During the winter months, student-athletes from multiple Yale varsity teams walk daily through the hallways of Coxe Cage, their place of practice and refuge from the cold outdoors. On the walls of these same hallways recently hung a fluorescent pink flyer with detachable slips at the bottom. The poster invited female student-athletes who had ever struggled with eating disorders to take a survey.

As of last week just one lone tear-off slip remained, casting light on the challenges many Yale female student-athletes face every day.

A recent Yale co-authored study found that disordered eating habits are seen in 25 percent of female collegiate athletes. These habits, which include inadequate calorie intake and purging behavior, such as induced vomiting, can lead to electrolyte imbalances, malnutrition syndromes and bone loss, according to the study.

Based on interviews with members of all 18 Yale women’s varsity sports teams, Yale seems to be no exception. At least one athlete on each team said either she or a teammate had struggled or continues to struggle with eating disorders or body image issues during college.

A WIDESPREAD ISSUE

At Yale, in most cases female student-athletes struggle particularly with the contrast between a body that performs well in sports and one that looks feminine.

A former runner on the Yale women’s track and field team, who wished to remain anonymous due to the sensitive nature of the topic, had never given thought to her personal appearance in high school. But after arriving at Yale her freshman fall, she felt she had “social standards” to live up to, and that she should lose weight in order to perform at the Division I level.

During her freshman summer, the runner lost nearly 40 pounds. She developed anorexia, bulimia and orthorexia — an obsession with only eating healthy foods — a combination that is especially threatening for an athlete training up to four hours a day.

While some see losing weight as a means for excelling at their sport, other athletes cited examples of the practice leading to malperformance instead.

For a second track and field runner who also asked to remain anonymous, issues with body image began when she started college weight training, which was more intense than her workouts in high school. She decided to lose weight until she looked more like the other girls on her team.

“I would make myself throw up and my diet was very restrictive,” the runner said. “But then people would tell me, ‘Wow, you lost weight, you look good,’ and that would incentivize me to keep doing it.”

Although the runner liked the way she looked after the weight loss, her performance on the track began to deteriorate. And yet the only solution she could see was losing even more weight.

The athlete ultimately sought her coach’s guidance and the support of a therapist and nutritionist. Although she said she is physically better now, after two years since beginning treatment, eating remains a constant source of stress for her.

“Logically, I know I am physically fit and better now, but I am always worried about food,” she said. “It is constantly on my mind. Mentally, it is a stressor, but not physically.”

Not all women who struggle with eating disabilities and body image issues go as far as developing anorexia or bulimia. Still, 21 of 28 female athletes interviewed said they currently or at some point in their collegiate career had issues with how their bodies look.

On the Yale volleyball team, during the spring season some players worry about developing “spring bods” — having “man arms” and looking “way too jacked” from spending increased time in the weight room — according to an anonymous player on the team.

Similar conversations occur on the women’s soccer team, where the common complaint for players is developing “soccer legs” because of the extreme leg strength necessary in the sport, women’s soccer midfielder Margaret Furlong ’18 said.

“People make comments a lot about how muscular we look,” a women’s hockey player who asked to remain anonymous said. “I know that a lot of us feel like we need to work extra hard to keep body fat off because the muscle we need for our sport already makes some parts of our bodies bigger than we might want.”

While the study also found that athletes in “lean-body sports,” such as swimming or gymnastics, were more prone to developing eating and body image problems than other athletes, in interviews with athletes at Yale the condition was more widespread throughout teams.

One member of the women’s golf team who asked to remain anonymous said that although she had always had healthy relationships with food and her body before coming to Yale, in her freshman spring semester she developed an obsession with food and her weight, often feeling guilt and shame after eating.

Elisabeth Bernabe ’17, another member of the women’s golf team, said she agonized over her weight for many years because other athletes on her team were significantly smaller, and that she feels more confident now that she has lost weight.

“After living the last 10 years of my life overweight and constantly being around a team such as mine, I finally had enough and decided to make a life change,” Bernabe said. “Though I knew that they all loved me for who I was, I did feel ashamed when we were delving up uniforms and I was the only large amongst many smalls.”

Her case is just one of many in Yale’s female student-athlete community. But many of these cases go unheard.

Athletes interviewed highlighted that while many face issues of eating disorder and body image, few come forward and discuss their conditions openly with their teammates and coaches.

“It’s the dirty laundry no one likes to talk about,” long-distance runner Emily Barnes ’17 said.

