Athletes and Eating Disorders

Are semesters really long orreally short? Both. With this one wrapping up, we’re revisiting some ofour favorite features from recent months, giving them one more playbefore the holidays arrive, the new year takes a bow, and the next longand short of it comes rolling around.

David Proctor is a Boston University track and cross-country legend. The middle-distance runner from Rochdale, England, is the only Terrier to break the infamous four-minute mile barrier, making him a strong candidate for Britain’s 2012 Olympic team.

His coaches praise his determination. His teammates try to channel his raw talent. And his fans applaud each new victory.

But there’s a darker side to his tale of success:

For more than two years, Proctor (SAR’08) suffered from anorexia, a disease that ravaged his nearly six-foot frame to a skeletal 130 pounds — nearly ruining his running career and his life.

Proctor’s shocking story is not uncommon. An estimated one-third of female college athletes suffer from clinical eating disorders, says Paula Quatromoni, a Sargent College assistant professor of nutrition. The problem occurs less frequently among male athletes, but remains a scourge.

“The demands of athletic training and peak performances, particularly in Division I collegiate sports, place athletes at an increased risk,” Quatromoni says. “The characteristics that make them exceptional athletes — a desire for perfection, an instinctual need to please — go hand-in-hand with eating disorders.”

Anorexia and bulimia are illnesses that often coexist with emotional problems such as anxiety and depression, says sports psychologist Joanne Pomodoro (SSW’99). The struggle to manage practices, competitions, and academic demands can be overwhelming; some athletes turn to unhealthy tactics to regain a semblance of control.

“Eating disorders are maladaptive coping mechanisms,” she explains. “Counting calories, restricting food intake, and monitoring the numbers on the scale are very tangible things.”

Proctor’s spiral into anorexia began the fall of freshman year. “My coach patted my belly and said, ‘You’re getting a little fat,’” he remembers. A weigh-in confirmed the coach’s suspicions: Proctor had gained 15 pounds.

His coach advised him to lose weight, warning that it could affect his performance. The conversation was short and almost nonchalant, but it had a profound effect. “I felt terrible,” Proctor says. “I knew I was letting down my coach, my team, and myself.” That night he slept fitfully, unable to get the coach’s words out of his mind: fat, slow, with the logical result never uttered — loser.

That was Proctor’s greatest fear. And before the year was over, it would drive him to extreme measures.

The next morning, he stumbled out of bed, determined to whittle his body to 145 pounds. He dieted unsuccessfully for several days before cutting out breakfast and lunch entirely, allowing himself a small dinner only after a grueling two-hour practice.

The results were almost instantaneous. He dropped 20 pounds in the first two weeks, and by mid-January, he’d shed an additional 10. But it came at an extreme cost. “I didn’t eat for three days,” he recalls. “On the fourth day, I went on a really long run and passed out.”

Paradoxically, the less Proctor ate, the faster he ran. He clinched second place in the America East Indoor Championships 800-meter race and a week later placed second in the New England Championships 800-meter race. His success validated his conviction that “thinner equaled faster.”

While coaches praised his performances, friends and teammates complimented his physique. “They’d say, ‘Wow, you’re really ripped,’” Proctor recalls. “I wasn’t ripped — I was gaunt. I was starving.”

He became fixated, obsessively counting calories and weighing himself several times a day. “I made up these arbitrary rules,” he says. “Like, I couldn’t eat until after six. So I’d be lying on my bed, staring at the clock and counting down the minutes until I could eat some yogurt.”

He recalls the validation he felt each time he stepped on the scale. “If I weighed a 139.9, I was infinitely happier than if I weighed a 140.1,” he says. “Some days I could barely get out of bed; the scale was my main motivator.”

By the time Proctor sought help, he weighed 130 pounds and had a body-fat percentage of 3.1. Even the leanest of athletes should never dip below 5 percent body fat, says Quatromoni. “While weight loss might increase performances initially,” she says, “chronic caloric restriction or purging habits will eventually ruin an athlete’s performance.”

Highly contagious behaviors
Proctor was lucky. He suffered only minor injuries: shin splints and stress fractures. Other athletes are not so fortunate. Women are susceptible to a syndrome called female athlete triad, three interrelated conditions that include disordered eating, menstrual disturbances, and osteoporosis.

“I’ve treated girls with such low bone density that they’re getting stress fractures in their backs and hips just from running,” Quatromoni says.

Maladaptive eating behaviors are highly contagious, she adds, particularly among athletes who live, eat, and travel together. “Eating disorders are oftentimes modeled, learned, and even admired as potentially successful training strategies by teammates struggling to gain a competitive edge,” she says.

