Allie was a dedicated runner. She started running cross country when she was 12, and found she was naturally gifted at the sport. When it was time for college, Allie got a partial scholarship to run Division I cross country. She wasn't an immediate standout, but she worked hard to earn her spot on the travel roster while she balanced her marketing studies. But despite her success and good grades, Allie never felt secure in her spot on the roster. She could sense that each incoming class was full of talented, hungry girls ready to beat her out for her travel spot. Allie had an injury history, and her coach seemed unsure if he could count on her to stay healthy. Her roommate, a fellow team member, had set PRs in multiple distances the season before, which she attributed to becoming vegetarian and losing weight over the summer. Allie wondered if she could achieve similar results if she, too, made some dietary changes. She had always felt just a little too heavy compared to her teammates. Surely this was the answer.
Allie started making changes. She cut out meat and dairy. She said no to ice cream with teammates. She started eating salads for lunch instead of burrito bowls or turkey sandwiches. The scale went down, and Allie felt like she was doing everything right. Teammates and coaches told her she looked fitter and praised her dedication. But at her next meet, Allie felt like her legs had no pop. She didn't advance to the finals in her best event. Allie was frustrated. If I'm thinner, I'll run faster, she thought. She just needed to try harder. Allie started skipping breakfast, figuring she'd lose weight faster if she didn't eat before she ran. She started drinking caffeine to suppress her appetite, and weighing herself daily to stay on track. When she stopped getting her period, she felt like it was proof she was dedicated enough to her sport.
This past week was National Eating Disorders Awareness Week. As a dietitian who works with athletes, I often hear stories like Allie's. They start off wanting to make a few changes, just to get a little fitter, a little lighter. But it can quickly escalate into something much more serious and dangerous.
Despite the number of coaches and fitness professionals out there who claim athletes don't have issues with food, I can assure you that is not the case. Eating disorders in athletes are not uncommon. According to one study of Division I NCAA athletes, 1/3 of females reported symptoms putting them at risk for anorexia nervosa. As many as 84% of collegiate athletes report problematic eating or activity behaviors, such as bingeing, fasting, purging, or use of weight loss supplements. Prevalence tends to be especially high amongst athletes in aesthetic sports (gymnastics, figure skating), endurance sports (triathlon, ultrarunning, distance running), and weight-based sports (wrestling, rowing).
Athletes are subjected to a rigorous and high-stress environment. Competition, whether amongst teammates, friends, or cross-town rivals, is everywhere. And your body is your success or failure. How strong you can get, how fit you can be - this determines whether you give yourself the best chance to win... or whether you fail. Throw in the ways that diet culture has invaded athletics, and you have the perfect recipe for an eating disorder cocktail.
Here are a few key things to know when it comes to eating disorders and athletes.
1) You can't tell how healthy someone is by looking at them
This applies to everyone, not just athletes, but it's an extremely common and problematic misconception. The stereotypical "eating disorder patient" may be a thin white girl, but eating disorders affect all ages, genders and body types. You do not have to be underweight to have an eating disorder. In fact, less than 6% of eating disorder patients are diagnosed as underweight. Futhermore, according to the National Eating Disorders Association, 25% of those with anorexia nervosa are male, and they tend to have more complications and later diagnosis due to the misconception that men don't get eating disorders.
Aside from eating disorders, it's important to note that appearance doesn't determine how fit or unfit someone is. Some people who have a six pack and toned muscles are struggling with health. Some people who have a higher body weight work out regularly and eat vegetables. Some people lose weight due to depression or chronic illness. The best move is to keep your eyes on your own paper and avoid making assumptions about others' weight or health based on how they look.
2) A lot of normalized behaviors in sport are actually disordered
One of the reasons athletes are more susceptible to eating disorders/disordered eating is that a lot of disordered behaviors get normalized in sport. Counting macros or calories religiously, frequent weigh-ins, and cutting out food groups are all accepted (and sometimes encouraged) behaviors in sport. Add in a dose of wellness culture - things like fad diets, sketchy supplements, and fasted training - and you can understand the pressure athletes face to micromanage their diet and training.
