Learning about Disordered Eating

"This will be the last time," she thought as she knelt next to a clump of bushes and forced herself to vomit.  "Never again."

Usually she purged in a bathroom in her college dormitory, but when privacy was unobtainable and the distress from her latest eating binge became too much to bear, she sought out the nearest place where she could sustain her disorder undetected by others.

"I can't believe it," she told herself.  "I'm better than this."

Just a few months earlier she won two gold medals at the Olympics in Los Angeles.  She missed the world record in the 400-meter freestyle by .82 seconds; in the 800 by  .33.  She thought those swims taught her all she needed to know about her body weight.  Before the Trials she bought into the notion that thinner meant faster.  She made a concerted effort to drop a few pounds from her lean frame.  Though she swam well enough to make the team, she swam way below her potential.  That, for a time, ended her concern with her weight.  She promptly put on five pounds in the weeks leading up to the Olympics and had the best swims of her career.

"I felt so much stronger," she recalls now.  "I felt I was swimming on top of the water."

Tiffany Cohen would never feel like that in the water again.

She entered college in the fall of 1984 focused on the next Olympics.  Her ultimate goal was a world record.  Then came the first team weigh-in.  She was assessed to be four pounds above top competitive form.  The public rebuke, regardless of how mild, was too much.  Her dream began to disassemble piece by piece.

Cohen had always obsessed over her weight and body image.  In high school, swimming 30-35 hours per week, she would occasionally go out with friends to indulge in fast food and ice cream, only to be consumed by guilt afterwards.  She knew teammates who forced themselves to vomit.  Cohen tried, but couldn't go through with it.  Instead, she did extra sit-ups and push-ups after practice or went for an hour-long run.

She had weigh-ins during high school, but the situation for Cohen in college was different.  She was the best female distance swimmer in the world.  She quickly discovered the mixed blessing of ascending the competitive pyramid:  Staying there was far more stressful than getting there.  Weigh-ins brought the pressure into laser focus.  An extra pound or two devastated her. Despite her gold medals, the scale had the power to tell her she was a failure.

Cohen's eating habits settled into a scary pattern.  She binged on food out of stress; purged it out of guilt.  The traits that made her an elite swimmer - determination, perfectionism, tunnel vision - worked against her.

"I'm an athlete; I'm disciplined," she would tell herself as she walked away from a bush, her undigested food lying on the ground.  "I can handle this."

She couldn't, of course.  Cohen had an eating disorder that had blossomed full flower.  She was bulimic, the eating and purging every bit as dangerous as anorexia, the other major eating disorder which, in essence, is self-starvation.  But whether anorexia or bulimia, eating disorders are, above all, about denial.  It would be another 3 1/2 years before Cohen admitted she needed help.  She wasn't in Seoul for the 1988 Olympics, but about to enter a hospital instead.  There would be relapses and even a suicide attempt before she regained control of her life.

An isolated case, the anomaly that warrants pity more than concern?  Hardly.  Dara Torres, the embodiment of longevity and health at the 2000 Olympics, endured five years of bulimia.  Like Cohen, Torres' disorder began with weigh-ins during her freshman year of college.

"Every day I constantly thought about food, what I was going to eat, how I was going to get rid of it," she recalls. "I was consumed by thoughts of food."

Unlike Cohen, however, Torres was able to maintain a swimming career, including a spot on the 1988 Olympic team.  No one suspected she had a problem until her mother confronted her a year after graduation and Torres began seeing a psychiatrist.

Allison Wagner, the silver medalist in the 400-meter individual medley at the 1996 Olympics, struggled with anorexia.  Wagner's roommate in Atlanta, Cristina Teuscher, can't recall Wagner eating anything the entire time they were together.  In a few months, the 5' 7" Wagner was down to 105 pounds.  She was 19 but had only three periods in her life because her body fat was so low. 

ALL ABOUT DENIAL 

Cohen, Torres and Wagner constitute a small subset of present and past competitive swimmers with eating afflictions in that they have chosen to go public.  How wide the problem spreads within the swimming community is hard to say.  Studies have produced varied results.  The outcomes, for the most part, rely on the honesty of the respondents.  The salient feature of eating problems, however, is denial.

"The individual truly does not believe he or she has a problem," says Katherine Beals, PhD, assistant professor of nutrition at Ball State University.  "A questionnaire would not accurately assess a problem if the athlete does not believe, and thus does not report, that one exists."

