Jennifer Wagner, who earned a master’s degree at Baylor, credits the university’s eating-disorders team with saving her life: “I had given up and accepted I wouldn’t recover.”Courtesy of Jennifer Wagner
It’s hard to pinpoint precisely when Baylor University’s horrific sexual-assault scandal hit rock bottom, but four years ago this month is as fitting a date as any. That’s when ESPN released blistering accusations that the university had failed its Title IX obligations to provide counseling and other support to women who reported being raped by their fellow students — many of them Baylor athletes, mostly football players.
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Jennifer Wagner, who earned a master’s degree at Baylor, credits the university’s eating-disorders team with saving her life: “I had given up and accepted I wouldn’t recover.”Courtesy of Jennifer Wagner
It’s hard to pinpoint precisely when Baylor University’s horrific sexual-assault scandal hit rock bottom, but four years ago this month is as fitting a date as any. That’s when ESPN released blistering accusations that the university had failed its Title IX obligations to provide counseling and other support to women who reported being raped by their fellow students — many of them Baylor athletes, mostly football players.
From the public’s vantage, many of the worst blows were yet to come: the release of an independent report that judged Baylor’s student-conduct processes to be “wholly inadequate,” the departures of President Ken Starr and top athletics leaders, and an uprising by outraged students and alumni.
In the depths of a sexual-assault crisis, Baylor’s regents chose to spend more money on student mental-health services. It was a life-saving decision.
In the days immediately following the ESPN report, the leaders of the world’s largest Baptist university desperately needed a win.
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Baylor’s counseling center, meanwhile, suffered from problems familiar to campuses across the country: inadequate staffing, long wait times, and limits on the duration of therapy. The sexual-assault crisis only underscored those deficiencies.
James Marsh, executive director of counseling services at Baylor, lobbied the university’s regents for more mental-health funding, and they delivered. The university directed an additional $900,000 to its annual counseling-services budget, allowing the center to increase its full-time staff from nine to 22. It also spent more than $1 million on renovations to expand the counseling center.
Raising the money only part of the solution, Marsh said. “Hiring people with a specific expertise” was the key to making it count.
Anxiety, depression, relationship issues, trauma, and substance abuse emerged as treatment priorities for the center. But so did another long-neglected set of mental-health issues: risky eating behavior and full-blown eating disorders, which together afflict nearly a third of college students nationwide. The American Psychiatric Association defines eating disorders as an illness in which “people experience severe disturbances in their eating behaviors and related thoughts and emotions.”
The transitional environment of college makes some students disproportionately susceptible to developing eating disorders, Claire Mysko, chief executive officer of the National Eating Disorders Association, said. According to the National Institute of Mental Health, the median age of onset for binge eating disorders is 21 years old; it’s 19 for both bulimia and anorexia.
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“For many people it’s the first time away from their support system,” Mysko said. “Eating disorders tend to thrive in isolation.”
Flush with the new cash, Baylor’s counseling center set out to build a multidisciplinary team to help students overcome eating disorders. Erin McGinty Fort, an eating-disorders specialist, joined the center’s staff in early 2017. The university and the city of Waco, Tex. — population 138,183 — “didn’t have any eating-disorder resources in the community before I came,” she said.
The move would prove pivotal for Jennifer Wagner, who had arrived months earlier to work toward a master’s degree in geosciences — and her dream of becoming a professor.
‘One Last Try’
Wagner had struggled with anorexia and bulimia as an undergraduate at the University of Central Arkansas. But when she described her symptoms to a campus therapist, she said in an interview, “nothing further was discussed.”
In an email response to an inquiry from The Chronicle, Susan Sobel, director of Central Arkansas’s counseling center, was apologetic about Wagner’s experience. None of the counseling staff is “actually certified as an eating disorder specialist,” she wrote. But since 2011, the college has had “at least one person we tend to funnel to, who works a lot with that issue/population.”
