My story

This first section is just me blathering on about myself. It’s probably pretty boring, and definitely not very informative, so feel free to skip over.

I first developed signs of disordered eating around Year 11/12. Looking back, there are many factors I can recognise as contributing to this – perfectionism and a need for control, ‘bad influences’ (i.e. a friend to eat ‘healthy’ with or a parent always on a diet) and a general lack of self confidence. However, there is one cause I want to talk about in more depth and that is sport. (I mean it is the point of the post).

Around this age, I had only fairly recently got into running ‘properly’ and had little background in high-level sports, meaning I had zero knowledge of nutrition, recovery or even proper training. I remember going to track meets and seeing all these slim girls running fast and the idea of weight and performance began to worm its way into my head. These thin girls ran fast, so I needed to be thinner to be faster…right? Another distinct memory I have was of asking one of the better girls on our team what she ate before our evening sessions. Her response, as I remember it (although maybe this has been distorted in my head over the years) was ‘nothing or maybe a bit of toast but I often throw up anyway’.

Anyway, things went a bit downhill – I lost weight, I lost my period and I lost the joy of running. Thankfully, my mum intervened and I stopped running completely for a while. I got ‘better’ and off to university I went. But here the problems came back. This relapse had many of the same triggers as before but somewhat amplified by the confusion and stress that is starting university (especially in the pressure cooker that is Oxford). At this time I also started rowing. Looking back it literally pains me to think how I ‘wasted’ my first couple of years as a rower not fuelling myself properly but hey, we live and we learn.

However, eventually I credit rowing for giving me the tools to overcome my (technically I think always subclinical) eating disorder. It is (generally) a sport that celebrates size and strength and it taught me to view my body for what it can do, not how it looks. It taught me to be brave and bravery is definitely something you need in recovery. Even now, it is now the one thing I can always rely on to keep me on the right tracks if I’m having a bad day.

In my fourth and final year at Oxford, I found myself feeling confident enough in my recovery to join the university lightweight rowing team. With this weight once again became an emphasis in my sport. Fortunately, I was better equipped this time and I made it through relatively unscathed. I was lucky to be coming up to weight all season and I had learnt how to block the Bad Thoughts out, but I know the general atmosphere of focus (and sometimes obsession) on weight and food would have been destructive for me only a year or two earlier. This has all left me very unclear on how I feel about weight categorised sports and their role in eating disorders, but I wouldn’t change my decision to get involved in them for the world.

Okay, enough about me, now onto some actual factual information.

Some statistics

In a study of Norwegian athletes (1620) vs. a control group (1696), the prevalence of individuals with clinical or subclinical (i.e. exhibiting behaviours or thoughts associated with eating disorders without meeting clinical diagnostic criteria) eating disorders was around three times that of those in the control group (13.5% vs. 4.6%). The frequency was highest for men in sports where athletes must work against gravity, and for females in aesthetic sports. The statistic for females in aesthetic sports was a terrifying of 42%.

Another study focused on elite female athletes (552 athletes vs. 448 controls) and used an eating disorder questionnaire, interview and clinical examination to evaluate the prevalence in each population. It found around 18% of athletes vs. only 5% non-athletes were diagnosed. Again more than a three times increase in prevalence.

These are just a couple of studies but there are many more which give evidence that this is a real problem. A problem we need to examine the underlying causes of before we can think about how to help.

So, more generally why is this happening?

Becoming the best in your sport is all about honing every tiny detail. It is about perfecting every aspect of your training, recovery, technique and physique. Undoubtedly, one aspect of this is optimising your body composition – a process that necessarily requires you to think about your diet and gives you an awareness of numbers that most people don’t worry about, such as body fat percentage. Marry this with a ‘win at all costs’ mentality (even if the cost is your mental or physical health) which is common in the sporting world and it’s not surprising we see issues.

And there are extra pressures from certain sports. This is reflected in studies, such as the Norwegian one. Some examples of this are:

1. Sports where an individual is working against gravity such as running, cycling and jumping:
   The physics says that less mass means faster speeds / greater heights are achievable. Some coaches may put pressure on athletes to lose body fat, in order to improve their performance.
2. Aesthetic focussed sports such as gymnastics, dancing, figure skating etc:
   In these sports athletes’ bodies can come under scrutiny for not only what they can do, but also how they look. It is unsurprising that this scrutiny, as well as comparison between athletes, leads to disordered thoughts and habits.
3. Sports that literally require you to be certain weight to compete such as weight categorised combat sports, lightweight rowing, weightlifting etc:
   Athletes must be a certain weight to be allowed to compete and this can lead to them pushing their bodies to unnaturally low weights or undergoing rapid weight loss pre-competition. For athletes who don’t naturally sit at their competition weight they may enter a process of weight cycling (i.e. the process of repeatedly losing and gaining weight).

