Content warning: This story covers disordered eating. If you are struggling with an eating disorder and are in need of support, please call the National Eating Disorders Association Helpline at 1-800-931-2237. For a 24-hour crisis line, text “NEDA” to 741741.
One of the most damaging myths about eating disorders is that they only strike adolescent white girls and women. In reality, anyone may suffer from some form of disordered eating, whether that’s shown in obsessively checking a fitness tracker for calories burned or not eating all day and then binging at night.
In fact, according to a 2018 report in the Journal of Clinical Sports Psychology, up to 45 percent of female athletes and 19 percent of male athletes struggle with an eating disorder. Among high school students, rates of eating disorders among athletes is higher than non-athletes.
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One reason for this increased risk? The idea that only certain body types are designed for running and sports. Because of this assumption, many athletes adopt strategies that, in the end, put them at risk for illness and injury. These strategies includes counting calories, overtraining, obsessively tracking every aspect of food and movement, or speaking negatively to themselves about food and exercise.
“A lot of times I’m helping runners and other athletes navigate the messaging about what their body should look like,” Abby Olcott, MS, RD, sports and eating disorder dietitian with Midwest Performance in Peoria, Illinois tells Runner’s World. “I always say that every body that shows up to that starting line has a runner’s body, but it’s hard at higher levels to not compare yourself and how you look. From a scientific point of view, suppressing your natural weight isn’t good for your mental or physical health and you’re more likely to get injured.”
Even though many of today’s most successful runners are more open and honest about their struggles with body image, food, and exercise obsession, there’s a lot of misinformation about these issues.
Here, we aim to clarify the differences between disordered eating and eating disorders, which include anorexia nervosa, bulimia, and binge eating disorder. Also, we offer advice on how to recognize the signs of these medical conditions both in yourself and others and how to take steps toward reducing stress and anxiety around food and exercise.
What is disordered eating?
While there are clinical diagnoses for eating disorders, “disordered eating” is an umbrella term (not a diagnosis) describing habits that many people practice to control their weight, according to the Academy of Nutrition and Dietetics. These habits may include dieting, frequently weighing yourself, having “good” foods only, and using exercise to make up for eating “bad” food.
The most significant difference between an eating disorder and disordered eating is whether or not a person’s symptoms and experiences align with the criteria defined by the American Psychiatric Association. However, eating concerns that fall short of a diagnosis deserve attention and treatment as they may turn into more problematic eating disorders and put individuals at risk of serious health problems, Cheri Levinson, Ph.D., associate professor at the University of Louisville and founder and clinical director of the Louisville Center for Eating Disorders tells Runner’s World.
Humans eat for a variety of reasons, including physical hunger and social events. Likewise, they exercise for a variety of reasons—health and fun, for example. But when someone exercises just to burn calories, especially to compensate for food, that behavior is considered “disordered.” In general, an obsession with weight, food, and exercise as a compensatory action for eating is a sign of a “disordered eating” pattern.
Disordered eating can also look like eating too little or too much for reasons other than physical hunger. Some athletes cut out entire food groups or go on “cleanses” or “detoxes.” They may consider themselves to be “picky” when, in reality, they are focused on calories and weight.
Disordered eating may also mean wanting to “bulk up,” and overusing protein, steroids, or supplements to get bigger explains Jason Nagata, M.D., an assistant professor of pediatrics in the Division of Adolescent and Young Adult Medicine at the University of California San Francisco.
Other signs of disordered eating
According to Levinson, there are a few behaviors that signify disordered eating:
- Always following a new diet
- Having “good” and “bad” foods
- Frequent weighing and measuring
- Avoiding social eating
- Letting negative thoughts about your body determine your mood or self-opinion
Disordered eating comes with health and social consequences, including gastrointestinal issues and avoiding going out with friends or family. When not recognized and managed, these habits can develop into an eating disorder. “Not every person who engages in disordered eating will develop an eating disorder, but everyone who develops an eating disorder started with disordered eating,” Alcott says.
“Like other mental illnesses,” Levinson explains, “disordered eating rises to the clinical levels when the behaviors and symptoms impair your life and ability to function.”
Do many of us check our trackers to see how many steps we’ve taken? Absolutely. But, picture this: If that number is low and you therefore don’t eat for the rest of your day or your day is ruined because you haven’t taken enough steps, then your thinking about fitness and food may be in need of some consideration. Talking to someone about this extreme response may help moderate your habits.
The line between disordered eating and eating disorders is fuzzy, but one consideration is conscious behavior and choice versus compulsion and uncontrollable behavior, says Levinson. Once someone feels out of control around their food and exercise behavior, they may have an eating disorder. If you feel like you can’t stop weighing yourself or you can’t stop eating or dieting, then your functional health may be at risk.
What are eating disorders?
According to the National Institute of Mental Health, eating disorders are not choices that people make around food. Eating disorders are serious mental health conditions that frequently present with co-morbidities, including mood disorders and suicidal ideation, as well as health issues, including heart disease and bone fragility. They affect people of all races, genders, and ages. It’s possible to suffer from more than one type of eating disorder, and the symptoms often overlap.
Eating disorder diagnoses include:
Anorexia nervosa
With the highest mortality rate of any mental health disorder, anorexia is considered a deadly disease. People with anorexia restrict the number of calories and the types of food they eat in order to lose weight, often quickly and almost always excessively. Some people with the disorder also exercise compulsively, purge via vomiting and laxatives, and/or binge eat. People with anorexia often don’t experience their bodies realistically, so they may feel “fat” when they are actually underweight.
