Earlier this week Jeanne Mack wrote about Disordered Eating and the Slope to Eating Disorders.

This Q&A is from a long conversation with Cory Collins on his personal experiences with an eating disorder, what’s complicated about male eating disorders, what he’s found in his research about how running complicates it further and how there isn’t enough information out there for men and boys to find the support they need.

While working on a large project for his Masters in sports journalism at Indiana, Collins did a lot of research on how sports, and more specifically running, can exacerbate male eating disorders.

There’s list of links and references at the bottom of the post.

Nicole: I want to talk about why it’s easy for runners to fall into an eating disorder or have disordered eating and just have a weird relationship with food.

Cory: Well is that where you’d like to start? [Laughs] I mean it’s–it’s a multifaceted answer as to why runners might be more susceptible to eating disorders, right? Because on one hand, part of it is because runners are very disciplined. So runners–kind of by nature, if you’re a good runner–it means you have a lot of self control. It means that you’re able to kind of bend your body to it’s limits, all in the name of a goal. And, if you simultaneously have a culture, or a media images, telling you that thinner is faster, you’re going to apply that same mentality to making sure your body matches that description. And I think what happens is that runners get rather–they’re capable of getting rather militant with their diet while they’re simultaneously running miles on miles on miles. And then not replenishing those calories. But instead of seeing that as dangerous, they see the weight loss as just another way in which they are pushing their body to the limit in order to be the best at their sport.

N: It’s like another reward system that you can build in?

C: Yeah, exactly. Especially because, at first–you know when I’ve talked with runners, and I’ve seen this with myself on a less elite scale, but even talking to elite runners who’ve been through this–what happens, at first, is that you are rewarded for it. Because you do get faster at first. And, people commend you for how dedicated you are. And your times change. And then that feeds–it’s like positive reinforcement to a negative training style. And it’s not until you get to extreme levels of energy deprivation that–you know by the time you’ve reached that point you’re kind of too far. At that point you can’t just turn it off like a light switch. So I think that there’s so much reinforcement right at the very beginning that people kind of get hooked on it. And runners often have that addictive personality too. It’s like this is part of my routine now and it’s hard to break back out of that, kind of until you hit rock bottom and we obviously want to stop people before it gets to that point.

C: I’ve done a pretty exhaustive look at all of the clinical studies on the subject because you get to the bottom of the barrel faster than you should. So I imagine I’ve read almost everything you could as far as studies about why boys have eating disorders, the prevalence of them. So from there–having experienced an eating disorder myself–I knew that I always wanted a more anecdotal, personal account to relate to. So I went looking for those and that’s how I ended up meeting Zachary–who I keep mentioning–through a series of blogs, I found him. And, spoke to him about the experience. And I spoke with a student–a teaching assistant at Stanford who had been through the same kind of issue with wrestling. And then through writing the story about Zachary I met a lot of people who reached out to me privately. And that’s what sort of inspired me to write about myself. Because I still saw the need for more examples to be out there.

So it started as a very academic endeavor where I was just trying to see what about certain things about sports–the cult of thinness, I think as Michael Atkinson calls it–what about certain sports causes this. And then that lead me to talking to a bunch of doctors, psychologists and then athletes, to get a more personal, journalistic look at the problem. From an academic and journalistic side, I have spent a lot of time on the issue.

N: How many athletes would you say you’ve spoke to?

C: On the record, it would be, maybe just like three or four. But as far as those who have reached out to me privately or who I just spoke to more anecdotally in doing the research–it’s dozens.

N: Wow. It sucks that there’s that big of a disparity between people who are willing to be public.

C: Right.

N: When did you start doing research?

C: In 2014.

N: What changes have you seen since then?

C: I want to say, one of the things that kind of makes me sad is that, I was hoping there would be–you know, as we’re becoming more progressive about gender dynamics and realizing that there shouldn’t be all this gendered approach to things. That’s something society is going through–but sadly, with eating disorders, there hasn’t been a plethora of stories that came out. So I mean, if it’s less taboo, then it’s by individual degrees. Because I still see–something that is simultaneously hardening and heartbreaking is that I still get replies to my stories. Despite the fact that we’re talking about–we’re starting to measure the distance between then and now, in years. And my stories are still coming up because there’s not enough to find.

N: Yeah.

