Disordered Eating, Eating Disorders, and Gymnastics
This week (February 27 - March 5th, 2023) is National Eating Disorder Awareness Week.
Eating disorders are serious medical conditions related to abnormal and persistent eating behaviors that negatively impact physical and mental health and ability to function in all different areas of life.
Eating disorders can affect people of all genders, ages, races, religions, ethnicities, sexual orientations, body shapes, and weights, and often their root cause goes much deeper than just "food". In the United States, 28.8 million Americans will suffer from an eating disorder at some point in their lives and the average age an eating disorder starts is between 11 and 12 years old.
Unfortunately, athletes, especially aesthetic athletes are at an even higher risk of developing an eating disorder; the sport of gymnastics and eating disorders have been intertwined for decades. A 2009 study of all-sport female college athletes found that ~2% were clinically diagnosed with an eating disorder, while 25% showed disordered eating behaviors. When specifically looking at aesthetic athletes, including gymnasts, the prevalence of disordered eating behaviors almost doubled! And what's even more shocking, is that the prevalence of eating disorders and disordered eating are often significantly under-reported, meaning that even more gymnasts (upwards of 50-65%) are likely to be struggling!
Why is the sport of gymnastics a breeding ground for eating disorders?
Gymnastics (like many aesthetic sports) has a long and complicated history with disordered eating and distorted body image. There are many reasons why gymnasts are at high risk for developing disordered thoughts, attitudes, and behaviors around food and body.
The dangerous link between gymnastics and disordered eating was highlighted in a short film put together by SHIFT Movement Science and Gymnastics Education, entitled The "Perfect" Gymnast Body
The basis of our sport is about being judged on how close you can get to perfection - unfortunately, sometimes the line between judging the skills and routines and judging the person gets blurred.
There are so many stereotypes in the sport of gymnastics that are built on assumptions and folk-lore.
"Gymnasts have to be small."
"Lighter girls fly higher."
"You need to have a gymnast body."
Sadly, many gymnasts feel like if they don’t meet this “thin, lithe” standard of the “gymnast body”, then they are not going to “make it” and will try to take matters into their own hands by manipulating what they do or do not eat.
Gymnasts are also often compared to each other, on and off the competition floor, by their coaches, by their parents, and eventually in their own minds. Many will start to view others' bodies, weight and performance as the ideal body and comparing that to what we see in our own bodies. For many, it is easy to compare their own body to that of a teammate, competitor, someone on social media, or well-known gymnast, and believe their body is the ideal gymnast body and ours is not. This comparison can be perpetuated by teammates and coaches who may praise another gymnast for their fitness level, beautiful lines, performance, or strong "self-discipline" with food and/or exercise.
Comparing one's body to what is seen online, to teammates, or others around us can lead to feelings of guilt, shame, and even anxiety about our own body’s natural (perceived) imperfections and flaws that in turn, can make a gymnast begin to manipulate their diet to cope or compensate. If you are feeling this way, you are not alone. This is unfortunately so common in the world of gymnastics.
We also cannot neglect the impact of coaches, who have grown up in and been groomed by the sport and it's history of misinformation, compounded by parents who are also surrounded and influenced by diet culture.
Eating disorders in gymnasts are often triggered by a comment made by a trusted coach about food, weight, or appearance. A 2006 study of disordered eating behaviors in gymnasts found that 71% of gymnasts reported receiving negative comments about their body from someone in the sport.
While in the past, gymnasts were publicly weighed, weight shamed, and outwardly told to restrict food or resort to other unhealthy mechanisms, diet culture in gymnastics has gotten sneakier in more recent years. However, it still exists and still causes harm to many gymnasts.
So often, gymnasts have been told statements like:
"Suck in your gut."
"You'd perform better if you looked like her."
"We only order size Small or Extra Small leos."
"Make sure you stay in shape while recovering from that injury."
So many gymnasts look up to their coach and put the fate of their career in their hands. The pressure to please the coach and listen to their advice, no matter how misguided, so often becomes a slippery slope.
What's the truth?
A gymnast will never perform their best or reach their full potential under fueled.
Under fueling (resulting from an eating disorder, disordered eating, or unintentionally) can not only impact performance, it can have an effect on every single organ and system in the body, including:
The heart and cardiovascular system
Digestion and the GI system
The brain and mental health
Hormones, endocrine system, growth and development
Tendons, ligaments, and muscles
Overall energy, body composition, and metabolism
There is no such thing as a perfect gymnast body (or perfect body in general). As a gymnast of any level, a gymnast's body can perform incredible skills and does need to be like someone else's in order to be successful. Gymnasts come in all shapes and sizes (just watch any NCAA meet)!
All bodies are meant to be different and that is normal. Additionally, bodies are meant to change, grow, and adapt. It is unrealistic to expect that a person will look the same at 10 years old as they will at 13, 16, 18, 21, and beyond.
Trying to make your body look a way it was not meant to be or by trying to stay small (especially by manipulating diet or exercise) will only lead to injuries, decreased performance, mental stress, and the very real possibility of developing a serious eating disorder that can impact the rest of your life. There is so much strength and power on the other side of puberty. And while it may take some time and a change in training plan to adjust to, it is absolutely possible (and necessary if your goal involves competing through high school, in college, or on the elite scene).
