Anorexia is often considered a rich white girl’s disease, but Laura Bozzi ’03, ECHO coordinator and outreach worker, said this is simply a myth.

Bozzi said she hears plenty of unfounded opinions circulate about eating disorders at Yale. One of the most common perceptions is that eating disorders will not befall athletes, or men, or minorities, she said.

But with increasing frequency, ideas like these — about just who is vulnerable to eating disorders — cannot survive against the evidence. Men have started to talk about their experiences with eating problems at Yale. Minorities have been less frequently visible, but often present, in the public discourse about this campuswide problem.

Still, full-time varsity athletes have been almost totally absent from the ongoing discussion about eating disorders at Yale. Spectator sports appear classless, egoless, energetic, and life-affirming — everything eating disorders are not. The other part of the silence surrounding eating disorders in athletes is a widespread push to keep such problems within the team “family.”

Despite the image and the silence, eating disorders do occur among Yale’s athletes. The afflicted are mostly women, and often the disorder is indirectly related to other health problems to which female athletes are especially vulnerable. These problems were grouped together by the American College of Sports Medicine in a 1992 report about the “Female Athlete Triad.” The triad is now familiar among sports doctors and the public at large, to the point where the most salient details have become common knowledge. The bottom line: female athletes often suffer from amenorrhea (long-term absence of menstrual period), and run a high risk of osteoporosis and disordered eating.

‘I’m going to eat well’

“When I got into Yale I thought to myself, ‘I’m going to be the best player, and I’m going to eat well,'” Alison Turney ’05 said. “This turned into eating lettuce.”

Turney was describing the circumstances that lead to the eating disorder she suffered from during her freshman year on the women’s ice hockey team.

When Turney was playing hockey at Culver Academy, a boarding school in Indiana, the Yale Athletic Department recruited her to join the women’s ice hockey team. She was the team captain in both her junior and senior years at Culver and had never had an eating problem before. Upon arriving at Yale a year later, she dropped down to 110 pounds from her previous weight of 140 pounds and started to suffer both on the ice and in her social interactions.

“It affected the way I acted around people,” she said. “I didn’t smile, I didn’t have fun, and I didn’t think anything was funny.”

Turney described the misery she sank into when she realized she was letting down her teammates. She was not playing much, and her coach was worried about her. She simply was not strong enough to compete.

“On the ice I couldn’t do anything. I was slow, I would get tired easily, and because I wasn’t strong I didn’t play much,” Turney said. “When I would fall or get hit on the ice, it was pure bone hitting. In the weight room, I couldn’t lift anything near what I would lift in high school.”

Teammate Nicolette Franck ’04 said disordered eating is a fairly common year-to-year problem on the women’s hockey team.

“A lot of girls, I find, go through it in their freshman year,” Franck said. “A lot of it is anxiety.”

Franck said she was surprised to find herself in a cycle of disordered eating during the second semester of her own freshman year.

“I wasn’t taking in the amount of calories I should have for athletic competition,” Franck said. “I had stomach pain and nerves about playing, and I didn’t want to eat.”

Franck described the period as tumultuous and said she somehow fell on the wrong side of every healthy benefit that comes from playing a varsity sport.

“People say it can’t happen here — we’re good kids and we’re aware of body image problems,” Franck said. “But you lose a sense of reality sometimes.”

Barry Goldberg, chief of Yale Sports Medicine, confirmed that disordered eating is more common among athletes than in the general population. Some physicians estimate that as many as 5 percent of athletes impair their health by purposefully consuming fewer calories than they need, Goldberg said. He added that athletes are a “population more at risk” than the general population, citing “competitive, compulsive, achieving or controlling” personality types as possible triggers for disordered eating.

Stereotypes and the female athlete

Franck and her teammate, Rory Neuner ’03, agreed that every season they have played ice hockey for Yale, they have seen a teammate with a highly noticeable eating problem. Shoshanna Engel ’03, captain of the Yale women’s gymnastics team, said disordered eating, if not clinical eating disorders, is a problem she has watched teammates struggle with over her four years on the team.

