In a journal entry from December 2018, I asked myself: “Can I be an athlete AND be in recovery from an eating disorder?”
The rest of the page was blank. I didn’t have an answer. And not having the answer to that was one of the reasons I checked myself back into an eating disorder treatment facility a few months later. While I didn’t know if my relationship with running and competing was disordered or enabling my eating disorder, I knew I needed to figure that out. Because the one thing I knew was that I loved running, and that my eating disorder was keeping me from it due to the string of endless injuries.
I’m now a year and a half removed from treatment. I’m running and competing. But I still ask myself that question regularly. And the answer is the most lawyerly kind of answer ever: “it depends.”
It depends on the person, it depends on the manifestation of the eating disorder, it depends on the kind of movement. Hell, it even depends on the day and the headspace you wake up in.
I don’t proclaim to have this figured out. Of all of the nuances in eating disorder recovery, I believe that navigating the relationship with running (or, the sport of your choosing) is by far the trickiest and most complex. So how have I been doing it thus far and what have I learned?
Note: this is my experience of n=1. I’m not a healthcare provider, dietician, psychologist, etc. As they say in AA, “take what you need and leave the rest”: your situation may be entirely different. Please work with your treatment providers on what is healthy for YOU.
Content warning: Discussion of eating disorder thoughts, body size and changes, and general food discussion. No numbers or weights.
Be constantly curious about your relationship with running (or sport)
When I was in treatment in both high school and college, sport and exercise was forbidden. The treatment model at the time said that there was no way to engage in sport in a healthy manner, so the option was taken off the table. Thankfully, in the past 20 years, the treatment models and thought process around exercise and eating disorders have changed: sport isn’t forbidden, but it’s a definite tight rope to walk. What I recognized was that I wasn’t sure if my relationship was sport and running was “healthy” or “disordered.” Luckily, at Opal Food & Body, I was able to do a lot of work to unpack that relationship.
What I learned: whether sport is “healthy” or “disordered” can change. It can change by the day, it can change by the sport. And to figure that out, I need to be constantly curious about how running and competing showed up in my life. What were the motivations behind it? Was I running to burn calories? Was I unable to eat my meal plan if I wasn’t able to run that day? What happened to my mental state if I wasn’t able to train?
These questions are actually incredibly nuanced, especially because it seems like so many of my running friends who don’t have eating disorders still struggle with those questions (how many times have you heard “oh I didn’t run today so I can’t eat x, y, or z?” Common, huh?). Diet culture makes it incredibly tough to know what is “disordered.”
But I came up with a few questions that really showed me my intrinsic motivations behind running. The ones that worked for me:
- If running had ZERO impact on the shape or size of my body, would I still do it? If running didn’t burn calories, would I still run? To go even further…if running actually could cause me to GAIN weight, would I do it?
- What am I thinking about when I run? Am I ok running without a watch? Or tracking it via Strava?
- If I can’t run (injury, illness, busy schedule, etc), do I find myself restricting food as a result? Do I get overly anxious if I can’t run? Do I have other coping mechanisms to deal with that anxiety other than running and movement?
In working through these questions in therapy, I can honestly say that I would run regardless of its impact on my body (as an aside: I actually tend to gain weight when I’m running versus when I’m not. That’s not the easiest thing for a person with an eating disorder to deal with).
On the other hand, I’ve found there are other forms of movement that I WOULDN’T do: I recognize that sitting on a spin bike or an elliptical in a gym actually comes from a disordered place: I don’t enjoy doing it and the only reason I would is to “stay in shape.” Therefore, I’ve eliminated those forms of movement from my life. (for a great podcast on this topic, go here.)
To stay in check with my motivations, I try to start each day with a journal entry. I note my emotions, I note where my headspace is at. Only after doing that do I get ready to run. If my headspace is in a disordered state on a day here or there, it’s not the end of the world and I’m not back at square one. But if I start to notice patterns emerging over time, I find it best to take a step back from running to reset the relationship and use other tools in the toolbox to work through the disordered thoughts and feelings.
