We explain the link between endurance athletes and eating disorders.Credit: cristinairanzo/Getty cristinairanzo/getty
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Triathletes and eating disorders: what's the link?

In endurance sport, it’s often believed that the lighter you are, the faster you are, which can lead to over-controlled diets and eating disorders. Tim Heming explores the link…

When Shane Sutton admits in a recent BBC documentary that he told Jess Varnish to “lose some timber,” he delivers the line unapologetically. With a lens on the culture of British Cycling, it’s clear Sutton enjoyed his enforcer role as technical director because the way he wielded power reaped results. Brits won gold. The stereotypical brash Aussie did his job.

In this particular clip, Sutton denies he told European track champion Varnish to “go and have a baby”, as has been alleged; the blunt comment about weight was instead just his honest opinion. Sutton is now removed from his post as Dave Brailsford’s successor, but the 60-year-old won’t flex in showing contrition because his role was pivotal in securing millions of pounds of funding and protecting the jobs of those colleagues he inspires – or intimidates – depending on your view.

In the same documentary, Brailsford too, told of his fears for elite sport going soft, further underlining that British Cycling’s hard-line approach had little wiggle room for empathy.

Unfortunately, it’s a myopic long-term vision. When power-to-weight ratios are the overriding concern, and it comes to telling athletes that they need to ‘shed timber’, there likely registers a human cost. We know this because we see it too often; a throwaway remark the catalyst to a chain reaction of destructive behaviours.

Not just a cycling problem

It's also particularly pernicious in endurance sport where evidence without context might suggest ‘lighter is faster.’ The problem being that ‘lighter’ also tends to sway toward malnourishment and a propensity for injury, and, in the long term, gripping mental addictions and a perilous relationship with food.

Thankfully, Sutton’s approach to weight management is largely seen as archaic in 2017, not least because body fat is the bluntest of tools by which to measure performance. Yet despite the oafishness, demonising any individual is largely unhelpful because while coach education has improved inordinately, the notion of disordered eating can be unfathomable to even the most well-intentioned mind. A crass comment might trigger a latent propensity for individuals to restrict their diet, but it can never be the whole problem. And sometimes it has little to do with a coach at all.

“I'm 20 years old and I have never had a period. I’m 20 years old and I have osteoporosis. I’m 20 years old and I have become ‘that girl’,” began Bobby Clay, a promising national-standard middle distance runner, in a recent interview with Athletics Weekly. “[I was] the girl who over-trained. The girl who under-fuelled. The girl who we are all told about, yet we all just believe ‘it won’t happen to me.’”

Four times in one paragraph she uses the term ‘I wanted’ as she speaks of her athletic ambitions; explaining that her coach tried to limit her insatiable desire to achieve greatness at speed. Despite advice from her coach, parents, and doctors, food in her training group “became the enemy”, and although she denies having an eating disorder, she twisted narratives in her mind – the slimmest chance that she might be a late physical developer seized upon as justification for not addressing her excessive training load.

In the past year she believes there has been just four weeks when she has not suffered with a bone fracture. Hormone Replacement Therapy drugs are being used to redress the balance and she finishes with a plea that she will be the last to become ‘that girl’.

Clay deserves every bit of the praise she has received for this honesty. Her words will have more impact than she’ll ever fully realise, but, sadly, she will not be the last ‘that girl’.

Holly Lawrence, the 2016 world Ironman 70.3 champion, also denied she had an eating disorder in a recent candid Instagram post, but the Welsh triathlete did explain how her relationship with food became skewed to the detriment of her performance this year. As so often the case, it started with injury. 


2/2 By the time I got to Worlds I felt like a total fraud- I wasn’t sure how much I could even run, my foot was semi-under control but totally unknown. The last couple months involved failling bike workouts, not only was I getting too precious about nailing bike workouts to compensate for not being able to run, but I wasn't fueling enough to hit my sessions properly because I focussed too much on body weight. Race day I had THE WORST swim of my life - I couldn't fake it, I'd lost my swim strength, the bike didn't get much better and I just didn't have anything. I was emotionally drained and didn't have the fight in me. I'm saying this because I believe I have a duty to all my followers to show both sides of the story, not just the picture perfect images from Instagram. I had pro athletes even asking what I was doing - what nutritionist I was working with, as If to give tips! I honestly felt so bad and reached out to those people after to explain my end whether they wanted it or not- and now I want to for my followers too. In a sport where people care too much about weight, when really it's matters who swim-bike-runs the fastest and not fighting what makes you, you. For me it was only a matter of a few kilograms but I can see how this can start in anybody and maybe people need to be a bit more switched on about what they say. Body fat does not necessarily correlate to fitness! I raced all season (winning!!) at a normal weight for me and I didn't need to change anything, yes injury sucks but you can't just lose weight and expect to get faster- it doesn't happen (and didn't!)! I'm proud to be back to my normal self, healthy body, and end the season on a high even though not at peak fitness! I’m now so excited to get rolling for next year! Bring on 2018! Again thank you to everyone who continues to follow me and support me 🙏🏻! ❤️ #honestyhour #weightdebate #strongnotskinny #triathlon #womeninsport #runlikeagirl #triathlon #ironman #truth #speakout #sayitlikeitis #honestypolicy #awareness #realtalk #everydayisaschoolday #learningcurve #itsok 📸 @talbotcox

A post shared by Holly Lawrence (@hollylawrencetri) on Dec 1, 2017 at 6:19pm PST

Lawrence too, deserves to be applauded for the introspection, but moreover hers is the best of examples to show to young triathletes risking unhealthy levels of low body fat for perceived performance gains. They simply do not exist.  

