With an estimated 725,000 people in the UK affected by eating disorders, it’s no surprise that amateur and competitive runners are among these. Much discussion around this subject has tended to focus on the female athlete triad - as a medical condition found in physically active girls and women, which can result in low caloric energy availability, irregular or missing periods and low bone mineral density.
However, a statement published in the British Journal of Sports Medicine specified that the phenomenon itself is not as simple as a triad of symptoms – it’s a syndrome caused by overall energy deficiency that impacts the body as a whole, affecting the immune system, heart health, protein synthesis and psychological health, in addition to the triad and more. This syndrome has been given the title Relative Energy Deficiency in Sport (RED-S). Most importantly, RED-S doesn’t only affect women – it can occur in men too.
Many factors, often psychological, can play into the development of RED-S. These can include perfectionism with regards to performance and body size. Traits considered to show good athleticism can also overlap with those of an eating disorder, according to consultant psychiatrist Dr Alan Currie. That means that while someone can appear to simply be committed to their sport, the traits they exhibit could be a sign of something more sinister. “You can hide weight loss behaviours in some environments,” says Currie. “For example, compulsive exercise might be harder to spot in a group of runners. People may also not know how to differentiate athletic leanness from a low BMI.”
This was certainly true for Allie Outram, a former junior cross country athlete who competed for Great Britain. Allie developed the eating disorder anorexia nervosa as a teenager and joined an athletics club. “I gravitated towards long distance running. I very quickly became successful due to my drive to succeed, steely motivation, uncompromising discipline and ability to push my body to the limit. I felt a sense of acceptance and belonging, and the athletics environment was one in which I could hide and legitimise my eating disordered behaviour.”
With runners under pressure to attain a particular physique, circumstances can push them to dangerous lengths. 27-year-old sub-elite runner Tom Fairbrother was encouraged to lose weight to improve his marathon running. “It was suggested that if I weighed 4-5 kilos less, I would be more efficient and therefore faster. I was unable to train at the time due to an injury, so I went about this by drastically reducing my food consumption to an unsustainable level, at which point I then developed bulimia.”
Developing an eating disorder as Allie and Tom did has a hugely detrimental effect on running performance, as well as general physical and mental health. “Substantial muscle atrophy resulted in me becoming athletically weaker and more susceptible to breaking down,” Tom says. “My running career suffered due to persistent injuries caused by overtraining to control my weight. My training and race times were also harmed by far lower energy reserves, especially over the marathon distance.”
So, can being pushed to these lengths cause any long-term issues? “Definitely, and they are not trivial,” says Currie. “Poor bone health is a major concern, but every organ in the body can be affected by energy deficit.”
Struggling from an early age can lead to particularly devastating effects. “I never started menstruating and as a consequence of this I sadly now can’t have children,” Allie says. “I have also suffered from several stress fractures and bone scans have revealed that my bone density is below what it should be. I have been on an oestrogen replacement intermittently since the age of 16 to prevent further bone loss.”
Symptoms such as these don’t have to be the end of the story, though. Through medical and psychological support, a full recovery is possible. “Treatment mainly concentrated on the physical side and restoration of my weight back to normal healthy range,” says Allie. “There was a strong emphasis on food, calories and meeting specified weight targets. However, food is not the issue, just a symptom of the underlying cause. I have seen many reputable psychiatrists, psychologists and counsellors."
“My journey to recovery has taken time but there has been a re-awakening of hope after despair. Having overcome this life-threatening eating disorder myself, I am now a registered member of the British Association of Counsellors and Psychotherapists and believe my experiences contribute to giving me enhanced empathy when working with clients.”
After his dentist raised concerns in December 2014, Tom went on to restore his weight and go public with his story. “Since overcoming my bulimia my performances have improved significantly and, in the year since my recovery, I have recorded personal bests in all distances from 5k, up to and including the marathon.”
“Running for long periods of time requires a great deal of physical strength and energy, so denying your body the fuel and nutritional requirements it needs will only inhibit performance. Eating disorders are illnesses like any other and they are nothing to be ashamed or embarrassed about, so please speak to a friend or your GP.”
If you're concerned for yourself or someone else, you can seek help from eating disorders charity Beat. Find out how to talk you a runner about eating disorders here.