The factors behind the development of an eating disorder vary, but beyond athletic pressures, causes include genetics, a desire for control, the practice of taking healthy to the extreme and the cultural pressure to conform to a thin ideal .
According to a study cited by the National Eating Disorders Association, more than one-third of Division I NCAA female athletes reported behaviors and attitudes that could put them at risk for anorexia nervosa.
For any person, this is a serious health issue, and for athletes, it can also critically impact their performances and increase their likelihood of injuries .
Metzger ran cross country at Kenyon College, and she said she saw other runners lose drastic amounts of weight or spend each season in an aircast to treat stress fractures.
Athletes competing in sports that emphasize size, endurance, weight requirements and appearance are more likely to develop disordered eating or an eating disorder. These sports include cross country, cheerleading, dance, wrestling and gymnastics, among others.
Mary Ellen Bingham, head nutritionist for UNC Sports Medicine, said there isn’t one team at UNC that is at the highest risk. She said disordered eating behaviors can exist on any team.
“I don’t see it as the athletic department has a worse problem than the university,” she said. “Eating disorders are something people struggle with across the university community.”
Bingham said the nutrition staff at UNC promotes a fueling approach — eating so players can compete effectively and healthily — rather than a diet approach, to student athletes.
When athletes do have problems, UNC has resources, including nutritionists, therapists and the UNC Hospitals, to deal with a range of issues, depending on the severity.
The diagnosis of an eating disorder is on a continuum of disordered eating. To be diagnosed with an eating disorder, the patient must meet the exact criteria outlined in the American Psychiatric Association’s classifications of mental disorders.
Disordered eating, which is more common than a diagnosed eating disorder, can include unnecessary elimination of a certain food group or not getting enough of a certain nutrient due to restrictive patterns.
For some, the problem can be alleviated with proper information, but for others, it can take longer.
“Everything is so case by case,” Bingham said.
‘I want to be like her’
Mariana Lucena isn’t one to back down under any circumstance. Her strong will pushed her to win the 3,200-meter state championship in high school. It brought her to UNC from Florida to run cross country and track in 2009. It helped her become the first varsity athlete ever to be in pharmacy school.
But before Lucena, now a Pharm.D. candidate at the UNC Eshelman School of Pharmacy, accomplished any of those challenges — before she even started to run — she beat her biggest struggle of all: anorexia nervosa.
Lucena said when she ran cross country, she knew there were members on the team who had struggled with eating properly, so she shared her story to try to help them.
“The problem with eating disorders is that as much as somebody else tells you what they’ve been through or that you have to eat, they’re never going to start recovering unless they realize, ‘Yes, I have a problem, and I want to help myself,’” she said.
Lucena said as a distance runner, she saw many women and men in the sport who needed help.
“Unfortunately, it is a very prevalent problem, and sometimes it’s the same teammates enforcing a certain diet or exercise regimen with a standard weight or body to fulfill. Other times, it’s actual coaches enforcing this pressuring environment,” she said. “It’s very easy to think, ‘That girl is so fast and skinny ... I want to be like her,’ and fall into a vicious cycle trying to achieve this state.”
Lucena’s eating disorder began the summer before eighth grade when she started exercising for hours each day to get fitter for basketball. As people commented on how fit she looked, she continued to exercise more and started to eat less.
Her battle included a 10-day stint in the hospital after her pediatrician told her she needed to gain weight.
“I was so hardheaded that my goal was to keep controlling myself no matter what anybody else said.”
Metzger completed a meta-analysis in 2008 that looked at 78 studies conducted on elite and collegiate athletes to determine if there was a correlation between sports and disordered eating behaviors.
In her research, Metzger found that for women participating in aesthetic sports — sports that heavily emphasize appearance, such as gymnastics, dance and figure skating — athletes were at a slightly higher risk for disordered eating. Both male and female endurance athletes were also at a slightly increased risk for developing disordered eating behaviors compared to non-athletes.
Eating disorders, as well as disordered eating, negatively affect athletes’ performances. Besides lack of energy, athletes are at risk for fractures, stress fractures and anemia, Metzger said. Female athletes are affected by the female athlete triad: loss of menstrual cycle, poor bone health and low energy availability.
“It’s definitely going to catch up to an athlete sooner than later,” Metzger said.
Genetics also plays a role in the development of disorders.
“Potentially for anorexia, anywhere from 20 to 50 percent of someone’s risk might be from genetics,” Metzger said.
Even with better information about proper nutrition, athletes with a family history should ????????be cautious, Metzger said.
Combined with the environment of an endurance or aesthetic sport, they might be at a higher risk.
Competing to stay healthy
Ida Valentine, a senior and former member of UNC’s dance team, said she has never felt any pressure to lose weight because of dance.
“When you’re out there in front of however many people, you don’t want them to look at you and think, ‘Is she eating? Is she not eating?’” she said.
Junior Allie Carter said the dance team has positively impacted her health. In 2013, Carter was going through personal issues that caused her to unintentionally lose a lot of weight, so her coaches restricted her from participating at games.
