After years of running competitively, the young college graduate was training and preparing herself for the upcoming Olympic Trials. The athlete marked the upcoming day in her calendar and began to self-train. She took before and after pictures of her body, charted everything she ate, researched the best American runners and what they weighed and even searched, “How do I lose weight?” on the internet.
Unintentionally, Esther Atkins, a U.S. marathon champion, started to adopt self-destructive habits in an effort to be the best, strongest, leanest athlete on the track.
“A running career has added body-image pressure,” Kate Grace, U.S. Olympian and Nike track athlete, said in a blog post. “Sponsorships involve racing in skimpy uniforms, as well as photoshoots and other sports modeling. While it’s billed as empowering, and it can be, it didn’t feel that way during that period. I more than once burst into tears from the idea of having photos taken; I was so uncomfortable in my skin.”
Research has shown up to 47% of elite female athletes in “leanness sports” — ones that emphasize size, such as running — have experienced eating disorders, as compared to the 21% of the randomly selected control group of women who are not elite athletes. Efforts are being made to raise awareness of the issue and help athletes — for good reason: the National Eating Disorders Association (NEDA) estimates 30 million people in the United States suffer from an eating disorder at some point.
“Eating disorders are incredibly prevalent,” Lauren Smolar, the director of programs at NEDA, said. “We tend to say everyone knows somebody that has struggled with an eating disorder and when you think about that, that really rings true.”
A study by Craig Johnson and other researchers looked at more than 14,000 NCAA student athletes from 11 Division I schools in 11 sports. Johnson and his team surveyed the athletes to analyze whether they experienced any type of eating disorder throughout their lifetime.
Results showed the frequency of purging behavior (vomiting, laxatives or diuretics) throughout the athlete’s lifetime was almost 18 percent higher in females than males. The results showed that of the women who engaged in purging behavior, the most common behavior was vomiting to lose weight. It also appeared that most of these females did it on a monthly, weekly or daily basis.
“All an athlete wants to do is what they love and participate in the sport that they probably have been doing for a really long time and are good at,” Simin Levinson, Clinical Associate Professor of Nutrition in the College of Health Solutions at ASU, said. “Treatment from a performance perspective sometimes really resonates with an athlete that suffers from an eating disorder: talking to them about getting back to training, being stronger, fewer injuries, having great energy, good recovery, etc. I think helping the athlete go through that visually and seeing themselves getting back to the sport that they love is really helpful part of the therapeutic process.”
The Female Athlete Triad is an interrelationship between menstrual dysfunction, low energy availability and decreased bone mineral density. Levinson said the female athlete triad can be dangerous to female athletes and their health. The female athlete triad affects the body by breaking down essential functions needed to maintain a healthy hormonal balance. Levinson talked to a group of collegiate athletes at Grand Canyon University about how important it is to have a good understanding of the danger it brings.
“One of the students came up to me afterward and said, ‘I haven't had a period in 8 months, and I just thought I was lucky or that it wasn't a big deal,’ ” Levinson said. “I said, ‘No, that is actually a sign that you are probably not taking in enough energy.’ She then talked about being tired, falling asleep in class, and not feeling like she had enough time to eat. And so, sometimes, it's just a big strategy to help students understand how important that is.”
A study led by Katherine A. Beals looked at a group of 93 elite women runners. The researchers found at least 82 percent of the group reported a history of one of the following: anorexia nervosa, binge eating, bingeing and purging, and disordered (undefined) eating practices.
“It all began with this thought that my appetite was ‘broken,’ ” Rachael Steil, author of the self-help memoir “Running In Silence,” wrote in a blog post. “That, maybe, if I just adjusted what and how much I ate, I would be ‘right’ again. I made these changes and lost weight. With weight loss, came the fastest times I had ever run in my life.”
Steil was a collegiate runner at Aquinas College, and she dedicates her time to spread awareness and be an advocate for athletes who struggle with eating disorders, just as she did. Steil works to encourage athletes to tell their stories about their eating disorders and all of the consequences they faced.
