Dr. Steve Soboroff

June 15, 2001

Here's something that you probably didn't know: According to the Council on Size and Weight Discrimination, young girls today express more fear of becoming fat than they do of nuclear war, cancer, or losing their parents.

While that may seem pretty shocking at first, the underlying issue is control. You can't control nuclear war, cancer, or losing loved ones, but weight is one thing you can control. At least physically, they say.

People who know me may be surprised that I would write an article about athletes with eating disorders. Isn't that something like the pot calling the kettle black? I will admit right here upfront that I have struggled and continue to struggle with worrying about my weight constantly. For many reasons I was motivated to lose weight last summer, and when I ended up losing more than 25 pounds in less than 3 months people began to worry. I also confess there are still times I will do anything to stay at or below my magic numbers, whether they be from the scale, clothes size, or calorie counts. But I know I'm not alone, and through my own experiences with losing weight, I've learned a lot about what constitutes going too far.

I wanted to write this article to get the issue out in the open, because the worst thing is to think that you are alone. If you haven't suffered personally, chances are you know someone who has. This issue affects just about everyone. Female athletes make up the most at-risk group for developing problems with eating, and I think the biggest areas that could make a difference are communication and education. While many guys may seem lost on this issue (since eating disorders in men generally have to do with gaining weight to get bigger) that's all the more reason men should try to understand what makes women want so badly to be thin. When people think about eating disorders involving men, they often give wrestlers as an example. However the weight concerns of wrestlers are strictly for better performance. Whereas in many women athletes weight concerns have to do with everything but performance.

The definitions of eating disorders seem as familiar as they are impersonal. Anorexia, or self-starvation, is characterized by severe caloric restriction that causes a 15% loss of normal body weight. Bulimia is--in contrast--characterized by binge eating followed by purging through various methods, including self-induced vomiting and/or the use of laxatives and diuretics. But, a distorted body image, low self-esteem and other psychological and emotional issues commonly drive both.

Of course, they rarely come in such nice neat packages. I got a chance to sit down with someone most Illinois athletes know, Dr. Stephen Soboroff, the chief physician for the UI Division of Intercollegiate Athletics. "The severe cases of anorexia or bulimia are not that common. What is most common is a mixture of everything put together. Really, whatever it takes to lose the weight. It's most often the person you wouldn't recognize as having a problem."

This is probably the scariest part of it all. "While there may be only five cases a year of the most severe problems throughout the whole campus, there are hundreds of the other and about 20 to 30 of our female athletes fall under that group. That we know of. Really, what we have seen is only the tip of the iceberg, as far as recognizing and treating what is going on."

Studies show that as many as 30 percent of female athletes have disordered eating behavior. But not surprisingly, the numbers are highest among female athletes at Division I colleges. A 1999 NCAA study found more than half the Division I college female athletes surveyed were diagnosed with some kind of eating disorder. Why is college such a crucial time for at-risk women? It comes back to the issue of control. Soboroff sits on an Eating Disorders team at the UI McKinley Health Center. The group includes a doctor, a counselor, a psychiatrist, a nurse, and a dietician. The team discusses education, treatment, and prevention, and they agree it all comes back to the central issue of feeling in control of your life.

Soboroff says being in control feels good, but it can bring a false sense of security and a façade of happiness. "The biggest reason is still societal and also major family issues. A lot of the things that happen to young women have to do with control, and this is the one thing they can use to have control over everyone. It's not an issue of food."

Athletes, especially, are confronted with a parade of instructions, pressure to look good, and to perform. Along with what society and the media say you should look like, you have a coach and teammates to contend with. Everything just seems easier when you are thin. You look the way society says. Coaches are happy because you look lean and in shape, the ultimate sign of hard work and dedication. Teammates look up to you as they wonder `how did she do it?' in the midst of locker room praise and coach comparisons.

You begin to wonder, well what if I got even thinner? More praise, more friends, more guys? Or even worse, what if I gained it back? No more praise, no more friends, no more playing time, no life. And that's where it goes too far. When your weight becomes your life and your means of achieving everything you want, you'll do anything to keep losing, and you worry constantly about gaining even the slightest bit back.

While many point concern towards the more weight conscious sports such as gymnastics or track and field, Soboroff says, "There is no sport that is immune. While there may be some sports that are at more of a risk than others, some of our more serious cases have actually occurred in sports that you wouldn't think of, like volleyball or tennis."

I talked to a female athlete here at the University of Illinois who suffered from a mixture of anorexia and bulimia. The worst part about it for her was the unexpected alienation among friends, along with the stares, rumors, and judgment associated with her eating problem. "At Irwin (Academic Center), people would whisper `Annie' when I was around (referring to anorexia), and when I was upset or struggling with playing well they would beg and plead, or even laugh, saying `all you have to do is eat!' But in the end it wasn't really about the eating. I just felt like no one understood what I was going through and that was the hardest thing about getting better."

If you suspect a friend or teammate may have an eating problem, don't let it go. You won't be protecting them from anything by letting them hide under the façade. It's very easy to make an anonymous request of concern to a trainer, coach, or directly to a team physician. Your friend never has to know it was you, and you may be helping them more than you could imagine.

I asked Dr. Soboroff how the situation would be handled. "They are handled as strictly a medical problem. We treat as a serious medical problem, and it stays between you (the athlete) and me. The first thing we have to do is agree on what is going on and where we're going to go with it. Nobody else will know unless you give permission. It is a confidential medical problem and it is dealt with in that way."

If you decide you would rather confront a friend about a suspected eating problem, remember, the issue should be viewed as a symptom of something bigger. Soboroff cautions, "It has nothing to do with food. It is a long term chronic disease, and it's about coming to terms with underlying issues."

Prevention, of course, starts with us as athletes. Education and communication are the keys to letting women know that they're not alone. Also, we need to get coaches involved. As college athletes, coaches are the most influential people in our lives right now. Their impact can trigger an at-risk woman to begin dieting and keep it going with positive reinforcement such as praise and added playing time. But, if coaches learn to know when too far is enough, if they can begin to recognize the warning signs of a problem outside just the realm of their sport, then maybe the problem will not get as far as it can go if undetected. They can then build on that experience to prevent further problems among teammates and other athletes down the road.

Personally, I'd like to end by offering myself as a friend to anyone who wants to talk about their experiences with eating problems or any pressure they're feeling to lose weight. I check my email about five times a day and, as you can see, I love to write! I have watched friends and myself struggle with trying to please everyone by looking the way they agree we should. What it comes down to is what you want, and how you feel about yourself separate from your body. To be able to disconnect judgment of you as a person or performer, with what the scale says.

In addition, here are some great links to check out for more information including common warning signs, treatment options, and some great `survivor stories' that will inspire anyone help out a friend or begin getting help themselves.

Anorexia nervosa and related eating disorders
Eating disorders awareness and prevention
National association of anorexia nervosa and associated disorders
Eating disorder referral and information center
Caring Online
Story on UConn basketball star Shea Ralph and her ongoing battle with anorexia