From the ingredients labels on foodstuffs to the digital display of the spin bike, you can’t escape calories. It’s also hard to avoid articles explaining that to enjoy X treat you must burn Y, but the view that sweet or fatty food is a guilty pleasure to be purged is being increasingly challenged.
Four-time Ironman world champion Chrissie Wellington even wrote an impassioned letter to 220, stating: “I am shocked and disappointed to see messages suggesting that the consumption of certain foods is concomitant upon undertaking exercise.
The implication is that exercise is a punishment. Some may think such messaging innocent and innocuous. As someone who has struggled with eating disorders, I view this narrative as being extremely unhelpful and potentially damaging.”
It’s undeniable modern society has an unhealthy relationship with food and exercise. There were 617,000 obesity-related admissions to UK hospitals in 2016/17, a rise of 18% in a year.
Eating disorders are estimated to affect 1.6million, with males comprising up to 25%, and studies suggest around 8% of women experience bulimia at some stage. There’s also thought to be a 20% higher prevalence of eating disorders among athletes. To seek a better way forward, we asked four experts to lead the debate...
The experts
The Olympian, Jodie Cunnama (JC)
Jodie’s competed at the top level for 16 years and written and spoken openly about mental and physical pressures of elite sport.
The coach, Dr Andy Kirkland (AK)
Coach and lecturer in sports coaching at the University of Stirling. Also worked as a physiologist in high-performance sport.
The dietitian, Renee McGregor (RM)
Performance and eating disorder specialist and dietitian, who works with a number of high-performance endurance athletes.
The Ironman pro, Jesse Thomas (JT)
IM Wales and Lanzarote champ and former All American runner at Stanford. Now runs his owns sports nutrition company, Picky Bars.
Q: Are statements such as “burn X calories to enjoy Y treat” a problem?
AK: There are inherent problems with simply focussing on an energy balance model because being able to measure something means it can be controlled. Such control is often related to disordered eating, so extreme care must be taken when using such statements.
It’s not about being politically correct, but to recognise how others may interpret messages. I often prescribe a café ride for cake and coffee. This isn’t about rewarding the athlete, it’s about enjoyable and relaxing things being conducive to welfare and performance.
JC: Yes. It’s especially harmful to youngsters to start counting calories. Exercise should be an integrated part of life and not incentivised by food.
The way we view food needs to be more balanced so we understand nutrients, our health, and our bodies, rather than being slaves to our taste buds and advertising.
RM: Anybody who has a slightly obsessive personality is at risk of becoming extreme in other areas too. If you’re fixated on training and it’s creating anxiety around food, you’re more likely to read into that statement and only feel you deserve a treat if you train.
Q: Have you ever read or been told something that has affected your own relationship with food?
JT: I had a pretty serious eating disorder in college for a few years and think some of it was caused by being told I was a ‘big runner’ and developing a complex. Small comments stick more than you’d think.
JC: I think most females have. I was schooled in balanced nutrition with the national development swim programme, but when I hit puberty, the focus seemed to change to watching weight.
When dealing with the hormones of adolescence, it isn’t as easy as calories in equals calories out. If the focus was on optimal nutrition for recovery rather than emphasising body fat percentage, it would have caused less problematic eating issues.
AK: Of course. We’re continually inundated with messages in the media, supermarket and beyond. I was an obese kid at a time when it wasn’t a societal problem, so I’ve always had a challenging relationship with food.
However, my partner’s great attitude to eating rubs off on me. When I studied Buddhism, we often spoke of the mindfulness of eating. That means thinking about those involved in the production chain, the quality of the produce and how it tastes. Eating is about respecting and enjoying food rather than simply considering it to be fuel.
RM: No, because I work with so many people with eating issues and see the impact it has on their life in general
– not just their health.
Q: Have you ever imposed rules around eating more healthily?
JC: Yes. For a long time carbohydrates were a sin, but I’m long past believing hard and fast rules on diet. The conclusion I’ve come to is that if I provide my body with healthy, balanced and nutritious energy, it responds well and doesn’t get sick and tired too often. If I don’t, I break.