“They were concerned that I wasn’t taking care of myself, that I needed to get back to a healthy place, so they helped me get back to a healthy place, and I’m so much better now,” she said.
With the help of an on-campus nutritionist and the support of her coaches, Carter said she got back to a healthy weight.
“I think that people think that dancers in general — not just Carolina dancers — that they don’t eat, that they smoke to stay skinny, and they step on the scale every second of the day,” Valentine said. “I would just say I’ve never met a dancer like that.”
Olivia Lanier, a junior on UNC’s varsity cheerleading team, said there is a sense of competition on the team amongst members to look fit, but that the team atmosphere encourages staying fit in a healthy way, noting that they hold each other accountable if there is speculation of unhealthy eating habits.
“I mean obviously we’re in uniforms, we show our stomachs at games,” she said. “My teammates and I are very competitive with each other, so we kind of use that competition to stay healthy.”
Derek Galvin, head coach of UNC’s gymnastics team, said in his experience, proper information makes a difference in preventing disordered eating behaviors in cases when there is no emotional motivation for it.
“I think gymnastics, because it’s a sport where the athletes are competing in leotards, and I think because of the influence of the media and popular culture about the ideal body type, it’s an additional stressor on the life of a gymnast,” he said.
Galvin said at UNC there have been gymnasts on the team who had dealt with disordered eating before starting college.
“The focus we try to have in gymnastics is that it doesn’t matter what you look like as an athlete, it’s really all about your fitness and the way you fuel your body,” he said.
Weight loss in wrestling
Wrestlers have to lose a certain amount of weight to meet their weight class, and there are varying views on the healthiness of this behavior.
“Wrestling is interesting,” Metzger said. “Within the studies looking at males, there’s probably most research looking at wrestling.”
Metzger said their methods to drop weight do not likely classify as eating disorders , as they are not done continuously. She said there are likely more wrestlers engaging in disordered eating than in full-blown eating disorders.
UNC’s head wrestling coach C.D. Mock said he thinks there is a misunderstanding about eating disorders and wrestling.
Mock said wrestlers only have to lose weight until they reach the weight they need, and then they stop.
“I don’t call that an eating disorder. Maybe a psychiatrist might, I don’t know,” Mock said. “I think an eating disorder is something that, in my experience, you lose control in some respect.”
The sport has become more aware about the potentially dangerous effects of rapid weight loss, Mock said.
He said to lose weight the right way, wrestlers slowly decrease the amount of food they intake while still getting all the necessary nutrients and increasing the intensity of their workouts. Food is viewed as fuel rather than something to enjoy. The wrong way to lose weight would be to starve, Mock said.
At the beginning of every season, wrestlers undergo certification, which measures body fat percentage, weight and includes a hydration test. The results determine how much weight the wrestler can lose each week to get to the weight required for his weight class.
“So once I make my weight class, then I don’t have to worry about losing weight anymore. There’s usually a weekly weigh in, so I have to make my weight at each tournament, but I won’t necessarily be losing more weight,” said junior wrestler Matt Williams.
“It’s not for everyone. You shouldn’t just try to lose 10 pounds in a week,” he said.
“But if you do it right — we have nutritionists, we have diet plans — you can’t lose more than 1.5 percent of your body weight each week.”
Williams is aware of the health concerns people have about wrestling, but he said if done the right way, he doesn’t feel like what he’s doing is unhealthy.
“It’s really interesting because I’ve talked to a lot of my friends, and they’ll ask questions like, ‘Oh, do you guys, like, not eat, not drink for like a week? And don’t you guys, like, cut off your leg?’ But it’s really not that bad once you’re used to it because I never feel — I feel bad, I feel tired, I feel grumpy — but I never feel like I’m unhealthy, which I think is a lot of people’s concern,” Williams said.
“I enjoy it. I would’ve quit freshman year if it was like, ‘College wrestling, you have to not eat.’”
Surviving that obstacle
Colleen Daly, a UNC alumna and founder of Embody Carolina — an organization dedicated to training people about the psychological complexities of eating disorders and how best to support people with them — said without professional help, it can be difficult for someone to recover.
About one-third of women who had anorexia nervosa or bulimia nervosa relapse after a full recovery.
“People don’t understand that so much of eating disorders is mental so when you get somebody triggered, those behaviors can step in in a way that’s incredibly difficult to reverse without professional treatment,” she said.
After she finally accepted she had a disease, Lucena said she started crying and telling her parents that she wanted help and to gain weight.
“Because I was basically in my deathbed at that point,” she said.
Because of her battle, Lucena had missed out on a lot of opportunities to be involved in middle school, so she asked her parents if she run cross country in high school, and she eventually ran well enough to run for UNC.
Lucena never relapsed despite the increased pressure at the collegiate level.
“Being able to survive an eating disorder makes you so mentally tough,” she said.
“You never want to give up. If you survive that obstacle, anything that is put on your plate is not going to be as tough as what you just overcame.”