Trigger warning – discussion of eating disorders and mental health.
This week (February 26th – March 3rd) is National Eating Disorder Awareness Week. Every year, charities, professionals and those affected by eating disorder come together to highlight and educate others about the realities and misconceptions around the illness.
We may look at athletes from an outside perspective and think that their lives are perfect. If they’re performing well, winning games, collecting trophies, then it’s very hard to imagine how they could be struggling. But that’s not always the case – eating disorders do not discriminate. Whether that be age, gender, ethnicity, occupation – they don’t have a look.
In actual fact, anxiety, depression and eating disorder remain significant amongst elite female athletes. The majority of findings about athletes’ mental health have tended to focus on male athletes, but recently there has been more research looking at women’s experiences in sport. One study in 2022 used an anonymous mental health questionnaire, completed by 115 players from the Women’s Super League and Women’s Championship, and the results were shocking. It showed that 11% of female footballers displayed severe anxiety symptoms and 11% displayed severe depression symptoms. Most alarmingly, 36% of footballers displayed symptoms of an eating disorder, with 45% trying to lose weight in the last 4 weeks.
But why is it that female athletes especially may be predisposed to developing an eating disorder, amongst other mental health issues?
Stress
Firstly, there are a number of qualities that you’ll commonly find in athletes of any sport. High standards, self-competitiveness, perfectionism – these are traits that if nurtured in the right way, can enable athletes to perform at the best of their ability. But if they were to experience external stressors in their environment, such personality traits may actually contribute to something like an eating disorder in order to cope.
There are so many environmental factors that can interact with an athlete’s personal traits which puts them at higher risk of developing mental health issues – living far away from home, injury, team selection to name a few. But for female athletes due to lack of investment in the game, this list is even longer, with financial instability, having to juggle a full-time job alongside playing and coping with misogyny as just a few reasons why female athletes could be under so much stress.
It was injury at England’s under-15s age group which began the start of a long mental health journey for Spurs vice-captain Molly Bartrip, who spoke openly in a very powerful piece with The Players Tribune, of her experience with anorexia, depression and anxiety. This began at an England under-15s camp, when a torn hamstring left her out of contention for selection in future training camps. Such an injury created a feeling of failure and that she felt that she simply wasn’t good enough, which sadly is so common in injured athletes. An eating disorder developed as a way of coping, a form of self-punishment and a sense of control when she had no control over her injury.
No athlete, no matter at what age or level, should feel like an injury is their fault, or that they are fighting against their own body.
Now, Molly Bartrip is a wellbeing leader at Spurs, and spreading awareness of mental health and the importance of speaking out. Whilst football was the catalyst for her eating disorder, it was also the thing that motivated her to recover. Her story especially highlights the need for more support for injured players – injuries and general wellbeing is as physiological as it is physical.
The Impact of Online Abuse
The women’s game is growing at a rapid rate. More games are being televised to the world and more easily accessible. Female athletes are having female-fitted kits instead of a looser men’s fit. These factors are great and are paving the way for greater equality in sport, however it’s easy to see how they can also lead to athletes feeling more self-conscious and exposed about their bodies.
Unfortunately, this often stems from the fact that social media is co-rising with the women’s game. Chelsea star Fran Kirby recently spoke out about how social media comments clouded her comeback from long-term injuries and illness, suffering a heart condition in 2020 and a knee injury which left her out of contention for the 2023 World Cup. Many would assume that such players do not read online abuse, but Kirby spoke about herself and her teammates being on the end of comments about their weight and bodies. While she claims to have become accustomed to such messages, these comments seem to be such a recurring theme that it’s hard to see how players don’t get affected. One recent video showed footage from Chelsea’s training ground featuring Kirby in a training jacket. “Fran, how are you wearing a jacket?” she gets asked, and replied matter-of-factly, “because I get called fat all the time”. Just because they’re athletes, it doesn’t mean they don’t read such comments, and it doesn’t make them immune to being affected by them. A single comment could be the catalyst for a very long and hard mental health journey. Be kind.
