30 comments on “Eating Disorders in Female Runners”

• Because listening to this and commenting is WAY BETTER than studying for my upcoming exams, I’d thought I’d add my two cents, as per usual. My medical background on the subject is maybe more than most, although we really only get a few lectures on the subject of eating disorders and far less exposure on the wards. Since I’m not really a runner, I don’t have that perspective either, but being a girl in a pretty competitive environment, rather school or athletics, I guess I could say I have some exposure on the topic.

  As far as the female athlete triad, I think it does have its merits as a screening tool, but is flawed, as you point out. I don’t have a regular menstrual cycles always (overshare, sorry) and you could argue I have some sort of disordered eating because, of course, I restrict certain things and definitely think about my weight (Who doesn’t?) And I happen to run and have a demanding lifestyle, but not enough to result in energy deficit, at least in my perspective. So, the points of the triad are not always linked as the female athlete triad suggests.

  Further, I think “disordered eating” is somewhat ill-defined. If I don’t eat fried food, does that make me a disordered eater since 90% of Americans do? If I turn down a cookie from someone (and think “that girl is trying to make me fat!”), is that disordered eating? I mean what does that even mean?!?

  Last, I think there is somewhat of a selection bias, so to speak. If you are a high level runner (or any athlete), you are probably competitive. Odds are, you are also going to be high achieving. In the sectors these girls will find themselves in – whether a competitive DI track program, medical school, the corporate world – being thin and fit is revered and the pressure to look good and be good can be immense. It then becomes easy to make eating and your weight become a competitive event and, in turn, become a problem although I think, for most women, a “sub clinical” one meaning they don’t have a true eating disorder, but probably could use some help.

  Just my two cents…for now…

  And, on that note, I want some ice cream, but is it disordered eating if I feel bad about it?!? (I think this term should be banned)

  • I think the issue of using the word “disordered eating” applies to most psychological disorders. When dealing with these things, that are not always visible and tangible and don’t always have specific biological markers or cures, it can be hard to define what is and isn’t a disorder. Everything gets even more complicated when you throw in the emotional, contextual, and biological factors that can be connected.

    “Shades of grey” comes up again and again.. but it is very appealing to use, and it follows nicely with current trends in psychological disorders aiming to look at disorders as qualities that everybody has different amounts of. Everybody experiences at least a little bit of sadness, anxiety, stress, fear, addictions (craving icecream, anyone?)… all of which are primary parts of some of the world’s major psychological disorders (depression, generalized anxiety disorders, post traumatic stress disorder, alcoholism… etc etc). It is very useful to think of these characteristics as ones that everybody possesses to some extend.. the question is where to draw the line. I think this becomes a very personal question, and differs on whether you are the one experiencing it or the one judging it. I also think we all deep down know where that line is drawn and can feel it if it’s been crossed.

    The best we can do navigating these unclear waters is remain honest and healthy, and support others around us to do the same. Labeling and diagnosis can be important for people to get the help they need.. my feeling is that for elite athletes, the support systems are there and it’s a matter of taking responsibility for your health and your performance and using those support systems.

• And, sorry, one more thing. If you don’t use signs/symptoms of the female athlete triad, with your experience/knowledge, what would you suggest would be a better way to screen young women/athletes for eating disorders? Similarly, do you think this probably has less to do with the medical community and more to do with changing the culture of how women (high strung ones) approach food? (I’m guessing, yes).

  • Someone just needs to write a tiny little book titled “How to adjust your weight as a female distance runner without getting an eating disorder.” The information is out there, people just need to hear it from a reliable source.

    Seriously though, the culture is the most important thing. Coaches run a huge risk if they sit back and leave their team environment to chance. A bunch of high achieving women figuring out these tough issues for themselves…not a good risk. They need to establish trust with their athletes and set the tone, and if they feel unequipped to do it alone, they need to educate themselves and find someone legitimate to talk to their team about it. Underscore legitimate.

    I think I’ll write a Q and A about this next…

• Individuals with eating disorders just need to have better food around them. I can’t stop eating when I have good, wholesome food around me!