A break at the beginning may be necessary
I firmly believe that to figure out if running is a healthy form of movement from you, you need to take a break from it in the initial stages of recovery. And it’s definitely necessary if you are medically unstable (please please listen to your treatment team!). Perhaps it was a blessing in disguise, but given the number of stress fractures I’ve had over the years, I’ve had to take extended breaks from running. Those breaks have actually helped me decouple the eating disorder and running.
But even better is a voluntary break: where you are physically able to run, but you don’t do it as you explore what comes up for you when you take a voluntary break: do you miss it? What do you miss about it? Can you learn other coping mechanisms aside from running? Are there other forms of movement you enjoy? These are all questions to explore, and it’s best done at a time when you aren’t running if you really want to untangle your relationship with it.
The goal may not be “intuitive eating”
I am 18 months out from my last round of intensive treatment, and I still follow a loose meal plan. While getting to “intuitive eating” tends to be the gold standard in recovery from an eating disorder, I think that’s a tough ideal for anyone with a long history of a restrictive eating disorder, and it’s even tougher for athletes.
Let me explain.
In an ideal world, we would eat according to our hunger/fullness cues. As any athlete knows, however, there are times post-run or workout where you are NOT hungry. And that doesn’t mean you don’t have to eat. Around training, hunger cues are not the gold standard.
For endurance athletes, there have to be certain times of mechanical eating. I personally tend to struggle with appetite after super long or hard efforts. But I know that I need to refuel, so I eat anyway (“mechanically,” as they call it). In that same vein, the amount of calories you need to support your training may be more than you are actually hungry for. For athletes, mechanical eating at times may actually be part of intuitive eating.
For me, that’s where a meal plan comes in. Working with a sports dietitian, I know how much I need to eat, at a MINIMUM, to support my level of activity. The real challenge for me is to eat in excess of my meal plan when I am hungry or when I have longer or harder efforts. The plan is always added to, never subtracted from: having a baseline for me is important to keep myself accountable and to keep myself healthy and doing what I love to do.
Set rules for yourself around training
Part of the reason I stick to a meal plan is that following it is a non-negotiable part of me being able to train: if I don’t hit my minimum exchanges for the day, I am not allowed to train.
Have I been 100% perfect in following this rule? In complete transparency, definitely not. But the slip ups have become fewer and farther in between, and I’m finding it easier and easier to eat beyond the baseline meal plan.
Another rule I’ve implemented in recovery: no fasted training. I train first thing in the morning, so there’s always a temptation to just chug some coffee and head out the door like I used to do for years. But I force myself to get up (even) earlier to get in a substantial breakfast before I run or ride. Why no fasted training? Well, for one, it’s a slippery slope for anyone with a restrictive eating disorder. But even more importantly, there is some research out there that fasted training for women can throw off hormones and increase risks for bone stress injuries. For anyone with a history of RED-S and disordered eating, it’s just not worth the risk.
Figure out where racing comes in
Is there a difference between training and racing when it comes to eating disorder recovery? Again, it depends.
Why do you want to race? For many years, I sought validation, approval, and love from racing. That’s not necessarily a bad thing – I think many of us do it, regardless of our relationship with food. But you need to have ways to fill that need other than racing – I did not for a very long time. I’ve now been able to fill those needs in other ways (connection, community, friends, giving back and helping others), so racing has taken on a new meaning for me. I intentionally choose races that light my soul on fire – that make me giddy and excited to take on a new challenge. How do I figure that out? I ask myself, “if no one knew I was doing this race, would I still do it?” If I would, it indicates to me that I’m doing it for the right reasons.
How does an upcoming race change your relationship with food and training? If you believe in getting down to a “racing weight,” that is a red flag. If you restrict food and cut out “bad” stuff before races…red flag. If you use an upcoming race as a reason to drive yourself into the ground with excessive amounts of training…red flag. If you are unable to fuel yourself properly during a race…well, you get the idea.
Through therapy, I’ve actually found that racing HELPS my relationship with food and training. When I have an upcoming race that I want to crush, I’m more serious about rest. I’m more serious about erring on the side of eating more than I “think” I may need. I’m less likely to want to overdo training since I have a goal I want to be fresh and ready for. If I’m just blindly training without a goal, I realize I’m more apt to take risks, to not care for my body as well, and to struggle eating as much as I should.
