How Sports Culture Undermines Athletes Long After They Graduate
Within the world of sports, it is common for athletes to suffer silently from the pressure of performance perfection, revealing uniforms, media attention, body shaming, and a culture that nurtures eating disorders, all of which increases their risk of developing a mental disorder that can stay with them long after their sports careers end.
By Madeleine Davison
As she finished her final track race of sophomore year for Wesleyan University, Yuki Hebner was pulled aside by her coach for an informal end-of-season chat. He congratulated her on a good season and told her he thought she could be an All-American — if she lost 15 pounds. Hebner, a 5 foot 2 inch 125-pound distance runner, reminded her coach that her muscular build made her fast and strong. But her coach convinced her that weight-loss offered a better strategy. She complied, losing 10 pounds in just a few weeks.
Then, she began to struggle. “Things got bad when I couldn’t lose the last five pounds,” Hebner says. “I remember being really disappointed with myself. I remember being like, ‘Why can’t you do this?’”
That summer, Hebner lied about missing meals to both her family and her friends, telling each that she was eating with the other and then not eating at all. When she returned to campus and meals became unavoidable group activities with teammates in the dining hall, she began purging after dinner in the library’s single-use bathroom. At the start of her cross-country season junior year, she suffered a stress fracture in her femur — an injury often associated with low bone density due to malnutrition. But she believed her “excessive” weight caused the fracture — because that’s what her coach told all his athletes. Hebner also became anemic, a condition which caused such exhaustion she’d dash to friends’ dorm rooms to sleep for 15 minutes between class and practice. A pervasive feeling of sadness dogged her day after day. Her senior year, she recovered from her injury, but her running times had taken a nosedive.
“I was running horribly, and I felt horribly about myself,” Hebner says. “I didn’t quit because I loved running, and I really believed it was going to get better.”
Many collegiate student-athletes share Hebner’s experience. According to the National Eating Disorders Association, college athletes may be at a higher risk of disordered eating than non-athletes. A pair of studies conducted by researchers at the University of North Texas and University of Wisconsin-Milkwaukee found disordered eating symptoms in more than one-fourth of female athletes and one-fifth of males. In addition, a 2004 survey of more than 1,600 elite Norwegian athletes found that cases of eating disorders were much higher than among non-athletes, with rates of more than 40% among female athletes in aesthetic sports like gymnastics.
Eating disorders deliver serious physical consequences: mood swings, trouble concentrating in school, digestive problems, testosterone decreases, lack of a menstrual cycle, decreased bone density, repeated bone injuries, osteoporosis, and even heart failure, says Paula Quatromoni, chair of the department of health sciences at Boston University. In fact, anorexia nervosa, one of several eating disorders (others include bulimia nervosa and binge-eating disorder), is the most fatal mental disorder and the most challenging to treat, according to the National Institutes of Health. Student-athletes are uniquely at risk. In addition to the societal and psychological factors that impact those in the general population, athletes face sports-specific risk factors. “There’s the performance pressure, there’s the pressure of how you look in that uniform, and with cameras on you, and so much of your body being exposed,” Quatromoni says.
A Culture That Nurtures and Hides Eating Disorders
In recent years, the ravages of eating disorders in sports have earned substantial attention. In February, Mary Cain, an elite distance runner and former high-school national record holder, told the New York Times that her coach, Alberto Salazar, had shamed her and other elite runners into losing weight, leading to depression and rampant injuries. In 2018, 13 former elite gymnasts told AP that U.S.A. Gymnastics coaches promoted extreme calorie restrictions and denigrated athletes with developing bodies, leaving many with life-long eating disorders. Athletes such as former UCLA gymnast Katelyn Ohashi, known for her viral PAC-12 floor routine, and Schuyler Bailar, a former swimmer at Harvard and the first openly trans DI athlete, have spoken publicly about their struggles with eating disorders and decried body-shaming in sports.
The desire to improve performance also drives some athletes to restrict their nutrition. Starla Garcia’s eating disorder began during her junior year in high school, before she was recruited to run for the University of Houston. The stress of AP courses and competing in track and cross country meant that nutrition went on the back-burner. As she lost weight, her times started to improve. And her peers began to praise her for being thinner. Soon, Garcia started to develop disordered eating habits, consciously restricting her food intake and running even more miles, in hopes that this would help her run even faster.
“You’re a teenager, and when you’re doing really well, you can only see the stuff that you’re doing at face value. That was something that I think definitely triggered the continuation of my disordered eating habits,” Garcia says. “It had started very innocently and unknowingly, and then it just kind of started to have a spiral effect from there.”
