Swimming

The Greatest Opponent: Swimmers’ battles with eating disorders

Female student-athletes experience pressures in their sport that make them more prone to eating disorders - and it is more common than they think.

Cassidy Bayer, a 19-year-old Olympic hopeful, flew through the water. At the 150-yard mark, she was two body lengths ahead of her opponents in the lanes around her. The UC Berkeley sophomore swimmer was on her way to getting a personal record in the 200 fly: her best event.

She turned to take a breath. Then her body shut down.

As she tried to raise her arms out of the water to breathe, the water collapsed on top of her, pushing her back down. Within mere seconds, the other swimmers overtook her, leaving Bayer in last place.

“But I was not about to let myself not finish,” Bayer said.

It was the final night of a four-day invitational at the University of Minnesota in the fall of 2019. Leading up to that fateful race of the 200-yard butterfly, Bayer knew something was wrong. After each race, her body went numb. It started with a tingle in her tongue, and then numbness shot through the rest of her body. She couldn’t move, she couldn’t talk; she couldn’t feel anything. Her trainer would come over to sit her up. But she was “managing,” according to Bayer. A jump into the warm-down pool after a race brought the feeling back into her body.

That final race was her breaking point.

“They pulled me out and I was paralyzed,” Bayer said. “It was the scariest moment of my life. I was just like, ‘This is what you’re doing to yourself.’”

Upon arriving back on campus at UC Berkeley, a campus with two dietitians for all 28 sports teams in its athletic program, she was told that it was time to enter treatment for the eating disorder she had been trying to suppress.

One month after the meet, Bayer announced to her 8,400 Instagram followers that she was taking a step back from swimming. She wrote, “So, as I ‘ring in the New Year,’ I will press pause and take a step back from the sport I love to seek care for my eating disorder and the voices within my head that drive it.”

It’s an eating disorder that has gradually manifested from one moment in time: the 2016 Olympic Trials.

“It starts with the smallest of things … or it can be as big as, for me, missing the Olympics by one spot,” Bayer explained over a Facetime call from inside the McCallum Place Eating Disorder Center in St. Louis, Mo., where she had been living for three months.

Bayer was 16 when she qualified and swam in the Olympic Trials four years ago. When she finished in third place in the 200-meter butterfly, she had to figure out what she could have done differently, when she thought she had done everything right. Bayer said she had been working extra hard in practice each day, doing things like putting her phone away earlier before bed … but something was obviously still missing.

And then it clicked for her: nutrition.

“There’s only so far you can go hiding this stuff, especially being an elite athlete,” Bayer said. “And what’s hard is my eating disorder loved it, my suits were becoming too big and I was feeling like I was succeeding at what I originally wanted to do. At the small cost of my relationships with my peers, my coach and being a teammate.”

When she first arrived at the center, Bayer was malnourished. An inflamed liver, alarming heart rate and metabolism that was essentially nonexistent meant 24/7 care and a plan of “50%” meals: half of a peanut butter and jelly sandwich, a handful of pretzels, fruit and a half cup of yogurt.

“We give everything to our sport, but when we need help, it hasn’t been there and we have to fight for ourselves.” - Cassidy Baker

“That is what is so hard for college athletes, putting your sport on hold isn’t a choice right now,” Bayer said. “Athletes see it as a time of weakness … well there is no time. Coaches and parents have a hard time understanding it sometimes. We give everything to our sport, but when we need help, it hasn’t been there and we have to fight for ourselves. I got to a point where I couldn’t fight for myself because it was clear and evident that I couldn’t even finish practice.”

Bayer isn’t alone. A 2017 survey conducted by ESPN revealed that out of 201 Division I female student-athletes, 14% reported that they had experienced an eating disorder. Over one-third of NCAA Division I athletes exhibit risk factors of anorexia nervosa.

The National Eating Disorder Association classifies an eating disorder as both a mental and physical illness, one in which “people experience severe disturbances in their eating behaviors and related thoughts and emotions,” according to the American Psychiatric Association.

“Eating disorders have the highest mortality rate of any mental illness,” said Dr. Amy Chambliss, a psychologist who specializes in eating disorders. “The most vulnerable individuals are those with ‘I have to, I must, I should’ thinking. The perfectionist. Since athletes tend to be extremely motivated, hard-working and disciplined, they can be susceptible to the perfectionistic mindset. The intensity of this mindset can be heightened by the stress of entering into college life.”

People suffering from anorexia in their 20s have 18 times the death risk of healthy people their age, according to a 2011 study. They carry four times the death risk of people who suffer from major depression.

Like any college student, the pressure to perform is immense. For young girls who have chosen to continue their athletics at a collegiate level, that burden is combined with the pressure to be the perfect athlete, outside of the classroom or pool.

And it can be crippling according to Dr. Chambliss, who said juggling both academics and athletics can lead to helplessness, loss of control and the need to be perfect at just about everything.

Athletes are nearly three times more likely to have an eating disorder than the average person, according to a 2004 Norwegian study.

