Eating disorders in running

A guide for running coaches and leaders

Food and eating have an important role in every runner's life. Most runners at some point will experiment with their diet from trying out special sports foods and drinks to calculating the required carbohydrates, proteins and fats needed for a particular block of training. Some runners may find that they run faster if they are lighter and so restrict their food intake.

A runner's fuel

Sometimes runners may take their eating patterns to the extreme, which may result in the runner developing an eating disorder. Eating too little or engaging in other weight loss practices over a period of time can be emotionally and physically harmful to the runner. Rather than improving their performance it may ultimately cause the runner to have to stop training and competing altogether. This is due to the fact that training and competing at a very low weight with insufficient calorie and nutrient intake can be dangerous, causing medical complications and increased risk of injury e.g. stress fractures.

The reasons for the development of eating disorders are never straightforward and differ from case to case. In some cases runners may develop eating disorders because they see weight loss as a means to better performance (i.e. running faster); in others, individuals may take up a sport such as distance running because they see it as a valid reason to continue losing weight at a faster rate. However, you must remember that not every runner who diets will develop a full or partial eating disorder, just as runners who are thin are not necessarily anorexic. However, it is very important that coaches and leaders are aware that the problem is out there and are able to spot it in the early stages.

Most commonly seen amongst runners are anorexia nervosa, bulimia nervosa and anorexia athletica, which is a concept within the sports field and not a clinically diagnosable disorder. Anorexia athletica has many similarities with clinical anorexia nervosa, though differs in one key area. The main difference is that anorexia athletica contains a component of excessive and compulsive exercise, whereby the individual will exercise beyond the requirements for health and competitive training and value their self-worth in terms of athletic achievement. Runners with this disorder will likely meet the main diagnostic criteria for anorexia nervosa and treatment will be the same. The table below details some of the more obvious physical, emotional and behavioural signs which those who are in regular contact with runners can look out for. Remember the list is not exhaustive and there is much overlap between all three columns.

Anorexia Athletica	Anorexia Nervosa	Bulimia Nervosa
*Physical Signs*	*Physical Signs*	*Physical Signs*
Weight loss >5% of expected body weight	Severe weight loss >15% of expected body weight	Has extreme weight fluctuations
Suffers stress fractures	Suffers frequent dizzy spells	Suffers frequent dehydration
Irregular or delayed menstruation	Growth of downy hair over the body	Complains of muscle cramps/weakness
Suffers frequent dizzy spells	Complains of feeling the cold	Abrasions on the knuckles

*Psychological Signs*	*Psychological Signs*	*Psychological Signs*
Defines self-worth in terms of performance	Insists they are fat when actually underweight	Has become depressed
Mood swings, including angry outbursts	Is more aware of food/calories/slight weight gain	Is increasingly self critical about their body/performance
Breakdown in relationships	Body image distortion	Sense of lack of control
Intense fear of weight gain	Increased irritability	Has noticeable mood swings
Desire to keep losing weight despite already low weight	Sets unreasonably high standards	Self-worth often determined by weight
Guilt and anxiety when they can't train	Wants to train alone	More likely to seek approval from others

*Behavioural Signs*	*Behavioural Signs*	*Behavioural Signs*
Forget that exercise can be fun	Does not want to eat around others	Shows self disgust at what they have eaten
Rarely shows satisfaction in athletic achievement	You suspect they are lying about what they have eaten	Constantly talks about food/weight
Will want to train even when ill or injured	Supplies food for others but doesn't eat themselves	May take laxatives/diuretics
Talks a lot about weight and diet	May wear many layers of clothing	May visit the bathroom more frequently
Likes to exercise in isolation and may withdraw socially	May complain of feeling full even when eating very little	Eats in secret
Has a preoccupation with appearance	May change their diet e.g. becoming vegetarian	Hoards large amounts of food

Runners who are suffering from an eating disorder will generally deny that they have a problem or not realise that there is a problem. Either way it is highly unlikely that they will approach you and admit they have an eating problem. Thus it is up to those who are close to the runner to recognise the signs and symptoms and try to approach the subject with the runner. Even if you are positive that the runner has an eating problem they are unlikely to admit to it when you first broach the subject. Even those runners who are aware that they have a problem are likely to go to great lengths to conceal the problem due to feelings of shame, guilt and concerns about having their training and competition cut back or stopped altogether.

Before bringing up the subject with the runner think carefully about how you are going to approach it and where and when may be the best time to do this. You could get advice on how best to approach this from an appropriately qualified sports psychologist in associations such as the British Association of Sports and Exercise Sciences (BASES) and/or The British Psychological Society (BPS) or by talking to one of the advisors at beat - the UK's leading eating disorder charity.

When first discussing the topic you need to accept that the runner will probably deny there is a problem and may react negatively, whichever approach you take. Don't let this deter you if you feel your suspicions are founded. Be prepared to listen and give time to the runner, letting them know that you are there if they want to talk. It is essential that you refer the runner to their GP. This should normally occur with the runners consent. However, a runner with an eating disorder will need to get professional help and support so it may be that a first step is to give them information about where they can seek help confidentially. Do not underestimate that by just listening and being supportive, you can help them take the first steps. The best way to help is to develop trust by being open, honest and supportive especially during recovery. Try and remember that recovery from an eating disorder can be difficult and frightening especially when runners start to gain weight and hear comments from training partners like: "You're looking well". The athletes reaction is likely to be, "Oh no, I'm getting fat".

Although sport is unlikely to be the direct cause of eating disorders there are a number of ways that increase the risk of them developing in predisposed athletes. Coaches should be aware of these factors:

Do not place too much emphasis on weight. Group and individual weighing practices should be avoided.

Remember that there is no 'ideal weight' for a runner.

Be aware that seemingly innocent comments about weight and/or physical appearance can be taken the wrong way by runners.

Remember that runners can be competitive. Do not extend this competitiveness to include bodyweight/body fat percentages.

Finally, eating disorders can 'spread' among a training group. Be aware that if one athlete loses weight, others may copy; or if a naturally thin runner is improving their times, the others may think this is due to her/him being thin.

For more information visit the beat website or call one of their helplines which are open to anybody wanting advice.

www.b-eat.co.uk

The helpline number is 0845 634 1414 and is open Monday - Friday 10.30 - 20.30 and Saturday 13.00 - 16.30

Dr. Louise Ewan is a research associate at the University of Glasgow, Section of psychological medicine.