Disordered Eating in Runners: When Does a Diet Become a Problem?

The word “diet” can conjure up negative thoughts for many runners. Concerns over eating disorders and disordered eating are continually making headlines in mainstream endurance sports media.

In 2019 World champion obstacle racer Amelia Boone spoke honestly about her 20-year struggle with anorexia. In that same year, young phenom runner Mary Cain came forward in a groundbreaking New York Times op ed piece disclosing how her professional coaches’ daily weigh-ins developed into a crisis state of disordered eating. 2020 Tokyo Olympic marathon bronze medalist Molly Seidel has been open about her anxiety struggles and how it manifested itself into disordered eating. In October 2021, the Oregonian published an article about six women who left the University of Oregon track and field program. The athletes were subjected to regular scans to measure their body fat percentages, triggering unhealthy eating patterns and anxiety.

How much focus on food is healthy for runners?

No matter what time of day you run, you are likely choosing foods, or avoiding them, to enhance your planned workout. Nobody likes to run out of energy or make a mad dash to the porta john in the middle of a group track workout.

According to an article published in the Journal of the International Society of Sports Nutrition, gastrointestinal distress is one of the top reasons many runners voluntarily avoid foods such as meat, milk products, seafood, poultry and high fiber ahead of a run. You could argue then that avoiding foods to decrease the risk for diarrhea is a type of diet. That type of diet isn’t inherently unhealthy in itself.

It would seem like normal thought behavior for runners to make dietary choices based on performance. So, should the word “diet” always have a negative connotation? Let’s briefly examine what a diet is.

A diet can be defined as habitual nourishment from eating a certain type of food. It can also be defined as a regimen of eating and drinking sparingly to lose weight or specific restrictions of certain foods for medical reasons. An example of this is when a person with high blood pressure reduces their salt intake.

Some diets are nutrient-dense and stave off disease. For instance, the Mediterranean diet, which is habitually eating a variety of fruits, vegetables, nuts and healthy oils, greatly decreases risk of diet-related death.

You may not consider obesity to be a form of malnutrition, yet a diet leading to obesity can be just as nutrient-lacking as a perpetual state of starvation. Low intake of whole grains and fruits are linked to the leading cause of diet-related deaths globally.

Disordered Eating Vs Eating Disorders

Many runners begin the sport to lose weight. Some runners then become fixated on their weight and diet and wonder if they have disordered eating. The National Eating Disorders Association (NEDA) states that the difference between an eating disorder (ED) and disordered eating (DE) is the level of obsession around food and weight.

Not to be confused with an eating disorder, disordered eating is like a precursor for an eating disorder. It’s considered to be more of a description of eating patterns versus a diagnosis.

In an article published on the NEDA website, author Temimah Zucker, LMSW, writes that eating disorders typically present with secretive eating behaviors, obsessing about food and its caloric content and limit the person's ability to function normally with peers. Runners with disordered eating can function normally without thoughts of food and weight keeping them from school, work, meeting with friends or doing group workouts.

“From my perspective, ED and DE overlap but are not necessarily synonymous,” says Laura K. Jones, PhD, during a recent interview. Jones is an Associate Professor and on Faculty at the University of North Carolina, Asheville. Her areas of expertise lie in the Department of Health and Wellness Promotion as well as serving as Mental Health Coordinator for UNCA Athletics and Peak Performance Biofeedback Lab.

“An ED is a category of diagnosable disorders, each having a set of specific symptoms, that has been defined and outlined within the American Psychiatric Association’s 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). These include disorders such as, Binge Eating Disorder, Anorexia Nervosa, Bulimia Nervosa, and Restrictive/Avoidant Food Intake Disorder.” This can even include diet trends, such as eating only “clean” foods.

Jones continues, “One disorder that has been proposed for the DSM-5 but has not yet been included is Orthorexia, which appears to be becoming more pervasive, especially among individuals who describe themselves as ‘health conscious.’ Orthorexia is an unhealthy focus on eating in a healthy way or a very rigid adherence to a “healthy” diet that becomes detrimental to the individual in some way – health, physically (e.g., injury), performance, social, or emotional.”

The NEDA also points out that normalized, non-disordered eating is simply eating a wide variety of foods when hungry and stopping when you’re full. So does this mean if you eat when bored, are on a keto diet or intentionally don't eat before your runs you have disordered eating? Likely not.