I think there is also a certain unique struggle that younger athletes face. Their energy demands are high, often significantly higher than their peers whom they spend a huge amount of time with at school.  As they enter their teenage years, they are also at a stage where peer pressure can have a huge impact and they are likely to be becoming aware of ‘diet culture’ for the first time. Without proper education and support, this may lead to shame or embarrassment about how much they are eating. Yet, they are not only training hard but going through hugely important developmental changes and thus have even greater need for proper fuelling.

I also believe that there is an element of high level sport attracting certain personality types. Perfectionism, hard work and even a slight element of masochism are traits that are almost needed to succeed. These are the very same traits that have been linked to a higher risk of disordered eating. However this can only go part way to explaining the increased risk.

Negative Effects

Part of what makes weight management in sport such a difficult topic is that athletes may see an initial improvement in performance as they begin to lose weight for all the reasons mentioned above. However this improvement is unlikely to last.

RED-S (Relative Energy Deficiency in Sports) is the new name for the female athlete triad, but inclusive of men and a greater range of symptoms and is often a direct consequence of eating disorders in sports.  It is essentially an insufficient calorie intake when compared with calorie expenditure; hence athletes end up in a negative energy balance. Three main signs, which gave the name female athlete triad, are: disordered eating, loss of period and low bone density. However symptoms of RED-S extend to gastrointestinal problems, immunological issues, psychological problems and more.

The end result is always the same: injury and illness. One such injury is stress fractures as the athlete’s bones are no longer able to take the strain of their training. I had one if these at age 7 and I can tell you, even for a kid who doesn’t care too much about sport they’re not fun. For an athlete suffering repeated stress fractures, they can be career ending. If RED-S occurs at key developmental stages, poor bone health and other problems are likely to affect the individual for the rest of their life.

The rapid weight loss and weight cycling common in weight categorised sports also come with their own host of negative effects. Rapid weight loss is generally induced by severe dehydration and taken to the very extreme this can literally kill you. Even not taken to the extreme this is pretty terrifying to witness and is not something anyone should have to put their body through. Weight cycling has also had proposed links to impaired immune function, increased risk of injury, impaired growth, eating disorders, cardiovascular disease and obesity later in life.

Finally, as with any individual with an eating disorder, an athlete consistently under-consuming food could put them at risk of deficiency diseases. They are lacking sufficient quantities and perhaps sufficient variety of food and thus are likely to be lacking in certain micronutrients.  Some of the most common deficiencies for athletes are Vitamin D and calcium (essential for bone health), B vitamins (essential for energy production and a range of other functions) and iron (needed for oxygen transport).

What can we do?

As with all mental health problems, the first thing to do is simply to talk about it. We must educate coaches, parents and athletes. We must make information on signs and symptoms, the risks and how to provide or seek help widespread. I can see that these conversations are starting to open up. In the running world, Mary Cain, an American middle distance runner, has recently come forward with her experience. She has told the world about how her coach encouraged her to push her body to a size that was totally unhealthy and ultimately ended her running career.

We also need to change how we speak and act on a societal level. We need to create a culture which promotes body confidence and a focus on all the hundreds of ways to improve athletic performance that come before losing a few pounds. Sports that traditionally focus on aesthetics need to rethink this focus. We need to change how we talk about food and nutrition by focussing on the benefits of food, never labelling a food as bad (how can a food, which is after all just an inanimate object, be bad anyway?).

Do I think we should we get rid of weight categorised sport? My personal view on this is no. Weight categories can give a platform for smaller athletes to excel in sport. We just need to make sure athletes are not being encouraged, or even forced, into a weight category that does not fit their body. In terms of trying to prevent rapid weight loss practices more stringent rules and regulations could be introduced into sports to make this process more difficult. We also need to make sure athletes who can safely lose some body fat are given the support and information to do it safely and without it becoming a triggering experience for them and those around them.

I definitely don’t have all the answers but I do know health needs to come first. A win at all costs mentality may get you places. Or it may end your career or even your life.