The anonymous golfer, for example, said she has not felt ready to discuss the troubles she went through with her team or coaching staff. She added that she believes others on the team face similar issues, but that no one has ever brought up the topic as a team.

Although two golf players interviewed for this article cited previous experience with body image issues or eating disorders, when asked if any athletes on the team had struggled with these issues women’s golf head coach Chawwadee Rompothong ’00 said she was not aware of any athletes on the team who had.

The second anonymous runner said although she talks with her teammates about her past condition now that she has improved, in retrospect she wishes she had been more open with them at the time.

“The tough thing is that most people who struggle don’t talk about it, and the signs that someone is struggling with an eating disorder can slip under the radar pretty easily,” women’s hockey forward Gretchen Tarrant ’17 said. “I think more athletes deal with this than most people realize.”

One of the first steps in curbing these issues, the anonymous runner said, is to be more open about eating disorders and bring up these problems more often with teammates and coaches.

Women’s fencing captain Joanna Lew ’17 said even when she notices “warning signs” in teammates, it is difficult to approach them outright without trespassing personal boundaries and making assumptions about a person’s lifestyle.

“The elephant in the room was just never talked about,” the runner said.

DEALING WITH CHANGE

For most student-athletes interviewed, societal expectations and pressures on how their bodies should look were the main reason behind their issues with weight and body image.

Spending up to four hours a day in intense workouts and weightlifting regimens, female athletes often end up with larger muscles and more defined bodies than non-athletes, features that can be seen as masculine, a softball player said.

“Body image is both a personal interpretation and one a society implores,” she said. “I feel as though everyone constantly worries about their personal body image just due to the society we live in today.”

It is often hard to reconcile society’s view of a beautiful woman with the type of body athletes need to succeed at the Division I level, Tarrant said. She added that it is impossible to be both “skinny” and strong.

This issue often comes up for the first time in college, where training is more intense than it is in high school. Many female student-athletes are introduced to regular weight training only upon arrival at Yale, causing their bodies to change significantly, Furlong said.

Female athletes are also sometimes bothered by the way they look because they are “bulkier” than non-athlete female students, a squash player said. This is likely because female non-athletes focus on cardio workouts and do less weight lifting than a varsity athlete, she added.

“There have been a few people on my team who have struggled with eating issues, and I think some of it came from how we became so bulky during lift and people did not like the way that they looked,” a varsity athlete who preferred not to specify her team said.

Karen Sutton, a professor at the Yale School of Medicine and a co-author on the study, also works for the University as the director of women’s sports medicine and for Yale athletics as a team physician and sports medicine orthopaedic surgeon. In those roles, Sutton works both alongside athletic trainers to help with injury treatment and alongside strength and conditioning professionals to help with injury prevention.

Sutton said strength conditioning is necessary for female student-athletes to perform at a Division I level — a fact not emphasized enough in high school.

“Being scared of being big has to go out the window,” Sutton said. “You have to throw body image out.”

Many female student-athletes interviewed agreed that they see their strong bodies and muscles as an advantage when competing in their sports.

For instance, women’s squash player Georgia Blatchford ’16 said she works hard to have a strong body, and that on the court it is preferable to be strong rather than delicate.

“If you love the sport you play, you should also embrace the changes that it does to your body,” women’s squash player Celine Yeap ’19 said.

Volleyball player Lucy Tashman ’17 added that being on a team helps athletes come to terms with how their bodies look, since the workouts make players better and help the entire team.

The problem, however, often comes when female student-athletes compare themselves to female non-athletes, a former women’s rower said.

She said because rowing is an intensive, calorie-burning sport, team members have to eat more than the average woman in order to recuperate the calories they lose in practice. While eating is not an issue when athletes are with their team members, the rower said it is disconcerting to always eat more than female non-athletes.

“Going home, I realized how much more I was eating and my friends noticed it, too,” she said.

YALE’S APPROACH

Members of all 18 Yale women’s varsity teams said that on their teams, each athlete is in charge of controlling her diet and making sure she consumes enough calories for practices and competitions.

While Yale women’s crew head coach Will Porter said taking ownership of individual nutritional needs is a “very basic part” of being a Division I athlete, student-athletes said many issues can stem from this approach.

“You come in, and there is a pressure to perform,” distance runner Emily Waligurski ’17 said. “That’s where the problem comes in: girls start trying their own thing, changing their diet without knowledge.”

Furlong said when she started weightlifting in the spring semester, she became “infinitely hungrier” and did not always know how to fuel right, leading her to overeat.