Body changes suck, but remember your values
Note: I write this section with a full acknowledgement I have thin privilege and I live in a smaller body. I understand an outside observer may look and me and roll their eyes if I talk about a changing body. I get that. But what I hope to impart is that just because you are in a smaller body, it doesn’t mean you can’t have feelings about how it changes during recovery.
For many people in eating disorder recovery, your body will change. It’s a necessary step as it finds its homeostasis and “set point” as you properly nourish yourself. My own body has changed in the last year, and it will likely continue to change as I age and progress in recovery.
Many runners fear getting slower if they gain weight, and they are reassured over and over again by well-meaning folks “no no that’s not true!”. I’ve had a lot of doubts myself, if I’m honest (I do cringe writing this because it may be triggering, but I want to be fully transparent here).
For example, my easy runs are almost a full minute slower than they were pre-eating disorder recovery. Now, is that due to my changing body? Or is that due to me moving to altitude? Or because I’m getting older and slowing down with age? Or, ACTUALLY, is it due to me just being smarter about my training and actually taking easy runs EASY?
Honestly, I don’t know. Maybe all of a bit of the above. But the eating disorder brain obviously wants to jump to changes in my body as the reason I’ve slowed down.
So how am I dealing with this? Trusting the process. Knowing that fitness will ebb and flow. And reminding myself, with each run, that I’ve been the most consistent and healthiest in training that I’ve ever been, and THAT is my most important value.
No one cares how fast you can run if you are spending most of your life on the sidelines with a stress fracture. So I tell myself I’ll take slower and healthier over fast and broken any day.
Adapt your training
If I had my druthers, I’d be a high mileage runner: there’s nothing I love more than long days in the mountains. But given my history of stress fractures, I’ve had to accept that high mileage is likely never in the cards for me: too many years of starving my body has taken a toll on my bones (though, encouragingly, my bone density is the highest it’s ever been. But at age 37, there’s no “building” more, so I’ve got to retain what I have).
I run 4-5 days a week with a day or two of cross-training. In the past, cross-training always meant being stuck in a gym riding an elliptical or a spin bike, which were kinds of movement I didn’t enjoy. I realized what I enjoy about running is being outside in nature (one of the huge reasons I’m always on trail). So I’ve found alternatives: I’ve been pretty vocal about my love of the ElliptiGO, and have recently gotten into gravel biking (along with everyone else, it seems). The wonderful thing about adding cross-training that I enjoy is that now when I have a niggle that pops up, a few days of cross-training doesn’t seem like a prison sentence. I’m just as happy on the Elliptigo or the gravel bike as I am running, and that’s key for me.
If you have struggled with stress fractures, I’ve written a bunch about my return to run approach: here and here (note: these were written before I opened up about my eating disorder, but I stand by the material).
Gear up for the long fight
I’ve lived with an eating disorder for over half of my life. There are days when I will break down in tears because I’m SO. TIRED. of hearing the voices in my head when they get loud. I’m so weary of staying vigilant, of the amount of energy and brainspace it takes sometimes to hear the eating disorder thoughts, but to not act on them.
But then I’ll go a few days and suddenly realize food hasn’t been stomping around in my brain incessantly. That the voices have been really quiet. And I’ll have renewed faith and joy that I’m on the right path.
Some people say you should be “fully recovered” before you engage in sport again. Perhaps I’m just jaded, and perhaps I’ve spent too much of my life with this entrenched in my brain, but I do believe that I will ALWAYS be in recovery.
Recovery is never going to be a linear path, and my relationship between running and the eating disorder will likely have its ups and downs as well. I tend be skeptical about people who claim “full recovery” from an eating disorder and that they NEVER have those thoughts anymore. Do I hold out hope that one day that could be me? Absolutely – it sounds delightful. But for me, recovery is staying curious, it’s staying vigilant, it’s consistently aligning my life with my values. And I believe running and competing fits in there, though I have to know when to pull the plug if it starts to veer in an unhealthy direction.
I’m playing the long-game: I want to be that 70 year crossing the finish line at Western States. And if I take care of my body and my relationship with running, I have faith that I will be.