One of my most vivid memories from my time as a pre-professional ballet student is a particular Thanksgiving that I had come home to spend with my family. The table was piled high with my parents' efforts: a huge turkey, multiple sorts of potatoes, deviled eggs with paprika topping. I sat quietly in my corner seat, pushing an olive around my plate, collecting my meager portions into little piles, when my father left his chair and approached me. As he knelt down beside me, my heart started to pound. Everyone was looking at me. “Please, Katie," he said, his voice low and desperate, “it's Thanksgiving." Within a year of this meal, I would be diagnosed with the first of a series of stress fractures that would haunt me for the rest of my dancing life.
I was not alone. Many dancers cannot and will not eat like normal people. But where is the line between the dedicated dancer making necessary sacrifices with food and the obsessive dancer with a disorder? A lot of people believe that the line is fairly simple: You either have an eating disorder, or you don't. But the daily eating habits of some dancers fall into a disordered pattern and can be almost as dangerous as full-blown anorexia or bulimia.
There are several reasons why dancers are more susceptible to disordered eating than nondancers. The first and most obvious is their need to be thin in the ethereal world of ballet. According to Roberta Anding, registered dietitian for Houston Ballet, most dancers weigh only 85 to 90 percent of what is considered ideal body-weight. She says that level of leanness can lower the metabolic rate so that it takes fewer calories to maintain it.
Peggy Otto Swistak, nutritionist at Pacific Northwest Ballet, says another reason is the personality traits of the typical dancer. “Dancers are perfectionists in many aspects of their lives," she says. “In school they're straight-A students, they're the perfect friends, the perfect daughter. Even in their cleanliness, their clothes—everything is perfect. They almost think their eating has to be that way, too."
This tendency is something Dr. Marcia Laviage, a psychologist specializing in eating disorders, sees repeatedly in her practice. “We tend to see an anxious temperament, they lean towards perfectionism, they want to perform at the highest level."
Ultimately, an eating problem is mentally focused. “A disordered relationship sees food as an enemy. A healthy relationship sees food as something that's necessary," Laviage says. “A disorder is when behaviors or thoughts or feelings have become so unhealthy that they interfere with one's daily life."
I counted calories so much that it upset my nondancing friends and created barriers between us. I talked constantly about how out of shape or soft I was. I will never forget when a dear friend of mine, who was naturally heavy, erupted into tears because of my self-defacing comments. She pulled me over to the mirror and said, “Look, how do you think it makes everyone else feel when you say this stuff about yourself?" My fixation on food turned me into someone people didn't want to be around.
My refusal to eat was a distraction that caused fights in my family, spurred on by their concern for my health and my defensive stance that they just didn't understand. Birthdays, holidays, and weddings became joyless and stressful.
The kind of record-keeping I was involved in would have been a red flag for Anding. “There's a difference between grabbing a handful of carrots to eat in your lunch and counting them out. Two dancers may eat exactly the same meal, but for one it's health promoting and for the other it's not."
It may seem like an unfair distinction because as a dancer, it's part of your job to control what you eat. But how you make your food choices reveals whether or not you've fallen into disordered eating patterns. Leslie Bonci, nutritionist at Pittsburgh Ballet Theatre, feels that the line is distinguished by whether you're making food choices that are selective or restrictive. “A dancer may decide that she isn't going to have a bagel sandwich because it is a little excessive calorically, but she may decide to do a wrap or a pita instead. That's being selective," she says with approval. “Somebody who's restricting may decide across the board, no carbs."
For both Anding and Swistak, the line between “normal" and “disordered" eating has a name: orthorexia (“correct appetite"). While it hasn't yet received its own listing as an eating disorder in the DSM (the official manual of mental disorders for medical professionals), its relevance to the dance world should not be ignored. Orthorexics are obsessed with eating “perfectly," even when their idea of perfect eating isn't nutritionally sound—and it's becoming more prevalent.
“They may be eating perfectly," says Swistak, “but it's just not enough calories for them at their growth or activity level. It's not normal to say, 'I'm never going to eat ice cream, ever—or have a brownie, or eat pizza with my friends.' "
Swistak sees signs of orthorexia when young dancers keep overly meticulous track of their food intake. “They have it precisely written down—in different colors of ink and it's perfect. Everything is lined up. They might even write down how many calories are in the three crackers they ate. That's on the verge of an eating disorder," she cautions.
To Anding, orthorexia is a means of eliminating foods you are afraid to eat by claiming health benefits. “It's food elitism that is under the guise of 'I want to eat healthy,' " she says. “But what you're doing is essentially restricting the foods you eat, not necessarily because of a true health belief, but to mask things," she says. “If I tell you that I'm gluten intolerant, then you're not going to offer me a slice of bread because you're going to respect my food choice," she says.
Eliminating certain foods from your diet completely, or not getting a high enough caloric intake, can have dangerous results and even cause malnutrition. One day you're fine; the next you're injured or sick, asking, “What happened?" Anding says that some diets with self-imposed rules create nutrient holes, like lack of protein or vitamin D, that are exposed when the body is stressed. (For a balanced diet, see the American Dietetic Association's website, www.eatright.org.) “Malnutrition can cause fatigue that creates stress fractures and other things that dancers can't quite rally from."
Dancers are impressionable when it comes to dieting methods. Swistak wants to educate them about orthorexia, but worries that they will use the information as a smoke screen instead of a warning. “Dancers are more health conscious than normal people and they talk a lot," she says. “One person tries something new to lose weight and then they're all doing it." Swistak reminds PNB members that their ultimate goal is to dance well and that disordered eating compromises their dancing.
While orthorexia may not have a DSM classification, it is widely agreed that orthorexic behaviors can be a gateway to—or a screen to cover up—a full-blown eating disorder like anorexia nervosa. Once that line has been crossed, it's imperative to put a medical team into place to deal with the disease. “An eating disorder is primarily a mental health concern with medical and nutritional consequences," warns Anding. “If you don't deal with the underlying stress, you're using a Band-Aid when you need a surgeon."
Laviage echoes the idea of a root cause, pointing out that a long-term solution is rarely possible without psychological help. “The thought processes that go into disordered eating become so ingrained and inflexible that they won't resolve on their own. Medically we can force-feed somebody and physically they'll feel better," she says, “but the fear about food is still there, and that's what we need to target."
When you're confronted with the possibility of a friend, colleague, or student developing an eating disorder, there are specific changes to look for. A dancer may show signs of malnutrition—loss of period, low heart rate, and lowered body temperature—and perhaps mood changes as well. “They become more grumpy, more anxious, more irritable, sometimes all three," says Bonci. Even with these telltale signs, however, one shouldn't jump to conclusions. All the experts I interviewed recommended addressing the person with concern, but without sounding accusatory.
A healthy relationship with food is vital to a successful career as a dancer. Without the foundation of a well-nourished body, your long-term stamina could be in jeopardy. And while it is easy to focus on the immediate desire to be skinny tomorrow—or by the time Swan Lake opens—you need to be patient. Your body is a delicate thing and your only instrument.
I spent my critical training years fixated on food. My negative attitude toward eating caused me more than injury; it affected my friendships and my family as well. Even after I began to eat in a healthier way, the fear of what every bite would do to my body remained. Eventually, I found my way out of this tunnel, but I wish I had spent those years focused on what really mattered—dancing. Today, with more information out there and greater awareness among teachers, I think that young dancers will have more help in their struggle to maintain a beautiful dancer's body—safely.
Kathleen McGuire writes about dance from her home in Pittsburgh, PA.