C: And it’s obvious that there’s not–it’s still too quiet. It’s not being addressed with the quantity I would like. There’s not enough out there for, I think, a critical mass where you’re going to see it addressed in any serious way. It’s still very much like, people will come across my article and be like, “ah I wish more people were talking about this” or, “I finally found this.” And they come from all over the place, it’s not even just America. So if they’re finding this, it leads me to believe there’s not too much to find, still.

N: Like you’re happy to help, but, it sucks that, that shows…

C: Right. I’m just one, not-famous-at-all person. So I mean, there needs to be a much more public face on this. And I’m not saying it’s not out there and that nobody’s talking about it. It’s just–it’s clear that it’s not receiving the attention it deserves.

N: Enough to really move the needle.

C: Right. Especially in the sports world. It’s really had to get to people in sports to talk about things like this.

N: Especially…Even considering anxiety and depression within the running world. People don’t want to talk about it because you don’t want to be open to your competitors about your problems.

C: Right.

N: It’s another thing of balancing what’s best for the sport with what’s best for you.

C: Right. And I also think there’s this kind of complex with Olympic sports where–or these sports where there’re not at many millionaires. Where you feel like you’re constantly competing for pause and attention. It’s not like the NFL. We love coming after things that are wrong with the NFL–it’s the most popular sport in America. But when you start calling out like–we see the Olympic sports as feel good sports. We want to inspire people with them–and that’s great! And they are inspiring. There’s so many inspiring runners that it’s crazy. But it does create this false screen of positivity that leads one to believe that there’s nothing wrong with it.

N: I think that we probably all agree that it’s a slippery slope to get from paying attention to your diet and then–it’s not like you pay attention to your diet and then all of a sudden you have an eating disorder–but how that can kind of come on slowly… and what are the stages of what that can look like?

C: Yeah. I think–and obviously it’s going to vary person to person–but I think what happens sometimes is, yeah it starts more innocently with the idea of I need to eat clean, right? And that–because you should! Because it’s a sport that’s not good to have double guts and digestive problems if you’re running. There are obvious reasons to eat clean. I think what happens though is that–especially in the world of competitive running–you’re bombarded with extremes. So you see people who are getting extreme times, who are often extremely thin. And often these how-to and self-help gods are often telling you that you should have a very strict diet. And while those diets won’t say, “don’t feed yourself,” they will be extreme in the sense that they’re not allowing for moderation or they’re not allowing for much of a–you know you can cheat here and there. They’re just telling you these are the recommended things to do. And I think the next step from there is ok, now how do I take this a step further? Now I eating clean, but, do I need to be eating this much? Like, am I still carrying more weight than I need?

And I think part of it too is that, it’s easy from an outside perspective to see someone getting super thin and think, ah, maybe you’re too thin. But from the insider perspective, you’re often talking about somebody who, either, one: sees thinness as something valuable. So in the case of the runner they see something that makes them faster. Or two: you might be dealing with somebody who, due to insecurities or some kind of unconfronted body image issues that they had before they ever even took up running, they probably might have some body dysmorphia–so they they’re not even seeing themselves as being too thin. You know, they’re more fixated on their faults. Which is another runner tendency, right? Like, you don’t think about you’re best time you think about your worst mile–kind of thing. And, I think that happens with body image too.

N: And this–eating disorders–obviously affect women, but how–are there statistics to how many men to how many women eating disorders affect? I feel like that would be even hard to get honest data on that. Are there a lot more men, than what people would think, who have eating disorders?

C: Definitely. And I think you’re actually right to say that it’s hard to get honest data about it. Because, there are a couple of limitations that are happening there. One: men are less likely–boys and men–are less likely to self-report eating disorders because it is, one, something that has been considered feminine for so long that they might not even recognize that it’s going on because it just not–it’s kind of a representation thing. Like if you don’t know–if you don’t see another man naming that as the issue, how would you know you have that problem?

Or they’re embarrassed–and if they’re embarrassed they’re not reporting it.

Another problem is that, even in the medical field itself, even in the most scientific setting, this has had a stigma for so long that the data is–largely skews towards studying girls and females. Because it hasn’t been that long since the AMA guidelines–the diagnostic guidelines would put, as part of anorexia, missing menstruation cycles as like a key way to see it.