As she entered the pressure cooker of collegiate athletics, she felt the need and the stress to discipline her body and conform to stereotypes of what a distance runner “should” look like. The lack of Latina role models in her sport, who could demonstrate to her the strength and beauty of her body’s shape, undermined her confidence. Then, during her sophomore spring, Garcia suffered an injury. Terrified of gaining weight while she recovered, she began to use other methods to control her body. “When I had my IT band injury and was swimming, I was very lost,” she says. “I ended up using laxatives to cope with it.”
Media attention and the exposure of performing in revealing uniforms can increase some athletes’ risk of developing body dysmorphia and eating disorders, says Toni Torres-McGehee, director of the graduate athletic training program at the University of South Carolina. She found that collegiate cheerleaders who wore more revealing uniforms during games experienced higher levels of body dissatisfaction.
Lanesha Reagan, a former Oregon State volleyball player, said she often felt exposed in her spandex uniform shorts, and found it difficult to avoid comparing herself to other athletes at games. “Being built very athletically and more muscular, my thighs were always the biggest thing in my head every time I got ready for volleyball,” Reagan says. “And that’s all I could think about.” In middle school, she developed depression and an eating disorder that followed her into college. She remembers the dread of being weighed at the beginning of every term in college — her freshman year, athletic training staff announced out loud each athlete’s BMI during team physicals, a practice she says they later discontinued.
For other athletes, the environment and culture of sports, with its emphasis on discipline and commitment, can obscure an eating disorder that stems from other mental-health conditions. That was the case for Mike Marjama, a former MLB player who played baseball at Long Beach State. The athletic environments of wrestling and baseball exacerbated his eating disorder, which began in middle school. Peers and coaches praised his restrictive diet and over-exercising as a sign of determination or hard work. “At first it was cutting weight to make a weight class,” Marjama says. “And then it was, ‘Oh, if I just work out a ton and keep working out and don’t eat anything, I won’t get fat, and by working out, I get big and strong.”
Soon, Marjama’s grades began to falter. In high school, at the peak of his eating disorder, he struggled to stay awake and to pay attention during class. Thoughts of his next meal consumed his mental energy. At lunch, he ate in the library to keep his friends from finding out how little he consumed. His social life deteriorated as he began to isolate himself from his peers to hide his struggles. “Sports allowed me to have an avenue where I could make it seem like I was doing it for sports, but I really was doing it because I was unhappy with the way I felt,” Marjama says.
The Role of Coaches
For athletes, coaches can be a crucial part of the support network — or a critical part of the problem. Cain, the elite Nike runner, said her coach weighed her constantly, berating her if she was over 114 pounds. In 2013, Oakland’s women’s basketball coach, Beckie Francis, was fired for emotionally abusing athletes, including allegedly taking pictures of them in spandex and sports bras to chart their weights over time. And at Wesleyan, Hebner recalls her coach pulling athletes aside for “fat talks” about their weight. They’d come back to the locker room “devastated” and unable to talk, Hebner remembers.
In her research on collegiate cheerleaders, Torres-McGehee has found that athletes tend to assume their coaches want them to lose even more weight than the coaches themselves report. That over-interpretation can magnify every word a coach says to an athlete, Torres-McGehee says. “The words of the coach are so powerful, and even if it’s well intentioned feedback, and the coach truly believes they are giving the athlete honest feedback to make them a better athlete, how damaging that can be to someone’s psycho-social well-being,” Quatromoni says. In the course of Quatromoni’s research, she met a distance runner, David, who shared his experience with an eating disorder, which began after a coach made a comment in front of the team implying he had gained weight. This interaction led him to a years-long battle with disordered eating. She says coaches often fail to realize, especially with male athletes, that their comments can be damaging.
“I’ve had coaches say ‘Oh, I coach male athletes, I don’t need to worry about that. They’re not sensitive about their weight and their bodies,’” Quatromoni says. “And they do public weigh-ins, and they shame the men — things they would never do to women.”
Athletic organizations such as the NCAA do not mandate that coaches be trained in nutrition or eating-disorder prevention or support, says Maura Knestout, assistant coach of cross country at Johns Hopkins University, a national championship-winning Division III program. Many coaches, she says, don’t have the educational background to address eating disorders among their athletes. “They just don’t know how to handle it,” Knestout says. “And the best way they cope with that is they just don’t do anything. They’re not bad people. They’re not bad coaches. They just don’t know, and there are no resources for that.”