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Nonetheless, an emphasis on physical appearance and a lackluster response from her campus counselor convinced Wagner, now 27, that her behavior “wasn’t that serious.” Besides, “you’re always told that being skinny is better,” she remembers thinking on a campus where her peers “were always trying to lose weight.”
By the time she graduated with a bachelor’s degree in biology in 2014, her body had reached its “breaking point.”
“I could feel it,” she said. “I didn’t have energy. I was passing out.”
She initially ignored the physical warning signs, thinking she could “handle it,” and accepted a wildlife-management internship in North Little Rock, Ark. “I like being outside,” said Wagner, whose career goal is to teach and research physical changes in the earth.
But she became overwhelmed by the toll of her illness and started self-harming midway through her internship. “I knew I needed help,” Wagner said, so she checked in to a private in-patient treatment program. She returned home to a bill for around $100,000 from the treatment facility, after it initially refused to accept her insurance.
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The consequences of Baylor’s sexual-assault scandal were still unfolding in the fall of 2016 when Wagner arrived there as a master’s student in geosciences. But her own personal trauma, including a close friend’s death and the stresses of graduate school, pulled her back into the bulimic and anorexic behaviors she’d tried to unlearn at the treatment facility.
In August 2017, she tried to kill herself. “I had given up and accepted I wouldn’t recover,” she said. “I would always have this problem.”
Anorexia is one of the deadliest mental disorders, with many of those deaths suicide-related. Among 71,712 U.S. college students surveyed, those with severe eating disorders were 11 times more likely to attempt suicide than their peers, according to a study published in October in the International Journal of Eating Disorders.
Baylor U.’s Eating Disorders Care and Assessment Team, filled a gaping treatment void in Waco, Tex. From left are Lisa MacMaster, Regina Mastin, Erin McGinty Fort, and Sara Addison.Baylor U.
After Wagner’s suicide attempt, she resumed her classes, still in poor health. She couldn’t sleep. Frequent forced vomiting disrupted her electrolyte count and kept her blood pressure dangerously low. Desperate, she decided to give eating-disorder recovery “one last try.” She made an appointment at Baylor’s counseling center.
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“I don’t think I would be alive right now” if not for Baylor’s Eating Disorders Care and Assessment Team, Wagner said in an interview. The team’s members helped her understand her illness.
On top of individual- and group-therapy sessions with McGinty Fort, Wagner met regularly with a nurse practitioner to discuss changes in eating behavior and physical health. A psychiatrist prescribed antidepressants, and a dietitian monitored her meal plan.
“They weren’t just my health-care providers, they were my support system,” said Wagner, who learned to integrate recovery into everyday life. “They were my source of accountability. They were who I could go to without judgment.”
Not all campus programs are as comprehensive as the one at Baylor, a private university with a $1.3-billion endowment. Sixty percent of 165 college counseling centers that the National Eating Disorders Association surveyed in 2013 — the most recent year for which data are available — reported having at least one eating-disorders specialist on staff. But only 34 percent had a specialized nutritionist, and just 6 percent offered eating-disorders group therapy.
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At many colleges, funding “can’t keep up” with the well-documented climb in reported student mental-health issues, said Ellen Fitzsimmons-Craft, an assistant professor of psychiatry at Washington University School of Medicine in St. Louis.
Persistent misconceptions about the prevalence of eating disorders also contribute to their low priority in campus mental-health conversations, said Fitzsimmons-Craft, a specialist in the field. Campus-counseling staff members have told her “we don’t really have” students with eating disorders. But they do have them, she said. They “just aren’t identifying them.”
A reduced social stigma has bolstered awareness about how to confront suicide, anxiety, and depression among college students, according to a recent report by the Associated Press. The same, however, is not definitively true for eating disorders, said Christine Peat, an assistant professor of psychiatry at the University of North Carolina at Chapel Hill. “Many people, even some health-care providers,” regard the condition as “a disorder of choice — that patients are vain or bored,” she said.