  On a serious note, I heard one universal truth from the three of you on the radio show: context. Context was brought up with the variables of control, support systems, culture, and pre-dispositions.

  This led me to two thoughts:
  1) In order to do anything exceptionally well it takes a lot of effort to maintain that knife-edge balance in life to keep it all going. A little slip-up could just be a minor cut on the finger, or a major slice of an artery…

  2)Why do people (I include myself) get all screwed up/confused when they try to answer the question: “Who am I?” Why is it so hard to be authentically ourselves both in our own heads and in public?

  I don’t have any answers, except the ones you mentioned in the radio show and that I “briefly” summarized above. So, how do you maintain that balance? Has the public Lauren Fleshman always been harmonious with the inner Lauren?

  • Thanks for your thoughts Danny. And funny about the solution to eating disorders…at first I thought you were serious and I was like “wha?”

    As for maintaining the balance between public and inner Lauren… what you see is what you get. I don’t share every single feeling and thought that I have, (because the point of this blog to add value to the running community rather than bore them) and I keep a private life, but if you met me in that private life, you would find exactly what you would expect from reading my blog. I think about my life deeply, I say what I think, and I tell the truth. I don’t kiss anyone’s ass, and I don’t pretend to be anything I’m not. The way I keep it in balance is by withdrawing from the public sphere when I need to. But whenever I have anything extra to give, I give it.

• FYI I’m a 19:40 recreational 5K runner, with hopes of dreams of winning my local marathon (need to lop off about 45 min off my personal best) sometime before 40 (29 currently). Who has his own regular job (graduated from college with a BS in math) and tries to maintain a “normal” social life. Just to give (some) context to my response.

• I almost became a psychiatrist, and when I did my fourth year advanced clerkship in psychiatry, I had my own therapy patient – a stubborn teenaged girl with anorexia. She didn’t want to be helped, and she tried to be as unpleasant as possible to ward off any attempts at getting near her emotional core. It reminded me of my experiences as a Resident Assistant senior year at Stanford, when I was trying to deal with an elite athlete with anorexia, who was so emaciated that she had regrown the lanugo (the fine hair covering a baby) on her hair as a response to her inability to stay warm. Her athletic performance was undoubtedly hindered by her anorexia, but she also made herself as difficult as possible — who wants to interfere or help someone who’s a total pain?

  Both experiences were incredible for me. It made me realize how destructive eating disorders can be to the person as well as those surrounding them. I think that disordered eating that winds up being harmful is probably one good way to distinguish them from disordered eating and obsessive eating (which most elite athletes undoubtedly do… one doesn’t get to 6% body fat without some draconian measures. I don’t care how many hundreds of miles one runs). But it’s a complicated situation. The eating issues – while sometimes lethal itself – are more the “tip of the iceberg” in terms of the stress and poor coping skills being exhibited by the person. And I think understanding and learning to navigate those emotional deficits are probably the most important ways of healing from eating disorders.

  • It is extremely difficult to help people who don’t want to help themselves. Impossible, actually. My first couple experiences being around anorexia were frustrating as well, because I didn’t respect it as a disease. Like alcoholism or a smoking addiction, people who are afflicted cling to the addiction. It can make no logical sense whatsoever to an outsider, but that is irrelevant. That is a rough subject to start off in for psychiatry.
    Once I adjusted my approach to eating disorders to be more like my experiences around alcoholism, it was easier to empathize. This may or may not be true, but in mind, the only way to cope with being around it was to care less. Not care less about the PERSON, but care less about their choices. It wasn’t my deal, and I was powerless to change their situation. All I could do was love them and focus on the rest of who they were, and when necessary, remove myself from situations that made me uncomfortable or made it harder for me to remain true to my healthy path. I am not in the business of saving souls. What I could do was try to be a good example in my own choices and try to generate enthusiasm around a healthier lifestyle for the vast majority of my teammates.

    And your point about draconian measures being part of the deal with elite athletics…you are right on there. It is a line we walk, but when you stay on the right side of the line, it is an incredibly rewarding way to live. Sacrifice and restriction are, in fact, life enhancers. There are great rewards, and not just physical ones, to leading a life that asks you to make difficult choices and live alternatively to the norm. Its nearly spiritual.

