Running, weight, food and health: the ideal is to have a perfect balance between all these things. But alarmingly, all too frequently this balance can tip in the wrong direction. We uncover the truths about running and disordered eating, and find out what we can do to help us all achieve the right balance.
Running is a fantastic way to look after ourselves as part of an all-round healthy lifestyle. But sometimes the balance can swing and we find we’re running for reasons other than for the enjoyment and strength that running brings; running purely to burn calories, running to justify what we eat. It’s easy to develop a negative relationship between running and food. The topic of disordered eating in runners is a sensitive one, but it’s important that we understand it – for our own health, for the health of those around us who may need our support, and to ensure that we’re encouraging the next generation to have a healthy relationship with food and exercise.
The term ‘disordered eating’ describes a range of eating behaviours including the most commonly known eating disorders such as anorexia and bulimia. An eating disorder is a psychiatric diagnosis, made by a specialist, when behaviours fit certain criteria. When behaviours don’t align with these criteria, then they may be called disordered eating.
Disordered eating can still be serious, have an effect on physical and mental health and need expert help. Orthorexia is an example of disordered eating not currently classified as a separate eating disorder. Orthorexia is the obsession with eating ‘correctly’; not focusing on the calorific value of foods but on their composition and whether it is perceived as healthy, ‘clean’ or ‘pure’, to an extent that the focus becomes obsessive and harmful.
It’s crucial to know that you can’t tell if someone has an eating disorder by looking at them. Weight can be normal, many underweight people do not have eating disorders and many overweight people do. We should never assume. This means it’s vital that we understand and recognise the different types of eating disorder and the warning signs that might mean we or someone close to us needs support.
Beat, the UK’s eating disorder charity, estimates that 1.25 million people in the UK have an eating disorder. Women make up 75%, with the highest risk being between the age of 12 and 20. 25% of eating disorder sufferers are men, though this number may be higher, with men feeling less able to approach a doctor for diagnosis. We don’t fully understand what causes eating disorders, but we do know that it’s usually a complex mix of psychological, environmental and possibly genetic factors. Traumatic life events, difficult close relationships and external pressure from society can all contribute. Importantly, eating disorders are not just about food per se, rather they are about the feelings of the person who has the disorder, and how those feelings make them behave with respect to food.
Eating disorders are serious mental illnesses and shouldn’t be underestimated. A full recovery is possible though, with the right treatment and support. There are many different types of eating disorder but they include anorexia, bulimia and binge eating disorder. Sometimes a person’s symptoms don’t fit into these categories and they may be given a diagnosis of OSFED (Other Specified Feeding or Eating Disorder).
With anorexia (also known as anorexia nervosa), a person restricts their food and energy intake to the point where their low weight becomes harmful to their health. Around 10 per cent of people with an eating disorder have anorexia and it has the highest mortality rate of any mental illness, so it’s very serious.
Who gets it?
Women are 10 times more likely to develop anorexia than men and it typically starts in the mid-teens.
Distorted body image. Despite being underweight, people with anorexia perceive themselves as overweight and deliberately try to lose weight. Fear of weight gain. Thoughts of gaining weight and becoming fat
can induce feelings of fear and a dread of eating. Reduced intake. Sufferers minimise eating and drinking. They may pretend to eat, lie, hide food and miss meals. Vomiting after eating, taking appetite suppressants or using laxatives are typical behaviours used to minimise calorie intake. Increased output. Excessive exercise and movement is a common way to use up calories and induce weight loss.
Bulimia (also called bulimia nervosa) describes a cycle of binge eating followed by a behaviour to rid the body of the excessive calories. Approximately 40 per cent of people with eating disorders have bulimia and like anorexia, it should be considered a serious mental illness.
Who gets it?
Bulimia is becoming increasingly common in men and boys. Around two in 100 women in the UK have bulimia and it tends to start in adolescence or early adulthood and a little later than anorexia.
Bingeing. Consuming large amounts of food quickly, with a lack of control and sometimes a disconnection from the behaviour. Purging. Self-induced vomiting, excessive exercise, periods of starvation and laxative or diuretic (water tablets) can be used to try and get rid of the consumed calories.
Distorted body image. People with bulimia often view themselves as much larger than they really are.
