For example, the National Eating Disorders Association (NEDA) found that 25% of college-aged women engage in binge eating and purging as a weight-management technique, and that “eating disorders have the second-highest mortality rate of all mental health disorders, surpassed only by opioid addiction.”

Additionally, there is an increased risk for nonbinary and transgender college students to develop disordered eating. Relative to cisgender women, genderqueer and nonbinary college students have the highest risk of developing an eating disorder, according to research published by the Annals of Epidemiology. According to The Trevor Project, 9% of LGBTQ+ youths ages 13–24 reported having been diagnosed with an eating disorder. In comparison to those who have never suspected nor had an eating disorder diagnosis, the same research found that LGBTQ+ youth who have ever been diagnosed with an eating disorder had nearly 4x greater odds of attempting suicide in the past year.

All of these statistics highlight the devastating and far-reaching impact that eating disorders can have on college students. It also demonstrates the importance of colleges and universities providing support and resources for students who are struggling with these conditions. By seeking treatment and support, students can work toward a healthier relationship with food and their bodies, reducing the negative impact of eating disorders.

Causes and symptoms of eating disorders

How is an eating disorder defined? It is a “behavioral condition characterized by severe and persistent disturbance in eating behaviors and associated distressing thoughts and emotions.” And the most common eating disorders include anorexia nervosa, bulimia nervosa, binge eating disorder, and other specified feeding and eating disorders (OSFED), according to the National Institute of Mental Health (NIMH).

Causes for eating disorders are complex and can vary from person to person, but some common contributing factors include genetics, environmental factors, psychological factors, trauma, and biology.

Most eating disorders involve a significant focus on weight, body shape, physical appearance, and food, leading to a negative body image and dangerous eating behaviors. Eating disorders are also serious mental health conditions that can have a significant impact on a person’s emotional and social well-being. According to the Academy of Nutrition and Dietetics, symptoms of disordered eating may include chronic weight fluctuations; preoccupation with food, weight, and body image negatively impacting quality of life; excessive exercise; and food restriction, fasting, or purging to “make up for bad foods” consumed. Symptoms and risk factors vary depending on the type of eating disorder.

How diet culture influences eating disorders

Diet culture refers to a societal belief system that values thinness and equates it with health, moral worth, and success. According to the National Alliance for Eating Disorders (NAED), it’s a pervasive cultural norm that glorifies weight loss, restricts food intake, and reinforces harmful beauty standards.

Diet culture has a significant impact on eating disorders because it promotes the idea that the path to happiness and success is through weight loss and food restriction. This mindset can lead to disordered eating patterns and an obsession with food and body image, which can contribute to the development of an eating disorder. Diet culture also promotes the belief that certain foods are “good” or “bad,” leading to feelings of guilt and shame when one consumes “bad” foods.

Whether students realize it or not, diet culture has a stronghold in the media and daily life. From juice cleanses to Keto and Paleo, the world of diet culture has wreaked havoc on the self-esteem and mental health of millions of college students.

Rather than trying to fit in a one-size-fits-all approach to health and wellness, students should focus on intuitive eating and self-care practices that prioritize mental and physical health, rather than weight loss or restriction. The result is that individuals can work toward a healthier relationship with food and their bodies, reducing the risk of developing an eating disorder.

Established peer-to-peer programs, including Active Minds, Project Let’s, National Alliance on Mental Illness (NAMI) Peer-to-Peer, and Lean on Me, have created comprehensive training and advocacy programs. These programs are designed to arm students with the knowledge and skills necessary to support student mental health on college and university campuses. Let’s take a closer look at what is needed to create a successful peer-to-peer training program.

The components of peer-to-peer program training

There is not a one-size-fits-all approach to care for students with mental health conditions. Similarly, there is more than one approach for selecting a peer-to-peer program model and training curriculum.

However, many programs incorporate similar competencies. It’s important that peers are comfortable and confident in their roles and can effectively support students with emotional and mental health concerns.

To help students better support their peers, these components are recommended for peer-to-peer program training:

• Strategies and techniques for self-care
• Signs and symptoms of emotional distress, serious mental illness, and a student in crisis
• Empathetic listening and communication skills
• Creating an accepting environment that involves peer support services and mentors
• Suicide prevention skills that include validating emotions, offering hope, and referring for support (i.e. a helpline)
• Familiarization with services, resources, and departments available both on and off campus (i.e. health services or virtual health care options)
• Care protocols that include who to call or get involved if a student needs support beyond what the peer can provide

Other considerations may be necessary for a training curriculum if the peer program includes a crisis line, workshop facilitation, fundraising, political organizing, or other wellness elements. Groups that may be responsible for recruiting new members, designing communications, or planning and implementing events may also consider integrating training content that fosters group cohesion and specific skills that will enable the group to achieve its goals.