Binge eating disorder
The most common eating disorder in the United States, according to the National Eating Disorders Association (NEDA), binge eating disorder or BED is a severe, life-threatening, and treatable eating disorder. It is characterized by:
- Eating, in a discrete period of time (e.g. within any two-hour period), an amount of food that is larger than most people would eat during a similar period of time and under similar circumstances.
- A sense of lack of control over eating during the episode (e.g. a feeling that one cannot stop eating or control what or how much one is eating).
Doing these two things repeatedly over the course of months is the sign of binge eating disorder. If someone regularly vomits or uses laxatives after this behavior, they may have bulimia rather than BED.
Bulimia
People who suffer from bulimia practice the habits of those with BED, but they also practice compensatory behavior in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise. The binge eating and compensatory behaviors both occur, on average, at least once a week for three months.
Orthorexia
Of particular interest to many runners and other athletes, is orthorexia, a term which was coined in 1998 by Stephen Bratman, M.D. It is not yet recognized as a clinical condition, but the symptoms include compulsive checking of ingredient lists and nutritional labels, an increase in concern about the health of ingredients, an inability to eat anything but a narrow group of foods that are deemed “healthy” or “pure,” an unusual concern about what others eat, and obsessive following of food and “healthy lifestyle” blogs on social media.
It’s not a bad thing to be a conscious eater, but when these habits detract rather than improve your life, it may be time to talk to a therapist who can help you bring your eating and exercising life back into balance.
Other Specified
Finally, there is the most commonly diagnosed eating disorder, “Other Specified,” which essentially means that someone doesn’t meet the clinical definition of one category, but meets some of the symptoms or a combination of the symptoms.
Getting treatment for eating disorders is difficult for many, including men, transgender people, and people of color. Medical recognition and insurance coverage for these populations can be difficult, and members of these communities may not find the emotional support they need from their families and friends who may think eating disorders only affect women.
How to navigate your relationship to food and exercise
It’s important to recognize that all of us can get lost in a maze of health misinformation, cultural and familial expectations around food, and our own goal setting. “Listening to your body is a complex navigation,” says Alcott. “Take hunger, for example, there’s a physical aspect, but food fulfills physical, emotional, cultural, and spiritual needs. We have to learn how to listen to those cues and then respond to them.”
This gets more complicated when you combine those cues with the goals we set around exercise. The way you eat or exercise shouldn’t take so much focus that you are unable to participate in other areas of your life.
Here are three tips to help you gain more self-awareness while you’re on your path to healthy heating and positive fitness.
Prioritize your whole self, rather than your athletic self
If you recognize disordered eating habits, such as frequently weighing yourself or overtraining, Alcott suggests trying to prioritize both your physical and mental health, rather than a specific weight or fitness goal. Even if you identify as an elite athlete who is determined to achieve a level of success, you can “still make choices to honor your health,” she adds.
In other words, instead of setting a goal to lose weight in order to run faster, recognize that confiding in friends or getting more rest may be more beneficial to your pursuit of better performance.
“Performance is a compilation of many factors, not just weight," Alcott says. She references The Athletes Program at McCallum Place, an eating disorders center with two locations in Missouri, which has a list of 40 factors that help optimize performance, such as sleep, mental toughness, teammate dynamic, and 37 others.
Know that disordered eating and eating disorders don’t have one “look”
According to the National Eating Disorders Association, 28.8 million Americans will suffer from an eating disorder at some point in their lives, and that includes people of all sizes and shapes. You cannot tell whether—or which—eating disorder someone has by the way they look, their age, or their gender.
Therefore, if some of the habits mentioned in this article feel familiar to you, you may want to consider talking to a professional, whether it’s a therapist or a dietitian. Cognitive behavioral therapy is the leading evidence-based treatment for eating disorders, according to Psychiatric Clinics of North America.
While it’s hard to replace a conversation with a therapist, it is possible to speak more lovingly and kindly toward yourself instead of continuing the self-conversation that leads to negative behaviors. If you practice some of the habits mentioned in this article, focus on one that you recognize as being problematic, such as weighing yourself too frequently or labeling food as “bad” or “good” and, without judging yourself, try to change your thinking and behavior.
When people who suffer with eating disorders and disordered eating are able to get professional treatment and longterm care, recovery rates are high. Unfortunately, many people don’t seek treatment because they are ashamed, afraid, or because they think they aren’t the kind of person who suffers from an eating disorder. Erasing all of these stigmas and assumptions can only help all of us create a healthier world of eating and exercise.
Use metrics as information not judgment
The combination of fitness trackers and metrics in the world of disordered eating is complicated. The apps and trackers that we rely on can, as research shows, inspire us to walk more and get more exercise. However, other published research suggests that people who struggle with food and weight issues may be “triggered” by the use of fitness apps and trackers.
While some runs and exercise sessions benefit from metrics, such as distance tracked and speed, Alcott recommends separating some of your fitness from numbers. “Can you enjoy your workouts without tying movement to a number?” she asks her clients.
Take a walk without your watch or turn off all the apps except the distance tracking when you run, as Alcott does. Instead of thinking about how you look when you run, focus on the happiness you feel, the elegance in your stride, and the power of your legs.
Donna Raskin has had a long career as a health and fitness writer and editor of books and magazine articles. She bikes in a nearby county park, lifts weights, takes Zumba, and loves to walk/run with her dog, Dolly.
