This article discusses eating disorders and may be triggering for some readers. The Canadian Mental Health Association Crisis Line can be reached at 1-800-875-6213.

 

When Branna MacDougall realized what was happening, it was too late.

After feeling an unexplained pain in her back on a practice run, she told herself it was nothing. Just to be safe, she had an MRI done.

Several days later, her coach pulled her into the showers of her Iowa State University locker-room to discuss the results of the MRI. The scans showed MacDougall had a grade three stress fracture splitting the left side of her sacrum.

MacDougall could only cry, knowing the fracture’s cause.

How we got here

One of MacDougall’s cross-country coaches since transferring to Queen’s, Brant Stachel, has always been alert for signs of eating disorders among his athletes.

In an interview with The Journal, he said that he always asks, “Are they afraid to eat at a team dinner? Did they bring their own foods? Do they have allergy restrictions that haven’t been diagnosed by a doctor?”

In part, Stachel is watching for the most common eating disorders among atheletes. One, anorexia nervosa, is the severe restriction of food intake. Another, bulimia nervosa, is characterized by binge-eating and purging. The third is orthorexia, or obsessive “healthy eating.”

MacDougall herself suffers from anorexia. 

Often, in Stachel’s experience, these disordered behaviours are about control. “You can’t control what your coach is doing or if you’re getting more practice time, but you can [control your diet],” he said. 

“This is coming from the mind down, not the body up.” 

Based on a 2016 Statistics Canada survey, an estimated two to three per cent of the population (725,800 to 1,088,100 Canadians) meet the criteria for an eating disorder. Though they can affect anyone, a 2004 study indicated they occur more frequently in athletes, but its results weren’t conclusive.

Stachel said disordered eating shares the same traits, regardless of athleticism. “The athlete’s goal might be to be skinnier and faster, and the non-athlete’s goal might just be to be skinnier because of body perception issues—but the goal is the same,” he said.

“The goal doesn’t change because this is performance based […] The goal is still, ‘Get my body to where I want it to be so I’m happy.’”

But whatever the goal, an eating disorder always demands a little bit more.

Researching the effects on varsity student-athletes, a study was launched into the National Collegiate Athletic Association (NCAA) in 1999 that sampled 1,445 students from 11 Division I schools. The survey was voluntary and anonymous, and asked 133 questions. 

It indicated a lower proportion of athletes were at risk of disordered eating than researchers had anticipated, but also noted inconsistencies between the interview phase and the survey phase of the study.  The problem with these statistics is often stated in the discussion of the studies: different definitions lead to varying results.

In a phone interview with The Journal, Geneviève Masson, a sport dietician at the Canadian Sport Institute, said that most datasets have conflicting information because of that reason. 

“If you look at the literature, the numbers vary a lot,” Masson said. “What terms they use to make a diagnosis, what they see as struggling. So, depending on the questionnaire, the criteria—the level, elite, sub-elite, recreational, if its adolescent or adult—there’s a lot of variation.”

She also noted a risk in looking at data and thinking that eating disorders occur more in one sport than another. “I think there’s a benefit and a risk to having numbers,” Masson said. 

“A vicious, vicious sport”

Originally a gymnast, fourth-year cheerleader Courteney MacNiven knows how the pressures of size and appearance intertwine with aesthetic competition. For her, gymnastics is a “vicious, vicious sport.”

When she started, MacNiven was seven. Her coaches would weigh her and her teammates at practice each week and give them a strict diet. After two years in the sport—at nine years old—she stopped eating.

“I remember growing up only eating yogurt all morning and then throwing out my lunch because we were getting weighed that day,” she said.

By seventh grade, MacNiven weighed around 60 pounds—the average weight for a 13-year-old girl is 101 pounds.

The risk for disordered eating in athletes is higher in aesthetic or weight-class sports, especially for young females, according to a 2004 study of elite athletes in Norway. 

Aesthetic and endurance sports—such as dance, gymnastics, swimming, and distance running—place a higher emphasis on an athlete’s appearance when compared to non-aesthetic sports. The difference has been reported to be up to 18 per cent higher for females competing in aesthetic sports. 

These ideal body types weren’t permanent, and MacNiven and her friends frequently studied and commented on the bodies of their older teammates. “‘Oh, this girl is getting bigger because she’s hitting puberty. She’s not going to be able to do this. Oh, look, she has hips. Look, she’s getting boobs. She can’t do it anymore. She’s not going to be a good gymnast,’” MacNiven recalled thinking.

She refused to make the same mistakes as her older teammates.  

She did everything possible to stay on top. She ate as little as possible and purged the rest until she was 15 years old. These struggles are common for athletes that began in gymnastics.

“As a little nine, 10-year-old, you’re not smart,” she said. “You don’t think, ‘Hey, let me eat all of this broccoli and spinach and kale and get strong that way.’ No, you’re thinking, ‘Well, I’m just not going to eat so that I don’t get bigger.’”

