It begins so subtly: a casual comment from a coach about how an athlete’s performance will improve if she loses weight, or a simple observation at a road race that most of the top finishers seem to have no body fat. The seed gets planted, and an athlete becomes convinced that the way to success is through calorie restriction and weight loss. The reality is that inadequate nutrition produces an athlete who is weak and fatigued at best; worst-case scenarios involve chronic injuries, bone loss, organ failure, and in the most severe cases, death.

The secret nature of eating disorders makes it difficult to ascertain exactly how prevalent they are, but two recent studies of college athletes done by eating disorder experts found that at least one-third of female athletes have some sort of disordered eating.

And it’s not just women. A 2002 study by Ohio State University found that 20% of male athletes surveyed thought that parts of their body were fat. Dave Dunham, a world-class mountain and ultrarunner, believes that the competitive nature of racing is a big factor that leads to eating disorders in runners. Dunham struggled with anorexia nervosa for close to a decade and is still experiencing the lingering effects of the disease.

Dunham’s story is probably not unique. After a successful college career, he gradually increased his mileage and noticed his weight dropping. During the same period his performances improved. On the surface it appeared that everything was fine, until he suffered a couple of stress fractures and was forced to take time off from running. Anyone who has been injured knows what this can lead to – intense cross-training and limiting food intake to avoid the weight gain that can occur during a layoff. Dunham found himself cross-training for up to five hours a day and becoming very aware of calories. Once he was able to resume running, the “obsession” with weight and calories didn’t lessen.

“Somewhere along the way, I went from eating to fuel for running to running so that I’d allow myself to eat,” he says. “Then it just got worse. It became a game to see how little I could eat. A victory would be going all day without eating.”

According to Anorexia Nervosa and Related Eating Disorders, Inc. (www.anred.com), this mindset is not uncommon. In many sports, emphasis on thinness and demands for self-discipline lead an athlete to believe he or she is being “good” when food is restricted. Elite athletes may be at special risk due to their belief that their single-minded discipline sets them apart as competitors. Food may be viewed as one of the sacrifices necessary for success. I remember cringing as I heard a friend express admiration for a high school cross-country star who was so dedicated that she didn’t even allow herself a slice of her own birthday cake. In another instance, an ultrarunning teammate of mine said that she couldn’t allow herself to eat a particular type of junk food because she had “only” run a fifty-mile race, not a hundred.

MIND GAMES

What leads to this type of thinking? Opinions vary, but most experts agree that a combination of genetic, social, and psychological factors lead some athletes to cross the line from dieting and excessive exercise to serious, diagnosable eating disorders. Scientists are still researching possible biochemical or biological causes of eating disorders. In some individuals with eating disorders, certain chemicals in the brain that control hunger, appetite, and digestion have been found to be imbalanced. There also appears to be a link between eating disorders and depression, leading researchers to explore how brain chemicals such as serotonin might be involved. Several family and twin studies are suggesting that anorexia and bulimia may be hereditary. Researchers are currently searching for the genes responsible.

Social or environmental factors that contribute to the development of eating disorders include cultural pressures that affect nonathletes as well as athletes. Studies have shown a higher occurrence of eating disorders in Western cultures that place a high value on thinness. The results of a recent Fijian survey demonstrated that key indicators of disordered eating among Fijian adolescent girls were significantly more prevalent after exposure to television. In our society, women and girls especially are given the message that in order to be successful, one must be thin. There is a powerful belief that thinness leads to success, beauty, and ultimately, happiness. The models and actresses who appear on our television sets and stare at us from the covers of the glossy magazines in the grocery store line become thinner each year, sending an unrealistic message of what women “should” look like.

Athletes face even more pressure to be a certain body type. This is especially true in sports that place a high value on low body fat and thinness. In sports like gymnastics and figure skating, coaches and judges often pressure athletes by criticizing them or making reference to their weight. As a high school track athlete, I was told by my coach that if I lost weight, I could shave seconds, maybe even a minute, off my mile time. I weighed 113 pounds at the time. In college, my cross-country team was subjected to body fat analysis. I was oblivious to the issue of eating disorders at the time, but looking back, I’m certain that some of my teammates suffered. A recent anonymous posting from a current NCAA Division I runner on www.letsrun.com, a popular message board for competitive runners, reported that all of the women on her team struggle from various forms of eating disorders.

Repeated exposure to extremely thin athletes has desensitized us to the point at which we no longer notice those who have crossed the line from fit to unhealthy. In fact, typically when an athlete loses weight, she is told that she looks fit.

