Separating Healthy Training from Disordered Eating
> 9/14/2006 1:08:09 PM

Earlier this week the regional government of Madrid passed a ban on using overly thin models during the city's upcoming Fashion Week. Many are rightfully lauding the move as a major blow against an industry that has promoted awful and unhealthy body images. There has even been murmuring that this could lead to a domino effect, with other cities following suit and thus forcing change upon the fashion industry.

This victory in the public relations battle against eating disorders such as anorexia and bulimia should be heralded as an important step. But there is another group of highly at-risk women who fly much further under the radar, and as a New York Times article today reveals, are often in just as much peril as those who strut their bony frames on the runway.

Many varsity athletes, both at the high school and college level, struggle with disorder eating and weight issues. Women's cross country and track programs struggle with this problem on a yearly basis. By the very nature of their daily lives, runners' weight trouble can often pass directly under the eyes of coaches and parents, going unnoticed and untreated. The trouble is that one of the main warning signs of a severe health problem, long term menstrual dysfunction or amenorrhea, can be awkward to discuss, especially for male coaches. Beyond that, many coaches don't even understand the gravity of the problem:

In 2003, the National Collegiate Athletics Association surveyed over 2,800 coaches about disordered eating, and found that only 19 percent of men and 26 percent of women were aware of the seriousness of amenorrhea.

Loss of bone density can become an issue for women whose amenorrhea is caused by weight loss. Studies have shown that for those whose amenorrhea is caused strictly by athletics, this isn't the case, but when simple training crosses the line into disordered eating, then women--like Mrs. Julia Stamps-Mallon who won three CA state cross country titles before several bones including her spine broke following density loss--place themselves at risk for many severe health complications.

Amenorrhea and loss of bone density are part of what coaches call the triad, a concept designed to help coaches recognize problems and help athletes avoid crippling osteoporosis, stress fractures and death. "The term triad refers to a pattern of decline that starts with disordered eating and leads to menstrual dysfunction, which can signal the loss of bone density," the Times wrote.

From a public perspective, and even from the perspective of a coach or parent, it can be agonizingly difficult to register problems. Someone might ask, "How can this girl literally compete at the highest level and fight an eating disorder?" The question is a tricky one, and as the previous data from the NCAA shows, many coaches cannot answer it.

Truly, there is an athletic benefit in competing at a low body weight, but the line between maintaining low body fat and suffering malnutrition from over-exercise and low caloric intake can be unbearably thin. It is when the behaviors become a health risk that they have clearly moved over this line, from successful preparation to pathological condition.

Any of a number of symptoms can indicate an eating disorder. As mentioned above, amenorrhea is a key one. Other things to look for however, can include losing body or head hair, unusual amount of fatigue or disturbed social functioning. Beyond that, the question of compulsivity comes into play. To what effect are these eating and exercising habits under your control? Building new muscles, maintaining strong bones and facilitating proper blood flow are all essential to competition. Coaches need to take time to be aware of the workload and eating habits of their athletes. Athletes need to communicate any troubles with weight and even menstrual cycles to their coaches, team trainers or parents.

As with the models on the runway, pretending that these athletes don't have a problem will not make this situation go away. And winning at the cost of your health or even your life is not a trade that any rational athlete should make. Running can be a great life-long habit to develop, and varsity level competition can teach many life lessons.  We just need to ensure that using nutrition to maintain a healthy body is one of them.

See Also:
  • This USA Today article from 2005 provides a great deal of information about disordered eating in many sports.
  • The PBS documentary, Dying to Be Thin, available online, addresses eating disorders in athletes.


It's not just female athletes, and it's not just college level. My husband's best friend rowed crew with him in high school. He rowed lightweight 4s and 8s. In this class, the boat's average weight has to be less than 140#. All of the boys rowing in these boats had a healthy body weight of 170-180. They did however win several US and Canadian national rowing championships in the 140# category. Had they maintained their healthy body weight they would have been rowing in the heavyweight category, which mainly consisted of men built like Schwartzenneger in his bodybuilding days. The whole system effectively encourages disordered eating just to make weight.
Posted by: dr nic 9/19/2006 9:54:04 AM

Men are certainly not immune to this problem. Beside rowing, sports like wrestling have had to make steps to ensure the healthy training of their athletes. Most states now require high school wrestlers to be certified at a weight before the season by a doctor. In theory, this certification ensures that the wrestler will not drop below a given percentage of body fat (usually between 5-10%). Not a perfect symptom, but a step in the right direction for a sport that has seen a number of competitors die trying to make weight.
Posted by: Jon 9/20/2006 9:04:23 AM

Don't forget cycling, where a lower weight is a considerable advantage and professionals compete at borderline unhealthy (ie unhealthy for long term) weights. And cycling isn't weight bearing, so it's easier to lose bone density.
Posted by: Eric 9/20/2006 3:22:21 AM

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