As four-time Ironman world champion Chrissie Wellington explains in her autobiography, A Life Without Limits, and interview here the choice to restrict her diet was about short-term emotional reward. For a high-functioning individual, to be able to control every morsel became the marker of success. 

“I’d set rules like not eating meat or carbs, and counting calories,” Wellington says. “Mum would visit and cook lasagnes and quiches for me, but I’d give it all away. My sleep became disrupted, I started to get downy hair on my body and grind my teeth. Everyone could see it, but I’d love it when people said: ‘You look thin or lean’, because that meant I was successful in living by the rules I’d set.”

Wellington had to first accept her own obsessive personality then understand how it could be best channelled into sporting performance as a healthier option. Guided by her coaches and with strong family support, she learnt fast that strength and power were the answers for triathlon. The evidence – retiring undefeated with four Ironman world titles – suggests it worked.

Others have found it harder, and for Britain’s Hollie Avil, triathlon was part of the problem, not solution. The 2009 Under 23 world champion, retired in 2012 after battling eating disorders and explained to 220’s Liz Barrett how the pressure of the build-up to the 2008 Beijing Olympics, and a comment about weight from a coach, put her in a dark place.

“I’d write things like, ‘Ordered a black coffee’ – I’d be too scared to have milk – ‘Biscuit on the side’,” she explained. “But in the margin I’d written, ‘Too scared to eat the biscuit’. It’s quite sad to look back on.” 

GB coach Ben Bright showed her evidence that she was running faster when slightly heavier and definitely healthier, and she echoes Lawrence’s sentiment in admitting: “I could also barely swim [when I was thinner]. I had no buoyancy, my times were horrendous and I would get very cold. Ben told me that in triathlon it’s about being strong rather than skinny." 

What the research says

Research into eating disorders bears out how elite sport can create a high-risk environment, particularly in individual pursuits, those that showcase bodily appearance, and sports that overvalue the belief that weight loss improves performance.

A 2004 study (Sundgot-Borgen and Torstveit. Clin J Sport Med) took 1,620 elite Norwegian athletes and 1,696 control subjects, and the overall prevalence of anorexia nervosa, bulimia nervosa and other unspecified eating disorders was 13.5% in the elite athlete group and 4.6% in the control group. Among elite women, it was 20% – twice that of non-athletes. Male eating disorder cases were 8% in the elite group – 16 times higher than among non-athletic males.

As the study found, this is not strictly a female domain. US triathlete Jesse Thomas, the 2015 Ironman Wales winner, told Outside Magazine that when he ran for Stanford as a college student every guy on his team wanted to lose weight. He says, “We had this joke: ‘Oh man, I’m so hungry I’m going to go take a nap.’ To a certain extent, maybe that made me feel better, like, ‘It’s not that big a deal. Everyone’s doing it.’”

Thomas self-imposed a rigid diet trying to “clamp down, clamp down, clamp down,” but said every once in a while he would crack and binge eat before fasting for up to 36 hours; adding extra run sessions as he purged himself. Now 37, Thomas believes he was an undiagnosed bulimic.

Of the examples above, some, such as Lawrence and Wellington, faced the stark evidence and were mentally equipped to make healthier choices. But shock tactics do not always work, especially if the condition is deeply ingrained.

Louis Theroux’s recent BBC documentary, Talking To Anorexia, was a brutal example of where eating disorders have taken an such an extreme grip any exercise is just the flipside of a self-punishing coin. Even though Theroux has embedded himself in many bizarre environments over the years, the London clinic left him banjaxed by the obsessive compulsive restrictions that enslaved the subjects of the film.

One woman kept a bar of chocolate in her cupboard for months, with just a tiny square as an occasional ‘treat’. Another would perform hundreds of star jumps to the point of exhaustion. As much as the patients were weak and emaciated, they were also intelligent and articulate, capable of understanding that unless they started to nourish themselves their systems would shut down completely. Yet sadly the condition had developed into an illness that overpowered the rational mind; the bitter irony being that with a threadbare national health service, psychological support is often prescribed too late.

"Unfortunately, a lot of people are turned away from treatment because they are not thin enough,” says Fiona Dunn-Lowes, a chartered consultant in clinical psychology. “It’s a shocking state of affairs, especially considering that when someone is very thin, the first point of treatment is re-feeding because cognitive processes are so compromised it’s not possible to make sense of psychological therapy.

“Younger people should be referred to CAMHS (Child and Adolescent Mental Health Services), but it depends what area you live in and what is available. There are also various charities you can access for help or advice such as Beat (www.b-eat.co.uk) or Anorexia & Bulimia Care (anorexiabulimiacare.org.uk).

“To support others, you need to help them acknowledge that there is a problem – and that can be tough. You’ll probably have to battle a lot of anger and denial because the person who is engaging in that behaviour will defend it fiercely because it has a function for them ie. achieving control.

“Once that problem is acknowledged, try to increase communication so they open up, and help refer them to professional support.”

What are the lessons for athletes?

An understanding that controlling diet can negatively impact performance does not strike the root cause of a problem, but it does lend evidence for goal-driven individuals as to why under-eating is the wrong choice.

Over and above that we need to listen and be supportive. We need not to be scared to ask difficult questions of those we care about, and at the same time reassure them that we always have their best interests at heart. It’s a kindness that can also be applied introspectively.

As Jodie Cunnama, the 2016 ITU world long distance champion, says: "Thin is not fit – strong is fit." This means strength of both body and mind, so given triathletes constantly look for ways to improve physically, maybe it’s time to apply the same coaching philosophy to the mental side too.


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