Running in Eating Disorder Recovery
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.