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Disruptions Add to Risks for Athletes With Eating Disorders - The New York Times

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On a recent weekend, feeling bored and a little out of sorts, the tennis player Madison Keys whipped up a batch of chocolate chip cookies at her home in Orlando, Fla.

For Keys, 25, baking, and its focus on finding the right mix of ingredients, has helped her retain some sense of control during the coronavirus pandemic, which has disrupted the rituals and rhythms of everyday life for people around the world, including top athletes. She is not alone. Baking as a meditative exercise has become so popular it has spawned the hashtag #stressbaking.

But Keys is very purposeful with her kitchen forays. As a teenager, she struggled for two years with an eating disorder.

“I went through a lot of therapy and help and just being really open and vocal about it, and I have — knock on wood — had a lot of consistent years of having less of an issue,” she said.

Deciding what, how and when to eat has become an unusually complex calculation for many people during this time of uncertainty, with each day of the lockdown melting into the next. But for those who have struggled with eating disorders — a group that often includes athletes, with their obsessive focus on fitness — the calculation can be even more fraught.

“It’s very easy to feel I don’t need that much fuel for my body because I’m not doing anything,” the Olympic figure skater Gracie Gold said in a recent interview.

Gold, 24, who sought treatment for an eating disorder in 2017, was working toward the 2022 Olympics when her training rink outside Philadelphia shut down in mid-March.

“The hoarding very much stresses me out,” she said. “You’re supposed to sit inside, where your kitchen is, sit on the couch and watch TV with a pantry full of food? That’s a really bad scenario for people who are prone to bingeing.”

According to the National Eating Disorders Association, roughly 20 million women and 10 million men in the United States will at some point in their lives have a binge-eating disorder or an eating disorder like anorexia or bulimia. Globally, an estimated 70 million people have an eating disorder, according to the World Health Organization. Such disorders, which are broadly caused by a mix of environmental and genetic factors, can result in severe disruptions to a person’s eating behaviors — for example, eating far too much, or too little — and often involve deep emotional distress.

The stay-at-home orders that have shuttered classrooms, businesses and athletic facilities can be triggering for those with eating disorders. Cynthia Bulik, the founding director of the University of North Carolina’s Center of Excellence for Eating Disorders, said the program experienced an uptick in requests for treatment evaluations in mid-March as schools and athletic facilities were shutting down.

One of Bulik’s students is the Olympian Rachael Flatt, a retired figure skater who in March successfully defended her master’s thesis on eating disorders in athletes. In accordance with self-distancing mandates, she spoke on a teleconferencing app with an audience of three committee members, including Bulik.

All her research, Flatt said, leads her to believe that this is a particularly precarious time for athletes with inflexible, or unhealthy, relationships with food.

“As an athlete, you want to go above and beyond,” Flatt said in a telephone interview. “It’s so easy to get that adrenaline rush off your perfectionism, of controlling what you can control, which is your food intake.”

From her years spent skating, Flatt said she saw that athletes who participated in what she described as “leanness” sports — endurance sports and aesthetic sports like skating, gymnastics and diving, where being thin is perceived to be an advantage — are at a greater risk for eating disorders. And the prevalence of eating disorders, she added, is much higher, particularly at elite levels.

Recovery involves a careful calibration of food intake, and mastering that can mean very controlled shopping, which is often not practical now when shelves are bare and preferred food items may be out of stock.

“It takes years sometimes for people to be able to manage a little more positive relationship with food,” Flatt said.

She added: “It’s not like a switch that flips on or off. So for someone who’s in the middle of treatment or who’s on the cusp of an eating disorder or engaging in some of these disordered eating behaviors to begin with, this is an incredibly risky time. And a lot of the things they’re being exposed to may be quite triggering, whether it’s stockpiling food or the lack of exercise, the lack of structure and the lack of social support.”

When Anton Olsson, a defender and captain for Karlslunds, a third-division soccer club in Orebro, Sweden, was depressed and in the throes of an eating disorder, he holed up in his apartment, walling himself off from the world. That was a little more than two years ago. Since then, Olsson, 27, has been in regular counseling and outpatient therapy for the treatment of bulimia.

After years of trying to cope in silence, Olsson overcame what he described as the fear of being “weak” and “not up to the task” to detail his mental health struggles in an article in a Swedish newspaper in November. He followed up last month with an article on the website of FIFPro, the global soccer players’ union.

“When you struggle with bulimia, when you cannot have your routines and not live the way you know you feel good about, you get so, so stressed,” he said in a telephone interview. “And the stress is getting you to feel even worse, and it becomes a bad circle.”

During the pandemic, Olsson’s club has continued to practice, but with the schedule suspended indefinitely, he said he had to fight his inclination to retreat into his head. “When I’m feeling bad, I need other people, I need to go out, I need to breathe the air, I need my regular routines,” Olsson said.

Olsson said that during the pandemic he has relied on the support of his doctors, counselors, family, friends and teammates. But what about the athletes who lose their safety nets?

Riley Nickols, the director of the McCallum Place Eating Disorder Center’s Victory Program, spent one March morning with a Division I swimmer in residential treatment who was debating whether to self-isolate in place or at her parents’ home. As long as she remained in treatment, she told Nickols, she would be surrounded by other people with whom she could connect and identify. She could not count on the same support or compassion from her family, who do not understand her ordeal and why she is unable to modify her eating habits. As he recalled, her concern was, “If I go home, I’m going to be lonely and isolated.”

In conversations with athletes, Flatt has sensed the same feelings of isolation. “I think a lot of them are struggling probably a lot more than they anticipated,” she said, adding, “When you’re an elite athlete and that’s your job, it’s not like you’re going to hop onto a Zoom meeting to continue your work together.”

For Keys, whose last competition was the Australian Open in January, her work as a professional athlete right now is limited to a circuit in her makeshift garage gym. Ranked 13th in singles, she is cognizant of not being able to put her body through its usual rigorous paces on the tennis court and what that could portend for her overall fitness level and weight maintenance.

“There’s been some days where that’s definitely been in the front of my mind in what I’m thinking about,” she said.

Keys has learned not to deny herself any particular food. She allowed herself two cookies fresh from the oven and one modest spoonful of dough from her most recent round of baking. To reject the pleasure of a cookie, she explained, had in the past led to “OK, instead of two cookies I’m going to grab a bag of chips and eat the whole bag.”

She set aside several cookies for her boyfriend, the tennis pro Bjorn Fratangelo, then wrapped several more in foil and left them on the front porch of a friend, whom she alerted by text to open her door and collect them. Keys saved the rest for another surprise drop-off, her effort to practice self-care while also looking out for her friends. “I’m lucky that this situation isn’t really one of my triggers,” Keys said.

She added, “Granted, you can ask me in three weeks and that could be a completely different story.”

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