Athletes' hunger to win fuels eating disorders

Kimiko Hirai Soldati, a 2004 Olympic diver, remembers exactly when her bulimia started.

She was transferring from Colorado State to Indiana University, and one day she felt she had eaten too much. "The idea popped into my head that I could get rid of this," she says.

And so she threw up.

That set her on a desperate course. At one point, she says, she was "purging pretty much everything I ate. I was so obsessed about calories that I didn't want to chew gum because there are 5 calories in a stick."

She struggled secretly with bulimia for 1 1/2 years, feeling "shameful and embarrassed" about what she was doing, before she sought out a psychologist who specialized in eating disorders. "When I finally did seek help, I felt like I had a blinking neon sign on my forehead that said 'bulimic, bulimic, bulimic,' and that's all people would see."

Disordered eating -- reported by one-third of female athletes in college -- is just one element in a spectrum of health problems many confront, studies show. Despite the opportunities that have opened up to women since Title IX of the Education Amendments of 1972 banned sex discrimination in schools that receive federal money, universities report that an increasing number of these competitors are suffering from depression and anxiety disorders. They struggle to juggle practices, competitions and academic demands. Some are so overwhelmed that, despite their athletic talent, they drop their sports or even drop out of college. There are extreme cases of anorexia and suicide even among elite athletes.

"It would be hard to find a female athlete in the aesthetic sports -- gymnastics, diving, cheerleading, figure skating -- who isn't preoccupied with body image and somewhat obsessive about what she is eating," says Soldati, 31, who is married to Purdue University diving coach Adam Soldati. They have a 3-month-old baby.

Since her recovery, she has spoken to hundreds of women who have troubling eating patterns, which includes dieting constantly, abusing laxatives, taking diet pills or occasionally binge eating and purging by means that include vomiting. Or they may have more serious eating disorders such as anorexia nervosa, characterized by self-starvation, or bulimia nervosa, frequent bingeing and purging.

"Athletes are driven personalities, completely focused as people pleasers, almost obsessive-compulsive," says Jenny Moshak, assistant athletics director for sports medicine at the University of Tennessee, which has led the way in offering counseling as part of its sports programs. "People who have addictive tendencies gravitate toward athletics."

Those obsessions can go far beyond the playing fields.

Anorexia and bulimia are psychiatric illnesses, but they often coexist with other emotional problems, such as anxiety and depression, says B. Timothy Walsh, a professor of psychiatry at New York Psychiatric Institute/Columbia University and author of If Your Adolescent Has an Eating Disorder.

For some, the eating disorder is triggered by an emotional problem, Walsh says; but for others, the disorder seems to develop on its own without other significant psychological factors.

Sobering numbers

At least one-third of female athletes have some type of disordered eating, according to two studies of college athletes done by eating disorder experts, one in 1999 by Craig Johnson of the Laureate Psychiatric Clinic and Hospital in Tulsa and another in 2002 by Katherine Beals, now at the University of Utah in Salt Lake City.

In the 2002 study of 425 female college athletes, 43% said they were terrified of being or becoming too heavy, and 55% reported experiencing pressure to achieve or maintain a certain weight. Most said the pressure was self-imposed, but many also felt pressure from coaches and teammates.

Disordered eating is probably much more pervasive than people realize, says registered dietitian Ann Litt, author of Eating Well on Campus and Fuel for Young Athletes. "You can't tell by looking at women that they are suffering with this, and many women fade in and out of it. Sometimes it rears its ugly head when they are going through some rough times in their lives."

Says Leslie Bonci, director of sports nutrition at the University of Pittsburgh Medical Center: "This is a tough topic to talk about, but it's not going away, and it's wreaking havoc on campuses."

Psychologist Ron Thompson, who consults with Indiana University's athletic department and the National Collegiate Athletic Association, counseled Soldati. "It is a problem at all colleges, although it may be a little more of a problem at Division I than Division II and III," he says.