So it’s not even something that’s been, even in the most scientific setting it’s been gendered. So it’s hard to really put a figure on how many boys are dealing with it. But I mean, speaking with experts, and also speaking with a lot of boy and men anecdotally who have reached out to me from stories I’ve written in the past–yeah I think there’s a lot of people out there that are kind of hiding the issue because they don’t know what resources are available to them. They don’t know who to talk to. And they’re ashamed or they’re embarrassed, because they think it’s a sign of weakness or emasculation.

N: So it’s like a two-fold problem for males?

C: Yeah and at least two-fold. The third fold might be that, you know, a lot of male eating disorders are going the opposite direction. It’s overeating or dangerous supplement use in order to try to get that superhero musculature that’s more common in today’s mainstream image than it was 20 years ago. The triangular, super muscular body. And there are dangerous things happening there, so, if the problem is in the opposite direction where you’re talking about boys and men with anorexia, it’s almost like a double shame because they’re going against the ideal male image to further dip their weight.

N: And I guess in the elite running world, as I understand, it’s almost like, women need to have a certain amount of body fat to menstruate and be healthy that way, but the male counterpart is like you can play with your body fat as you want and like it’s fine.

C: Right.

N: And so it’s even–it almost, for a while, it would almost be hard to tell is someone was having an issue…from my perspective, just because there is–there seems to be that leeway. Because for women, it seems like it’s so much more obvious because there more places for body fat to kind of red flag people when it starts to go away.

C: Right. Yeah, sadly I think a lot of times other people aren’t going to notice until there are, either medical side effects. Where someone passes out or they are clearly more fatigued than normal. Or maybe if people start to look gaunt, like in the face–almost skeletal. Before then, yeah, in a runner it’s hard to detect because runners are so often thin anyway. It’s a fine line.

N: Would you say at that point–and maybe they’re each on the spectrum–passing out or exhaustion or bigger medical problems–at those points is it almost too late? Never too late to do something about it, but the problems gotten out of hand?

C: Yes, absolutely. If you’ve reached a point where someone is having visible, obvious, medical malfunctions because of what they’ve done to their body, then you’re probably months beyond when intervention would have been needed. Especially when you’re talking about a runner, who had built up their resting heart rate, is so healthy, because of their cardio health and their body is built to withstand a lot; so if they’re getting to the point where they’re medically fragile, their body is going through a lot. And by the time you’ve reached that point, they have so little body fat and so little stores of extra energy, then I mean yeah, you’re talking about needing to hook an IV up to them. And that’s before you even start the process of mental rehabilitation and therapy and talking to someone about the root causes of why

N: What are other facets of those symptoms? What are those red flags and what do those symptoms look like?

C: Some of the red flags come earlier. And I don’t want to speak on the behalf of professional, medical practitioners who study this subject. But based on what I can recall from conversations I’ve had with them–and my own experiences–I think a lot of what you see is, on one hand, social isolation starts to happen. Because there’s something about eating disorders that becomes a very lonely insular place. And runners are even more susceptible to this because running in itself is a very isolated activity. Even if you’re on a cross country team, at the end of the day, your performance is singular and you are in full control, for the most part, of what you accomplish. And eating disorders can take on the same sort of like race mentality. Where it’s like I have a goal. I might go through hell to get there, but that’s my race to run and it’s no one else’s. And so isolation will often happen. So if you see people who are normally really social, or normally really outgoing, kind of retreating into themselves, eating by themselves, eating out of sight, or pretending that they’re eating by themselves or out of sight.

I think a lot of it too is if you notice, people will often drop warnings in jest. When people poke fun at themselves, a lot of times it’s a kind of a request for someone to legitimize what they’re saying.

But as far as the more obvious warning signs, it’s, is someone getting dizzy when they stand up? Do they not have the same energy they used to? Are there sleeping patterns changing?

N: Would those sleeping patterns change because of lack of nutrients or something else?

C: Any combination of things. Mental stress, changed eating patterns, lack of energy. It might be somebody isn’t getting enough to eat in the afternoon and that 3 o’clock feeling would be more pronounced in that person.

But I mean it’s going to, sadly, a lot of it is going to be masked by a runner. Because that’s part of what a runner does, is hide their suffering.

N: What is your advice for someone who is concerned about a teammate or someone they care about having an eating disorder? How would you suggest approaching something like that? Because I feel often it’s not approached and that’s obviously not helpful. But what are potential ways to approach it that could be received well?

