This week is Eating Disorder awareness week.
It is estimated that 1.25 million people in the UK have an eating disorder - a prevalence of 1.8%. More women are diagnosed than men, but eating disorders affect every gender, age and ethnicity.
In sport, the numbers are higher. Though precision is extremely difficult, a study of elite athletes found a prevalence of 13.5%. It showed that:
“Eating disorders are more common in female athletes, at 20.1%, with 7.7% of male athletes struggling. But, the prevalence of eating disorders in male athletes is about 16 times higher than in male non-athletes.”
“over one-third of female athletes reported attitudes and symptoms placing them at risk for anorexia nervosa.”
A recent survey of the Women’s Super League and Championship found that 36% of the 115 who completed a confidential survey displayed eating disorder symptoms.
Why is that the case? Why are sports people more susceptible to eating disorders? What help is there, and what good news does the Gospel have to bring into this area?
As we look into these questions, let me share something of my own story. Along the way I’ll highlight other things which reflect the stories of other people. Perhaps you’ll find something of your own story in here. Probably you’ll find something of the story of someone else you know - even if you don’t know about it yet.
Perhaps it is worth saying that as I write this I’m not in the thick of the battle. Much of the storm has passed, though some wounds remain. This means I have had years to reflect on my experience. The patterns, the pathways, the pressures which brought me there. And also the transforming grace of God. It is easier to see these things with hindsight. I couldn’t have written this in the midst of it.
Rosie is at St Mary's Church Basingstoke and an ultimate frisbee Player.
I got into the team I had been wanting to play for. It was a big step up for me, and I wanted to prove myself, I wanted to be good enough. I did all that was required, and brought my training, fitness and diet up to what befitted an elite athlete. And I loved it. My fitness improved, my physique changed, and my performance enhanced. I was well-versed in the idea that sport can be worship, and the dangers of idolatry. I genuinely prayed that I would do it all for the glory of God.
But my heart was more attached to it than I knew. When things in life got tough, my performance in sport became even more important - it became a source of satisfaction and worth which I should have sought in God. Then - as so often happens - sport broke my heart. Every year there seemed to be a major disappointment. Not qualifying for that tournament, or an early exit. Or finding myself on the sidelines. Not good enough to be on the pitch.
Sport broke my heart. But what did I turn to? What did I still have? I still have my body. I still have my fitness and my physique. Keep training, keep my diet in check. That’s something that I can control.
There are many factors which can lead to the development of an eating disorder, or disordered eating. It is complex. As Emma Scrivener writes, “there are, I suspect, a thousand answers. It’s bullying, Barbie and biology. It’s sickness and it’s sin. It’s death and God and the universe. It’s ‘us’ and it’s ‘them’. It’s global media and the kitchen table. It’s the Western world and it’s the human heart.” In our society there is a cultural ideal of what the body should look like, which influences many of us and becomes an ideal we strive to achieve.
But there are factors in sport which make this worse. As one elite athlete put it, ‘sport puts you in a greenhouse.’ It gives an extra rationale, as it is believed in many sports that a certain body type will lead to better performance.
Three categories of sport carry higher risks for the development of disordered eating.
First, sports that are judged on aesthetics, such as gymnastics, diving, figure skating and dance.
Second, sports where low body weight is thought to aid speed and efficiency of movement including distance running, cross-country skiing, swimming and rowing.
Third, sports that require you to ‘make weight’, including wrestling, powerlifting, rowing and horse racing.
Naturally, eating disorders are more prevalent in these risk sports. Indeed, a small study of distance runners in the UK found that 16% had an eating disorder. However, they can occur in any sport.
Pressure from coaches - not just in these sports - can be unhelpful. There has been a growing conversation in women’s football about the pressures which have contributed to the high prevalence of disordered eating among players. Fara Williams and Claire Rafferty have both spoken out about ‘fat club’, where you end up if you fail the ‘fat test’ - ie regular weighing. Everyone knew each other’s results, which added further shame.
For more high profile athletes, attention from the media can be damaging. In his 2020 documentary, “Living with Bulimia”, Freddie Flintoff said he had suffered from the eating disorder since being shamed for his appearance by the press in Britain at the start of his international career.
I went too far down that road. In my bid to eat ‘healthily’, my diet became too restrictive. Certain foods became my enemy, the list of forbidden foods became longer. In my bid to keep ‘fit’ I overworked my body, but I didn’t have the nutrition to fuel it.