The vast majority of programs also lack sports dieticians, who can help detect eating disorders and direct athletes toward treatment options. This places an intense burden on under-resourced coaches and athletic trainers, who often are educated in physical therapy but are not specialized in sports psychology or eating-disorder treatment. “Often the athletic trainer is the point person, but come on — they are also overburdened, they’re not the experts on this either,” Quatromoni says. “They’re the closest to it because they fall under the sports medicine umbrella, and they’re there day in and day out, and they know the athletes.”
The Path to Protecting and Supporting Athletes
Hebner graduated from Wesleyan in 2018 with an M.A. (and a B.A., earned in 2017) in biochemistry and molecular biology. She says she wanted to move on from her experience as an athlete at the university. Then she saw the story about Mary Cain — someone she’d raced, and looked up to, in high school, someone who used to be “bubbly” and kind and full of enthusiasm for running. “That full day I was … nonfunctional in a way that was kind of surprising to me,” Hebner says. “And then I was like, ‘Okay, you’re still not moving on from this.’”
She reached out to other alumni of Wesleyan track and cross country, and together they penned a petition to the school’s athletic department, which had received complaints about the coach’s behavior since 2014, according to Wesleying, a campus publication that broke the story. Hebner and her fellow signatories demanded institutional change within the athletic department: more athletic trainers, more women staff, improved access to medical professionals and guidance on how to maintain proper nutrition and bone health, and better record-keeping. The athletic department said in a statement to Wesleying, published Mar. 2, 2020, that the university was investigating the allegations of misconduct and planned to issue a report of its findings.
Maura Knestout says she channeled her experiences as a Division I cross-country runner for Syracuse University into her coaching. She holds team meetings every season to discuss body image and nutrition, among other issues, with her athletes. She says body image is a topic that comes up every year and earns a lot of engagement from her athletes. She also says these meetings help open the door for athletes to talk to her about their struggles one-on-one. When an athlete discloses that they are struggling, she often refers them to the athletic trainer, who can refer them to mental-health professionals and other resources. But as a coach, she can’t always help as much as she would like to.
“It’s not stressful at all,” Knestout says, with a wry chuckle. “Not keeping me up at night whatsoever.”
Protecting, screening, and treating athletes requires major changes to the infrastructure of many athletic departments, Quatromoni says. She recommends colleges hire at least one registered dietician and several mental-health therapists in their athletic departments. And she rejects the idea that hiring speakers once a year to talk about nutrition or mental health is enough. “Bringing in a speaker doesn’t put the person with the open door to actually do anything, it doesn’t build a relationship, it doesn’t build trust that a person’s going to come and confide in you, like ‘Yeah, you know how I’m this invincible athlete and starter with all these accolades … yeah, I’m struggling and I need help,’” Quatromoni says. “To make that leap takes so much trust.”
Screening also plays a critical role. She suggests athletic departments screen athletes for disordered eating at the beginning of each season as part of their physicals. And the screening tools themselves need to be improved, she says. The only tools available are based on studies of female athletes and might not catch symptoms that are more common among athletes of other genders.
Screening works to catch common eating disorders such as binge eating disorder, bulimia (characterized by patterns of bingeing and purging), and atypical anorexia (restrictive eating without the low BMI associated with anorexia nervosa). However, binge eating disorder, which is the most common among athletes, especially men, doesn’t always result in noticeable weight loss, Quatromoni says. “You can’t wait until someone has dropped so much weight that they look emaciated, because first of all, that’s way too late, and second of all, some of the more prevalent eating disorders don’t involve that much weight loss,” she says.
Quatromoni also suggests more eating-disorder-treatment options tailored for student-athletes. She works with Walden Behavioral Care, one of the few eating disorder centers in the country that specifically serve student-athletes, along with McCallum Place, in Missouri, and EDCare in Denver. Athletes benefit from specific treatment options because their lifestyles and triggers often differ substantially from those of the general population. If a treatment program fails to address their identity as athletes, performance pressures, coach-athlete relationships, and team dynamics, athletes may feel alienated and give up on treatment. “And then they go on to struggle with this for the next 20 years,” Quatromoni says. “And that’s just a crime. It does not go away on its own.”
Mike Marjama believes athletic departments need to invest more resources in training coaches on how to deal with mental health and need to destigmatize athletes seeking mental-health support. He urges athletic departments to frame and treat eating disorders and other mental-health conditions as seriously as they do physical injuries. “If I pull a hamstring in a sport, I need to go see the trainer or the physical therapist, to help me with that,” he says. “But what makes your brain any different?”
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