C: Yeah, it’s a tough one. The first thing I would say if you are a friend, or you are a teammate and think that someone is going through an eating disorder, being a bystander out of politeness is in the long run the worst thing you can do — even if in the short run it is the most polite thing you can do. A lot of times, someone with an eating disorder, especially if we’re talking about a guy, they might not recognize that, that’s the problem. And even if they do recognize it, there’s a pretty good chance they’re not going to want to name that as the problem. So it is possible that you talking to them about it will create defensiveness or some hostility or somebody might toss it aside as ridiculous. I did that. I mean, I was 6-foot-tall, 110 pounds and just told somebody ‘No I’m fine.’ But I think it’s important to try and have that conversation because the more–if you’re truly coming from a compassionate place that’s like ‘I’m just asking you about this, I’m not accusing you of anything. As your friend I see these things going on and I want to know, can I help? Is there something wrong? Are you getting enough to eat?

If it’s not framed as accusatory and it’s just framed as ‘I want to make sure you’re okay’ You will hopefully have less hostility, but in the long run you’re going to help that person recognize what’s going on.

I know for me, it took having people who kept saying ‘Something’s going on’ before I finally recognized the problem for what it was. And I know that I’ve spoken with other guys who read my piece about Zachary Stepanovich or they read my own story and they’re like ‘I relate to this and now I get it.’ And I think that’s part of it, is just like giving somebody the chance to recognize their own problem. Because they might not. And making sure that they know you’re not judgmental about it.

The thing you don’t want to do is tell somebody, in negative terms, what they’re doing to themselves. So the tactic is not to say ‘Hey you’re not going to be a great runner if you pass out.’ Or, ‘Hey you were more attractive when you had more body fat on you.’ You know, you don’t want to phrase it as that and you don’t want to take somebody you might already feel defeated or feel like they’re caught up in something and make them feel like they’re doing more damage.

N: Another failure they hadn’t considered, but now they have to?

C: Yes. Exactly. Because this is first and foremost a psychological disorder. So you have to realize you’re dealing with someone who is not in a great place mentally, potentially.

N: Yeah.

C: Because I think running can be a conduit for disordered eating and it can be a catalyst for it. But it is often not the root cause. Like there might be something else about that person, their part, their body image issue, obsession with numbers, their obsession with performance. There’s some root cause that running exacerbates, but that’s not to say it’s the sport of running. The sport of running’s culture isn’t a problem when it comes to disordered eating, but it’s not the most basic cause of it.

N: Yeah. So like it can foster one, but usually it comes from somewhere else? And [running] is a good way to mask one as well. Not good–that’s a poor word choice. It’s a successful one, a lot of the time, for a while.

C: Right. It can turn–because I mean if you think about why some people may enter running as a sport, and this is not an exhaustive list, but it might be–so some people start running because they want to lose weight. Or they want to be healthier. Some people start running because they want some kind of escape, some kind of outlet for energy or issues or they just need to get out there and pound the pavement and feel that runner’s high. Or they might get into running because it comes natural to them–any of these reasons. But a lot of those reasons, at the root of them, is that you are in some ways literally running away from something. And I think that, what happens, is that a lot of people who are drawn to running, are drawn to something measurable, something they can track, something that requires discipline because these are people who tend to have a lot of self control, repeat the same action over and over–even if it’s hard. People who are going to document their experience, keep track of it.

I think, if you’re noticing parallels to that and someone who’s trying to lose weight, or trying to manage their body. It’s a lot of the same qualities–to the same activities. That it runs parallel.

N: It fits right in. You’re running a certain amount of miles. You’re tracking those miles. How fast did you run those miles? How fast did you run those miles compared to the last time you ran those miles? How many reps on the track are you doing? How many more reps can you do? How fast can you do it? How much do you weigh? How much less can you weigh? Like…

C: Exactly.

N: It all… your shoes weigh this much.

C: [Chuckles]

N: How much less can your spikes weigh? It’s all numbers and it’s all tracking. What do you think an athlete who has a healthy relationship running and eating, look like? Hows’s that look compared to an unhealthy relationship with running and eating?

