Eating disorders in sports: When being lightweight becomes a serious problem

"I was also always told in the past: 'pensils run in front, not erasers,'" Sabrina Mockenhaupt tells DW. "That sounds casual, but it can quickly get stuck in your head."

Mockenhaupt, 40, is a former distance runner that won 40 German championship titles over long distances in her career.

"I was never too thin. Maybe that's why my career was so long," she surmises. "I don't think many of the thin 20-year-olds currently competing will still be racing at 35."

Norwegian ski jumping star Maren Lundby has recently rekindled the discussion about the danger of slipping into serious eating disorders through starvation in top-level sport. The Olympic and world champion surprisingly decided at the beginning of October to forgo the entire season culminating in the 2022 Winter Olympics in Beijing.

"I'm a few kilos too heavy for the highest level. And I'm not willing to do crazy things to change that," the 27-year-old said in a television interview, during which she repeatedly burst into tears.

Lundby said she also wanted to send a message to young athletes: "Uncompromising weight control shouldn't be an issue. You can destroy everything with that."

The danger of developing an eating disorder

"I think she's doing exactly the right thing," Katrin Giel tells DW. "She's behaving in a very caring and healthy way. That should have a radiance."

Giel is a professor at Tübingen University Hospital and an expert in eating and weight disorders — including in sports.

"Top-level sports are about peak performance," Giel explains. "Competitive athletes are good at failing to do things, torturing themselves to some extent and enduring pain. Maybe even going beyond their limits at times. That favors being strict in eating behavior as well."

There is a fine line, she says. "Then you might slip into an eating disorder. And it's very difficult to get out of it."

At the Tübingen clinic, there is a RED-S consultation for elite athletes, where RED-S stands for "Relative Energy Deficit in Sports." Those who put a lot of strain on their bodies but don't feed them enough calories risk serious health problems.

"If, for example, female athletes in their 20s have never had a menstrual period, the alarm bells must be ringing," says sports medicine specialist Christine Kopp, who heads the consultation. "Also if they have hypothyroidism, have clustered fatigue fractures, depression and, of course, if they're underweight."

In addition to ski jumping, high-risk sports for eating disorders include gymnastics, rhythmic gymnastics, diving and endurance sports such as triathlon, long-distance running, biathlon and cross-country skiing.

Role models on social media

Just like during the interview with ski jumping star Lundby, tears are often shed during consultations in Tübingen — from the people concerned themselves and, if they are present, from the parents as well.

"They were happy to have a daughter or son who was successful in sports in a great club. But suddenly every meal at home becomes a problem," Kopp explains to DW.

"The sport threatens to kill their child in extreme cases. At the same time, the daughter or son can't live without sports. It almost has the character of addiction. That's why therapy belongs in the hands of professionals."

Of those seeking advice at Kopp's RED-S consultation, there is an average of one man for every 10 women. That roughly corresponds to the gender ratio in clinical eating disorders.

"Anorexia is a classic female disorder," says psychologist Giel, explaining that social reasons play a role in addition to the patient's own attitudes and behaviors. "There are slimness ideals that can exert pressure on women and girls in particular. This is becoming more and more extreme in our Western world, also through social media."

Kopp, a sports physician, has also had this experience. She places blame on a "stupid image of beauty" that is fueled on social networks.

"There are young female athletes sitting in front of me whose role models are certain influencers who proclaim on YouTube: 'You must be thin and wiry, must have no body fat, must eat in a special way!' The girls look in the mirror and say, for example, 'I want to look like (successful German influencer) Pamela Reif!' And then they work toward that."

Jealousy towards competitors

This process is often reinforced from the outside, according to Giel. "Experimenting with diets can initially provide a sense of achievement, such as when performance improves or when the coach or teammate says, 'Great, you've lost weight!'"

The environment can also provide additional pressure, as former long-distance runner Mockenhaupt describes: "When I once had trouble getting up a mountain in training camp, a coach told me, 'Look at yourself!' Depending on your psychological makeup, it's already hard when someone tells you something like that."

It becomes even harder when you then compare yourself with competitors, says Mockenhaupt, mentioning a training colleague of hers leading up to the 2012 London Olympics as a personal example.

"I really envied her. She was rail thin, but she could perform at her best and was faster than me. I wondered how she could do it. And she just complained, 'I'm still too fat.' That got me down and out. I thought I was fat, and it made me feel uncomfortable."

'No one wants to be stigmatized'

That runner did well in London, Mockenhaupt said. "But a year later, it was over for her."

Mockenhaupt herself had "also tried once in her career to train even more and eat less, but it backfired and my performance plummeted."

Awareness among sports federations of the risk of eating disorders has increased in recent years, reaching as high as the International Olympic Committee.

"However, many athletes deal with eating disorders with themselves and don't externalize their problem. That also makes it difficult for those around them to even notice," says psychologist Gies. "And so it remains a bit of a taboo."

Her colleague from Tübingen, Kopp, agrees: "Nobody likes to go in front of the press and say, 'By the way, I have an eating disorder and can only do sports if I go to the bathroom and spit three times beforehand.' Nobody does that. Nobody wants to be stigmatized!"

That makes performances like that of Norwegian ski jumping star Maren Lundby all the more important, says former long-distance runner Sabrina Mockenhaupt. "This is perhaps also a cry for help about the state of the sport."