Bruce Lehane, Proctor’s cross-country coach, does not discuss what passes between him and his athletes. But in nearly 30 years of coaching at the University, he says, he has worked with several runners who have had eating disorders. “I don’t think it’s widespread,” he says, “but when it does happen, it impacts every member of the team.”

Although Lehane doesn’t screen athletes for eating disorders, he seeks Quatromoni’s help if he has concerns about a runner’s eating habits. “Coaches shouldn’t try to treat or diagnose athletes,” he says, “but rather, refer them to someone who has proper medical training.”

Quatromoni is appreciative of coaches like Lehane. “I wish more coaches would send athletes our way,” she says, “because supporting their nutrition and mental health is just as important as supporting their performances.”

A BU tennis star we’ll call Becky Arnold (she has requested anonymity) remembers exactly when her bulimia started. As a senior in high school, she was ranked 30th in the nation. But when an injury left her unable to compete during recruitment season, Arnold became depressed.

She vomited for the first time just days before high school graduation. By the time she arrived at BU the following fall, purging was a daily ritual. Even though she was one of the best players on the team — Rookie of the Year and Most Valuable Player freshman year — she was unhappy. “I never wanted to be at BU,” she says. “But UCLA didn’t want me because of my injury. All of my self-confidence was gone.”

So Arnold ate — everything. She recounts late-night visits to convenience stores and fast-food restaurants, where she’d buy boxes of donuts and bags of French fries, polishing off every morsel in one sitting. What little comfort such binging provided was fleeting; within minutes, she brought it all back up.

“You can’t imagine the anguish,” she says. “It just consumes your life. And the stuff I did to hide it — I’d throw up in the shower, in trashcans. It was disgusting.”

The world of athletics is harsh, Pomodoro says. Athletes undergo constant criticism from coaches and scrutiny from teammates. “They’ll do anything to win,” she says. “Even if it just about kills them.”

Arnold agrees. “Sports are very black-and-white,” she says. “You win or you lose — there’s no middle ground. And you do what you need to do to win.”

Because anorexia and bulimia are virtually invisible, an eating disorder can go undetected and untreated for years unless an athlete is grossly underweight. “People would be shocked at how many BU athletes have eating disorders,” says a soccer player we’ll call Jordan Lewis (she also asked that her real name not be used). “I don’t even know if the coaches are aware of how common it is.”

From the time she was 15 years old, Lewis wanted to play professional soccer. And when BU offered a full-tuition scholarship, she thought she was on her way — until she was injured freshman year. Unable to train, she gained 20 pounds, angering her coach. She felt a stifling pressure, afraid that she had to lose weight or she’d lose her scholarship.

In the beginning, Lewis threw up only after she’d eaten a big meal or a lot of junk food. Soon she was vomiting uncontrollably after even the smallest snack. “I’d take a sip of water and bring it back up,” she says. “It was scary how quickly it accelerated.”

Lewis dropped the weight, but at a terrible cost. The eating disorder persisted even after she’d recovered from her injury. “I’d be on the field, and stuff would just come up,” she says. “I had no control over it. My friends were so worried about me. I’d be in the bathroom throwing up, and my roommate would be pounding on the door, screaming at me to stop.”

Her coach had no idea. “I wasn’t underweight,” Lewis says. “In fact, bulimics are typically 10 pounds overweight. So even though I had this raging eating disorder, my coach was still after me to lose more weight.”

Lewis began seeing Quatromoni during freshman year; it took the rest of her college career to get the problem under control. Even senior year, when she was playing the best soccer of her life, she struggled. And although she no longer purges, she cannot part with her scale.

“I weigh myself every week,” she says. “I never miss an episode of The Biggest Loser. I’m obsessed with weight.”

Arnold also wonders if she will ever be free of her eating disorder. “It’s something I struggled with for four years,” she says. “Some days I wake up and it’s like I never got better.”

Quatromoni says there’s no quick treatment. “People tend to think, oh, you gained back the weight, you’re cured,” she says. “But it takes years for people to recover.”

And as with any addiction, there can be setbacks. Last year during cross-country season, Proctor suffered a relapse; he stopped eating and dropped 15 pounds. “It was tough,” he says, “but I had my support systems in place, and I pulled myself together.”

In spite of all that’s happened, Proctor says, he wouldn’t change anything. “I’m the runner I am today because of my eating disorder,” he says. “And the lessons I’ve learned are going to take me far.”

Perhaps even to the 2012 Olympics.

Vicky Waltz can be reached at vwaltz@bu.edu.

This story originally ran September 25, 2009.