    • While I agree that it is frustrating dealing with people who don’t want help, a lot of times I walk a fine line of feeling sorry for them and wanting to yell at them. I feel sorry for people with true psychiatric pathology as diseases such as depression, alcoholism, and anorexia nervosa at some “tipping point” become, well, not a matter of “willpower” or lack thereof, but a neurochemical disturbance causing such choices, decisions, and ways of viewing one’s self. There was actually a study in which soldiers were starved (under physician supervision, as crazy as that sounds) to be underweight and then re-fed. It was noted that being underweight caused drastic changes including that of their relationship with food. I haven’t looked at that study recently (and although a long time ago, I believe it is still relevant), but the subjects (soldiers) attitude towards food changed and even when allowed to eat to regain weight, they didn’t want to (in addition to other psychologic and physiologic effects). I think it was called the Minnesota Starvation Experiment (and I don’t think this would get approved by an Institutional Review Board in this day and age!)

      I think it is more difficult dealing with those who are in the “shades of grey” who don’t truly have a disease, per se, but who cling to controlling their food intake/exercise. I bet a lot of girls struggle with this, but probably don’t want to talk about it as they don’t want to lose “their edge.” You know how when you’re in a class and they say “there are no stupid questions…I’m sure if you have a question, someone else was wondering that same thing (etc etc).” I have a feeling that maybe its like that with disordered eating and young female athletes (or just young females)…maybe if there is more of a discussion and, furthermore, education, maybe it would help alleviate some of the mystery or confusion of the topic for young girls so they could, as a GROUP, make informed decisions. And, I think this discussion shoudl start with from the top down with open discussions with coaches, adults, family members, etc as I seriously doubt 15 year old girls are going to want to openly discuss their eating habits (and would rather discuss Justin Bieber…)

• Hey Lauren! so i think the whole female athlete triad is so BOGUS!!! im a collegiate runner and the school’s doctor insists that i have the triad…she actually was going to hospitalize me when the doc has absolutley NO IDEA what i eat and how much(and its a lot). i only started seeing her bc i got 2 spinal fractures running. i left school to deal with my injuries and what not in feb and now im just waiting on what the doc’s “recommendations” (more like what restrictions ill have holding over my head/running). Doctors just dont understnad our sport and they look at fit females as unhealthy. Sorry im just so frustrated and i was really glad u started this topic. i do think eating disorders are very prevalent among women but i frustrates me that the docs make usumptions and try to categorize female runners bc of the “reputation”. how would u deal with this???

• Thanks for addressing this topic Lauren, one that is often present in women’s running but not always discussed in the open. I have been a runner for about two decades now – first high school, then D1 cross country and track, and now as a competitive local recreational runner. I was never the fastest runner on my team, but have made choices that I am happy with and keep me healthy.

  I still see eating disorders occasionally when I go to local races, but it was much more prevalent when I ran in college. There was more than one girl on my team struggling with anorexia, and it affected not only them but the team as a whole. We knew that the coach and a nutritionist were working with the girls who were sick, but it was never mentioned by anyone other than saying that someone wasn’t going to participate in a particular race (which was of course because they hadn’t improved their weight enough). It definitely affected the team dynamics in a negative way, and I wish that our coach had been able to manage it differently. At the beginning of each season the team would be introduced to our team doctor and nutritionist with the comment that they were there if we ever needed them, but that obviously wasn’t a strong enough preventative approach. Maybe taking a few minutes from training on a regular basis to work on preventative measures for all teammates could help – possibly working with both a nutritionist and a psychologist?

  I remember wincing while watching a teammate eat an apple and a cup of dry Cheerios for dinner after we had just done a two-hour speed workout and strength session. Like you I had to change my perspective, and your quote above, “The only way to cope with being around it was to care less. Not care less about the PERSON, but care less about their choices,” hit the nail on the head. Sadly a few them only ran 1 or 2 years in college, as injuries (including stress fractures) or burnout cut their athletic careers short.

