The Olympic rings in Tokyo in March, 2020. Twenty-one per cent of Canadian national team athletes report struggling with eating disorders, compared to about 3 per cent of the general population.Jae C. Hong/The Associated Press
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An eating disorder problem that is hiding just beneath the surface of Canadian amateur sport is a troubling situation that can no longer be ignored and will not go away on its own, says a leading expert who has seen the disorders proliferate in Olympians.
Following an investigation by The Globe and Mail earlier this month, which reported that one in five national team athletes have struggled with debilitating eating disorders, sports nutritionist Jennifer Sygo said more must be done.
“This is an awakening,” said Ms. Sygo, a registered dietitian who has consulted for several Olympic programs as well as the Toronto Raptors. “We’re starting to have a conversation that has needed to happen for a long time.” She took to social media after the article was published, calling the problem an “important and overlooked issue.”
The Globe examined more than 40 cases in the past five years of national team athletes from multiple sports who faced problems with binging, purging and starving themselves. This often stemmed from pressure placed on them by coaches or by themselves, in misguided attempts to better their performances. These disorders took a devastating toll, leaving some athletes hospitalized and others with lifelong damage to their health and careers. The investigation looked at several national team athletes in depth, including some who had never told their stories. Several of them described situations where questionable coaching methods, a toxic sport environment, chronic overtraining or unjustified pressure to be thinner led to problems.
Twenty-one per cent of national team athletes report struggling with eating disorders, according to a recent survey by researchers at the University of Toronto. That compares to about 3 per cent for the general population in Canada.
Jennifer Sygo, a registered dietitian and sports nutritionist who consults for Olympic teams and the Toronto Raptors, said disorders were just 'accepted' in some sports, which needs to change.Mark Blinch/The Globe and Mail
Ms. Sygo said those who diagnose and treat disorders have seen the trend developing, and that the problem has been swept under the rug by sports programs in the past – not only at the elite ranks of amateur sport, but also at the grassroots levels where these issues are showing up in younger athletes.
To fix it, coaches need to be better educated, and sport governing bodies must start ensuring the right expertise is in place to confront the problem quickly, Ms. Sygo said. Some experts have called the prevalence of disorders in amateur sport a form of abuse, in cases where athletes have felt pressure to adopt unhealthy or dangerous habits.
“I think in some cases, we almost just accepted that there was a certain amount of disordered eating behaviour that was normalized in sport, as part of what you do to be a champion,” Ms. Sygo said. “But if we want to be serious about being a country that doesn’t produce medals at all costs, but rather produces medals by supporting athletes who are psychologically and physically well,” then a different approach is needed in Canada, she said. “We need to invest time, resources and – when available – money in order to be able to ensure that our athletes are safe and healthy.”
The Globe investigation showed the problem often begins early, when athletes are young and impressionable and exposed to coaches or systems that don’t look out for their interests. With athletes’ mental health increasingly coming under scrutiny, several Olympians said the problem is a widely seen but under-diagnosed issue.
The Globe talked to several specialists who treat disorders to get a sense of what can be done to confront the issue, particularly in younger athletes in the junior levels of amateur sport. More work is needed, they said, to identify the early warning signs, and to intervene sooner.
Better education for coaches
Among the most pressing needs in the Canadian sport system, experts agree, is more effective training for coaches. Team staff need to get better at spotting the problem, and learn how not to encourage or inflame it.
Alexia de Macar, a Montreal-based performance dietitian who runs seminars on how to identify and treat disorders, said national team coaches and other staff will often say they don’t have an issue inside their programs. But when they learn more about disorders, their view quickly changes.
“They’re like, ‘Oh my gosh, it was everywhere, but I couldn’t see it,’” said Dr. de Macar, who treats several Olympians, along with Cirque du Soleil performers and ballet dancers.
“The line between normal athlete behaviours and an eating disorder is not easy to detect.”
Though 21 per cent of national team athletes report suffering from disorders, only 4 per cent are diagnosed or treated.
She said team staff are often in denial that there is a problem, telling her, “Well, my athlete is just super motivated to perform better, but there is not an actual eating disorder.” But in fact there is a problem, Dr. de Macar added.
Disorders flourish because there aren’t enough people on a coaching staff, or around teams, who can distinguish the symptoms. If they do see the signs, many don’t know how to address them or where to find help. Not acting can set a dangerous tone within a team. “When you just say nothing about it, you’re kind of spreading the message that it’s not that bad, or you don’t care,” Dr. de Macar said.