I tried to be disciplined but I was so hungry. The end of a meal felt like a tragedy. My self-control would collapse and I would break my rules, I would go too far. It was as if I had sinned. And sin needs atonement. I had to get rid of it. Just as if I had never eaten it.
But these things come at a cost, and I felt the effects then and some of them I feel still. Various things in my body didn’t function like they should. Instead of enhancing my performance, I got worse. I was not the player I used to be. A gloom surrounded my mind, relationships suffered. Social situations were hard. Gatherings based on food became a source of terror. But worst of all was the guilt and the shame which could not be purged away.
An unhealthy relationship with food and exercise can manifest itself in different ways. For some, like me, it will be a diagnosable condition like bulimia nervosa. This is characterised by recurrent episodes of binge eating, followed by some form of purging as a means of controlling weight. These include vomiting, laxatives, diuretics, fasting or excessive exercise.
Others suffer from anorexia nervosa, defined as a 'serious life threatening disorder characterised by deliberate self-starvation.'
There are other eating problems which do not meet the criteria for anorexia and bulimia and come under the category “EDNOS”: Eating Disorder Not Otherwise Specified. This includes 'disordered eating' which describes those who use potentially harmful weight control measures including excessive exercise, extreme dieting, self-induced vomiting or other purging methods, but not meeting the bulimia criteria.
EDNOS also includes 'anorexia athletica,' which is distinct from anorexia nervosa in that the diagnostic criteria for weight is 95% or less of expected (rather than 85%), because the weight of muscle mass brings up the athlete’s overall weight.
A condition which affects predominantly (but not only) men is ‘bigorexia’ or ‘reverse anorexia’. This is defined as a “body dysmorphic disorder that triggers a preoccupation with the idea that your body is too small or not muscular enough.” This can cause sufferers to think constantly about building muscle on their bodies.
Eating Disorders can lead to various and serious medical issues, as well as adverse effects on performance.
I guess there were some warning signs I could have picked up on earlier. My teammates did not restrict their diets in the same way I did. They didn’t leave socials early because they were getting up before dawn to run sprints. I guess it should have been pretty obvious that it’s not a good thing to be throwing up your food. But I found ways to explain it away and that it didn’t count.
Then a combination of a talk at church and a chat with a friend helped me see I was having issues with my mental health. I looked on the NHS website and identified with many of the symptoms of depression and of bulimia. It was unbelievably hard to admit to myself and to others. I felt so ashamed. But I knew it was time to go and get help.
It can be hard in sport, especially elite sport, to recognise eating disorders. An athlete will be able to justify reasons for their eating and exercise behaviours, because they are expected to have a strict diet and will be commended for working hard in training. A female athlete may also claim that it is not unusual for athletes to suffer from some form of menstrual dysfunction. An athlete with bulimia may use over-exercising as a form of purging, but easily disguise it as working hard for their sport.
Indeed, the lead author of the study in elite women’s football, Carly Perry, said
“We believe this finding warrants further investigation as this could indicate that disordered eating symptoms are not self-recognised. Instead it’s possible they are normalised in the footballers’ sporting environment.”
Fighting the battle was not easy. A key step was to go and see the GP. Thankfully I was met with great understanding and compassion and I was referred to a Cognitive Behavioural Therapy (CBT) course. Unfortunately I had to wait many months until I had a place, but in the meantime I used a CBT resource which the course was based on. It was gold dust. It helped me understand the psychology behind my eating disorder. It helped me see what it was doing to my body. It explained a lot of other things I was feeling. It helped dispel myths about my ‘forbidden foods’ and set me on the way to a healthy relationship with food.
Amidst this I was still training. I had a World Championship to prepare for. I shared my situation with some of my teammates and had their support. I also spoke to my fitness coach and asked for a nutrition plan. For me, this was massively helpful. It meant I had a trustworthy guide and again broke many of my misconceptions about what was ‘healthy’ eating for a sportsperson.
I completed that season, but decided to take a year off at the end. There were many reasons for this, but one was because I wanted to make space for my recovery.
When struggling with disordered eating, we need to seek help. There is no shame in doing this - in fact it is a sign of strength, not weakness, that you are ready to begin fighting this battle. It is crucial to seek trusted, medical help through your GP. It is also hugely important to speak to your coach so you can work out what is best in terms of your training, triangulating with health professionals. And, especially for young people, it is important to involve your parents as well.