• I am a 39-year-old runner and the mother of a beautiful six-year-old daughter. In college I struggled with eating disorders that hurt my body, my racing, and my relationships with the people around me.

  I was atypical in that I ate healthy, well balanced meals that were sized appropriately for an inactive person trying to lose weight. They were much too small for an athlete with a demanding training schedule. I was never over weight to begin with, and I lost weight quickly.

  There was a great deal of pressure from coaches and peers to be light. No matter how thin I got, I seemed to be getting positive feedback on my weighloss. For a while, I got faster. Then I got weak and sick. It took me a long time to accept that there was something disordered about my eating, even as my weight had fallen below 85 pounds. Luckily, at that point I realized that in fact I had a serious problem.

  Anorexia destroyed my college running years. I am fortunate to have overcome my eating disorders without damaging myself in any permanent way. Still, even now, I have to remind myself that thinner is not always better. I have to remind myself to be a good role model for my daughter and focus on being healthy instead of being thin.

  I know that it may be a drag to be falsely labeled with the triad. I am sure it is a hassle to have to defend your weight, exercise, and eating habits. In actuality, though, I doubt that it does any actual harm. I can’t help but feel that caution on the part of doctors and coaches who may try to intervene when perhaps it is not needed is still better than the alternative.

• Wow thank you for being brave enough to open up such a complex and difficult topic. I think every female runner (and most athletes) have been touched by some shade of grey with eating disorders either personally or by somebody around them. I loved reading how you would approach a team on the subject, and it would be awesome to have more women like you coaching. While weight, or more specifically body composition, is undoubtedly linked in this sport I would be hesitant to even mention weight loss to a group of college or high school women. Unfortunately some girls may not be able to and should not lose any weight at all because they are already at their natural weight and underweight. The problem with the shades of grey is that many women do not have a healthy or accurate perception of their own body, so this advice “to lose weight at some times, maintain, and gain weight” is enough to set even the most secure girl out of whack. With eating disorders so prevalent in this society (even non-runners) I think a stronger emphasis needs to be placed on how to eat and exercize in a healthy and non-cumpulsive manner. While losing 2 or 3 pounds may make a girl faster (or weaker, slower, and unhappy), it is not worth jeopardizing her confidence and self-worth. Frankly too many girls are too close to this edge to go there. The emphasis should be on health and doing the best you can with what you have. As the daughter of a mom who has struggled with eating disorders for years, no ounce of fat, health, or fun is worth being sacrificed for something like a fast time. We are only given one body in this lifetime, and as runners we are blessed to do something amazing with it. I have seen many many girls who some coaches would consider “over weight” for runners kick the a$$es of skinny minis. I have also seen naturally tiny girls ostracized even when they have a healthy outlook and appetite, while larger girls take extreme measures and have bad habits that destroy their self-esteem. The issue is too broad and grey to judge at face value. Ultimately there must be a societal shift in how we value women and how women value themselves.

• Hi, Lauren.

  Thanks for this awesome comment thread. I loved reading it.

  Like some of those who responded, I once struggled with anorexia. During graduate school, I starved my 5’4″ frame down below 100 pounds and shivered with cold in the middle of the summer. I was obsessed with club aerobics at that point and even became a certified instructor. I had always been curvy and busty, and it was a real rush for me to feel my hips and abs get flat and cavey, to see ribs through my leotards, and to watch my breasts melt away. I didn’t realize how bad it got until I began to feel an arrhythmia that had begun to develop. At the same time I lost my period and began to grow downy white hair on my belly and thighs. And then I passed out once during my student teaching. It was then that I realized that holding on to this way of treating myself could cost me everything I’d worked so hard for in my life.

  It was scary how hard it was to give up the anorexia. I actually felt that the healthy food I placed in front of me was dangerous. I had cultivated this solipsistic belief that healthy food like tofu and sweet potatoes and nuts were ok for other people, but that they were poison for me. Slowly, through the help of wonderful friends and family members, I came to leand that feeling myself healthy delicious food was just one of many important ways that I needed to love myself. And I realized how much I do love and respect myself and how passionate I am about living a strong and healthy and meaningful life.