“USC Athletics posts pictures of you to their thousands and thousands of followers, so you’re definitely this public figure,” said Hanni Leach, former team captain of the USC women’s swim team. “There is this pressure to look the part, to look like I’m toned and ready to go in the middle of the season. You’re just very public.”

For Leach, the pressure to perform well in her sport was coupled with societal pressures. The expectation to maintain a particular body type initially became apparent when she moved to Los Angeles.

Born and raised in Montana, Leach said the term “eating disorder” wasn’t in her vocabulary before college.

“It’s coming at you from all different angles,” Leach said. “You have social media, you have athletics, you have living in a Metropolitan area like LA, having to look a certain way, dress a certain way … it all just came down on me at once.”

Food became an exaggerated topic in her mind. It was all she could think about. She would constantly plan the timing of her next meal and what it would consist of.

“As an athlete, you’re on such a regimented schedule, it just fit with this mentality of scheduling what I eat or what I buy for groceries,” she said.

But the real trigger came when Leach wasn’t even in the pool: it was in the offseason or while doing rehab for her torn ACL. Time away from swimming meant fewer calories being burned each day, which meant cutting back on food.

She told herself she could only have two eggs instead of three. In place of lunch, she only needed a snack. She figured there was no reason to fuel herself for an afternoon training session anymore. And dessert? Never.

As one of the team captains, great responsibility was placed on Leach to initiate a conversation around topics like mental health for the team. If she wanted the whole team to have weekly meetings with a sports psychologist, it was on their own time. Practice time could not be sacrificed by coaches. But determining a time where the whole team was available outside of practice and classes proved to be an impossible task.

“It’s not just about the physical training, it’s about everything. A holistic view of what it takes to be a good athlete is so much greater than just the physical performance,” Leach said.

USC Sports Dietitian Kristy Morrell is an advocate for the importance of mental health among collegiate student-athletes.

“I don’t think it’s just straight nutrition. I don’t think you can talk to a freshman athlete just about how you fuel your body, which is great and important but there are also other things that are coming up,” Morrell said. “So, it’s open dialogue, having a discussion, possibly having a program that really hones in on this and a safe place where athletes can support each other.”

From the very beginning of their college athletics career, Morrell takes time during orientation to ensure freshmen know she is a resource to them. As the semesters pass, the teams are required to attend events where Morell brings in speakers like Victoria Garrick, a former USC volleyball player who has pioneered the conversation around mental health among USC student-athletes.

One tactic Morrell has implemented was placing a whiteboard in the swimmers locker room for the girls to write something positive about themselves, after she learned about the frequent conversation that occurred within those locker room walls.

“When they were in the locker room getting ready to change into their swimsuit, some of the girls would be like, ‘Oh my god, I ate so much last night … Or my stomach or my thighs,’” Morrell said. “Nobody can practice well under those conditions. And even if you weren’t thinking about your body, now that somebody else brought it up, now you’re thinking about your body. So, I really wanted to make the locker room area, where they would change, a positive area.”

She doesn’t like talking about calories. Instead, Morrell monitors the “body comp” that is required of the swimmers. Using an inbody machine, each swimmer is given both their body fat and lean muscle mass percentages. Within that same reading, the athlete is given their resting metabolic rate, which tells them the amount of calories needed to be completely dormant. Morrell then combines that number with an activity factor of practice hours per week.

“That helps them to understand the amount they actually need to be consuming, and everyone is different. That’s about as far as calorie counting goes, based on what their resting metabolic rate is,” Morrell said.

Swimmers don’t even have to look at the numbers in the body comp if they don’t want to according to Leach, who has been taught by Morrell that feeling good is most important. However, the numbers are given to the coaches, who use the body comps as a way to regulate what the swimmers are eating. If their coach is looking at them, the athletes know that they should be too.

“I think it would be beneficial for coaches and trainers to take an approach that looked more at muscle,” Leach said. “To attach it more to the weight room, not attach it to the nutrition. It would switch the perspective in our minds to think, ‘I’m tracking how much muscle I’m building, instead of how much fat I gained.’”

A 2002 study by University of Utah clinical professor Katherine Beals found that 55% of female student-athletes experienced pressure from both internal and external sources “to achieve or maintain a certain weight.”

These external sources are most often the people who are closely invested with the athletes: coaches.

“Your body is your performance vessel. It’s easy for coaches, unfortunately, sometimes to really hyper-focus on that and not really see you as a person with feelings.” - Olivia Ontjes

One swimmer recalled a particular travel meet when a coach thought the whole team was eating poorly or too much. In a team meeting, he proceeded to yell at them, lecturing that what they were eating was going to make them fat and slow. Another swimmer had trained with an older coach, who expressed outdated habits and phrases, warning the swimmers to return from seasonal breaks in shape, not “in shapes.”

“Absolutely [pressure] from coaches, 100%,” said Morrel, who has spent years working with coaches on various sports teams at USC. “I’ve had coaches who were super inappropriate and very blunt and it did not go well. I think over time, it’s gotten better. I know there have been many instances where I was like ‘How could you say that? What were you thinking?’ But I think to a coach, it’s so much about winning and getting better, and so they see that as a way of slowing them down. They may say something that is not the right approach.”