By the 10th grade, MacNiven felt she wanted a change and tried to become healthier. She started eating, but stabbing pains greeted every tentative bite of a new diet. 

When she first saw a doctor for the pain, they said the complaints were excuses to refuse food. In response, MacNiven’s mother insisted that if her daughter said she wanted to eat, she meant it. MacNiven began seeing specialists shortly thereafter. 

For athletes like her, the physical symptoms of eating disorders often alter the approach to treatment, regarding them as a condition rather than a mental illness. However, the symptoms are often hidden in athletes.

Along with weight loss, the physical symptoms that can result from disordered eating vary, but often include a thick layer of hair over the body, poor circulation, abnormal menstrual cycles, and reduced bone density, according to Healthline.

For MacNiven, the result was even more extreme.

After several tests, she was scheduled to remove her gallbladder. Before the surgery, she received one final MRI, where doctors determined that was not the problem at all. 

MacNiven’s stomach acid burned the lining in her organ, forcing it to be surgically stripped all the way to her lower esophagus.

Following the surgery, MacNiven was in and out of the hospital for the remainder of high school. Today, she takes around seven vitamins and one anti-acid a day. They’re necessary: damage to her digestive system prevents her from gaining enough nutrients through food. 

All the while, none of MacNiven’s doctors ever referred her to a mental health professional. According to a 2016 Statistics Canada survey, only 6.3 per cent of psychiatry residents felt they’d be effective working with patients struggling with eating disorders.

Throughout MacNiven’s treatment for stomach issues, the real danger, her mental illness, was never addressed.

Soon, MacNiven was a first-year at Queen’s, but nonetheless reverted to old habits.

The pressure to lose weight returned in her first-year routine. As a cheerleader, MacNiven is a top, being thrown into the air by her partners before they catch her. Some teammates frequently groused during practice: she’s too heavy, they said. 

 “I never really said anything because I was in first year, and they were all vets,” MacNiven said of her teammates’ comments. “I didn’t want to be like, ‘Hey, stop, this is me and I am a person,’ but because I was on them for this term, I was like, ‘Okay, I’ll stop eating.’”

When her first competitive season was over, MacNiven managed to get herself back on track because of her previous struggles. But she said the urge to restrict her eating and purge her meals subtly persists. 

“There’s always this voice in your head that’s like, if you eat too much, if you feel too bad, ‘Hey, throw up,’” she described. “Once you throw up and make yourself throw up once, and you do it for so many years—it’s just simple.”

“You don’t even have to think.”

Courteney MacNiven.                                                                                 Photos by Tessa Warburton

 

On the scales

Similar to aesthetic sports, eating disorders affect weight-class sports like rowing, wrestling, and boxing. To control their weight, athletes can quietly perpetuate toxic eating habits in these sports, according to a 2006 study published in the journal Sports Med. 

One of these sports, rowing, has two classes of athletes: lightweight and heavyweight. 

The benchmark weights between the classes differ between leagues and genders. In the OUA, the maximum weight for a female lightweight rower is 125lbs, while men’s is 160lbs.

In his first year, Queen’s rower Michael Bryenton lagged behind his heavyweight competitors on the water. To gain a competitive advantage, his coach recommended dropping down to lightweight.

Having struggled with his body image since the eighth grade, Bryenton agreed. He liked the idea. It meant he’d lose more weight. 

He consulted with a dietician to construct an 1800 calorie meal-plan would allow him to lose the necessary weight safely. He checked in with the dietician throughout the competitive season and several times after. 

He admitted it wasn’t healthy. 

At 6’3”, his weight dropped from 178lbs to 154lbs over the course of his first season.

But Bryenton enjoyed the diet because he enjoyed the feeling of hunger. “Because if I was [hungry], I was losing weight,” he said.

The opportunity to race as a lightweight allowed him to bury his disordered eating in athletics.

“Even looking back now, is kind of when I was most happy with how I looked,” he recalled.

The weight-loss also affected his performance. Shortly before the OUA Championships, he didn’t hit the same standard as the first weeks of the season. The coach who suggested he shifted to lightweight asked if he was eating enough. 

“I remember saying, ‘No, of course not,’ kind of jokingly. But it was true that I wasn’t eating enough.”

Then, two weeks after the competitive season ended, Bryenton gained back 30 pounds. 

He unsuccessfully tried to go back on the diet and bring his weight down.

Without the need to make his weight class, Bryenton had no clear reason to maintain the diet. “Especially after I gained the weight, I went back [to the dietician] and tried to see if she could give me something else to follow, but she wouldn’t.”

When asked why she refused to make him a new plan, Bryenton simply said, “It wasn’t healthy, and the season was over.”

 

Michael Bryenton. 

 

***

 At the end of his first year, football player Tim Vanheuvelen wanted to improve. He became fixed on one idea: if he lost weight, his performance would improve.