Nonetheless, studies have been consistent on three points:

• Women overwhelmingly outnumber the men when it comes to eating disorders by a factor of anywhere from five to seven to one.
• The prevalence of eating disorders among female athletes is roughly five percent, which is in line with the general population.
• Since the bars for clinical anorexia and bulimia are high, they exclude eating problems that are dangerous in their own right and could lead to clinical disorders.  These sub-clinical disorders (often referred to as disordered eating) are believed to be far more prevalent among female athletes, particularly those competing in sports such as cross country, gymnastics, diving, and swimming, than women in the general population.  Beals found that 15 percent of the 475 college female athletes she surveyed had some form of sub-clinical eating disorders.
• "They are bingeing and purging, but not frequently enough or not for the right reasons to be diagnosed with a clinical eating disorder," says Beals.  "Or, they are severely restricting calories, but not enough to be considered clinically anorexic."

Torres, for example, purged herself sporadically and never in the weeks leading up to major competitions, but she certainly had a problem.

"I had no energy, and I was extremely, extremely, moody." she says. "I knew what I was doing wasn't good for me."

Other studies have come in with figures considerably higher than Beals' for sub-clinical eating disorders.  But whether 15 percent or two or three times that, the conclusion is inescapable.

"People who say they don't have swimmers with eating disorders on their teams are people who don't want to know," says Cyndi Gallagher, the head women's swim coach at UCLA.

NOT ABOUT FOOD

The irony about eating disorders, whether clinical or sub-clinical, is that they have little to do with food and body weight.

"It's what's underneath -- the trauma, the self-image-that's the problem" says Tara DeSorbo, a registered dietician with the eating disorder service at Deaconess-Waltham Hospital in Massachusetts and an age-group coach with Bernal's Gators.  "Whatever that scale says, it's never good enough.  That's why these things spiral out of control."

Cohen had a history of depression in her family.  She now believes that her own bout with depression began about the time she arrived at college. Wagner says the root of her anorexia was a life severely out of balance.  She had pushed everything else aside to accommodate swimming.

"I had no life outside of swimming, and the only and most important thing in my life was winning a gold medal," she says.  "I yearned for something that swimming could never have given me even if I had won gold at the Olympics: complete happiness and fulfillment."

HALF NAKED

Kristine Quance-Julian, a '96 Olympian, has never been anorexic or bulimic, but she has a hard time explaining why she weighed herself five times a day, or why on the day before leaving for the Olympic Trials in 1996 she announced to her roommate that she wasn't going because she weighed two pounds heavier than when she began her taper.  Her roommate convinced her to make the trip.

"It's hard to spend so much of your time in a swimsuit and not worry about how you look," she says.  "And it's hard not to watch your weight closely when you are trying to swim fast.  Society sends mixed messages.  On one page of a magazine you read about eating disorders, and on the next there are pictures of some emaciated models."

Therein lies the rub.  So many factors contribute to eating problems that a comprehensive solution will always be elusive.  Society won't change and neither will girls.

"There are times when I feel gross about my body," says Teuscher.  "Every woman does."

"Think about it," says Anita Nall, a '92 Olympian and a former world record-holder.  "You spend half of your life half naked.  What do you expect?"

Swimming won't change.  The medals will usually go to the fittest competitors.  The public weigh-ins might go the way of cheap gas, and coaches might be more guarded with their comments, but a swimmer's weight will invariably become part of the mix that makes for top performance.

"You can pretend to take weight off the table," says Murray Stephens, the founder of North Baltimore Aquatic Club and a 1996 Olympic coach, "but it's still going to be there.  You go to the Olympics and nine times out of ten you will see people who are extremely fit and extremely lean, which, by the way, is not the same thing as skinny."

Most important, the swimmers won't change.  They will succumb to insecurities.  They will attempt shortcuts without considering the costs.  They will take the signals coming their way and invert them.  Nall remembers a practice where another swimmer complained of chaffing caused by the shoulder straps on her suit.  The coach suggested that she get a bigger suit.  A subsequent discussion among the girls in the locker room after practice concluded that the coach was trying to tell her to lose weight.  Quance-Julian says a coach could launch her into an emotional tailspin by requesting that she show up for a Monday morning run.  His subtle message, no doubt, was for her to lose weight.

Perhaps the best advice comes from three swimmers who have survived the vicious cycle.  Cohen is now Cohen Adams, a married mother of two children.  She is training for triathlons.  She has been free of her eating disorder for 10 years.

"You have to get informed," she says.  "Listen to your body and know what nutrition it needs.  Do not let weight become the issue.  Stress other things, like getting stronger.  And if you are struggling with an eating problem at whatever level, get help before it's too late.  The earlier the intervention, the better the chance for a full recovery."

Torres, who has been free of her bulimia since 1991, agrees. 

"Coaches need to educate their swimmers as to what works best as far as diet goes, maybe even get in a professional nutritionist," she says.  "And swimmers need to realize that there are people out there who want to help.  I found out later about people at college I could have gone to, but I didn't because I was ashamed of my problem.  That's not the situation nowadays.  People are more open to it.  You can't solve it on your own.  You have got to get the help."

"The key to my recovery," says Wagner, "was accepting help from others, namely professionals like my therapist.  She saved my life without a doubt."