This is exacerbated by the competition and comparison that springs up between teammates, and by coaches who fixate on weight or appearance as a metric for health or fitness. By promoting a certain body composition and encouraging athletes to "lean out" to improve their performance, coaching staff can inadvertently cultivate a disordered mindset. Meanwhile, the very mental strengths that make an athlete good at their sport - competitiveness, commitment, pursuit of excellence - can easily slide into traits that further an eating disorder - obsessiveness, perfectionism, and denial of discomfort.
3) You can participate in sport and be in recovery
As a dietitian who works with Division I athletes, I often run into a reluctance from student-athletes to open up about what's going on. They don't want to get help, because they're afraid they will get pulled from activity. This can happen at any level of sport, too. It's extremely tempting to think you can just keep managing on your own, rather than risk taking a forced break from activity.
My goal is always for athletes to be able to participate as much as is safe. Recommending a break from activity is sometimes the best course - especially if an athlete is injured, needs to restore weight, or is using exercise as a way to "burn off" energy consumed. But often athletes can still participate in some or all of their sport during the recovery process, under the guidance of an eating disorder-informed treatment team. They may be modifying some activities, and they may be asked to increase energy consumption to account for what is used during training, but I find that participation in sport can often be motivating and beneficial for athletes in recovery. It helps ground their identity beyond the eating disorder, and reminds them of what they are working towards.
4) ED recovery is not linear
Eating disorder recovery is hard, y'all. Many eating disorder patients require multiple attempts with treatment over the course of their lives. Especially in the beginning, eating disorder recovery can feel impossible, as an athlete is typically challenged to comply with guidelines that are very uncomfortable for them. Watching your body change during treatment can be difficult as well. And since many athletes develop disordered eating behaviors as a way to cope with other stressors, taking away those coping mechanisms can intensify feelings of anxiety and urges to restrict or purge.
Even the most committed athletes struggle to stay engaged in treatment from time to time. The eating disorder can feel much easier and safer in the moment. By consistently choosing to address challenges in the moment, without focusing on choices made in the past or future, and by continuing to show up for treatment even when it's hard, athletes can start to see more and more victory over their disordered thoughts and progress in their recovery process.
5) You can be successful after an ED
Athletes (and coaches) sometimes fear that if they get treatment for an eating disorder, that will be the end of their competitive career. However, these fears are unfounded. From developing the mental strength required to overcome such a serious mental condition, to the enhanced capabilities of a body that is appropriately fueled and nourished, athletes can not only return to sport at high levels but succeed competitively after an eating disorder. Look no further than some of the athletes who have been vocal about their recovery process - cross country skier Jessie Diggins, OCR and ultrarunner Amelia Boone, or figure skater Adam Rippon - who have since gone on to win international accolades.
Eating disorders can be persuasive in convincing athletes their success is dependent on maintaining their low body weight or minimal intakes - but the truth is, bodies function best when they are adequately nourished. The earlier in the process the disorder can be treated, the more likely it is that an athlete will be able to achieve prolonged success following recovery.
Eating disorders are pervasive in athletics, and often go under-reported until symptoms are severe. Early treatment is a key factor in successful recovery. If you are an athlete struggling with your relationship with food or exercise, or if you know someone who is, I encourage you to seek help from a qualified professional like a therapist or an eating disorder dietitian. And for all of us, we can do our part to reduce eating disorder incidence by promoting healthy bodies over restrictive diets or emphasizing body weight, by demonstrating a positive relationship with food, and by shutting down negative body talk amongst friends and teammates. By continuing to promote a positive relationship with our bodies and our sports, we can encourage others to recognize early red flags and avoid many of the pitfalls that can start the slide into disordered eating as an athlete.
If you are an athlete struggling with an eating disorder diagnosis or the symptoms of the Female Athlete Triad, I invite you to contact me for counseling information and wish you all the best in your recovery.
4) Eating Disorders in Sport. Thompson, Ron A. and Sherman, Roberta Trattner. Taylor & Francis Group, New York, NY. 2010.