Content warning: eating disorders, disordered eating, depression, suicide
Written by @movingwithsoph 10/03/21
Last week was Eating Disorders Awareness Week (#EDAW) in the UK and there was a lot of discussion on social media, particularly Instagram. It might have been overwhelming to consume so much important content, but hopefully this blog might be able to help you better understand the relationship of eating disorders with exercise.
Background of Eating Disorders:
Eating disorders span across many areas, but often the focus is only on the restrictive behaviours like anorexia nervosa or orthorexia. However, eating disorders also take into account things like obesity, binge eating disorder, and disordered eating– as the sports dietitian Renee McGregor says, it is anything related to food and exercise that is going to create anxiety and stress (1).
Eating disorders are mental illnesses which present as unhealthy attitudes to food that can take over your life and make you ill (2). The most well-known disorders are anorexia and bulimia nervosa; 10% of eating disorder cases are anorexia and 40% are bulimia (3). Anorexia is when someone tries to keep their weight as low as possible, and one way to do this is by over exercising (4). Bulimia is when someone binge eats and then purges, and one way they can purge is by overexercising (5).
Although those are the disorders that come to mind most frequently, more people actually live with binge eating disorder (BED) than either anorexia or bulimia. One in fifty people have BED and that was why it was the theme for #EDAW this year, because more awareness needs to be raised about it (6). There are also the lesser known, but equally important, disorders like avoidant/ restrictive food intake disorder (ARFID), Other Specified Feeding or Eating Disorder (OSFED), and many other eating and feeding problems.
Eating disorders are often interlinked with other mental illness like depression, as one in three of those ever affected by BED considers taking their own life, and one in six attempts suicide (6). Eating disorders are very complex issues and have the highest mortality rate of all mental illness, which is why specific days and weeks exist to campaign for more awareness and support.
Eating Disorders and Exercise:
The sport and fitness industry has played a large part in perpetuating idealistic body shapes and sizes that are unattainable to the majority of people, with things like calorie trackers. In the sporting world, athletic competition is a key contributor to psychological stress. Many athletes experience eating disorders when the pressures of competition combine with society’s focus on bodies, particularly the cultural emphasis on thinness. This harmful combination of factors can lead to an increased vulnerability in athletes for developing disordered eating.
A study of high-performing female athletes in America found that one-third reported attitudes and symptoms placing them at risk for anorexia (7). Men are very much at risk too, as shown recently by those in the public eye like Freddie Flintoff, and those in sports which place an emphasis on weight are particularly at risk, such as wrestling and running.
Some risk factors for athletes include:
- Sports that emphasise appearance, weight requirements and muscularity (e.g., gymnastics, diving, or bodybuilding)
- Sports that focus on the individual rather than the entire team (e.g., running or figure skating, versus basketball or football)
- Training for a sport since childhood or being an elite athlete
- Overvalued belief that a lower body weight will improve performance
- Coaches who mainly focus on success and performance (not the athlete as a whole person)
Some protective factors for athletes include:
- A positive, person-centred coaching style (not performance-focused)
- Social encouragement and support from team-mates with healthy attitudes to size and shape
- Coaches who emphasise positive factors of success e.g., motivation and enthusiasm (not body weight or shape)
Three risk factors that can particularly affect a female athlete’s vulnerability to developing an eating disorder are:
- Societal expectations on the thin-ideal
- Performance anxiety
- Negative self-appraisal of athletic achievement
A recent paper found that 73% of female athletes felt pressured by their sport to alter their physical appearance to conform to gender ideals, with 15% engaging in disordered eating practices (8). 22 athletes reported being told to lose weight by their coach for performance related reasons, and that the comments made them feel unhappy with their body. As shown above, that is a risk factor for disordered eating and very harmful for the athletes.
Athletes in recovery:
An interesting article written by Carly Reid (former UCLA swimmer & eating disorder advocate) shared some ways that athletes can use their competitive nature to actually help them recover from an eating disorder (9). Here are a few she mentioned:
- Technique – focus on your technique – but for recovery. How can you make each meal different, and how can you learn new coping mechanisms throughout the day?
- Community– connect with others in recovery, follow social media accounts, listen to podcasts, read books.
- Discipline– stay disciplined with your recovery, be honest with yourself and those helping you – they want you to succeed in your recovery.
- Break a record – how many days can you let your body rest and relax?
The best thing we can do is educate ourselves so that we can support those around us (like team-mates and training buddies), but also maybe notice changes in our own behaviour and seek help as soon as possible.
If you think you might need help, or want to support someone, you can contact the charity Beat in 4 ways:
1. Phone: Helpline 0808 801 0677 – Studentline 0808 801 0811 – Youthline 0808 801 0711
2. Webchat: if you don’t want to speak out loud or the phones are busy
3. Email: for out of hours / non-urgent response.
4. DM: Instagram – Twitter – Facebook (@beatedsupport)
(1) Renee McGregor: @r_mcgregor
(2) National Health Service (NHS) (2018). Eating disordersAvailable at: https://www.nhs.uk/conditions/eating-disorders/
(3) Priory (N.D.). Eating Disorder Statistics.[online] Available at: https://www.priorygroup.com/eating-disorders/eating-disorder-statistics
(4) National Health Service (NHS) (2018). Anorexia Nervosa. [online]Available at: https://www.nhs.uk/conditions/anorexia/
(5) National Health Service (NHS) (2017). Bulimia.[online] Available at: https://www.nhs.uk/conditions/bulimia/
(6) Beat (N.D.). Beat’s Official Website. [online] Available at: https://www.beateatingdisorders.org.uk/
(7) NEDA (N.D.). Eating Disorders & Athletes. [online] Available at: https://www.nationaleatingdisorders.org/eating-disorders-athletes
(8) Heather, A.K., et al. (2021). Biological and socio-cultural factors have the potential to influence the health and performance of elite female athletes: A cross sectional survey of 219 elite female athletes in Aotearoa New Zealand. Frontier in Sports and Active Living, 3.
(9) Reid, C. (N.D.). Athletes and Eating Disorder Recovery. [online]. Available at: http://sterlingnutrition.com/athletes-and-eating-disorder-recovery/