But much of it is unspoken pressure. Rumors circulated on one swim team that the coaches only recruited tall, thin girls.

Whether the words are spoken or not, the swimmers feel that pressure every single day, according to Leach,”Your job in college is to be a student-athlete and basically your coach is your boss. You have to perform in any job for your boss in the same way that we have to perform for our coach,” she said.

For Olivia Ontjes, former USC breaststroker, she found support in her coaches, who stood by her side as she learned to tackle bulimia. However, their attentive backing of her wasn’t necessarily expected by Ontjes.

“Your body is your performance vessel. It’s easy for coaches, unfortunately, sometimes to really hyper-focus on that and not really see you as a person with feelings,” Ontjes explained.

After suffering a string of illnesses and injuries her junior year, Ontjes felt like everything around her was uncontrollable. As someone accustomed to a regimented schedule, her eating habits became the one thing she could control.

“An eating disorder for most people is really a form of hyper-micromanagement of your own self,” Ontjes said. “Essentially, what you’re putting in and what you’re not putting in, what you purge yourself of … it’s used as a coping tool when you feel like everything else around you is uncontrollable and feeling lost.”

Flagged as someone to keep an eye on, Ontjes was placed into an optimal performance team. This meant multiple appointments each week with different doctors.

“It was absolute hell,” she said.

Although Ontjes deemed the team of specialists as excellent in their field, she soon found that they were more trained for athletes dealing with sports-induced performance anxiety, not eating disorders.

“The stuff they would say to me was very off-putting and belittling of my struggles and anxieties,” she said.

“You’re supposed to tough it out. Ignore, deny and keep going.”

Looking back now, Ontjes wished that she had realized the severity of her disorder earlier on. It wasn’t until her eating disorder began to affect her performance in the pool that she started taking it seriously.

“An injury you can see. Mental illness you cannot. You’re supposed to tough it out. Ignore, deny and keep going,” Ontjes said.

External pressure for these swimmers can also come from their own teammates. As underclassmen entering college, the young adults look to the older girls to learn the culture of the team.

“If they’re worried about one thing, that means you should be worried about one thing. You’re blinded coming into college, especially in the athletic environment,” explained Leach. “You look to them to set that example. And if they’re the ones who are worried about what they look like, eating too much, having dessert, or counting all their calories, that sets a standard for the team.”

“It’s just astonishing how many people suffer from this.” - Cassidy Bayer

At the same time, much of the change may come from within the athlete bubble itself, made up of unique relationships athletes possess with one another. In facilitating events where older athletes can speak with current student-athletes, similar to USC’s hosting of Victoria Garrick, the wall of silence can be broken down. These events also give athletes better understanding to recognize an eating disorder and that there is strength in seeking help.

“There’s still that stigma around athletes, especially around high-performing athletes, where you’re tough in your sport, so you’ve got to be tough [in your head] too,” Ontjes said.

Ontjes found healing in speaking with athletes like Garrick, who understood what she was going through in her bulimia.

UC Berkeley had eight freshmen join their women’s swim team this year and an incoming class at USC typically ranges from six to ten athletes, according to the team rosters.

Next year, the underclassmen will become upperclassmen. They will lead the team as new freshmen join, ready to take the sport they love to the next level. Seasons will pass and the current pressures athletes face will still exist unless change is made. Luckily, the door has been cracked open.

Athletes are speaking publicly about their disorders, now more than ever, often serving as a voice for others.

When Cassidy Bayer publicly announced her hiatus from swimming to enter treatment, swimmers reached out to personally commend Bayer for her strength and share that they, too, had dealt with an eating disorder. Some were on the U.S. Olympic Team.

“So many people have reached out to me that I’ve realized have flown so far under the radar. It’s just astonishing how many people suffer from this,” said Bayer.

According to Dr. Chambliss, both the NCAA and university athletic programs should be held responsible to provide more resources for their student-athletes.

“Incoming freshman student-athletes should be required by the NCAA to fill out an eating disorder [EDI] and depression inventory [Beck Depression Inventory] before the first day of practice to assess what their needs are, if any. If they score in the susceptible range, it should be required for them to attend therapy sessions once a week or at least be assessed by a trained professional,” said Dr. Chambliss.

That awareness can be brought about like other topics are in school, according to Bayer.

“I’ve learned about alcohol addiction, drug addiction, anything that is an addiction of some sort. Never eating disorders. To educate the student body, coaches and all athletic trainers about very clear signs of an eating disorder at the beginning of the year, whether that’s through a slideshow or having a separate group of athletes talk to your team,” Bayer explained. “Because believe it or not, eating disorders are an addiction in and of themselves. You become addicted to this control of consumption. It’s still a deadly addiction.”

In the same way athletes are required to participate in study hall hours, alcohol abuse seminars and team building exercises, eating disorder awareness can also become an essential lesson.

“There are some really broad and easy ways to just educate teams,” Bayer said. “And that’s all. Just doing the bare minimum, let’s start there.”