Training logistics for peer-to-peer programs

When designing or selecting a training curriculum for a peer-to-peer program, it is important to consider the logistics and timing to ensure that students participating in the program are supported in the process, and are exposed to a relevant and meaningful training experience.

Consider the following when making decisions to create an on-campus support network:

• Timing: When would be the best time for students and other training participants (i.e. employees) to attend? Should the training be spread out over time or all at once?
• Format: Would in-person and/or a virtual format fit the needs of your training?
• Space: If in-person, what space can accommodate the training?
• Student experience: What elements of the training need to be considered to ensure the students have an excellent experience?
  • What materials can be provided to students that enhance learning?
  • Consider the comfort of the student and what they have access to during the training (i.e. food, fuel, breaks to rest).
  • Consider that some students may serve in another capacity on campus where they have received similar training.

Gathering feedback from students during and after the training to measure the effectiveness of the curriculum and experience will be helpful. Taking time to gather their feedback, review, and make changes for the next training cycle will be a beneficial task to allow for continuous improvement.

Mental health peer-to-peer programs are designed to mobilize students to become agents of change for mental health and well-being on their college campuses. The peer-to-peer model is an effective approach to shifting social norms that encourage positive health behaviors. Because peers shape one another’s daily decisions, from study habits to coping strategies, peer-to-peer programs use that same influence to promote positive health norms. Research from Scholastic and NIDA finds that when students model supportive, stigma-free behaviors, their peers are more likely to follow. Conversely, students can also be influenced by their peers to make unhealthy choices.

Young adults are more likely to seek help from their friends versus a mental health care provider or any other person in their lives. That’s why implementing a peer-to-peer program in the college setting is considered an effective practice by The JED Foundation (JED). Not only can peer-to-peer programs expand the network of individuals who can intervene before a mental health crisis occurs, but it also creates an environment where students are modeling positive health behaviors that influence other students to practice self-care and seek help for themselves or a friend before a critical situation occurs.

Types of peer-to-peer programs

A variety of peer-to-peer mental health programs exist on college campuses across the country. Programs like Active Minds, Project LETS, and Lean on Me have a network of chapters supported by national organizations that provide training and technical assistance. Other programs, such as Worcester Polytechnic Institute’s Student Support Network and the University of Albany’s Middle Earth Peer Assistance Program were developed by campus professionals to mobilize and train students to provide a range of peer assistance, support and education services. In addition, professional organizations such as NASPA host Certified Peer Education training and provide technical assistance to institutions that establish peer education programs.

Program goals and activities

Generally, peer-to-peer programs aim to enhance mental health literacy, which involves:

• Reducing stigma and other barriers associated with seeking help for mental illness and emotional distress.
• Increasing awareness of self-care for mental health and well-being.
• Increasing awareness of services available and help-seeking behaviors.
• Creating a culture of support for student well-being.
• Using shared experiences to offer help to friends or peers dealing with mental health conditions.

Peer-to-peer support services differ from each other in the activities that they offer.

For example:

• Lean On Me and Middle Earth Peer Assistance Program have hotlines where peers answer text messages or calls from students looking for emotional support on topics that range from college adjustment to alcohol and drug concerns.
• Student Support Network focuses on training students over six weeks through a variety of skill-building activities to help friends in crisis or distress.
• Active Minds and Project LETS establish chapters on campuses that are designed to support students through peer education and advocacy in their communities.

These groups function as extensions of existing campus resources and often partner with campus departments such as counseling centers to expand their reach and impact.

The spread of health misinformation, whether intentionally or unintentionally, can have serious consequences. Unfortunately, misleading and false information often spreads like wildfire online. One study found that falsehoods are 70% more likely to be retweeted on Twitter than the truth, and reach their first 1,500 people six times faster. The challenge for young people on college campuses is the influence and reliance on peer networks, social media, and other potentially unreliable sources of information. This is why it’s critical that colleges and universities have a plan in place to share reliable health information with students, as well as collaborative strategies for combating misinformation when it occurs.

Confronting misinformation in the U.S. during the COVID-19 pandemic

In 2021, the U.S. Surgeon General Dr. Vivek Murthy released an advisory called “Confronting Health Misinformation.” The purpose of the advisory was to immediately increase the awareness of the significant public health issue that misinformation became in the wake of the COVID-19 pandemic. The spread of health misinformation occurred rapidly early in the coronavirus pandemic when information about COVID-19 was sparse. But, the desire for clear guidance was paramount, and the scientific community worked quickly to release reliable information on COVID-19 precautions. However, the varied approach and political climate caused mistrust that further contributed to the spread and acceptance of misinformation by the public.