An offensive lineman for Queen’s, his first-year roster profile listed him at 6’6” and 356 pounds. 

By the middle of second semester, he’d lost 70 pounds. His second-year roster shows him at 312 pounds. 

Initially, Vanheuvelen’s goal was to be healthier to increase his performance, but he thought he  controlled his eating habits. The thought of seeing the numbers go down on the scale was “captivating,” he said.

According to Geneviève Masson of the Canadian Sports Institute, disordered eating habits can emerge as a method to exert control over a schedule. 

 “Sometimes it’s harder when they lose that control for whatever reason—injury, travels, or they go home [during the holidays] and their patterns change, and then they realize, ‘Oh, I can’t have control over my food the way I that I’d like to,’” Masson said. 

In her work, she watches for the time athletes devote to thinking about food. If 50 per cent of their energy goes into thinking about what they’ll be eating, it’s become a problem. 

“Sometimes, that’s where it’s, ‘Oh, okay, I’m not in charge right now. Something bigger is in charge.’”

The loss of control that Masson describes is similar to what third-year football player Vanheuvelen experienced. 

“I always had this feeling in the back of my head that was kind of saying, ‘Oh, there are better ways to do this,’” Vanheuvelen said. The problem was results weren’t guaranteed. 

As time wore on, Vanheuvelen’s teammates and friends praised his weight loss. When he went home for the holidays, his parents were concerned, but passed it off as a result of his training.

One February morning, he followed his routine. He stepped on a scale before a workout. Looking down, there was a new, unexpected realization. His weight loss was out of control, dipping under 300 pounds for the first time since ninth grade.

“That was the part where it was initially,  good, bad, and then, ‘There might be an issue,’” he said. “It was just kind of awe, just shock.”

“That I’d done something I wanted to do, but I felt so much guilt about it.”

“That’s part of the obsessive part of it—where the scale is what’s telling you if you’re good or not good, so the scale holds a lot of power,” he said. 

Vanheuvelen never told anyone the truth behind that moment on the scale.

 

 Tim Vanheuvelen.

 

Branded

Branna MacDougall still thinks about her moment with her coach in Iowa and the MRI. Her long battle with anorexia aided the fractures running along the left side of her sacrum.

A third-year engineering student on the Queen’s cross-country team, she was first diagnosed with anorexia nervosa in eighth grade. 

She knew part of the reason for her stress fracture in first year was from an enduring struggle with disordered eating and failing to fuel herself properly.  “You’re just starving yourself so much that you’re just losing control, and your body can’t be irregular like that,” she said of her disorder’s contribution to her injury.  

Hearing her first diagnosis was being “branded,” she said. “This was going to be part of my identity for the rest of my life.” 

Initially, running was an escape from her eating disorder. But once her competitive career began in grade 10, she realized distance-running culture is surrounded by disordered eating. 

Nonetheless, she distinguished herself. MacDougall has raced in the 2016 under-20 World Cross Country Championships, and is the 2016 under-20 Canadian 5,000 metre record holder. She was both the OUA MVP and U Sports bronze medalist in 2017.

On all the teams she’s been a part of, and despite all her success, disordered eating has always been a taboo. “I’ve been on national teams where it’s just whispers about it,” she said. “In Iowa, I found people would whisper about other people, too.” 

A Kingston local, MacDougall transferred back to Queen’s after sustaining her sacral stress fracture to live at home and train with her long-time coach, Steve Boyd, who’s head coach of the Queen’s cross country program.

“[It’s] not something that I’ve felt comfortable saying before, but I think a lot of [the injury] did have to do with my eating habits, just not fuelling myself properly,” MacDougall said. 

By the end of her semester at Iowa, she was equipped with strong eating habits despite her injury. But this summer, she began to struggle again. “It starts so innocently,” she said. 

She began by cutting out sweets to be healthier for the season, but it wasn’t enough. “I just felt like I needed to be in control more and more, and I needed to restrict more and more.”

Because of her reduced caloric intake, she suffered a knee injury that took her out of the beginning of the competitive season. The injury fed into her eating disorder, and it inhibited recovery. 

Then, two months later, MacDougall saw a photo of herself with some of her teammates at the Queen’s Open Invitational Meet, and could see how much weight she had lost. 

That was the moment she realized she lost control. Looking at it, she almost cried. 

“I looked so terrible.”

Shortly after, Boyd approached her, concerned. “So I was like, ‘Okay, I need to decide what’s more important to me: if I get to race, or this eating disorder,’ and I had to kind of make that decision,” MacDougall said. 

She chose racing.  

Granted, the struggle has never gone away since the beginning. “It’s this misperception that you’re cured,” she said. “You’re never cured. It’s something you’re always dealing with.”

“It’s like this other person that’s kind of attached to me. Because I’ve had this thing for so long, it scares me less, because it’s almost like I know it.” 

 Branna MacDougall.