Battling Stereotypes
The barriers of cost and expertise are only part of the problem in eating-disorders treatment. According to a recent study in the journal Eating Behaviors, 86.5 percent of students with risky eating behaviors never seek treatment. The reasons include a lack of time, a preference to deal with it on their own, or a lack of perceived need.
In the various treatment programs she’s participated in over the years, Jennifer Wagner sees a lot of women who look like her: slender and white. Films like The Secret Life of Mary Margaret (1992), For the Love of Nancy (1994), and To The Bone (2017) all portray rail-thin, white, female college students battling eating disorders.
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“I remember watching those and thinking ‘maybe I don’t have an eating disorder,” said Jesi Taylor Cruz, a black woman who struggled with bulimia in college. “Maybe this is me just taking care of my weight, because obviously it’s not happening to anyone but white women.”
When Cruz finally did go to the campus counseling center at the small, private Florida college she attended, she said the therapist seemed genuinely concerned. But the center didn’t have the resources she needed, making Cruz feel “completely helpless.” Now a 29-year-old freelance writer, Cruz said she has a much healthier relationship with food, although she achieved it largely on her own.
Cruz’s experience represents what is known as the treatment gap. Among mental-health problems affecting college students, it’s the widest for eating disorders, said Sarah Lipson, an assistant professor of health law policy at Boston University.
Myths about who is vulnerable to eating disorders are one reason the gap is so big.
“We need to recognize that there’s risk across the student population,” said Lipson, who specializes in eating-disorders research. “We’re neglecting a large population of students that are not female-identified, that are not underweight.”
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Patrick Devenney said he “had no idea a male could get an eating disorder — especially an athlete.” But when he played football at the University of Colorado at Boulder from 2005 to 2009, “restrictive eating and ‘clean eating’ was a way for me to kind of have organized chaos in my life,” said Devenney, whose coach administered weekly weigh-ins. “Everyone looks at you and compliments you with how disciplined you are and how great you look ... but it really was an internal hell.”
Devenney said he didn’t seek treatment until years after graduation, even though he did have access to a team of therapists as a student. The biggest hurdle, he said, was the stigma associated with mental-health treatment. He feared that his coaches would “think to themselves, ‘What’s wrong with him? He’s no longer suitable to play.’”
Expertise Is Key
Distorted perceptions and limited funding both contribute to the dearth of eating-disorder treatment on college campuses. But one of the biggest barriers is the lack of specific expertise — like Baylor’s Erin McGinty Fort has — said Casey Tallent, collegiate outreach director for the National Eating Recovery Center. She works with colleges to establish treatment centers and inform them on protocols, outreach, and risk factors.
The decision by Baylor’s regents to increase funding for the counseling center allowed it to offer comprehensive eating-disorder services. But on a campus of 18,000 students, there are limits to what can be accomplished. The program serves 50 to 60 students a semester, but after that “we have to transition them out into the community,” McGinty Fort said. People with eating disorders, she said, typically require months if not years of treatment to reach a healthy emotional and physical place.
After Wagner’s semester of therapy ended, McGinty Fort connected her with a virtual intensive outpatient program hosted by the Eating Recovery Center. For about six weeks Wagner participated in nightly video conferences with other patients.
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“It was helpful,” said Wagner, who continues to recover as she pursues a doctorate in integrative biology at the University of California at Berkeley, which also offers on-campus eating-disorders services. “But I wouldn’t have been able to get to that point, and I wouldn’t have had those resources if I didn’t have someone like Erin — or anyone else in that program — to advocate for me.”
If you are struggling with an eating disorder or know someone who needs support, call the National Eating Disorders Association Helpline at (800) 931-2237. For a 24-hour crisis line, text “NEDA” to 741741.
Kathryn Palmer is a former editorial intern at The Chronicle. Follow her on Twitter @kathrynbpalmer.