According to the advisory, there are specific steps that individuals, communities, and organizations can take to stop the spread of health misinformation. This enables reliable factual health information to be found and used to inform health decisions that can influence positive health outcomes. The spread of health misinformation typically stems from unreliable sources or the misunderstanding of good information. College and university campuses have the opportunity to take a leadership position and educate the community on how to assess, share, and utilize information that is factual, accurate, and reliable.

Individuals who are exposed to factual health information are more likely to make healthy choices and have positive health outcomes in the short and long term. Having a strong communication infrastructure and strategy allows higher education institutions to establish trust among community members and be reliable sources of health information. Doing so not only assists with policy compliance and pro-health choices, but also has a ripple effect on the families, friends, and other institutions and communities that employees belong to away from campus.

How to identify health misinformation

Health “misinformation” is “information that is false, inaccurate or misleading according to the best available evidence at the time.” The intentional spread of misinformation for political or monetary gain is referred to as “disinformation.” Misinformation typically spreads from individuals who are not aware that the information is false or misleading. Often, those who believe the misinformation are under the impression that they are helping others by sharing what they think is useful, true information.

Health misinformation spreads for a variety of reasons. As noted, social media and click bait titles on the internet play a large part in how fast and what type of information is available and shared. Algorithms, engagement strategies, and incentives are ways social media platforms and search engines operate to connect people with information rapidly. However, these methods do not necessarily supply the public with vetted, credible, or accurate information. And as more people interact with information, the more that many sites populate and offer the same type of information. This perpetuates the dissemination of information—valid or not.

If you’ve seen health misinformation online, the U.S. Department of Health requests that you send them details on what you’ve seen.

How health misinformation impacts health and well-being

Health misinformation can cause confusion and lead individuals, families, communities, and organizations to make health-related decisions that can directly influence short- and long-term health outcomes. The impact of false beliefs about diseases and prevention strategies like vaccines can be seen around the world. Misinformation and false beliefs held about HIV/AIDS by policy makers in South Africa contributed to decreased access to treatment and preventable death. Misinformation has been associated with health choices related to vaccines, herbal supplements, and other behaviors that can influence both short- and long-term health and well-being risks.

A compounding effect can happen based on the amount of a person’s exposure to misinformation. Research on COVID-19 vaccine hesitancy revealed that the more misinformation a person was exposed to made them more likely to not be vaccinated against COVID-19. Immunization is a life saving public health approach to outbreak and disease prevention. In fact, research conducted in early 2021 estimates that nearly a quarter of a million COVID-19 related deaths were prevented through vaccination, and 1.2 million hospitalizations were avoided in the first six months of the year. Due to the correlation between vaccine misinformation and low vaccination rates, it is likely that those who experienced more exposure to COVID-19 misinformation were more likely to not be vaccinated and at higher risk of contracting COVID-19.

You may have heard the term “health coaching” in conversations about student health and well-being services. But what does health coaching for college students actually mean? Over 20 years ago, health coaching was identified as a way to help individuals achieve health and well-being-related goals. Now, the concept of health coaching is expanding and is implemented in a variety of settings. From primary care to chronic disease education, to wellness programs on college campuses, health coaching is a way to support individuals and groups who have an identified health and well-being need.

What is health coaching?

Let’s start by defining what is meant by health coaching and health coaches.

The AMA defines health coaching as:

“… a patient-centered approach where patients determine their goals, use self-discovery or active learning processes together with content education to work toward their goals, and self-monitor behaviors to increase accountability, all within the context of an interpersonal relationship with a coach.”

A health coach is:

“…qualified to perform health and well-being coaching by education, training, national examination, and, when applicable, licensure/regulation, and has completed a training program in health and well-being coaching whose content meets standards established by an applicable national credentialing organization. The training includes behavioral change theory, motivational strategies, communication techniques, health education and promotion theories, which are used to assist patients to develop intrinsic motivation and obtain skills to create sustainable change for improved health and well-being.”

Although there is currently no state licensure for health coaches, the National Board for Health and Wellness Coaching (NBHWC) and National Commission for Health Education Credentialing (NCHEC) certify individuals who are eligible and pass an exam based on their independent national standards.

What sets health coaching apart from other health and behavioral health providers are the behavioral change, health education and promotion theories, motivational strategies, and communication techniques implemented by the health coach to ensure that the patient and coach collaborate on discovering the motivations, identifying the goals and establishing the strategies that are most likely to be sustainable and effective for each patient’s needs and desires.