Nutritional rules cause me to fixate on a single failure. When I was bulimic for instance, eating a single piece of chocolate could mean a downward spiral of binging and purging for days. Or starving myself could mean a weekend of euphoria. I will never let food have that control over my self-esteem again.
JT: I joke that my only rule is ‘don’t be an asshole!’, by which I mean don’t do crazy stuff that doesn’t make sense – just eat mostly healthy when you’re hungry. Rules cause people to be too strict and then binge as a result. I’ve seen it in a lot of Type-A athletes.
AK: I’m a vegetarian for ethical and sustainability reasons and avoid food that has been highly processed when possible. This typically means diet is automatically healthy without healthy eating being part of my identity.
RM: I’m liberal with my advice. Some find that hard because they want specifics. Generally, I’ll say when building into a high-intensity training session, have sufficient carbohydrates. Athletes that do well train hard but can also happily eat pizza and not stress about it.
Q: Are we more educated – or in a tangled mess – over diet than ever before?
RM: It’s an absolute shitstorm. Too many unqualified people make broad statements about what they do, and others see them as the epitome of health or performance and treat it as gospel.
People adopt diet trends – gluten-free, refined sugar-free, whole plant-based – as a means of restriction. I’d never put an athlete on ‘low carb, high fat’ because I do a lot of biomarker checking and see immediately the impact it has on performance, thyroid function and immune health.
There will be low carb, high fat advocates saying they don’t feel hungry, it’s the lowest weight they’ve ever been, and they’ve got the best glycaemic control they’ve ever had, but at some point it’ll bite them in the bum. I’ve seen it with so many athletes, it worries me.
There are also issues around who you should trust because the term nutritionist is not regulated. The only person who is technically qualified to work in clinical conditions, with eating disorders, diabetes or cancer is a dietitian, yet a number are offering advice and it’s dangerous.
Junior athletes, especially, are not taught to manage expectations. They are going to fail on occasion, so come up the pathway not believing in themselves and always looking for the next answer, jump on the next bandwagon and become so restrictive that their performance starts to fall.
AK: The reductionist nature of science also plays a role. The media and marketeers often pick up on single studies with limited sample sizes to promote products, superfoods or call out ‘bad-guy’ foods. Some scientists even ‘play the game’ by using the media to promote messages in which they have a vested interest.
JT: Owning a nutrition business, I’m even more conscious of the many coming and going trends and how people capitalise on fad diets with sketchy science. A lot of it is marketing. In fact, it’s tough for us to get our products out there because we don’t follow some crazy fad trend. Healthy, balanced, real food is not sexy from a marketing standpoint.
JC: Orthorexia [an obsession with eating foods considered healthy] is definitely present in the sporting community and often mistaken for healthy eating. Too many others – the low fat/low calorie/sweetener consumer type – only see calories. They monitor weight, but not health, when choosing foods.
Q: What’s your view of how the media projects ‘healthy eating’?
AK: It reflects wider society. Some messages helpful, some not. Even quasi-scientific programmes such as Panorama get it wrong by failing to recognise nuance and attempt to make things too simple in the belief that this is what the audience wants.
There’s also a danger in how magazines present overly aspirational healthy diets from a lifestyle perspective and sometimes I wonder what relationship some nutrition gurus have with food themselves.
JC: Rather than restricted calorie labelling, they should emphasise fresh, unprocessed consumption. People think whole fat milk is unhealthy because it has more fat than semi-skimmed. It’s 4% fat and fills you up for longer.
RM: Social media probably has more to do with holding people in bad places, but I never blame media completely. If somebody is vulnerable they’ll always look for validation. Even without the article, that person would go in search of the answer they’re looking for.
Q: Is there such a thing as junk food?
JC: Yes. But if you need sugar in a race, Haribos are perfect. In fact, sometimes they’ll do if you haven’t had time to eat and are waning. If you need salt after a race, crisps fulfil that need. Everything has its place – just like junk TV. It’s about keeping perspective.
AK: Processed and overly packaged food is junk. The food industry does this to ‘add value’ to low cost produce. For example, most boxed breakfast cereal is junk and most mass-produced supermarket bread is junk – typically composed of bleached flour, flour improvers, sugar, too much salt, a really high yeast content to make production quicker, and all sorts of other things not on the label.