C: That’s a good question–I think that it’s all about perspective. I think that a healthy athlete and a healthy runner, recognizes that in order to perform their best, for the longest possible time–and running is one of those rare sports where you can be really good at it up into your middle ages–and I think a healthy athlete recognizes that in order to do that you have to feed your body a lot of fuel to make up for the incredible amount of fuel you use up running long distance. And the healthy relationship is to realize that ‘I don’t have to be at my lowest possible weight. I need to be at the weight that I can–I have to find that healthy balance of the weight I can run with, but that I can also feel my full amount of energy with. And less so, how light can I get?’

The unhealthy relationship is correlating thinness with performance and thinking that it, at some point, is no longer a corollary relationship. [And] realizing it’s more of a bell curve. That I will reach a point when I’m so thin, that I will no longer have energy to perform at my best. Or I no longer have the stamina to do this for very long. And that I’m limiting–not only my capabilities as a runner–but my capabilities to function in day-to-day life.

Part of the problem with is we also need to get to the point where performance isn’t the only barometer of why something is a good or bad idea. And I think that’s kind of how this can get exacerbated in running. That there is so much focus on performance, even at a really young age–and you see this in wrestling too, that there’s so much focus on the right now, ‘What are you capable of?’, performative aspect, that we don’t just don’t think about what is best for you if you never run again? Or if you never wrestle again?

What is healthiest thing your body–what is the healthiest weight your body can hold? What would make you feel the best mentally and physically, no matter how fast you’re running?

And can I find a way to find pleasure in running that is not performative? Can I make it more of an exploration? Can I make it more of an activity I enjoy with other people? Can I make it less isolated and less performative? I think ultimately that’s healthy. But it’s hard to convince running coaches of that.

N: Yeah, finding that balance of being able to talk about eating healthy without it being like, ‘Okay I have to eat 100 percent clean and I can’t make any changes to that.’ I think too, maybe, being able to–having your period and stuff like that is also somewhat of a barometer for if you’re doing well, that men wouldn’t have. But I’ve always hated, from anybody, “race weight.”

C: Exactly.

N: Like, no. If you aren’t doing anything crazy–as long as you aren’t eating completely unhealthy or eating so strictly, your body’s going to do what it needs to do.

C: Right. I remember–and it was the reason I used it as the last sentence–but I thought the simplest way that I saw, the story I did about Zachary, who was a college runner–the sentence he told me that let me know he was better, was when–it was kind of an off the cuff comment, honestly. And he was just kind of–it was our last conversation, we had talked for months–and the last conversation we had he’s like, “Yeah, I don’t weigh myself anymore.”

And to me that is the point to reach. Because he was at a mentally healthy place where he no longer felt the need to chronicle the numbers in order to feel successful. Or to feel like he was on the right path. And I think that, that’s a hard thing to tell someone who runs, right? And I still have issues with this now, where it’s just like–you know one of the reason I was drawn to running was because it’s so measurable. And there’s a certain, like, comfort to knowing–I know exactly how I’ve improved, or not.

N: Yeah.

C: But at some point we have to put mental health first and we have to put physical health first. Before the numbers. They’re not quantifiable all the time.

N: Yes, especially if you’ve done it for a long time. It stops being as linear as you’re used to.

C: Right. It too easy to get obsessed, you know? It’s too easy to get lost in journals and lists and minding differences in numbers.

N: Yeah.

C: And, if we’re talking about people who are already predisposed to disordered eating, or who already have problems with going from self control to over-control, that sort of mentality is going to be their undoing. And there’s too many examples of that.

N: Yeah, and it’s just–it’s such an obsessive sport in the first place. That I feel like–you’re not a distance runner if you don’t have some sort of capacity to be obsessive.

C: There are not enough resources. Men and boys can’t find the resources to do it. Or two, they don’t know the resources exist. Or three, there aren’t enough resources to serve them all. And they’re scattered about the country. There are a few specialist here and there that deal with male eating disorders. But it’s not prevalent. And certainly not to meet the actual need.

So a lot of guys aren’t addressing the actual underlying issue. And that’s the fact that this is a psychological hurdle–to use a running metaphor–that has to be surpassed.

N: What do you think that looks like the difference between someone who can help with female eating disorders versus someone who can help with male eating disorders? What are the potential characteristics that would make someone a specialist in male eating disorders versus female disorders?

