Jackson’s treatment involved meeting with a nutritionist, psychologist and medical doctor. When she was placed on medical release after her sophomore year, her coaches mandated that she could not run or practice with the team until she was cleared by a medical professional, Jackson said.
During her medical release, Jackson did not have to give up her athletic scholarship. Instead, the athletic department paid for her scholarship, and the cross country team was able to give her scholarship to someone else.
“That was a huge burden relieved from me — that idea that I needed to perform because I felt guilty about getting a free education and then not being able to give anything back for it,” Jackson said. “That gave me the space to focus on recovery. It gave me the space to ultimately develop a healthy relationship with running and return to the sport."
Endurance sports require optimal weight levels and training to maximize one's potential, which Jackson said causes "a lot of potential issues for both young men and young women, in that they might take things too far.”
Rachael Flatt, the 2010 U.S. ladies figure skating champion and a member of that year's U.S. Winter Olympics team, said she witnessed many of her figure skating peers struggle with disordered eating and poor body image.
“I struggled with that myself, in large part due to a number of negative comments that I received about my physique and how I looked when I was on the ice,” said Flatt, who is now a clinical psychology Ph.D. student at UNC.
These experiences inspired her to research eating disorders in athletes at UNC. Flatt studies how technology-based tools, such as online screening tools and treatment programs, can increase access to mental health care for eating disorders.
With the help of Cynthia Bulik, founding director of the UNC Center of Excellence for Eating Disorders, Flatt hopes to improve the body image environment of athletics around the world.
Bulik said her research has found a positive correlation between physical activity and anorexia nervosa, possibly due to a genetic component.
Instead of over-exercising to lose weight, many anorexia patients are actually genetically pre-disposed to high physical activity, Bulik said. This can often lead a person into sports.
Eating disorder vulnerability in athletes is also influenced by the sport they choose to play.
Athletes who engage in endurance, weight-class or aesthetic sports, such as gymnastics or figure skating, are most vulnerable. Risk factors they commonly face include an emphasis on appearance, body size, uniforms, perfectionism and pressure to perform well, said Rachel Manor, director of Olympic sports nutrition at UNC.
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However, "eating disorders can come in any sport, any gender, any size,” Manor said. “Eating disorders don’t discriminate.”
Through nutrition education programs, Manor teaches UNC athletes about the principles of intuitive eating, which include honoring your hunger, rejecting the diet mentality and respecting your body.
“Dieting is the number one risk factor for the development of eating disorders, so we tell athletes we don’t diet and exercise, we train and we fuel,” Manor said.
'We're not about plate-shaming'
When a first-year athlete comes to UNC, they are screened by the sports nutrition department for disordered eating risk factors, Manor said. Should athletes develop an eating disorder, the department refers them to a sports dietician, a sports psychologist and a physician.
Kelsee Gomes, UNC's director of sports nutrition, said her department’s focus is on teaching athletes to make their own healthy food choices. It offers resources that include four full-time sports dietitians, team nutrition talks, grocery store tours and individual counseling, she said.
Much of Gomes’ work focuses on managing nutrition for the football team. She said the team has a dining hall on the second floor of Kenan Stadium, where players are fed a breakfast snack and a post-practice lunch.
The NCAA allows universities to provide one meal per day and unlimited snacks, but players on athletic scholarship are also given dinner, Gomes said.
Gomes meets biweekly with the football team’s catering company to go over what players prefer and what should be served. For each meal, both a lean option and heavier option are offered to give weight-gain players an opportunity to increase their calorie intake, she said.
With that, Gomes collaborates with strength staff and coaches to determine weight goals for players based on the needs of their position. She sometimes even helps players make food choices during meals.
“We’re not about plate-shaming over here," Gomes said. "We’re all about fueling for performance.”
During Tyler Powell's time as defensive lineman on the UNC football team from 2014 to 2018, he spent many meals with Gomes. Powell said he had to be on a 10,000-calorie-a-day diet for over a year in order to gain weight for his position.
“It made eating work," Powell said. "I got to the point where I missed being hungry. I wanted to be hungry so I could enjoy my food again.”
Powell said having a certified dietician whom he trusted helped him the most during the weight-gain process.
“She did everything she could to make it manageable for me and to figure out the best way to get the calories I needed without pushing me too far to the point where I refused to eat,” Powell said.
Weight-monitoring and daily encounters with a nutritionist are largely limited to the football team. For other UNC athletes, the sports nutrition department helps with pre- and post-game meal planning, on-the-road eating recommendations and suggestions for what teams should keep in their fueling stations.
Ru Mucherera, a fifth year on the UNC women’s soccer team, said the sports nutrition department has played less of a role in her eating choices. She simply keeps her nutritionist’s recommendations in the back of her mind.
“I know if I don’t eat, I feel sluggish — or I just know that I won’t be performing my best — so I try to eat what I think will help me perform the best that day,” Mucherera said.
Mucherera sometimes misses meals because of her busy schedule, but she said a key resource the sports nutrition department provides is the Fueling Station in the Loudermilk Center for Excellence, which supplies a variety of snacks to athletes during early-day hours.
“I think having that as an option actually encourages a lot of us to actually go there and eat,” Mucherera said. “I feel like if it wasn’t there honestly a lot of people probably wouldn’t be eating, skipping meals, and stuff like that.”