But for Annie Graf ’03 and many other female athletes at Yale, one of the toughest parts of being a female athlete is the stereotypes about anorexia that form within the athletic community. Graf has spent every day of her last four years at Yale training for, playing, or thinking about her varsity lacrosse team. She said her athletic experience has been overwhelmingly positive because she has learned to take care of her body and love a collective effort. But on the subject of disordered eating in women’s sports, her tone is different.

“Eating disorders [in sports] reflect poorly on all female athletes,” she said. “It’s sad that there are so many stereotypes. I like to work out when I feel like it, and I sense no competition on my team. An eating disorder isn’t a part of my sport.”

Graf and the captain of her lacrosse team, Clarissa Clarke ’03, agreed that the stereotypes they have encountered do not reflect the reality they have lived as female varsity athletes.

“We have a really healthy team,” Clarke said. “We’re very goal focused and driven, but we also create a very nurturing and comfortable environment, where health is encouraged as a part of team unity.”

Some lacrosse players said the perception that female athletes have eating disorders has become as big a problem as the actual presence of these disorders. Neuner said she recognizes the persistent problem Graf and Clarke described.

“Female athletes are judged a lot more, their behavior more scrutinized than male athletes,” she said. “If a male athlete comes back from a summer 30 pounds lighter, people tend to assume he’s just trained hard.”

For women, the assumption is always the worst case scenario, Neuner said.

Engel said the assumption that gymnasts face a large number of eating disorders is higher than the reality. Members of several other women’s teams, in fact, predicted that the gymnastics team suffered from more eating disordered problems than their teams did.

Engel said she can see how the stereotype forms. She cited the would-be Olympic gymnast Christy Henrich as a tragic case that brought much negative publicity to the sport. Henrich died in 1994 at age 22 after struggling with anorexia. She weighed just 47 pounds at one point. Eventually, she suffered multiple organ failure. Henrich’s story is used as an introduction to ECHO’s presentation for Yale gymnasts.

Keeping it in the Team

Although the gymnastics team has been a group of particular concern for ECHO, Engel testified that disordered eating is a problem that does not discriminate between sports. She said that even among gymnasts, eating disorders do not always occur in one recognizable form.

“No two problems are the same,” she said. “They make themselves evident in different areas. Some people have had a problem with their appearance, some a problem with how their weight and appearance specifically affects their gymnastics.”

Even though eating disorders may be hard to recognize in all of their forms, perhaps the hardest task for a teammate is working up the nerve to broach the issue with someone suffering from disordered eating. Because it is rarely discussed, eating disorders often have a stigma attached, Neuner said.

“It affects the whole team as tension, and teammates just don’t know what to do, or how to respond,” she said.

Among athletes who eat together frequently — and watch each other eat –the tight communal atmosphere may be one more way to keep problems within the team, Bozzi pointed out.

“When we go to a team meal, we look at what everyone is eating,” Turney said. “Sometimes, one person’s eating disorder can cause a domino effect on the team — I have noticed teammates with the same tendencies as I had.”

Turney’s undereating was compounded by overexercise, which she says is the most common disorder among Yale athletes. Discussion about overexercise and underexercise, which team members are uniquely situated to recognize in their teammates, may never spread beyond the walls of the gym or weight room.

“For athletes, it looks normal for them to be running all the time,” Turney said.

Franck said during her freshman year, several of her team members did not like to lift in the weight room.

“Maybe girls don’t like that appearance,” she said, referring to the noticeably strong shoulder muscles she has since acquired. “But the weight program is there to make us strong, not to turn us into beasts.”

Franck said team problems spread quickly, but rarely move beyond the team.

“Your team takes up more of your social life than your residential college does,” she said.

Bozzi said even though discussion of eating disorders is becoming less of a taboo in both the athletic community and the larger Yale community, it is still something that is kept within teams. She said she has become aware of the problem in the athletic community by word of mouth. ECHO is planning to extend the informational presentations they offer to all athletic teams.