Altered behaviour. Mood swings and irritability are common, especially at meal times or after bingeing or purging behaviours, which can be distressing and cause guilt and shame.
Binge eating disorder
Binge eating is not as simple as over-indulgence. It’s a mental illness where people consume large quantities of food on a regular basis and feel unable to control this.
Who gets it?
Anyone, male or female, can develop binge eating disorder. It tends to start a little later in life, usually in the 30s and 40s.
Bingeing. Either in a planned way or spontaneously, usually alone, sufferers consume large quantities of food very quickly. Even if they don’t feel hungry they can’t stop themselves and eat until they are over full.
Altered behaviour. Mood swings, irritability and isolation are warning flags that something is wrong. Behaviours to enable bingeing may be hidden but include buying large quantities of food and planning the day around binges.
“I find it hard to balance my weight due to binge eating and lack of exercise,” says Sasha. “When I overeat I have feelings of guilt and shame which impact on my motivation to exercise. If I do feel positive enough to exercise, I notice how ‘bad’ I am, which again leaves me with feelings of guilt and shame – so I binge and the process starts all over again.
“I am working closely with mental health professionals to try and break the cycle. I know the path could be a very long one, but every day I can see some small improvements.”
Almost every part of the body can be affected by eating disorders, especially if the condition has been present for years. Effects include:
• Constipation, abdominal pain and bloating.
• Weakness and dizziness from periods of starvation.
• Tiredness yet difficulty sleeping.
• Poor concentration, low self-esteem and lack of confidence.
• Anxiety and depression.
• Isolation and social withdrawal.
• Other forms of self-harm such as cutting or alcohol misuse.
• Tooth enamel and vocal cord damage by repeated contact with acid vomit in bulimia.
• Irregular or absent menstrual periods (amenorrhoea) in bulimia and anorexia.
• Infertility and difficulty conceiving.
• Reduced bone density (osteoporosis).
• Liver, kidney and heart damage due to chemical imbalances in the body induced by anorexia and bulimia.
• Obesity from excessive calories in binge eating disorder leading to an increased risk of type 2 diabetes, high cholesterol, high blood pressure and heart disease.
• Death. It’s very rare to die from bulimia, but anorexia can be a life threatening condition if not treated.
Treatment for eating disorders
The earlier someone gets treatment for their eating disorder, the higher the chance of success. Treatment focuses on understanding the thoughts and feelings behind the disorder and developing healthy coping strategies and a different relationship with food. This needs to be carried out by specialists using psychological therapies and to access these you need to see your GP.
“It’s really important to seek help if you have, or think you may have an eating disorder,” says GP, Dr Kate Breckon. “It’s very difficult to tackle alone and can be hard to admit, even to yourself.” Seeing your GP can feel daunting so Dr Breckon explains what you can expect. “A good GP will listen to your story, ask about your eating, your day to day life, and your mood. They will enquire about your physical health, your periods, and any changes in your body. They may examine you, take your blood pressure and suggest you have some blood tests. At some stage they will ask to weigh and measure you. This can be difficult to accept, but it’s important to do every so often, to monitor the severity of the disorder. This doesn’t all necessarily need to be done on the first meeting. Your GP can direct you to national and local charities that will support you and refer you onto specialist services. Your GP will always be happy for you to take someone with you, and writing down what you want to say before you go can help. The first time you talk about it is hard, but can bring a sense of relief that it’s shared and hope for a better future.”
In any type of disordered eating there can be a mismatch between the energy taken in and the energy expended.
When the mismatch is a negative one there can be serious consequences on the body. Dr Nicky Keay, Sports and Dance Endocrinologist and Honorary Fellow of the Department of Sport and Exercise Sciences at Durham University, is an expert on RED-S – which stands for Relative Energy Deficiency in Sport – and leads the RED-S clinic at the Royal National Orthopaedic Hospital.
“Essentially RED-S means that energy intake is insufficient to cover the energy demands of training and basic body function,” she says. “Preferentially, energy intake goes to cover training demands. The residual energy is known as energy availability and is used to cover life processes to keep healthy.
If energy availability is insufficient, then the body goes into energy saving mode and switches off some biological systems. For example, in women, menstrual cycles become disrupted or stop, digestive function becomes impaired and bones weaken.”