How health coaching sessions can help a patient

Health coaches typically assist with setting personalized goals and identifying patient-specific strategies on a broad set of health topics including:

• Tobacco cessation
• Healthy eating habits
• Exercise strategies
• Weight management
• Sleep improvement
• Stress management

Regardless of the setting or topics, health coaches partner with patients to support their motivations to develop sustainable behavior change based on their unique needs, leading to an improved quality of life.

The impact of health coaching on patient outcomes

Research provides evidence of the positive impact health coaching has on motivating health and lifestyle changes. Health coaching is proven to be effective in helping manage chronic disease and improve short- and long-term physiological, psychological, and behavioral health outcomes. In addition, there is strong evidence that health coaching is a cost-savings approach that reduces healthcare utilization by helping patients live healthier lives. A number of barriers exist for patients to overcome in order to manage their health and well-being. Often, patients with chronic illnesses or health concerns who require education and lifestyle changes need a higher level of care, time, and resources, which can be challenging to manage in traditional health care settings.

Incorporating health coaches into a healthcare team and patients’ healthcare strategy can help reduce barriers and enhance the amount of one-on-one time and individualized guidance/education a patient receives. Patients also benefit from an approach that engages them in the process of identifying intrinsic and extrinsic motivators, meaningful goals, and strategy development. Including health coaches on a patient’s care team enhances continuity of care and enables all providers involved in their care to understand, monitor, and reinforce the motivations and goals set by the patient.

Higher education continues to grapple with change as the COVID-19 pandemic enters its third calendar year. Though the pandemic has presented challenges across the globe, COVID-19 has disproportionately affected college and university students who identify as lesbian, gay, bisexual, transgender, and queer (LGBTQ+). This is why college and university leaders must understand and utilize best practices for creating a campus and learning environment that reduces psychological distress and improves a sense of belonging for LGBTQ+ college students.

The Proud and Thriving Report, published by The JED Foundation (JED) in collaboration with The Consortium of Higher Education LGBT Resource Professionals, gives higher education administrators a comprehensive framework to enhance support systems for college and university students who identify as LGBTQ+. With findings from literature reviews and multiple research studies, it offers a deeper understanding of the risk and protective factors experienced by LGBTQ+ students, as well as a starting point to address psychological distress and improve belonging.

Risk factors for LGBTQ+ students

What are the risk factors commonly connected to LGBTQ+ students? Let’s take a close look at the data. Although colleges and universities strive to assist students in building connections between students, faculty, and staff, LGBTQ+ students experience more rejection, victimization, and disciplinary action than their non-LGBTQ+ peers. Research shows that LGBTQ+ students are more likely to misuse substances, experience eating disorders, and have suicidal ideation or attempt and self-injury. Additionally, several interpersonal factors exist due to societal prejudices and discrimination of people with marginalized gender identities or sexual orientations.

Structural risk factors also exist within the LGBTQ+ student experience. These can take the form of pressure to conform to campus norms and/or barriers to engaging in academic and co-curricular activities. Institutions that do not collect data on gender identity and/or sexual identity can contribute to these inequities. When the unique needs of LGBTQ+ students are not accounted for, it’s impossible for the necessary advocacy efforts, support systems, and resources to be in place.

Students of color who identify as LGBTQ+ experience even higher risk rates of physical and mental health concerns, and have greater barriers to overcome in building protective factors and accessing services and support that can enhance their well-being.

Protective factors for LGBTQ+ students

JED’s report also highlights individual, interpersonal, and structural protective factors that support LGBTQ+ student well-being. Here’s a closer look at what each of these protections means:

• Individual protective factors include characteristics that demonstrate a belief of one’s own worth and ability to be cognitively flexible, resilient, and self-affirming.
• Interpersonal protective factors include having people such as family, friends, role models, and mentors who are identity affirming and foster connectedness.
• Structural protective factors include policies and procedures that are equitable and take into consideration the disparities that exist for LGBTQ+ students.

Education and professional development training for employees and the addition of services specifically for LGBTQ+ students are supplemental structural protective factors that create an inclusive and safe environment.

How to enhance support systems for LGBTQ+ college students

For colleges and universities, it’s important to invest in programs and initiatives that are dedicated to partnering with higher education to equitably address the needs of college students. In order to promote equity and support LGBTQ+ students, campus administrators can utilize The Proud and Thriving Report’s framework to address the individual, interpersonal, and structural risk factors and promote protective factors in the following ways: