It was only after Jessie Diggins won an Olympic gold medal at PyeongChang in 2018 —America’s first Olympic gold medal in cross-country skiing—that she went public with the fact that she had an eating disorder. In her book Brave Enough, she described in detail her downward spiral into bulimia during her senior year in high school, then her recovery, thanks to the WithAll Foundation (formerly the Emily Program).
Diggins, a talented endurance athlete, as well as a highly competitive Type A personality, realized she was “preloaded with red flags” to develop an eating disorder, she said. As a promising teen coming up through the ranks, Diggins remembers thinking, “If I feel like changing my body will help me win, I guess I have to do that.”
Diggins is one of many athletes who have struggled with body image issues and eating disorders. But she is one of few who have spoken out about them. They are secretive disorders that people wish to hide, said 2010 Olympic figure skater Rachael Flatt, a PhD candidate in clinical psychology with a focus on eating disorders at the University of North Carolina.
“Until people are really out of the depths of it, that’s the time that they’ll be willing to talk about it in most cases,” explained Flatt. While there are programs to help people struggling with body dysmorphia disorder, disordered eating, and eating disorders, there has not been much emphasis until recently on what triggers these conditions. Diggins described it as, “trying to go upstream of eating disorders to figure out where people are falling in.”
So what can set the stage for body dysmorphia disorder and eating disorders to develop? And then what can trigger them?
How Genetics Come Into Play
Eating disorders have long been thought of as a mental health condition augmented by social inputs and cues.
But recent studies have shown that they are based in genetics. In 2018, the journal Nature Genetics published a study with the acronym ANGI—Anorexia Nervosa Genetics Initiative, run by Dr. Cynthia Bulik, a distinguished professor of eating disorders, founding director of the University of North Carolina Center of Excellence for Eating Disorders, and Flatt’s PhD advisor.
ANGI studied more than 13,000 subjects from the U.S., Australia, New Zealand, Denmark and Sweden who had experienced anorexia nervosa.
It took blood samples from those subjects as well as from people related to them. After analyzing the results, the researchers identified eight regions of the genome associated with anorexia. Coincidentally—and strikingly—they found that some of the same genetic traits that increase risk for anorexia might also attract people to sports.
“One of the things that we see in anorexia is these patients who, even when they’re really underweight, continue to be very hyperactive,” explained Bulik. “It’s always been psychologized in the past, ‘Oh, they’re just trying to lose more weight, and they’re trying to burn more calories.’ But now we see that there’s actually a genetic connection between high physical activity and anorexia nervosa.” Similarly, the traits that make someone a great athlete—perfectionism, determination, focus, achievement orientation, pain tolerance, competitiveness, and the ability to deny reward—are also traits that are risk factors for anorexia, pointed out Bulik. “When focused in a healthy direction, those traits can be amazing assets to an athlete—to anyone really,” she added. “But when focused inward on weight loss or reduction of body fat, they can become deadly.”
Those predisposed to eating disorders also respond to caloric restriction differently than others. While many people become anxious, irritable, or “hangry” when hungry—what Bulik calls a negative energy balance—those predisposed to anorexia nervosa feel calm.
In a negative energy balance state, individuals predisposed to anorexia “get that sense of actually feeling better,” she said. “That’s what can trigger and maintain an eating disorder.”
Bulik and her team have recently launched EDGI—Eating Disorders Genetic Initiative—the largest genetic study of eating disorders ever undertaken. This study aims to identify the hundreds of genes that influence a person’s risk of developing anorexia, bulimia, and binge-eating disorder, and ultimately to improve treatment and eliminate deaths.
While genetics is a major reason that people develop eating disorders, there are more factors. “Anorexia is an inheritable psychiatric illness,” pointed out Flatt. “But it’s truly a combination of both genes and environmental pressures. … My advisor’s saying is, ‘Genes load the gun and environment pulls the trigger.”
Compare and Despair
Since the beginning of recorded history, “ideal” body types have been depicted through art, literature, media, and most recently, social media. From curvaceous fertility goddess figurines to fleshy Rubenesque nudes to corseted waif-like Gibson Girls to full-figured Marilyn Monroe body types, women of all races have had no shortage of comparative models. We are forever dieting, or worse, reshaping our bodies to fit the ideal.
Nor are men immune. Depictions of the Greek gods, Da Vinci’s David, and the body-building craze started by Charles Atlas, to name just a few, all set the bar high in terms of musculature. Striving for the body ideal is perhaps even worse for men, as it’s not a subject that they readily discuss.
Sports adds another layer to the body image ideal. Young athletes often compare themselves to those at the top of their sports, then try to change their bodies to conform.
Jessie Diggins remembers her first trip overseas to the Nordic Junior World Championships when she was a high school junior. She saw older girls whom she looked up to skipping dessert and “meticulously cutting every piece of fat off their meat.”
“I started looking around going ‘wait a minute, should I be doing that?’” remembered Diggins. “’Why am I the only one drinking hot chocolate? Why am I the only one having dessert? I must be doing something wrong.’”
Diggins came home with a new relationship to food—“good athlete food” and “bad food.” And she had a new ideal of what her body should look like, even though she was already one of America’s young phenoms in cross-country skiing.
“You see certain athletes on the podium and assume that you have to force your genetics to look like what they were born to look like in order to succeed,” she said.
Research shows that athletes who compare their bodies to others tend to be at higher risk of poor body image and developing disordered eating and full-fledged eating disorders.
“Social comparisons are a huge piece of this,” said Flatt. “Comparisons on body shape and weight tends to increase the risk of developing an eating disorder.”
Pressure to Perform
Diggins began struggling with an eating disorder during her senior year in high school—brought on not just by comparisons to the world’s top cross-country skiers but also by internal pressure to perform and meet others’ expectations. She was so good that winning was no longer enough. Or so she thought.
“I was expected to not only win but win by a minute and then beat most of the guys,” she said. “You start to internalize that. ‘Oh my gosh, even winning isn’t enough, now I’m supposed to beat the boys too.’”
As life became even more pressurized, with AP classes, extracurricular activities, and her body simply going through another growth spurt, Diggins began purging as a way to control her body. She was trying to shed food that her body badly needed to build and repair itself after hard workouts.
“I wanted to be really, really good at skiing, and I believed that to do that, I needed to have a super-lean body,” she wrote in Brave Enough.
Expectations of what an athlete should look like are particularly prevalent in aesthetic sports that are judged, like figure skating and gymnastics.
Not only do the athletes have their own expectations from comparison, but officials and judges can have certain expectations about looks. And those expectations can factor into final scores.
“It’s hard not to say, ‘Well, my success is going to be determined by how thin I am, or how toned my body is,’” said Flatt, a national figure skating champion at age 17.
With results conflated with how athletes look as they perform in aesthetic sports, a missed move or faulty technique can be blamed on weight or size.
“Instead of focusing on what our bodies can do,” Flatt added, “we then scrutinize how our bodies look.”
The Ramification of Comments
Before she was a World Junior medalist in cross-country skiing, Hannah Halvorsen was an active youngster growing up in California. She developed a powerful upper body and, after hours of training, consumed more food than her less-athletic friends. But it wasn’t her friends who made comments about her appearance. It was her friends’ parents.
Halvorsen would eat before she went to her friends’ houses, just to avoid hearing comments about how much food she consumed. And if she was wearing a tank-top or swimsuit, some of friends’ parents would say, “I don’t want to get in a fight with you.” “I got that all the time,” she remembered.
From middle school through college, she always wore a sweater to cover her arms. “I would go to dances and never take off my sweater,” she said. “I’d be so hot.”
The sheer number of comments about her powerful build eventually drove Halvorsen to disordered eating in high school—a condition she battled until a strength coach pointed out that she was such a good cross-country skier because of her power, and if she lost too much muscle mass, she would lose what makes her good at the sport. Even then, it was a long road back to normal eating habits.
Bulik has labeled these comments—well-intentioned or not—as “Velcro comments,” and they are often made by people whom an athlete respects or wishes to please—teammates, siblings, coaches, judges, officials. Even unflattering comments by unknown social media trolls can send athletes on a downward spiral, depending on what’s going on in the athlete’s life at the time.
“They’re comments that just stick to you, and they never go away,” Bulik said. “Like I’ve never forgotten that I was called Lead Bottom (as a young figure skater) by my coach.”
In sports where a lean physique is deemed important, coaches often will feel like it’s their job to get athletes to cut weight on the presumption that it will optimize performance. “But it ends up backfiring,” said Bulik.
How to Improve?
Given that athletes may be at especially high genetic risk for traits that contribute to eating disorders, what can we do to reduce the triggers that bring on these conditions?
Perhaps the best people to keep an eye on athletes are their coaches.
Flatt and Bulik developed a course for figure skating coaches that focuses on creating body-positive environments at the rink. The course educates coaches and support staff about the signs and symptoms of poor body image, disordered eating, eating disorders, and how to convey supportive messages to struggling athletes. The course teaches communication strategies that steer clear of direct comments.
“Really, a coach should not be making any comment about an athlete’s weight,” stated Flatt. “The priority is focusing on technique and what the technical success is of an element and not attributing the lack of a triple jump to weight.”
With a focus on eating disorder prevention across the board, not just for athletes, the WithAll Foundation has developed “The What to Say Pledge.” This initiative equips people with simple tools to help kids develop healthy relationships with food and their bodies. “We’re starting by asking all adults to stop talking about weight and stop engaging in harmful food labeling for the kids in their life,” reads the pledge.
The organization offers “what to say” worksheets, with suggestions, for example, that focus on a person’s great energy, not their weight, and reminds adults to steer clear of their own diet and weight concerns in front of children.
Diggins also encourages people to focus on character and the values that they bring to their community instead of body image.
Recently, she asked a group of junior cross-country skiers to write down values that they like about themselves—“I’m a hard worker, I’m honest, I’m a good listener, a loyal friend”—and values they want to bring to their team—“I want to show up on time, I want to cheer on my teammates,” etc.
‘When you look at the list, nowhere does anyone write, ‘I want to be skinny,’” Diggins pointed out. “Also, nobody writes, ‘I want to win races.’”
“Really refocusing how we rate ourselves can be one thing that we can do to refocus attention from our bodies,” she added.
For coaches, Diggins encourages them to see their athletes as humans, not simply results machines. Like all humans, athletes have emotions and feelings, in addition to passion and talent. “If you’re coaching an athlete who will do eight intervals if you tell them to do five, that’s someone you want to watch out for,” she cautioned. “Make sure that you’re checking in with them as humans, see how they’re doing. Those are red-flag warning signs that could potentially lead to an eating disorder.”
“It would be a better place,” Diggins said, “if we saw each other as humans first.”
Rutland-based journalist Peggy Shinn writes for TeamUSA, where this first appeared.
Lead photo by Matt Whitcomb of Jessie Diggins training in New Zealand in 2007.