“These issues surrounding food were not resolved by finding ‘discipline’ and ‘willpower’ (as I thought they would),” Steil wrote. “They were healed by realizing that binge eating was an eating disorder and that restricting food had played a role in its development. They were fixed by going through a long, intense recovery process to accepting my body as it was, and understanding that happiness couldn’t just be found in fast performances or my sole identity as a runner.”
Competitive runners have helped shed light on the issue of eating disorders associated with sports. Atkins is among those who have struggled with eating disorders and have decided to share their stories publicly in order to raise awareness of the dangers. Atkins has had a good relationship with food and sport, but she is aware of how dangerous it can be for those who don’t have the same outlook as she does now — such as her sister.
So how can female athletes who are experiencing similar tendencies work to better their awareness on the dangers?
Two years ago, three runners, Heather Caplan, Alexis Fairbanks and Samantha Strong, created a nonprofit organization, Lane 9 Project, that is dedicated to bringing awareness to the prevalence of eating disorders among athletes. All three women experienced hypothalamic amenorrhea, the lack of menstruation, as a result of harmful relationships with food and sport.
— Lane 9 Project (@lane9project) March 21, 2017
The trio have created a virtual community where those with similar experiences and struggles can find support. They work to remove stigmas and stereotypes and spread awareness of the severity of how dangerous disorders can be.
“I still have people tell me, ‘You’re a 20-year-old woman; this is normal. You’re supposed to feel self-conscious about your body,’ ” Samantha Strong said in a Washington Post article. “With Lane 9, we tell people, ‘No, you don’t have to live with this. You can love and cherish and support your body -- nutritionally, physically and emotionally — and do so in a healthy way.’ ”
Eating disorders and unhealthy body image issues can stem from different factors, but recent studies indicate a combination of genetic and environmental factors playing significant roles.
Megan Kniskern is a lecturer at ASU who developed the first course at the university on eating disorders and addictions. Kniskern is passionate about creating awareness for a healthy body image and eating disorders. She talked about how eating disorders typically result from a collection of experiences.
“The tricky thing is is it comes to somebody acquiring an eating disorder, it's almost never just one thing happening,” Kniskern said. “It is usually a really significant compilation or series of events that creates a perfect storm for whatever is going on for that person.”
Both Atkins and Caplan point to society playing a key role in contributing to eating disorders. However, they say society is starting to move toward a positive outlook on body image.
“There are several movements coming together at once, like #metoo and body positivity, that are removing the shame and allowing people to tell their stories,” Atkins said. “We need more of that.”
Some protective factors have been recognized by NEDA in order to help eating disorders among athletes. Their recommendations include:
- Positive, person-oriented coaching style rather than a negative, performance-oriented coaching style
- Social influence and support from teammates with healthy attitudes toward size and shape
- Coaches who emphasize factors that contribute to personal success such as motivation and enthusiasm rather than body weight or shape
- Coaches and parents who educate, talk about and support the changing female body
“It is really hard for athletes, especially ones in sports that tend to focus on weight being relevant to their performance,” Smolar said. “One of the reasons we do suggest, and actually have a coaches tool kit for coaches related to supporting people who may be struggling with an eating disorder or how to cover that topic, is because we understand how sensitive that content can be.”
Kniskern said society plays another factor in developing an eating disorder. Our society has created a culture that makes individuals more susceptible to struggles with self-doubt.
“There's also an aspect of the culture that is sports,” Kniskern said. “Athletes aren’t often the ones that are being listened to. There’s a combination of a coach’s mentality, a family’s mentality, a trainer’s mentality. All of those outside influences can really guide an athlete on their journey.”
In order to decrease the prevalence of eating disorders in our society today, sources such as social media awareness, education and starting the conversation early need to be implemented. Bringing awareness to family members, friends and especially coaches is important in the process.
“We know that social media, even unrelated to athletes, certainly can put pressure on people,” Smolar said. “I think that often, social media is portraying somebody’s best self, so it’s the same thing with athletes, in particular when we are talking about accounts on social media that are portraying fitness, that a lot of times they are really just showing somebody’s best self.”