  I didn’t become a runner until later in my twenties, and it was never a question to me that, if I was ever going to be good at this, I needed to think of food as fuel and nourishment. I plan my mealas as carefully as I do my training schedule.

  I agree with your other poster that it is certainly ok to have bottom line standards for food. No, I don’t use sweets as an occasional reward or pick-me up. I don’t eat cookies of cake or bakery muffins, ever. I’ve recently adopted a gluten and dairy free eating plan, and I feel such well-being; my skin has imporved, my mental clarity is better, previous abdominal discomfort has all but subsided. But I know that I always have to make sure that I don’t allow my restrictions to grow beyond what is sensible and rational. I make a point to include new foods that are pleasurable and delicious. I just ordered a case of Picky Bars, and I can’t wait to add them to my snack list.

  At age 44 this year I became a marathoner. I just ran my second, the Marine Corps Marathon. I’m learning the art of fueling up for these enduring events–loving the GU Roctane and Bonk Breaker bars–and post-run recovery–a piece of salmon, a baked potato and a salad never tasted so good. It is such an honor to be among others who live this life of discipline and sacrifice and always striving to be the best one can be. And there’s no place for anorexia in this world where the ultimate goal is a strong finish.

  So, OOOOO-Rah. And thanks for this beautiful blog.

  Namaste,

  Shira

• Hi Lauren,
  I am really happy that you have addressed that the Female Athlete Triad is too vague. I had abit of a “reverse” experience during uni which doesn’t fit into the “textbook” ideas of eating disorders- I was healthy, but became injured and then had severe issues with disordered eating, but since I gained weight (I was 5’9 and peaked at 150lbs- I only used laxatives, restricted bread and dairy, had binge-purge tendencies, was stuck in an injury cycle for 4+ years-gah!), no one ever really picked up on it, and my teammates just thought I was getting fat and slow. In reality- I was a mess mentally (as well as slow and unhealthy).
  Luckily I’ve been able to regain healthy eating habits (and a health Gastro-Intestinal system again thanks to normal meals and kefir!), have kids, breastfeed, and run better than ever- I am at a “lower” weight (125lbs- thats borderline to underweight according to various charts), but I am healthy and sane again. I’ve never been healthier, and it pisses me off that NOW people assume I have an eating disorder, rather than before when I really was having problems. Eating Disorders could be affecting anyone, regardless of how “fat” or “thin” they are- most important is if they really are healthy and happy or not.

  Thanks for raising awareness- eating disorders are sadly still a prevalent topic in running- but they do need to be addressed correctly (and not just based on the “female-athlete-triad”)

• Hi! I have a huge problem with disorded eating. It is tearing me apart mentally and phsically as well as destroying my family relationships. I know I need to eat a lot in order to perform well and run fast, as I had a crash late last Cross Country season. I just CAN’T seem to bring myself to eat anything with out looking at the nutrition facts and ingredient list, which usually results in me not eating the food. What is your take on all the strange ingredient names? Should they stop a competive athlete from eating it? Will it make the person slow? I think eating bad stuff may make a person not perfom well. Please share your take on food! How much should a competive runner eat?? THanks so much!

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• Thanks for this post Lauren, it’s fantastic to hear your opinions on this complex subject. I was a late-comer in some ways to the world of competitive running. I didn’t start competing until I was in college. I walked onto a team that had won a National Championship the year before I arrived, and the team was riddled with eating disorders. My Sophomore year I lived in a “track house” with 8 other women, all of which suffered from eating disorders. As a previously healthy person myself, it was crazy to see myself morph into someone who counted calories, avoided high fat foods, and constantly measured myself against my housemates/teammates. I had never before struggled with eating, until I was in a situation where it completely surrounded me and defined my “purpose” in the social sphere I was a part of. Luckily, I had the support of family members to “wake me up” to what was going on, and the conviction to change my ways despite the norm. Ever since then, I have been fascinated with the complex psychology behind eating disorders. I competed at a high level in DIII and DI ,on numerous club teams, and with casual running clubs- and eating disorders are everywhere. I even lived with a group of guys later in college, a couple of whom struggled with eating as well- it’s a disease that transcends gender!
  Now I am a young assistant coach for a team that is one of the best in the nation. Eating disorders, and my ability to target them early and address them correctly are a large part of my job. After being on several teams where coaches approached eating disorders in a variety of ways (mostly the wrong way) I have become fascinated in the correct way to address my athletes issue with eating. Not just my athlete’s issues with eating disorders, but my athlete’s struggle to strike a healthy balance (not over-eating is a difficult one to address without giving someone a complex). I was wondering if you could tell me a little bit about what your experience with coaches addressing these sensitive issues was like. It is a subject that fascinates me, and is deeply rooted in psychology. I could talk about this for days, but would love to hear your response. Thanks!