'Horrific' eating patterns

About 2% to 3% of female college athletes have full-fledged, diagnosable eating disorders, about the same as the general population, according to several studies. There have been high-profile cases such as Christy Henrich, the former world-class gymnast who had anorexia and died at age 22 in 1994 from multiple-organ failure. She weighed less than 50 pounds.

Bonci recently received a desperate call from a college coach in Pennsylvania. He wanted her to come talk about the importance of healthy eating to his team of female cross-country runners because they were competing with each other at dinner to see who could eat the least. "Some of the girls who were running 70 miles a week were eating only one baby carrot at a meal," Bonci says. "That was it. It was horrific."

Another time, she worked with a female college soccer player who would go to team practice for three hours a day and then would go over to the fitness center and spend another three hours on the treadmill.

"An athlete with disordered eating doesn't see food as fuel that helps build her body but as calories and fat. In their world, food has become a four-letter word," says registered dietitian Lisa Dorfman, the sports nutritionist for the University of Miami. "When they start asking if ketchup has sugar in it, I know we are in trouble."

People with disordered eating are not comfortable with their bodies, Dorfman says. "They may be self-conscious about how they look in their uniforms. They may be pinching their thighs. They don't want their belly to show. They may look at other people on the team and compare themselves."

Bonci agrees. "They look at the bodies on the cover of Glamour and Shape magazines and think those bodies are better than theirs."

The 'thin-build' sports

Female athletes who seem especially vulnerable to disordered eating and excessive exercise are in either the "thin-build sports" or activities that require a lean body weight, such as long-distance running, gymnastics, swimming, diving, figure skating, dance, cheerleading, wrestling and lightweight rowing, says Beals, author of Disordered Eating Among Athletes.

Athletes may start dieting to enhance their athletic performance, and the goal is what some experts call "performance thinness."

A cross-country runner may want to lose weight so she's lighter and faster, Beals says. A gymnast may want to lose weight because she thinks the judges are looking at her size and shape and that her scores will improve if she's leaner. This may be partially true, at least in the short term.

Performance may improve with weight loss initially, but eventually the caloric restriction or purging habits take a toll on the athlete's nutritional condition and subsequently her performance, Beals says. Often this drive for thinness begins in high school and sometimes even younger, she says.

Soldati says it's no wonder some female athletes have body image problems. As they're developing and becoming women, they're out there in "nothing but a skimpy little Speedo or leotard."

Sometimes the dieting begins because a coach mentions their weight. Girls and young women tend to remember "absolutely everything a coach ever said to them," Soldati says.

Coach: 'Don't get fat'

When Soldati was on the gymnastics and diving teams in high school, one of her coaches jokingly told her she was "getting big." Another time when she asked a college coach what she could do over the summer to improve her diving, he said, "Don't get fat."

The pressure to perform and look good is much greater in college than high school, she says. "Your scholarship may be on the line or you may want to get a scholarship. Or you may want to be the starter on your team or be taken to the meets. Being a female in this culture, it's hard to have a normal relationship with food, and on top of that almost every athlete in the aesthetic sports has to watch what she eats. It's hard not to cross over and become obsessive."

In fact, Soldati says, the same personality traits that made her excel at diving became a liability when it came to her body and eating habits.

"I was a perfectionist, people pleaser, control freak. I was a high achiever and had a high pain threshold. There's a fine line between dedication and obsession. I thought if one hour of cardio is good, then five hours must be great."

A sport like diving doesn't use a lot of calories, she says, but athletes are expected to look a certain way, so "it's hard to really enjoy food."

Soldati isn't sure whether the eating disorder affected her performance, but it did take a toll on her emotionally. "I felt so horrible about myself. Here I was, a supposedly amazing athlete with a 4.0 (grade-point average) and doing all these amazing things, and yet I couldn't stop throwing up."

She says many girls with disordered eating and their mothers have contacted her through her website, www.kimiko-usa.com.

"I've had girls tell me that I'm the only person who knows that they have an eating disorder. I can point them in a direction and tell them where to get help. I let them know they are not alone because it is such a secretive disorder."

Contributing: Andy Gardiner

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