While many athletes are exposed to the same pressures, certain psychological factors increase an individual’s risk for developing a full-blown eating disorder. Individuals who suffer from anorexia are often perfectionists and high achievers. They also tend to be people-pleasers, making them particularly sensitive to the comments of coaches and others. Often the same characteristics that make an athlete successful can lead to his or her undoing. Kimiko Soldati, an Olympic diver who has been open about her struggles with bulimia, says, “I was a perfectionist, people pleaser, control freak. I was a high achiever and had a high pain threshold.” These are qualities that lead to success in the athletic realm but can wreck havoc if taken too far.

OUT OF CONTROL

Change and control are big issues for individuals prone to anorexia. Eating disorders often emerge as a young female athlete enters puberty. The physical changes that occur during this time can be terrifying for an athlete who has experienced early success, and excessive dieting is one strategy for maintaining a petite pre-pubescent body.

Individuals who suffer from bulimia often binge and purge as a way of coping with anxiety or other uncomfortable emotional states. One trail runner from the West Coast who chooses to remain anonymous talks about how her bulimia increased during the stress of medical school. “Jane”, who had previously used purging to control her weight, found herself binging on cereal and junk foods as a way of relieving stress. The fact that she was studying esophageal disorders and was acutely aware of the dangers to which she was subjecting her body did little to curtail her behavior. “It’s kind of like the oncologist who still smokes,” she says, underscoring the powerful hold that an eating disorder has on an individual.

Unlike Dunham, whose anorexia grew out of his competitive nature, Jane’s bulimia predated her involvement in athletics. She began experimenting with purging during her first year of college, finding it to be an acceptable way to counter the dreaded freshman fifteen. She describes the feeling of empowerment that came from controlling calories in/out so easily. “It was almost an addiction-it was just so easy to eat whatever junk food, cake/sweets/ice cream-whatever, and then get rid of it.” Many bulimics eat very little all day then binge at night. This behavior is easily justified by athletes who claim that eating before workouts makes them feel heavy or tired. At the peak of his disease, Dunham was running several times a day, so that by the time he recovered from one run and began to experience hunger pangs, it was too close to his next run to eat much. “In my mind I wasn’t restricting, I was just doing what I needed to do so that I could run three times a day.”

ADDICTED TO EXERCISE

For athletes with eating disorders, the focus gradually shifts from performance to weight. Weight loss rather than training becomes the key to improved performance. This can begin spontaneously when an athlete drops a few pounds and finds that his or her times improve. But it’s a slippery slope. Once an athlete crosses the line from healthy eating to extreme dieting, it’s only a matter of time before performance begins to suffer. By this time the link between thinness and athletic success is so strong in the athlete’s mind that he or she cannot see that continued calorie restriction will lead to further physical deterioration. Instead, poor performances are met with increased determination to train harder and lose even more weight.

Compulsive exercise is closely linked with eating disorders in athletes. All of us know athletes who seem obsessed with their sport. Once again, in competitive athletics this attitude and behavior is condoned, even praised. In order to reach the highest level in his sport, an athlete must be singularly focused. While friends and family question a runner’s need to head out once more in rain, sleet and snow, the athlete sees this as a measure of his dedication to the sport.

Eventually, however, the athlete reaches the point at which the activity is no longer enjoyable. Working out becomes a necessity rather than a choice. Training begins to interfere with other aspects of life, including work and family. Many compulsive exercisers work out beyond the point of pain. They’re the ones who insist that it’s possible to run through stress fractures. Some have been known to work out in their walking casts. I remember seeing a fellow ultrarunner strenuously doing push-ups and crunches during a post-race awards ceremony. In her mind, running fifty miles that day wasn’t enough exercise.

So how can you recognize if you or someone you know might have a problem with eating and/or exercise? There are a couple of warning signs for exercise addiction. First, is the sport still fun? Exercise should not feel like an obligation. A missed workout shouldn’t create guilt or anxiety. Secondly, repeated comments from family, friends, or your physician that you are hurting yourself and losing perspective should be taken seriously.

There is a lot of shame attached to having an eating disorder, and as a result many athletes with eating disorders can be defensive about their eating. Jane describes going to great lengths to keep her “dark secret." To this day she still hasn’t told her husband about her past struggles with food, even though she has been in recovery for years.

In the end, eating disorders aren’t as much about weight or food as they are about self-esteem. Jane attributes part of her recovery to the discovery of trail running. As she began to spend more time on the trails, her focus naturally shifted toward a healthier lifestyle, including healthy food and nutrition for strong running. Dave’s path to recovery was more challenging and included hospitalization and therapy in an eating disorders clinic.

Recovery from an eating disorder can be as individual and unique as the athlete struggling with it. Treatment for an eating disorder can be successful but it is hard won -sometimes with two steps forward and one step back. As with any problem, the first step is identifying the issue and having the courage to talk about it.