I suspect poor quality bread has driven the trend in people thinking gluten-free is healthier, which is nonsense for most. Yes, they may feel health benefits by reducing consumption of food high in gluten, but it was probably too much yeast and other unnecessary additives causing the GI discomfort.
RM: I don’t believe in any food being bad or junk. If you want to have a burger, chips or ice cream, as long as it doesn’t make up the majority of your diet, I have no issue.
JT: The term is fine. There’s food that’s less healthy, but that doesn’t mean you should never have it.
Q: Is there a problem with marketed sports nutrition being contradictory to healthy eating?
JC: Sports and health is not the same thing, especially at the top level. We intake a lot of sugar and salt, but burn off far more. It would be unhealthy not to fuel yourself with these nutrients and I don’t think there’s a problem if people understand that logically. Where there’s an issue is in replacing sugar in sports drinks with artificial sweeteners.
RM: I’ve challenged many athletes on this. Messages about not eating sugar and carbs have made it difficult. When racing, you’re going to mainly be using carbs for fuel as it’s the quickest source for your muscles.
You can only store between 90mins to 2hrs depending on how fast you’re moving, so you need to keep on top of that. I struggle with those who say they want to use dried fruit instead of a gel.
Our bodies can only absorb 30g of fructose an hour. Dried fruit is more fructose than glucose, and if you don’t get the balance right you’ll end up with stomach issues. I tell athletes that those messages around sugar are for another population that do absolutely nothing – not for those training every day and racing every weekend.
JT: No. I believe a human body runs best primarily on carbohydrate during exercise, so you need more sugar. It’s that simple.
AK: Sports nutrition can complement healthy eating but should never be viewed as a replacement. There’s a place for gels and sports drinks because of their convenience during racing, but it angers me when I see youths guzzling sports nutrition when their racing is too short to need it.
I also believe that elites should only endorse products they’re happy to use. I once asked a famous triathlete if they actually liked the product advertised on their helmet. Their face was telling.
Q: Which sector of society has the most problems in its relationship between food and exercise?
JC: I’ve seen more issues with female athletes, but women are predisposed to higher levels of fat than men and therefore the margin of manipulation is wider. I also believe that many sporting females have inherently lower levels of self-esteem because it remains a male domain – and can therefore be more vulnerable.
RM: I see a fairly equal male/female split, but there are global studies showing a 20% higher prevalence of eating issues with athletes. I’ve recently seen a lot more teenagers with eating problems who are not technically athletes but have become exercise-obsessive. The rise of Instagram has played a part in promoting the eat-clean, body-beautiful.
JT: The female side has more stigma as they have more societal pressure to live up to a ridiculous media standard. It exists on the male side, but isn’t as prevalent. I think it’s improving as you have more representation of different body types in media, but it still exists.
Q: If you had carte blanche to intervene and change regulation around food provision, what would you do?
JC: I’d eliminate low-fat foods like sweetened yoghurt and skimmed milk. Greek yoghurt and full-fat milk satiate, and you eat far less of it than these processed replacements.
AK: Government needs joined-up policy on food, physical activity, health and education. The didactic provision of advice rarely results in behaviour change.
I’d start with legislation on food marketing and supermarket design and ban the sale of poor-quality foodstuffs in sports centres, hospitals and educational establishments. I’d also have strict food procurement policies for food in any publicly-funded body.
RM: I’d ban anybody who didn’t have a proper degree from giving nutritional advice, and I’d ban publishers from using celebrities to write books about health, nutrition and exercise.
JT: Outlaw all the crazy fads.
Q: Finally, if you could offer one piece of advice around diet to cut through all the noise, what would it be?
JC: If it grows, either from beast or plant, eat it until you aren’t hungry. When you are hungry again, eat it again.
AK: Eat whole, unprocessed foods with transparent origins and minimal packaging.
JT: Long-term, consistent, sustainable balance is king.
RM: Food feeds the soul. I love sitting around a table with friends, the conversations we have and the sense of wellbeing that gives me – can’t beat it!