On the surface, Kendra Glassman was the picture of health. The 31-year-old registered dietitian carried 100 pounds on her 5-foot-1-inch frame, within the "normal" range, according to the Centers for Disease Control and Prevention. Glassman ate 1,500 nutritionally balanced calories per day while training for her fourth marathon and working toward her sports-dietetics certification.
Beneath her healthy appearance, however, was a different story. Glassman's bones were slowly cracking, and her mind was constantly spinning with negative thoughts about food.
In February 2010, when Kendra was diagnosed with two stress fractures, one in each shin, she realized immediately what had caused her injuries. "I'm a dietitian, so I knew the consequences of just barely eating enough to get by," Glassman says.
Troubling ThoughtsPrior to her fractures, Glassman hadn't been binging, purging or starving herself--the telltale signs of an eating disorder. Instead, she had become an example of a growing trend. Disordered eating describes the condition in which a person doesn't have a defined eating disorder (such as anorexia or bulimia), but harbors an unhealthy relationship with body image and food.
Kendra is far from alone. According to a survey from the University of North Carolina at Chapel Hill, 65 percent of women in the U.S. suffer from disordered eating. Dietitians and sports psychologists believe that societal expectations, mistaken beliefs about weight and performance and the ability to use training to rationalize nutrition restrictions make this issue especially prevalent in women who run.
"In the sports world, I see so many women harming their physical, mental and emotional health through disordered eating," says Suzanne Girard Eberle, a sports dietitian, former elite runner and the author of Endurance Sports Nutrition. "There's a myth that you must have a clinically diagnosable eating disorder to be in trouble, and that is not the case."
Subtle DangersExperts agree that disordered eating is a problem made all the more dangerous due to its subtlety. Glassman, for example, ate a fairly healthy diet for someone her size--who wasn't training for a marathon. During long runs, Kendra skipped carbohydrate-replacement drinks to save calories. Instead of refueling post-run, she'd often try to wait until her next meal to eat. "It was a normal intake for someone who wasn't running as much as I was," Glassman says. "But it was way less than I needed."
Janet Hamilton, an Atlanta-based running coach, says roughly one in five women runners who seek her training advice are struggling with some form of disordered eating. Hamilton describes the "nebulous category" as a variety of behaviors, including binge eating, overtraining, under-eating and adhering to strict food rules.
Disordered eating and its companion, compulsive exercising, are largely defined by internal motivation. It may be appropriate for a woman training for an Olympic-distance triathlon to put in a few hours on a stationary bike after a run. But for someone training for a 5K, it could represent over training driven by a fear of weight gain. "You need to ask yourself, 'Is this training pointing me toward success in an event, or is this just about extra calorie burning?'" Hamilton says.
Playing With FireThough the markers of disordered eating are subtle, the consequences can be anything but. Dr. Carol Otis, a Portland-based sports medicine physician, says women who don't adequately fuel their training could be deficient in essential minerals, thereby forcing their body to break down lean muscle mass. This in turn puts them at a high risk for chronic musculoskeletal injuries, such as stress fractures and osteoporosis.
The psychological impact of disordered eating can be just as detrimental to performance as the physical effects. Otis explains, "Ninety percent of performance is mental. If you're on an emotional rollercoaster because of disordered eating, you don't have the mental edge to be your best."
Changing the GameThe good news? There is hope. According to Otis, one of the best ways to combat disordered eating in female athletes is to "take weight out of the equation and focus solely on training for a sport." While recovering from her stress fractures, Glassman promised to adhere to her coach's advice and "practice what she preached" as a sports dietitian. That vow required minor tweaks to her diet and a major mental shift. Now on the morning of a long run, Kendra drinks Gatorade early and often and refuels with a real meal--eggs or a breakfast taco.
At first, adding calories and increasing portion sizes was "terrifying." Glassman explains, "I thought, am I going to look different? Am I going to gain weight?" The result? "No one even noticed," she says. "I still fit in my clothes."
Glassman admits she still struggles to keep her thought process in a healthy place, but she hasn't been injured since she started adding more calories to her diet. Recovering from long runs is "a breeze compared to what it used to be," and she was strong enough to complete the Redman Triathlon last September.
"Almost immediately, I was more mentally clear and alert," she says. "I wasn't so tired all the time. I felt strong. That feeling is 100-times better and more important than how my clothes fit."
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Amy Reinink is a marathoner and award-winning writer whose work has appeared in publications including the Washington Post and Entrepreneur. She can be contacted through her website, amyreinink.com.