Additionally, you cannot “tell” just by looking at someone how healthy they are, what their diet or relationship with food is like, or if they are or are not struggling with an eating disorder. A gymnast consistently lower on the growth chart percentiles doesn’t necessarily have a “food problem” or “eating disorder”; conversely, a gymnast with the bigger build is not necessarily “fat”, “overweight”, or "unhealthy". An individual's appearance, body composition (or if they have visible abs or not) has much more to do with genetics than it does diet or training.
When a gymnast's body is adequately fueled (with the optimal dose of training and recovery) they will feel and be able to train at their best while their body will settle at their genetically predetermined "sweet spot".
What's the difference between eating healthy as a high level athlete, disordered eating, and an eating disorder?
For high level gymnasts to be successful in the sport of gymnastics, adequate nutrition is an important foundation for competitive success, health, and longevity in the sport. It is almost expected that gymnasts are disciplined with their nutrition. However, what can be seen as disciplined nutrition often toes the line between normal and disordered eating, which can be especially difficult for a teenager to know the difference. Additionally, so much of what is common when it comes to food attitudes and eating behaviors, both in the sport of gymnastics and within are culture, are actually quite disordered. Just because these habits are common, does not make them normal. So, how can we determine what is normal and what is not?
Normal, healthy, intuitive, non-disordered eating looks like:
Eating a variety of foods from all of the food groups (aside from those with a diagnosed medical reason)
Eating choices mostly influenced by hunger & fullness cues, performance nutrition strategy, food preferences, schedule, culture, and food availability
No food rules or fear foods
No guilt or shame surrounding food
Body acceptance and body trust
Disordered eating often involves:
Having a list of "food rules" to try to adhere to
Occasionally engaging in diet behaviors, including clean eating, counting calories or macros, intermittent fasting, or any fad diet (like keto, Whole30, etc.)
Limiting certain foods or food groups (like going gluten free or cutting out dairy) beyond medical necessity
Food choices are often influenced by others, including diet culture, sport culture, or social media
Exercising beyond the training plan, especially to burn calories or influence body shape or size
Being overly worried about food quality or how food was prepared (especially with food made outside the home or at a restaurant)
Categorizing foods as "good" or "bad" (and noticing a change in mood or emotions that go along with that)
Occasional guilt or shame after eating, especially when failing to adhere to food rules or indulging in "bad" foods
Limited or inflexible with what foods are eaten or where foods are coming from
Being overly concerned with what others are eating
An eating disorder is a complex condition characterized by abnormal eating habits that impair health and an individual's ability to function and will be diagnosed by a medical team. The most common eating disorders seen in gymnasts include:
Anorexia Nervosa, which is characterized by an intense fear of gaining weight, severe restriction of food intake, and a distorted body image
Bulimia Nervosa, which is characterized by episodes of binge eating followed by purging behaviors (such as vomiting, using laxatives, or excessive exercise).
Binge Eating Disorder is characterized by episodes of eating large amounts of food (often even when they are not hungry) and feeling out of control around food, followed by feelings of shame, guilt, and distress.
A diagnosable eating disorder often includes:
Being so preoccupied by food and weight that it directly impacts other aspects of life
Overtly preoccupied with the desire to change body type, shape, or weight
Extremely rigid with food rules
Extremely limited in safe foods
Cycles of restricting and/or binging, with or without purging
Over-exercising, even through an injury or illness
The main difference between disordered eating and eating disorders involves the severity and degree of the symptoms. Disordered eating frequently involves many of the same behaviors that occur in eating disorders, but such symptoms occur less frequently or less intensely. This does not mean that disordered eating is not serious; disordered eating can often be more subtle, making it more difficult to recognize or, at times, more challenging to address. However, disordered eating can lead to the development of an eating disorder.
What are the warning signs?
As a gymnast, teammate, parent, coach, or medical provider for gymnasts it is important to be able to identify the warning signs of disordered eating and an eating disorder:
Sudden weight change
Sudden change in strength, endurance, ability to keep up with the team
Obsessed with the scale / preoccupation with weight
Often makes comments about "feeling fat"
Limits social life, especially when it involves eating in public
Change in mood
Skipping meals or snacks, especially before a workout
Dressing in layers (to hide one's body or weight loss)
Obsessively tracking food, calories, macros, etc.
Constantly thinking or talking about food
Growing list of forbidden foods / only a handful of safe foods
GI issues (often made worse by eliminating more foods to figure out what causes symptoms)
Frequent trips to the bathroom, especially after meals
Signs and symptoms of RED-S or the Female Athlete Triad
It is important to remember that while sometime eating disorders or disordered eating will come with weight loss, the majority do not. An eating disorder does not have a look and you don't have to be "sick enough" to get help. Eating disorders, specifically anorexia nervosa, has the highest mortality rate of any mental illness. The earlier you are able to identify the signs and symptoms and intervene, the more likely recovery is possible.
If you or someone you know is struggling with disordered eating or an eating disorder, you can find more information on The National Eating Disorders Association website.
Seeing a registered dietitian or therapist may be scary or feel unnecessary, but they can help you reflect on the root cause of comparison and body checking and help you develop a plan to reduce and stop these intrusive habits before they develop into further disordered eating and more severe eating disorders.
NEDA has a quick and easy screening tool (appropriate for ages 13 and up) to help determine if it's time to seek professional help.