That might seem really hard. And it might be that some of those people are exacerbating the problem as they are putting added pressure on you. If so, do escalate your concerns to the leadership of your club, and involve parents or a trusted friend to help you navigate this.
The health of the athlete must take utmost precedence over sporting success, so for some it might be wise and necessary to suspend training, temporarily or permanently.
That might seem like a heavy blow. But there is a deeper battle to be fought here. One which secular CBT cannot fight for you. We need to get to the heart. That is the root of the struggles, and that is the place where real, lasting transformation can occur.
Eating disorders are complex. They are a medically diagnosable condition, they are a sickness which requires medical and practical help. It is far too simplistic to say they occur due to the sin of the sufferer.
However, there is a spiritual dimension to everything. Our hearts are wayward, we do not worship God as we should, and this leads to damaging consequences.
I felt so ashamed of this situation. It was hard to come to God. I knew I had sinned. I knew I had messed up. I knew I had not guarded my heart (Proverbs 4:23). I knew I had looked to other things for my worth and satisfaction rather than God. I knew I had harmed the body He had given me to take care of.
But deep down I knew He is a Father, who sees His prodigal child coming and runs out to meet and embrace them, welcoming them home. I knew that it was while we were still sinners that Christ died for us (Romans 5:8). I was reminded of the words of Jesus: “a bruised reed he will not break, and a smouldering wick he will not snuff out” (Matthew 12:20). God knew me in my weakness and called me into His arms, inviting me to cry out to Him with all I was feeling.
I received some Christian counselling. It wasn’t always easy and certainly not straightforward, but I was able to locate some of the idols of my heart, and be reminded of the infinitely better story of the Gospel which can transform every area of life.
I saw the consequences of finding my worth in my sporting performance. It is a shaky foundation. You always have to perform. You need to strive to be better and it’s never enough or it never lasts. And sport breaks your heart. Sport lets you down. And it brings you down with it.
Body image is no better. It sets before you an ever-changing, unreachable goal which leaves you feeling superior or inadequate. It gives you rules to follow and punishes you when you fail. It is an unkind master. And it will perish. It will spoil. And it will fade.
Approval fails us as well. The need for external validation drives us to push our bodies beyond their limits to meet the expectations of others. We live or die on the basis of others' opinion of us.
But with God? No, it’s not like that.
He tells us we are of infinite value. We are human beings made in the very image of God. What greater worth could be bestowed on us!
He tells us that we are loved. Loved unconditionally. Loved by the Creator of the universe. Loved even in our failures, our weakness, our brokenness. Loved not on the basis of our performance or our looks. We are MORE than our bodies. We are MORE than our performance.
That is security. That is a strong foundation. And in that security we are free…
Free to see sport as a gift from God which we can use to glorify Him, rather than to justify our existence.
Free to use our bodies to do the good works He has prepared for us to do, rather than to work ourselves to the ground to chase some ever elusive ideal.
Free to enjoy food again. Free to say yes to foods or say no to foods, receiving them with thanksgiving as good gifts from our heavenly Father.
Because we know that no matter our performance on or off the pitch, no matter our appearance, no matter what others think…we are loved by the King of the universe who loved us so much He was willing to die for us when He didn’t have to.
If you are struggling in this way, please seek help. This is not something we need to hide - eating disorders are very common. You are not alone. There is great help out there. Speak to a doctor, and speak to a Christian. Have friends you can be accountable to and who can pray for you and encourage you, reminding you of your infinite worth in the Lord’s sight.
The journey of recovery will look different for all of us. Everyone will progress at different rates, and what it will mean for sport will vary for different people. Let me reiterate that it is essential to work with a health professional, your coach or a trusted figure in your club, and your parents if you are a young person and/or a trusted friend, to determine the best care for you and what that looks like in sport.
The battle against sin is a real one. It is a lifelong one. God may help us make great progress in busting the idols which lie deep in our hearts. But they may rear their ugly heads over and over again, and we may fall. We may relapse. But God’s grace never runs out. God’s love is unchanging. Come back to Him. Again and again. Let Him love you.
To borrow a line from the book and recent BBC adaptation, The Boy, The Mole, The Fox and the Horse:
‘When things get difficult remember who you are.'
'Who am I?' asked the boy
'You are loved' said the horse.
We recognise that eating disorders are complex and you may wish to read further, here is a list of resources you may find useful:
A New Name, Emma Scrivener
A New Day, Emma Scrivener
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