At the national team level, a vigilant strength and conditioning coach might notice problems building muscle, poor workout recovery or frequent illnesses. A mental performance coach may see depression. At the younger levels of sport, a family doctor may notice low levels of iron or stress fractures in bones.
“The problem is big and it’s sort of been hidden,” said Dr. Jodie Richardson, a clinical psychologist who specializes in eating disorders. “If we can get this early, we really have a better chance of success.”
Sometimes a nutritionist is required. Other times it’s a psychologist. It can vary depending on the athlete and their situation. Choosing the wrong approach can delay badly needed help.
“We need people who know how to handle an eating disorder ... who know how to refer to the right practitioners, how to build a team, and how to create an appropriate treatment plan,” Ms. Sygo said.
There has been a lack of clinically trained psychologists on teams, she said. “I’ve been part of conversations even within the last year to 18 months where there still is a sense of ‘We don’t need a psychologist here. What do we need that for?’”
A visitor walks by the Olympic flame in Beijing. Experts say educating coaches on how to avoid outdated thinking and to spot the problem early is key, particularly at the grassroots levels of sport.Kevin Frayer/Getty Images
Discard dangerous metrics
The problem also stems from the overuse of data and metrics that don’t have any direct impact on performance, but can be damaging not only to elite athletes but also to younger ones starting out.
Having worked with several Olympic teams, Shaunna Taylor, a professor of sport psychology at the University of British Columbia and a clinical therapist who treats athletes, has seen bodies poked and measured, and the anguish it sometimes inflicts.
She recently challenged the use of callipers – instruments used to pinch and measure skin thickness to calculate body-fat percentage – on a team of female athletes.
Dr. Taylor said she’s known athletes to starve or dehydrate themselves in nervous anticipation of that test. Some have told her that test was a tipping point for their eating disorders.
But the sports world can be slow to change. Dr. Taylor recalled one physiologist saying callipers had been used for years, were inexpensive and the only method that made sense for some programs.
But coaches need to question the usefulness of the data they collect, how they are gathered and which metrics really matter, she said.
Some sports have stopped having group weigh-ins and posting body measurements of young athletes. Others still believe in those methods, telling Dr. Taylor, “Well, you know, it just keeps them accountable,” she said.
“I work with some really great exercise physiologists, and trainers and strength and conditioning coaches who are very well-informed and sensitive – and some who are not,” Dr. Taylor said.
Athletes need to question the data gathered about their bodies, and why they are actually needed, she said.
In the cases examined by The Globe, some athletes were encouraged by their coaches to adopt unhealthy habits that led to disorders while others were fortunate a coach or their organization stepped in to get them help.
Krista Van Slingerland, who researches mental health in sports, said educating coaches on what to do, and how to talk to athletes, is badly needed. “It’s one thing to say ‘Stop doing that’; it’s another thing to say ‘Replace it with this behaviour,’” she said. “They want to understand what their duty of care is to an athlete who’s experiencing mental illness. So that’s what we’re starting to educate coaches about, empowering them to create healthy environments.”
She is the mental-health manager for Game Plan, a wellness program created by the Canadian Olympic Committee. Though its primary focus is helping athletes with career transition and mental health, it offers some assistance with eating disorders. However, funds are limited, and only senior national team athletes are eligible, not those at lower levels.
The ski jump for the 2022 Winter Games. In Canada, research is being conducted into Relative Energy Deficiency in Sport (RED-S), a condition some experts see as an early warning signal, particularly in younger athletes.Kevin Frayer/Getty Images
Prevention must start younger
Finding ways to identify eating disorders earlier is now seen as a key strategy to reduce the problem, not just among Olympians but throughout amateur sport.
A considerable amount of research is now being focused on Relative Energy Deficiency in Sport (RED-S). The condition occurs when an athlete overtrains and does not eat enough over a prolonged period of time. This either inadvertently or intentionally causes a significant calorie deficit.
In some ways, RED-S is seen as an early warning signal, particularly in younger athletes, long before more serious clinically diagnosed eating disorders emerge.
RED-S, which was defined less than a decade ago, can appear as everything from low energy and depression to cardiovascular or immunity problems.
Research has shown up to 60 per cent of elite athletes have displayed symptoms of the condition. Several Canadian studies are in progress, including research on how to diagnose the problem, analysis of its impact on volleyball players and a study on how it affects gymnasts.
Researchers liken the work on RED-S to the progress made in the last decade on concussions in sport, which resulted in changes in practices and policies, particularly for younger athletes.
“Our knowledge is increasing. Now, we need to get it to the grassroots in sports,” said Ms. Sygo, who is leading the study on gymnasts.