Jody Whipple, a dietitian who works with Penn State athletes, said while disordered eating is different in every case, some risk factors are worth noting. Whipple said that, especially in adolescent years, family influence is huge. He advised parents to take a “no dieting approach” with their children.
“Family meals are an important place to exhibit this and communicate it,” Whipple told NBC. “If there is any history of disorder, it is especially important to put those glasses on and use them for prevention.”
Whipple explained personality is also a factor in the prevalence of disordered eating. Whipple said individuals who tend to have more of a “perfectionist” personality are more prone to a disorder; whereas an individual that is laid back is more flexible in his or her thinking, this being more protected.
A study led by Simon B. Sherry, a professor and director at Dalhousie University, examined whether the personality trait of perfectionism and bulimia nervosa had any type of link. Their results showed perfectionists have higher odds of developing bulimia and are at greater risk for developing the disease as time passes.
“Our results suggest treating perfectionism as early as possible may help to stop the development of bulimia nervosa,” Sherry said in a report on The Conversation. “It is time to go beyond entirely symptom-focused treatments. Building on our research, clinicians may want to assess and to treat both bulimic symptoms and underlying perfectionism.”
When outside influences come into play, sports coaches can have an impactful role in an individual’s life. According to NBC news, Whipple said in many sports, coaches have created toxic environments too often for their athletes. Whipple said it is important that coaches emphasize success as a whole person, as opposed to tying it into performance only.
In many sports, leaner is considered to be better and when coaches focus the conversation away from this stigma, the athletes will have a better chance of having a healthy body image.
“There are different types of female athletes,” Levinson said. “There are certain types of female athletes that might be more prone to eating disorders and they tend to be in those sports that are more aesthetic to where there is judgement and emphasis on the figure and the body.”
The role of media also plays a role in body image and how people perceive the way they look. There are several social media influencers who link restrictive eating with exercise, for the wrong outcome. As a result, athletes see these influencers and succumb to comparing their bodies.
“Social media is starting to really represent itself in the research realm of having some pretty significant impact on how we view ourselves,” Kniskern said. “And for the most part, its not coming back positive.”
Kniskern said social media promotes a “perfectionistic” portrayal of people’s bodies and lives. She talked about how it can be a breeding ground for a lot of comparison and competition, regardless if an individual is an athlete or not.
“Comparison is a trap,” Fairbanks wrote in an Instagram post. “I cannot stress how many times I’ve fallen for the trap of comparison whether in real life or on social media. Comparison exacerbates even our smallest doubts and leave us painfully questioning our value and self-worth.”
In efforts to decrease negative body images on social media, the Lane 9 athletes promote unrestricted eating on platforms such as Twitter and Instagram. In addition, NEDA launched a social media campaign, Come As You Are, that highlights a movement toward inclusivity in the greater eating disorder community. This campaign sends a message to individuals who are struggling with body acceptance and eating disorder recovery.
“It's great that there are people who are both passionate about fitness but also understand that there are some harmful components about the culture and are trying to do their part to change it.” Smolar said.
As awareness increases on this issue, more athletes are prone to share their stories and embrace the help they need to overcome their disorders. It is a work-in-progress, but society is starting to recognize this issue more every single day.
“Perhaps one of the most powerful aspects of recovery is being honest and staying connected to support,” Crystal Karges, Registered Dietitian Nutritionist at Eating Disorder Hope/Addiction Hope, said in an interview. “Because of the nature of the eating disorder, it is easy to go through the motions or fall back into patterns of isolation. Having accountability and consistent support can help an individual stay committed to their recovery process and continue progressing forward.
Logan Huff is a senior journalism major at Arizona State University
Editor’s note: For the coming 2019-2020 academic year, the Global Sport Institute’s research theme will be “Sport and the body.” The Institute will conduct and fund research and host events that will explore a myriad of topics related to the body, including nutrition.