Food is Fuel: What Runners Should Know About Eating Disorders

A woman runs alone on an exposed trail surrounded by greenery

My clients are constantly inundated with weight advice from non-experts. As an eating disorder therapist I work with high school runners, college athletes and adults. They see pro athletes on Instagram with very little body fat and say, ‘I need to have this type of body to be a good runner.’ --Caley Featherstone

An estimated 30 million people, or nine percent of the US population will suffer from an eating disorder in their lifetime. Each year, eating disorders directly cause 10,200 deaths, which equates to one death every 52 minutes.

According to a 2008 study, up to 47 percent of female athletes who participate in “leanness sports” that emphasize body size (like distance running) have experienced an eating disorder in comparison to 21 percent of non-athletes surveyed. A 2014 study indicates approximately 19 percent of male cross country runners in high school are at risk for disordered eating.

Caley Featherstone, a licensed clinical professional counselor and certified eating disorder specialist, in Meridian, Idaho, specializes in athletes with eating disorders, many of whom are runners.

Featherstone reached out to Fleet Feet after reading an article we posted in which a pro runner advised that eating “junk food” would result in poor performance (we have since updated the article). It wasn’t that Featherstone was implying that junk food is necessarily good (or bad) for performance, but rather that, in general, moral statements about food and eating are harmful. We arranged a phone call with her to learn more.

A pair of Mizuno running shoe being tied

Fleet Feet: Describe the problem that the running community has with eating disorders

Caley Featherstone: Many runners falsely believe that in running especially there’s an unspoken or spoken code that lower body weight means better performance all the time. And that’s for every athlete all the time, when that’s definitely not the case.

I've had so many patients who are runners at the Division I or Division II level who say, ‘my coach says I have to race at X pounds. I weigh Y pounds and I have to lose 10 pounds to get to my race weight.’

While there is some science to say lower body weight can be helpful or effective in some ways, if someone is starving to get to that lower body weight, it’s going to cause a lot of damage and it might not actually help them run faster.

The biggest problem is the idea that you have to have a certain look to be a runner, and if you don’t look like that specific body type, then you aren’t a good runner. That’s starting to change. But in general, there’s an idea that you can be a recreational runner and have any type of body, but if you’re in the pros, you have to be very small with a very low body fat percentage. It’s damaging because it’s not true.

FF: How should we talk about bodies and weight?

Featherstone: Know that there’s never really a good time to comment on someone’s body. Rather than saying hey, you look like you lost weight or gained weight, focus on who people are rather than what they look like. Commenting on someone’s weight often reinforces weight loss and stereotypes.

Unfortunately, some coaches give nutrition advice to athletes when they aren’t trained dieticians. They don’t know everything about their athletes’ nutritional needs.

FF: What is problematic about labeling foods as inherently good or bad?

Featherstone: Diet talk is toxic. We know that a diet is the impetus of a majority of eating disorders. When we’re modeling diet behavior, that impacts our mental health and the mental health of those around us. What we say impacts how we feel and behave. What we tell other people and ourselves impacts our entire lives.

Diet culture is rooted in shame. Shame greatly impacts mental health and can lead to increased feelings of depression, anxiety, isolation and withdrawal.

On top of that, young athletes will hear a runner call certain food “junk” and think, I can’t enjoy Doritos, I can’t eat “junk.” I have to be disciplined with food if I want to run like a pro athlete.

FF: How might it be harmful for coaches to give diet advice?

Featherstone: Some coaches give nutrition advice to athletes when they aren’t trained dieticians. They don’t know everything about their athletes’ nutritional needs. In the worst cases, a runner ends up with an eating disorder when given poor nutrition advice from their coach. These are the types of athletes I often see.

I’ve had a lot of patients with electrolyte imbalances because their coaches told them to cut out sugar and processed foods and salty foods. I had an athlete whose coach said things like, ‘any time you have sugar you will run an extra mile at practice.’ As a result, she was experiencing heart failure because she wasn’t getting enough electrolytes. She heard ‘sugary things’ and interpreted that as fruit, Gatorade. She assumed those things were ‘junk food.’ Her coach doesn’t know about her heart condition and he’s not trained to give nutrition advice.

A man runs alone on a dirt path

FF: What can the running industry do to make changes?

Featherstone: What I love about the message I hear from my local running store is that their message overall is about community over performance. I talk with my clients about process versus content. Content is about performance, about being the best. Process is more focused on community, togetherness, understanding and inclusivity. It’s making running more about the holistic view than just about being at the top and being a competitor. It’s really changing the way we view running.

At the bottom of it all, to me, running is about freedom. Everyone has a reason behind why they run. Hopefully the reason isn’t just to have a small body or to win at all costs. That’s where I’d like to see the sport go. If it was more about how amazing it is to celebrate your body or to value the freedom that running gives you instead of just the content of what running can give you.

Hopefully, as more athletes are talking about eating disorders, the systems of oppression start to change. Some brands have done a good job of pivoting. They have changed mannequin sizes and have tried to become more inclusive. Many companies now say that everybody can run with any body type.

FF: Are you saying runners shouldn’t have a competitive mindset, strive for fitness and push their limits? Is competition inherently unhealthy?

Featherstone: It’s important to focus on an individual’s universal health. There are many different forms of health. Physical, emotional, spiritual, financial, spiritual, sexual health. There are more that I’m missing. In our society we’re mostly selling physical health. It’s seen as the most important at all costs. I’ve had clients who are running for three hours and missing their daughter’s birthday.

In a case like that, you may be in good physical health, and might be getting your marathon time down, but your relationship with your family might suffer. It’s important to look after your entire health. I look at my work right now. I used to be a faster runner. I could be faster again, but I would have to pull time from work, and that would impact my work health.

FF: What advice would you give on how to balance different aspects of health?

Featherstone: Look at your values and balance those first. When you see one part of your life is off kilter, that you’re continually missing things, or that you’re in credit card debt, you’ll see your life is out of balance. I had a sobering moment racing with an old teammate. She kicked my butt. I was so ashamed of myself at first and then I stepped back and said, ‘whoa, Caley, you can’t have it all. You can’t run a business, can’t see all those patients and run the way you used to.’ I look at using values as a compass.

If running isn’t bringing me contentment or joy, how can I change that? I love using the word delight with exercise. Is exercise delightful? If yes, then, of course, do it! If you feel like you have to go to the gym, studies show people who don’t want to go won’t go for long if it feels like a punishment. And your body doesn’t respond as well.

Editor’s note: This interview has been edited for clarity and brevity

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