Perhaps not surprisingly, comments like these can leave nutrition being entirely overlooked in sport. Instead of athletes fuelling their bodies to allow them to perform at optimum, they are more concerned with making sure that they look a certain way, to avoid the online scrutiny. Nutrition is imperative for such an demanding job, and under-fuelling can lead to poor recovery and even injury. Unfortunately, this is a familiar story for many athletes, including Arsenal and England striker Alessia Russo. Last year in an exclusive interview with Women’s Health, she openly spoke about hitting a low point with her relationship with food during lockdown, when players had to train and fuel on their own. She admitted to tracking all of her food and calories on an app, and lost a lot of weight during the pandemic. It was when she then signed for Manchester United that she tore her hamstring – her first muscle injury which she relates back to this restricted food intake. Looking back, Russo reflects that athletes shouldn’t be eating to look a certain way, but rather should be giving their bodies enough energy to allow them to perform at their best.
It’s an all-too-familiar story for athletes to become obsessive over tracking their food and exercise intake, focused on high protein and low carbs, with Russo describing it as “a bigger issue among female athletes than people realise”. One recent survey revealed that fifty percent of athletes say they have consciously restricted their food intake to improve their performance, when actually it would be having such a detrimental effect, mentally as well as physically.
This problem with a fear of nutrition is something that Chelsea manager Emma Hayes has also called for action on. She has insisted for greater education around body image for players, following Fran Kirby speaking up about the impact of social media comments. Hayes echoed the fact that there is a problem with under-fuelling and over-loading, which stems from the fear of being body shamed, both in real life and online too. The Blue’s boss has been a pioneer in the women’s game, being a step ahead on everything from the menstrual cycle to women’s mental health. She especially believes that weigh-ins and body composition tests are not needed in the women’s game – something that previously has been a huge factor in how players’ health and fitness has been monitored. Actually, a number on a scale can only tell you so much about an athlete’s ability to perform, and nothing about the mental side of their wellbeing.
“I always urge everyone to be mindful of that because we’re destroying people in many ways.” – Emma Hayes
The Effect of a Sporting Environment
Unfortunately, players’ struggles with body image and nutrition has not always been something that’s been particularly supported by their teams, whether that’s been for club or country. Ex-England international Fara Williams spoke to the BBC about an ‘eating disorder culture’ created by teams in the women’s game, referring to her own experiences with training camps for England. She said that players were tested every time they went to a camp, and if they were not under a certain body percentage, they were put into something openly labelled as ‘fat club’. Williams reported players being shamed if their body fat was deemed as too high, and feeling very uncomfortable, as if they were being watched every time they ate.
Worryingly, this will be a familiar story for so many athletes, with Williams reporting that there are now younger footballers who are understandably reluctant to go away with their national teams. Former Lioness Claire Rafferty also echoed William’s concerns, as she reflected on her own experience of body-shaming in the game. She spoke about the regular weighing even in England’s youth teams, from just fifteen years old, which led to her and other players becoming very conscious of their bodies and what they were actually eating. No only this, but players were weighed in front of each other so all players’ weights were common information and could be easily compared. Rafferty too was exposed to such ‘fat clubs’, being made to do extra sessions at Loughborough’s player development centre if her body fat percentage was considered too high. She recalls it being so shameful that they just had to make a joke out of it to cope.
It was such experiences which led to Rafferty’s battle with bulimia, binge eating and excessive exercise, leaving the player feeling incredibly conscious of what her body looked like and feeling the need to compensate for what she had eaten. Perhaps not surprisingly, the retired athlete still reports these feelings now, saying how she was treated has left a ‘lasting scar’.
Lack of Support
It would be nice to think that much has changed in the last few years of the women’s game, and some things have – but there is still a long way to go. There is especially a lack of support for players in the Championship or lower leagues. The PFA, who athletes can go to in order to access psychological support, only covers the Women’s Super League, and any league under the top flight is really up to the team itself in what help it provides. The only Championship players who have access to PFA support are those who have retained this help through having previously played in the WSL. This often means that psychological help is unstandardised, and players won’t really know what will be offered until they desperately need it. The women’s game is greater than just the WSL, and not being in the top league by no means should lead to a reduction in mental health support. Asking for help is a massive step in itself, and can be really daunting for players to even admit that they are struggling. So to make that step and then have very limited access, if any, to professional support can be incredibly demoralising and put them off asking for help in the future.