• I enjoy reading the article.

  I can’t help it but share some of my experiences. While competitive running is good for optimum health and
  body framework, I often encounter people having binge eating disorder after they work out or something. Lmao!

• I think athletes, and not just runners tend to experience eating disorders because of the pressure experience from being in sport. Because of the intense pressure and rigid training exercises, athletes become very conscious of their weight. Perhaps, this is also the reason why some of them develop eating disorders.

• I am an elite runner in a southamerican country and we see a lot of disoredere eating among the girls here… most of them dont qualiffy as an anorexia or a bulimia but they are not healthy habbits in girls whi wnat to loose weight….
  n my experience i have learn that if the athlete focus on performance rather than in being thin it gets easier to accept the food and extra calories.
  You need to tell the girls that their weight doesn´t mean anything…yo can have a 45kg girl with 30kg of fat wich is fatter than a girl who is 55kg but only has 15kg of fat on her body…
  My coach always says that in order to performance well you need to be thin, thats a reallity and we cant deny it… you need to be thinner than doctors says it is healty.. yo need to be a man with 1,70mts and 60kg or a woman of 1,60mts and 45 kg….and have very very low fat on your body…. but ….YOU ARE AN ELITE RUNNER NOT A TOP MODEL and if you don´t show ripped abs but you still perform better than the other girls you are the winner…. we have to enfatize this to the younger girls….. you need to be thin, yes…but that is not the key to succes… just eat clean and focus on performance rather on the looks… if the girl is performing bad tell her “thats because you are eating too litlle”, “shou should add some carbs to your breackfast”… things like that i think it helps

  sorry about the bad english, we speak spanish here

• You know, I know I am in the shades of grey category. And I am finally dealing with it at age 43 and only because I am so tired of falling into adrenal fatigue because it robs me of my passion for my sport. I don’t weigh my food, count calories, weigh myself even but this does not mean that I don’t have issues with food and my body since I regularly don’t eat enough before or after my runs (old bad habit) nor do I eat enough on the long training runs. And then I don’t have a good post running meal to restore my glycogen. The only time I indulge is when I race but even then its very restricted. I have this bad habit with fat. I was raised in the nonfat generation of which my mother was apart and I still adhere. Its so dumb. Fat is good, especially plant fats but I really don’t indulge much. Lots of white sugar and caffeine.

  But now that I realize that my symptoms are adrenal fatigue/parasympathetic overtraining and not “anemia” I am learning about how I can keep my adrenal glands strong. And that means more carbs before, during and after training. Just today I had a banana post run. On weekends I plan on doing a banana smoothie using perhaps some adrenal supplementation (powder). And I ate a bit more at lunch today.

  It’s a process to break old habits. At my age I won’t change overnight but I am determined to not let myself burn my adrenals out again because it takes from me the main thing I am so passionate about: trail running.

  I do like Emelie Forsberg’s blog and learning from Anna Frost since they are pro’s in my sport. Emelie tends to gain a bit of weight during her 1-2 months and does nothing but baking, eating and reading, light hiking while Anna at one point burned herself into such a hole that she could not run more step.

• With everything which seems to be developing inside this subject matter, many of your points of view are actually very radical. Having said that, I appologize, but I can not give credence to your whole theory, all be it exciting none the less. It seems to everyone that your commentary are generally not totally justified and in simple fact you are yourself not even totally convinced of your argument. In any event I did appreciate reading through it.