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This past week, Feb 22-28, was National Eating Disorder Awareness Week. “Eating Disorder” is an umbrella term that encompasses the diverse conditions of Anorexia, Bullemia, Binge Eating Disorder, Orthorexia, and the spectrums between all of these diagnoses. Eating disorders have the second highest mortality rate of all mental illnesses, surpassed only by opioid addiction. Anorexia Nervosa has a mortality rate of 10%, with 1 in 5 of those deaths due to suicide. These conditions affect men, women, adolescents, adults, BIPOC, and members of the LBGTQ+ community, an important fact to acknowledge as it is often seen as a vanity disease of young white women. This stigma can be extremely dangerous, because those “less common” populations are less likely to be taken seriously and offered the help that they desperately need.
Eating disorders are more prevalent in competitive and elite-level sports, particularly in sports where aesthetics, weight, or a lean physique are favorable. This, of course, includes our beloved endurance sports of running, triathlon, and cycling. Studies have shown that nearly 1/3 of female NCAA division 1 athletes reported signs and symptoms of subclinical eating disorders, and a similar percentage of men in weight class and aesthetic sports such as wrestling or bodybuilding (running isn’t specifically mentioned in the studies, but male distance runners also exhibit these symptoms).
Severe food restriction and malnourishment can cause a number of multi-system health challenges, and while musculoskeletal conditions and overuse injuries may not be the most critical of these, athletes with eating disorders are twice as likely to incur injury in sport participation.
It is important to note that Eating Disorders (ED’s) occur on a spectrum, and even mild disordered eating can increase injury risk, particularly at higher training levels. Even if eating habits don’t necessarily result in physiological changes or impact one’s health, poor relationship to food/body increases anxiety and decreases training enjoyment.
A common misconception about ED’s is that food restriction is always driven by vanity and desire to look a certain way. The truth is that while pressure to look or perform a certain way can force a strong undertow in these conditions, ED’s are rarely rooted exclusively in aesthetics.
Using my personal experience as an example, a poor relationship with my body was the symptom of a much deeper self-loathing and sentiment of “not enough”. The extreme behavior was driven by lack of control, obsession with success, and utter discomfort in my own skin. I couldn’t control the external circumstances or success in other areas of my life, so the numbers I counted: the calories I ate or the one on the scale filled that void. This basic structure of controlling something-- anything-- overflowed from food to the stories I told myself, the amount of training I did, and risk avoidance. The list could go on and on. I never felt enough, and I ensured that my body wasn’t enough, by shrinking it down to as little as possible.
Even if obsession about body image and weight is the primary decision driver, it is not the culprit of an Eating disorder. Food restriction becomes a coping mechanism when one is unable to deal with emotions in any other way. For me, it was always worthlessness, perfectionism, and fear of failure. This narrative of hopelessness perpetuates a poor regard toward well-being, and subsequently the ignorance of the severe decline in health that results from starvation.
Depression and anxiety often occur in tandem with ED’s, and can be thought of an “emotional starvation” of sorts.
Specific to running, a rampant misconception is that lighter is faster. Many stories have surfaced recently about toxic training environments and errant pressure on both female and male athletes to weigh a “magic number” for optimal performance. Health is faster than thin. No amount of short-term success should supercede this idea.
Perhaps the most challenging aspect of ED recovery is that one must learn to exist with their “drug of choice”-- food-- still present. Complete abstinence is not possible, and rekindling the damaged relationship between the brain, body, and food can be incredibly difficult to understand from the outside. The fear of certain aspects of nutrition can feel the same as life-threatening danger. I remember times where eating certain types or quantities of food felt like walking a tightrope over the grand canyon. Staying on the tightrope was imperative, and that meant protecting what I ate.
Relationship to exercise and training in these circumstances is also important. Personally, once I was out of the critical phase of food restriction, I had a lingering stranglehold on exercise to help me cope and feel good about fueling my body. This became a big problem in times of injury or when life would get in the way. I really leaned on this throughout college and graduate school, and my running performance declined. I was no longer running for stress relief or race goals, but rather running away from ED relapse. An important series of questions I had to ask myself was “Would I run if it had no impact on my bodily appearance? Would I run if it didn’t affect food intake? Would I run if there were no race goals to chase?”. I thought long and hard, and while the answer was unequivocally “Yes”, there was an aspect of running and training that was self destructive, a way to pacify anxiety. Once I began to exclusively look through a performance and health lens, my attitude toward training and racing drastically changed. Excitement over how good I could be usurped the need for control. I hired a coach, set goals that excited me, and focused on smaller improvements. Truly giving up control of exercise, for the first time in my life, was a huge step for me. I proved to myself that it can be done, even if it was scary. A mantra I use now is “You can be afraid and do it anyway”.
Running while in ED recovery requires frequent self-reflection and pattern interruption, just as with any mental illness. My biggest piece of advice here is to be honest with yourself every time you lace up your shoes. You have to do it for yourself. You have to set goals that are for you, not anyone else. Run like you love yourself. Eat like you love yourself. Speak like you love yourself.
Professional help is imperative to repair these relationships between food, exercise, and yourself. Reading books, blogs, listening to podcasts, etc. are all helpful along this journey, but no one should go it alone. A team of a therapist, nutritionist, and small support system is important for short and long term health. I’ll include some resources below. My inbox is always open to anyone struggling: Kacy@precisionpt.org.
Keep going you got this!
Dr. Kacy Seynders, PT, DPT
REDS (A previous blog with signs/symptoms and additional resources)