C: I think of people like James Lock at Stanford–is one example–they’ve treated a lot of male patients. So they know that there are differences between the two. Part of which is just, again, part of the relationship with the culture and what our culture says about men with eating disorders and what our culture doesn’t say men with eating disorders. I think these are people who studied specifically what tends to be the profile of a boy or a man with an eating disorder, what tends to be the root cause. What activities exacerbate those causes? James Lock is a good example because he’s worked with athletes. Ron Thompson, who runs a clinic in St. Louis, is another. I think the big difference, honestly, is they’re willing to look at eating disorders without a clouded judgement of who could get it. They don’t look at it from a gendered perspective. They look at it from more of ‘This sort of mentality breeds eating disorders in men and women and boys and girls.’ And they address it with a more egalitarian, equitable approach.

But there’s not a lot of that out there. I’m not in a position to judge psychologists en mass, but I know because when I was doing the research it was definitely hard to find anecdotal stories. Which I think is what more people are looking for. Because it’s hard to relate to a scientific study. And it’s hard to see yourself in a scientific study–there’s just something too sterile about it.

N: Let alone trying to read it in the first place.

C: Yeah, exactly. If you’re not sitting at a university on JSTOR–like finding it’s hard enough, much less understanding it and then seeing yourself inside of it. So I think there’s a definite need for just like personal stories but also–it was even hard to find new studies, or new cases of the issue that were willing to talk about it.

I mean it’s just–it’s still something that exists in the shadows. Which just further puts shame attached to it.

N: Yeah.

C: A when you’re talking about–and not to keep pretending I know every runner that exists–but I think something that’s common in runners is self-reliance.

N: Yep. Yeah.

C: And this belief that ‘I can fix what ails me.’ Whether is my stride or my pronation or what shoes I need or something more serious. I think that these are people who tend to think ‘I can fix this, I can come out of this, I can control it and handle it.’ So they’re even less likely to come forward for a problem like this. So I mean I think it’s something that needs to be addressed more aggressively but the sport and leaders of the sport, so that these people–so that people with problems can feel more comfortable addressing it and not feel like they’re betraying their performance to do so.

N: Or even the sport in general, I feel like would be a lot of uncertainty with that.

C: No doubt. There’s a fear of talking about it and it’s easier to not talk about it.

N: It falls in line with another conversation that I’ve been having with some people–it’s like, talking about getting out of the sport and how no one really talks about getting out of the sport. Or like why people get out of the sport. Because, some people get to leave on their terms and some people just quit because they’re like, ‘I’m sick of feeling like this. I’m sick of the anxiety and the obsession. And what I’m putting in, I’m not getting back.’ And just not talking about the actual obstacles in the sport. Because it seems like the story is: I thought about quitting but I didn’t and look how fast I’m running now. But no one’s telling that other story. Because everyone wants to continue narrative that running is super happy, positive community thing. And it is! But because there’s that community, it would helpful if we could lean into that and talk about more serious issues within the community.

C: I think a lot of times what happens running–and this is true in youth wrestling as well–is that people know there are leaders who are breeding this obsessiveness, who are demanding dangerous levels of commitment to body composition, or exercise and disciplined routines. And they’re doing so without weighing the impact of that on young people. Especially who are still very susceptible to body image issues and not being in full control of their physique. And I think until those issue are addressed it’s an act of negligence to not name it out loud, to say that ‘Yeah, this sport exacerbates these problems and we need to talk about why that’s not necessary.’

N: Yeah, it’s the dark side that people don’t want to talk about, instead of it being part of what we should talk about and address on a normal basis.

C: Thank you for tackling the topic because I’m sure–I know it’s not the most fun thing to think about, but it really does matter. I appreciate that you’re doing it.

N: I get frustrated that everyone acts like the sport’s so hunky-dory. It’s a great sport! But, you know what, it might be–it might be better if we talked about the stuff that people are actually overcoming. We say the sport is hard, but we don’t say why it’s hard and then talk about it. So if you’re like, “Oh someone overcame an injury!” Well no, let’s talk about what being injured entails and what someone really overcame. So talking about the bad stuff–the dark-side of running–is interesting to me because I just feel like it’s important.

Links/resources:

You can follow Collins on Twitter @CoCoCoryCollins

This has been edited for clarity and content, but not really length (because it’s obviously a long conversation (about a serious topic).