How do Eating Disorders and Disordered Eating Patterns Typically Present?

“This looks different in everyone,” explains Jones. “I would say one of the first signs we see often is an unhealthy preoccupation with food (i.e., thinking about when one will eat, what will be eaten, how much, and/or where), hiding aspects of this from others, and an increase in unpleasant emotions surrounding eating (e.g., guilt, shame, etc).”

Jones says that there is often a misconception that eating disorders are always about food or body size and shape, but this isn’t always the case. Rather, attempting to have a sense of control over one’s life is an important aspect of many eating disorders. “That is one reason why it is not uncommon to see EDs or even DE pop up following very stressful or traumatic life events,” Jones says.

Does Being an Athlete Influence Eating Disorders?

Being an athlete in itself doesn’t equate to developing an eating disorder, but certain sports are more likely to promote cultures of disordered eating. In an Australian study of elite athletes, it was discovered that athletes who participated in a sport which emphasized low body weight or emphasized looking like you had a thinner body shape, determined the vulnerability and subsequently the presence of an eating disorder.

Runners, in almost every distance other than sprinters, fall into this category.

“An important thing to consider is that there is not one specific way that someone who struggles with DE or an ED looks, so we have to be cautious around making judgements based on body shape, size or composition alone,” Jones says. “Runners, coaches or parents should never use the number on a scale as a predictor for someone’s potential performance capacity, especially in younger runners or athletes.”

How Do I Know if I Have a Problem?

It’s such a simple question, and one that many runners still aren't quite sure how to answer. Being honest with yourself is a good place to start.

If you think you might have disordered eating patterns, here are 10 quick yes/no questions to ask yourself:

During the past month, have you:

1. Been regularly preoccupied with your weight and/or the shape of your body?

2. Avoided eating certain foods due to fear that something bad could happen to you?

3. Felt out of control over the amount of food you ate one or more times in a week?

4. Worried frequently about the nutritional content of different foods?

5. Felt intensely disgusted or anxious when looking at your body or seeing it in a mirror?

6. Frequently avoided eating because of disliking the taste, smell or texture of foods?

7. Felt guilty or upset after eating an unusually large amount of food one or more times a week?

8. Intentionally made yourself exercise excessively to prevent gaining weight?

9. Been consistently anxious when eating food or drinking liquids?

10. Felt a need to check the appearance of your body often throughout the day

If you answered yes to even one of these, consider visiting a licensed professional. Some examples are a Masters level Clinical Social Worker or PhD Psychologist who specializes in eating disorders, a primary care MD/NP/PA and a Registered Dietician or even all of them for a team approach. Certainly a Psychiatrist could be helpful for medication management if needed.

What should you do if a friend is exhibiting signs of DE/ED?

“My opinion is that we all have a role to play in decreasing the stigma around seeking support from a mental health professional,” says Jones. “This includes providing support to friends about whom we are worried and encouraging friends to reach out for professional support when needed.”

If you approach a friend or loved one who may be struggling, keep in mind that eating disorders and disordered eating are heavy, sensitive topics that require thought and care. Jones offers the following suggestions:

1. Do your reading and research.

Learn as much as you can about EDs and DE to understand how to best support your friend.

2. Approach your friend privately.

Be sure to come to them from a genuinely supportive place.

3. Use “I” statements ("I am worried") and be honest. Stick to the behaviors and do not speak about the person’s character.

For example, if the behaviors are starting to impact your friendship, do not say that they are being a bad friend. Instead, consider sharing that you miss how the friendship used to be.

4. Prepare for a little pushback.

DE and EDs serve a purpose in people’s lives. Many will struggle to shift those patterns until the underlying cause is addressed in some way and they have healthier patterns in place to support themselves. Be compassionate around this. Having empathy does not mean you are endorsing what they are doing, but that you recognize that there are many factors, and usually strong emotions, to consider.

5. Encourage them to get support.

Destigmatize reaching out for that support and offer to help them find or get in contact with someone. Also, remind them that there is hope. One can be both healthy and perform optimally. We typically perform at our personal best when we are at peak health mentally, physically, and nutritionally.

Find help through NEDA.