Low energy availability will result in adverse effects on both performance and general health. “Specifically for female runners, lack of menstrual cycles due to RED-S doubles the risk of two or more stress fractures due to progressive bone weakness.
“In addition to increased injury risk, there are many potential health issues, such as adverse effects on the cardiovascular system, immune function and mood. RED-S also limits your running performance and the ability to reach your full potential as an athlete.”
If you think you may be affected by RED-S then you need to seek a diagnosis from your GP. “In the first instance, other medical conditions need to be ruled out,” explains Dr Keay. “And if RED-S is confirmed as the diagnosis, appropriate management discussed.”
Achieving a healthy relationship with food
So how can we get the right balance between our eating and running? “As soon as food or training becomes an obstacle in everyday life, then it’s a warning sign to take stock,” says Renee McGregor, Sports and Eating Disorder Specialist Dietician and author of Orthorexia, Training Food and Fast Fuel books. She offers these tips:
- Listen to your body. As a society we are losing the ability to use internal cues to make decisions. We look at other people, social media and fitness trends, and make decisions based on these external cues rather than what will work for us. We need to listen to what our body needs. When our body is working well and is balanced and in harmony, then it works with us to naturally regulate our appetite.
- Stop feeling you need to earn your food. Your daily run only accounts for a small percentage of the energy your body uses each day. Therefore missing a run will not have as big an impact on your weight as you might think it does.
- Ask yourself if you are really in control. While you may feel like you’re in control, you’re only really in control when you have choices. So if you can choose to run or not run, eat a pizza or not eat it and not feel controlled by what you’re doing, only then are you truly in control.
- Know that just being you is enough. You don’t have to prove yourself through times and distances or the shape of your body. Particularly as women, we often don’t feel worthy, that we have to prove our place.
- Running should be one part of you. Your happiness shouldn’t just depend on running; you should be happy both with it and without it. Family, friends, work and other hobbies should be fulfilling you too. It’s a warning sign if running is your sole focus.
- Take time out. Make time to be present and mindful, to calm the anxious mind. Try swapping a run for yoga based activities to reduce anxiety and increase strength.
The warning signs
Do you have disordered eating patterns? Ask yourself these questions to find out if you should seek support.
#1 Is food dominating your life?
#2 Do you think you are fat when other people say you are too thin?
#3 Do you feel you have lost control of your eating?
#4 Have you lost a stone or more in weight over the last three months?
#5 Do you ever make yourself sick or take laxatives because you feel uncomfortably full?
These are the signs to look out for in others.
#1 Altered mood, irritability and withdrawing from social activities.
#2 Losing weight or wearing baggy clothes to hide body shape.
#3 Secretive behaviours such as shutting themselves in the loo after eating, and hiding food, wrappers and laxatives.
#4 Avoiding family meal times, being fussy, eating slowly, moving food around the plate.
#5 Spending lots of time reading food labels and calorie counting.
#6 Becoming distressed if unable to exercise, or exercising when injured.
Help is at hand
- If you think you or someone you know may have an eating disorder, then go to the Beat website for further information and advice.
- Beat is the UK’s eating disorder charity. It raises awareness and understanding of eating disorders as well as offering support and advice for anyone affected.
- It hosts an email and helpline (0808 801 0677) because Beat knows that the faster people get help, the greater their chance of making a full recovery.
- The NHS now has a dedicated RED-S clinic at the Royal National Orthopaedic Hospital, in London. You can ask your GP to refer you directly to Dr Wolman’s RED-S clinic.
- The EN:SPIRE clinic (Endocrine Nutrition, Specialist Practice In Restoring Equilibrium) will open soon in Bath. It will be the first Sports, Dance and Eating Disorders recovery clinic in the UK and will be designed to cater for anyone who feels they have RED-S, Over Training Syndrome or an eating disorder.
For information on RED-S visit health4performance.co.uk the world’s first open-access educational resource on RED-S, written by Dr Nicky Keay and hosted by the British Association of Sport and Exercise Medicine website.
Sharing stories, raising awareness and providing resources and support about eating disorders and RED-S for athletes and coaches.
Overcoming Amenorrhea: Get Your Period Back. Get Your Life Back by Tina Muir
Orthorexia: When Healthy Eating Goes Bad by Renee McGregor and Bee Wilson