Yale Health’s Athletic Medicine Department currently has one nutritionist on staff for all teams. The nutritionist, Lisa Canada, said the interactions between her and student-athletes depend largely on the team, as she meets with teams on a per-request basis. Most teams do not meet with Canada as a whole, and in most cases, student-athletes are simply encouraged to meet with Canada individually if they wish to.

The cross country and track and field teams, for example, have a team meeting with Canada at the start of each school year. Runners are then encouraged to reach out to Canada if they want individual meetings. In addition, if coaches are worried about a particular runner, they will recommend they set up an individual meeting with Canada, Barnes said.

While other teams, such as soccer and golf, have also had team meetings with Canada in the past, that is not the case for the majority of teams. In most cases, student-athletes are simply encouraged to meet with Canada under their own discretion.

Yet several student-athletes interviewed had no knowledge of a nutritionist on staff with whom they can meet.

“It is a little difficult since I am only [at Yale on Tuesdays and Thursdays] part-time,” Canada said. “But as of yet, I don’t think anyone that wanted an appointment has been unable to schedule.”

She added that she also has the flexibility of adding more hours if necessary, but that those hours are limited because of a fixed budget.

Student-athletes also said they believed the approach to athlete nutrition should be more proactive. Often, female athletes are encouraged by their coaches to meet with Canada only once eating and body image issues have already developed, Waligurski said.

Furlong added that on the soccer team, coaches step in only when they notice “drastic changes” in a player’s weight.

“Just getting word out that help is available is important,” Canada said. “Both individual and group support is available to students and athletes, they just need to reach out and ask for it.”

According to Director of Yale Health Paul Genecin, when a student-athlete is going through an eating disorder, a physician and nutritionist are generally involved in the treatment, and depending on the case a mental health clinician may also be part of the team. He added that varsity athletes have access to the same mental health clinicians at the Mental Health Clinic who treat all Yale students.

“Often those struggling with an eating disorder or disordered eating are in need of additional support, but it can be overwhelming for them and perhaps intimidating to walk through the doors of mental health,” Canada said. “I sometimes help bridge to bridge that gap.”

A DESIRE FOR MORE

Athletes also largely called for more resources, such as mandatory training and individual and group counseling, as well as more sports-specific nutritional advisors. Multiple coaches interviewed expressed similar views.

“I believe more can be done in terms of education and counseling for all including our team,” women’s swimming and diving head coach James Henry said.

The anonymous golf player said mandatory training and resources tailored to athletes with eating disorders and body image issues would be “really helpful,” and added that if such resources already exist, athletes do not know much about them and have not been explicitly encouraged to use them.

Canada agreed that student-athletes could benefit from additional resources regarding eating disorders but added that getting students to utilize the ones that are already available is also important.

The runner added that having mental health professionals specifically dedicated to athletes would help because they could understand the specific issues student-athletes face, which are often different from those of the typical Yale student.

Support from the coaching staff is also essential, Barnes said. Before coming to Yale, she had unsupportive coaches who avoided talking about the topic, but said Director of Track and Field David Shoehalter and women’s cross country coach Amy Gosztyla have dealt well with issues within the team.

A women’s tennis player added that coaches should be trained in how to speak with women athletes and be sensitive to these types of issues.

The player also said access to food can trouble student-athletes. Because dining hall hours and practice schedules are not coordinated, often by the time teams arrive to eat there are no healthy options left. She added that the women’s tennis team often holds four-hour practices with no snacks, which lead to undernutrition and overeating afterwards.

For Sutton, an important step to eliminating body image issues is to further develop a female athletic culture. Raising awareness of female sports, increasing their marketing and air time and making more sports accessible to young women are all ways of bringing public attention to women’s sports up to par with men’s, she said.

She cited last year’s 2015 FIFA Women’s World Cup, which drew significant fanship from American citizens towards the U.S. Women’s National Team, as an example of how much players can look up to women athletes.

An anonymous member of the fencing team said if the media brought more attention to “less accepted” female body types, such as those of muscular athletes, the stigma of being masculine could start to fade.

Being able to see more female athletes in the media embracing their athletic bodies can help shift the narrative away from “unhealthy and unrealistic” body expectations, women’s basketball forward Meredith Boardman ’16 said.

“I think that the best way to attack these issues is to keep reiterating that it’s way better to be a badass at your sport than to live up to some imagined skinny ideal,” Tarrant said. “Someone once told me that your body is an instrument, not an ornament. Work hard for your body and own it. It is far more important how much you can achieve athletically than how you fit into a material ideal.”