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.