“[Among athletic teams,] there’s an idea that talking about it opens floodgates,” Bozzi said. “But you find out somehow that’s it’s a problem. It might be through some of the literature; it might be from friends.”

Franck said she wished the Yale Athletic Department had a mental health specialist for athletes, to lend help and specific understanding when problems like eating disorders arise. Neuner said that awareness training for coaches and a statement about eating disorders in the Yale Student-Athlete Handbook would be two big steps in the right direction.

“We had an older male coach before and he would have had no idea about what to do with people who were almost going to break their bones [because they had eating disorders],” Neuner said. “That’s nothing against him — that’s just a reality.”

Beyond disordered eating

Eating disorders may be the most psychologically-painful and physically-traumatic health problems female athletes are prone to facing. But highly active women need to watch their health in more ways than one.

When Ashley Ford ’04, another varsity lacrosse player, rolls up the pant leg from her left knee and lower leg, the outside leg muscle bulges out; the inner skin clings to the bone. The way her team weight trains, she said, emphasizes hamstrings and quads only. She has started to have knee problems this year because her large hamstring muscles pull on her kneecap. The problem is much more common in women, her doctor told her, because of the smaller muscle mass they bring into the training room to start.

Goldberg said that non-impact injuries like Ford’s have increased over the last 20 years. He said that in female athletes, this trend can be attributed in part to the new understandings of how women need to train and condition, and how their bodies perform differently from men’s bodies. Since Title IX was passed with the Educational Amendments of 1972, sports medicine has been playing catch-up with women’s health problems in athletics as participation in women’s sports has skyrocketed.

“In the seventies there seemed to be a greater frequency of injuries, both macro and micro, in the female athlete, because they weren’t as well conditioned as they are today,” Goldberg said.

Non-impact injuries continue to run higher in female athletes in 2002 for reasons that have yet to be confirmed. For example, the higher prevalence of non-impact knee problems in female athletes may result because the strength of the local ligament varies during a woman’s period, Goldberg said. Also, because young adult women have a wider pelvis than men do, the weight on their kneecap puts more pressure on the ligament.

Hormonal differences between women and men also contribute to the higher prevalence of stress fractures in female athletes. Stress fractures are small fractures in bone, which slowly coalesce until the bone’s integrity is compromised. This disorder results in excruciating pain to the athlete, and the inability to continue playing until the bone heals its tiny holes.

Ford suffered a stress fracture at the end of her freshman year, along with a handful of her teammates. She was still dealing with the pain and wrapping her shins in thick tape all of last season.

“Now I’m like an old person. My shins tell can me when it’s going to rain,” she joked.

Goldberg said no one variable has ever been able to totally explain the cause of stress fractures, or why they are more common in female athletes.

“Nutrition is one factor — some women don’t get enough calcium and protein,” Goldberg said. “Morphological changes also contribute, since women have a smaller bone mass. But the higher incidence of stress fractures in women is not related to intrinsic, structural factors.”

A long-term loss of menstrual periods can also contribute to the risk of bone fractures if the condition is not corrected. But the condition, called amenorrhea, is easy to correct by taking hormones — as in birth control pills, Goldberg said. Neuner said about 70 to 80 percent of her team has suffered from amenorrhea, and that it is easier to discuss than eating disorders are.

Still, Clarke said she fears some female athletes may not be addressing the problem.

“I don’t think female athletes know enough about the health consequence of missing periods,” she said. “It’s not natural, and I hope people deal with it.”

Ford said she has been taking birth control pills to regulate her period since the end of her freshman year in high school.

“Medically, there’s something wrong [when someone misses periods],” Ford said.

But as a female athlete, amenorrhea seems to come with the territory. She said that doctors can advise female athletes about the proper ways to treat the problem.

Likewise, Turney said these days, she fears athletes who suffer eating and exercise disorders may not realize how great the costs are.

“I didn’t realize it was that big of a deal, and that it would affect me so much,” she said. “Everything was off balance inside my body, chemicals, my heart, everything. If another girl had told me I had an eating disorder, I probably wouldn’t have listened. But if a doctor says you have an irregular heartbeat, you can’t not believe that.” n