So, what is changing?
What are clubs and associations doing now to try and reduce these alarming stories and statistics that reflect the experiences of so many past and present women in the game?
In January last year one spokesperson from the FA reported that the mental health and physical wellbeing of all players is of paramount importance, and that with the evolution of the women’s game, they have mandated that all clubs have a player care strategy that includes mental health, wellbeing and nutrition.
There is also a growing number of campaigns aiming to use sport to improve mental wellbeing and body confidence in girls and young women. After such a successful Euros, Arsenal and England defender Lotte Wubben-Moy set out to use her platform for good. Among many other things, she helped to launch a new campaign with Gillette Venus called Move Your Skin, hoping to tackle the issue of skin-consciousness and improve body image in girls – something that has been a major barrier to sport for women. In fact, one third of women in the UK don’t participate in sport because they are worried about how their skin looks. Social media again plays a massive role in this, with athletes being able to select one good picture from a whole set of photographs, or having their skin airbrushed in photoshoots. This campaign aims to show girls and young women the real side of sport – real skin, real bodies and real athletes.
Another campaign looking to destigmatise mental health in the game is Create The Space. Formed by the organisation Common Goal, the initiative aims to create a psychologically safe environment within the football ecosystem, which provides a supportive environment for players to openly express and understand their emotions. It’s unique top-down and bottom-up approach equips all people involved in the sport with the right tools, skills and knowledge to prevent and deal with mental health issues, should they arise.
Create The Space has received huge support from players all across the globe, for instance Molly Bartrip, Ben Chilwell and Vivianne Miedema. US international Naomi Girma is also heavily involved in the campaign, having experienced her own heart-breaking loss of her best friend and fellow footballer Katie Mayer, as a result of mental health. She has been at the heart of creating a retreat for 2o NWSL players and young coaches this January, where they would learn strategies for understanding and expressing their mental health in an open and inclusive environment. This also brought the team together and helped players to understand each other’s needs.
Activities like this can be fundamental in educating athletes on how they can support themselves and others, and speaking about mental health much more openly. As a result, it may make it easier for athletes to recognise and ask for help – preventing any serious mental health issues from occurring, instead of reacting to if they do occur.
What can we do?
You may be thinking as players, fans and everyone involved in the game, what can we be doing to help counteract the rising concerns over eating disorders and mental health in sport? The women’s game is growing at a staggering pace, and gaining so much promotion, but we also need to be promoting the mental health side of it equally as much.
Firstly, we need to be proactive rather than reactive. We can equip staff and players with the right skills for a healthy mind and body, but also the right support for when things aren’t going so well. And this support needs to be accessible to people regardless of their age, ability or gender – everybody deserves the help that they need.
It’s also important to note that disordered eating is not exclusively a female issue. Whilst this is a page dedicated to promoting women’s sports, there are so many male, non-binary and athletes of other genders who too suffer with eating disorders. Neither are eating disorders, or any mental health disorders, just limited to sports. Mental illness doesn’t have a look and we can never judge if or how badly somebody is suffering from what we can see from the outside, making it all the more important that we raise awareness of these issues as they can affect anyone.
To do this, we can talk more openly about mental health, in the game and in general society. The more we keep these difficult topics inside, the more these issues become stigmatised and then the harder it is to admit when we are struggling. It builds shame, and there’s no shame in asking for help.
We can all be kinder too. Whether that be to teammates, friends or strangers, on social media or in real life – we can all make a conscious effort to be less judgemental and kinder people to anyone inside or out of sport.
We can know where to signal people for support, or indeed ourselves, if we feel like we or someone else needs a bit of help, and there is no shame in that.
BEAT is a fantastic charity that provides education and support for a whole array of eating disorders, for both the person suffering and those around them who are affected too. They have telephone and online support which is available 365 days a year.