“If it’s now somewhat well understood at the elite level, now we have to get it down to those coaches of the 15-year-olds and coaches of the 12-year-olds, and university coaches,” she said. And reaching younger athletes early in their careers is also paramount – particularly those “who may be under fuelling or have eating issues and maybe haven’t come to terms with that. It takes a long time for these things to trickle down.”
In data: Athletes and eating disorders
To see how prevalent eating disorders are among Canadian athletes, researchers at the University of Toronto held an anonymous poll in 2019 of 764 current members of national teams and 237 retired members. Here are some of their findings.
Correlation of criticism with the development of eating disorders among athletes
Current athletes
Retired athletes
Negatively criticized about body or weight
68
53%
37
27
10
5
Occasionally
Frequently
Often
Eating disorders*
28
22
20
16
4
3
Thought about
engaging
Engaged in
behaviours
Diagnosed
*Roughly one in five athletes surveyed reported eating disorders. Above is a breakdown between current national team athletes and those that have retired in the last 10 years.
Harmful behaviours most frequently experienced by athletes
Current athletes
Retired athletes
Shouted at
in an angry or
critical manner
39%
31
Gossip/
told lies
about you
32
29
Put down/
embarrassed/
humiliated
35
26
35
Intentionally
ignored
25
31
Criticized as
a person
22
26
Removed
from practice
18
26
Weight
criticism
18
17
Sworn at
16
25
Called
names
15
Athletes who have had suicidal thoughts
Current athletes
Retired athletes
35
33
20%
19
13
9
Had suicidal
thoughts
Sought help
Felt supported
SOURCE: GRETCHEN KERR, ERIN WILLSON AND ASHLEY STIRLING / UNIVERSITY OF TORONTO, PREVALENCE OF MALTREATMENT AMONG CURRENT AND FORMER NATIONAL TEAM ATHLETES (2019)
Correlation of criticism with the development of eating disorders among athletes
Current athletes
Retired athletes
Negatively criticized about body or weight
68
53%
37
27
10
5
Occasionally
Frequently
Often
Eating disorders*
28
22
20
16
4
3
Thought about
engaging
Engaged in
behaviours
Diagnosed
*Roughly one in five athletes surveyed reported eating disorders. Above is a breakdown between current national team athletes and those that have retired in the last 10 years.
Harmful behaviours most frequently experienced by athletes
Current athletes
Retired athletes
Shouted at
in an angry or
critical manner
39%
31
32
Gossip/ told
lies about you
29
Put down/
embarrassed/
humiliated
35
26
35
Intentionally
ignored
25
31
Criticized as
a person
22
26
Removed
from practice
18
26
Weight
criticism
18
17
Sworn at
16
25
Called
names
15
Athletes who have had suicidal thoughts
Current athletes
35
33
Retired athletes
20%
19
13
9
Had suicidal
thoughts
Sought help
Felt supported
SOURCE: GRETCHEN KERR, ERIN WILLSON AND ASHLEY STIRLING / UNIVERSITY OF TORONTO, PREVALENCE OF MALTREATMENT AMONG CURRENT AND FORMER NATIONAL TEAM ATHLETES (2019)
Correlation of criticism with the development of eating disorders among athletes
Current athletes
Retired athletes
Negatively criticized about body or weight
68
53%
37
27
10
5
Occasionally
Frequently
Often
Eating disorders*
28
22
20
16
4
3
Thought about
engaging
Engaged in
behaviours
Diagnosed
*Roughly one in five athletes surveyed reported eating disorders. Above is a breakdown between current national team athletes and those that have retired in the last 10 years.
Harmful behaviours most frequently experienced by athletes
Current athletes
Retired athletes
39%
35
35
32
31
31
29
26
25
22
Shouted at
in an angry or
critical manner
Gossip/
told lies
about you
Put down/
embarrassed/
humiliated
Intentionally
ignored
Criticized as
a person
26
26
25
18
18
17
16
15
Removed
from practice
Weight
criticism
Sworn at
Called names
Athletes who have had suicidal thoughts
Current athletes
35
33
Retired athletes
20%
19
13
9
Had suicidal thoughts
Sought help
Felt supported
SOURCE: GRETCHEN KERR, ERIN WILLSON AND ASHLEY STIRLING / UNIVERSITY OF TORONTO, PREVALENCE OF MALTREATMENT AMONG CURRENT AND FORMER NATIONAL TEAM ATHLETES (2019)
Dangerous Games: More on The Decibel
Listen to reporters Grant Robertson and Rachel Brady as they discuss their findings about athletes and eating disorders, and a former Olympian shares her personal experience. Subscribe for more episodes.