- Elite runner Mary Cain said her experience with the coaching system at the now-shuttered Nike Oregon Project encouraged unhealthy levels of weight loss, leading to injuries, serious mental health problems, and a derailed career.
- The serious medical condition Cain experienced, RED-S, seems to be common among athletes of all levels, though higher-level athletes may be most vulnerable.
- Female athletes in Division 1 cross-country and track are among those who’ve been vocal out about the issue. One spoke to Insider.
- Supportive teammates, proactive coaches, and female role models can make a big difference in helping women perform their best while staying healthy.
- Visit Insider’s homepage for more.
Elite runner Mary Cain said in the New York Times this month that her experience with the coaching system at the now-shuttered Nike Oregon Project encouraged unhealthy levels of weight loss, leading to five broken bones, mental health problems.
The ordeal also derailed her career, according to Cain.
Her experience eating too few calories, having dangerously low bone density, and missing her periods is illustrative of what seems to be a disturbingly common condition among female athletes: Relative energy deficiency in sports, or RED-S. It’s also been called female athlete triad, but most professionals now refer to it as RED-S, in part to include male athletes, and to recognize that undereating isn’t always related to an eating disorder.
While the condition or symptoms of it can affect anyone from the weekend warrior to the Olympian, it seems to be an especially pervasive, though still under-the-radar, problem among higher-level athletes, including Division 1 female runners.
College runners seem to be especially at risk of energy deficiency and disordered eating
When Delaney White, now a Division 1 cross-country and track runner and senior at Portland State University, entered the collegiate running scene, she had already begun to have irregular menstrual periods, she told Insider. She thought it was normal for competitive athletes at her level.
That mentality seems to be pervasive. Cate Barrett, a former Division 1 track athlete, wrote on Instagram that “college programs today are still preaching thinner is fast, and telling women to lose weight, or that low weight and lost periods aren’t a problem.”
“For so long, I thought I was the problem. To me, the silence of others meant that pushing my body past its healthy limits was the only way. But I know we were all scared, and fear keeps us silent.” — @runmarycain Mary Cain’s exposé of abuse she suffered while training as a young pro runner is shocking and upsetting. A decorated coach at Nike, Alberto Salazar, pressured her to lose weight to run faster. This is an inexcusable abuse of power. Salazar had nearly every resource available to boost Mary’s performance, yet chose to emphasize a strategy that risked her health. And it didn’t even fucking work. It drove her to slow races, self-harm and quitting the sport. Mary’s story resonates with the amateur and collegiate running community all too well. We’ve experienced the same thing. Being shamed for our size. Told that our poor performances were because of weight. And that we were lucky to be here, so we shouldn’t complain. That this is part of the sport. I competed for a D1 NCAA track team for all four years of college. While this was a great experience, it did leave me with a disordered view of my body and food. 11 years after I entered the NCCA, I still feel the strain that I’m not small enough. I know this is not factual and rational, but my mindset is a work in progress. I do not know any teammates who emerged from the NCAA system unaffected by the pressure to be thinner. It may seem like the entire running community is already woke to this issue, but please listen: IT IS WILD how deep this goes. It is still happening. Girls still need help. College programs today are still preaching thinner is faster, and telling women to lose weight, or that low weight and lost periods aren’t a problem. College sports are not the only offenders here, but they have to do better. They, along with the whole running world, have the opportunity and obligation to make a positive impact in young people’s lives. I am thankful that Mary Cain and many others have faced their fear and brought their stories to light. This is how we change.
And, Andrea Toppin, a former runner at Iowa State, wrote on Twitter that her teammate and boyfriend at the time told her she needed to lose 20 pounds in order to contribute to the team. “All I cared about was the number on the scale and pleasing my boyfriend until I got my first awful stress fracture after 2 muscular injuries and 2 years of not having a period,” she wrote.
Research backs up these women’s experiences.
While estimates of the ubiquity of RED-S vary widely, but some research has shown women at higher levels of sport may be at greater risk because of the high competitive pressure and specific demands of certain sports, such as running. Research also suggests as many as 54% of female collegiate athletes being unhappy with their weight.
What’s more, studies suggest disordered eating is especially common in sports that emphasize aesthetics or leanness, like running and gymnastics, with as many as 69% of female athletes in those types of sports missing their periods.
Eating disorders “have continued to increase for girls ages 15 to 22, which directly overlaps with the peak of adolescence, commonly spent in high school and college sports,” professional runner Lauren Fleshman wrote in the New York Times. “Over one-third of N.C.A.A. Division I female athletes exhibit risk factors for anorexia nervosa.”
She was one of them, writing that her final year of her collegiate career she restricted her diet to look more like the professional, older runners she hoped to become. “I may have looked the part, but I lost my energy. I lost my period, and injuries set in, derailing the first half of my professional running career.”
A lack of awareness can normalize disordered eating and missing periods
No matter how common, a disrupted menstrual cycle can be a dangerous sign that low calorie intake is messing with the body’s hormone levels, which can cause long-term health issues like permanent bone loss and potential fertility problems.
But awareness lags among athletes and professionals alike. A small study found 44% of high-school female athletes reported that they thought losing their period was a normal response to a high level of athletic training, Dr. Aubrey Armento, a sports medicine physician in Colorado, reported on Twitter.
And one 2018 study found that less than half of clinicians, physiotherapists, and coaches could correctly define RED-S.
Women also get cues from the environment that “thin is better,” Mary Jane De Souza, a professor of kinesiology and physiology at Penn State who specializes in the syndrome, told Insider. “It’s a huge problem,” she said. “We need a lot more widespread knowledge to be disseminated that you get to be a great, high-performing female athlete but coaches and other people without dietary expertise don’t get to tell you what to weigh.”
Proactive leaders and supportive teammates can make the difference
White’s first college team didn’t talk about missing periods, body image, eating, and weight. But when she transferred to Portland, she found her new teammates were open about discussing their experiences and checking in with each other.
There, she was told that irregular periods were an important sign that something was going on with her body, and she was encouraged to talk to a female trainer about it. Her performance, and health, immediately improved as a result.
“I was running 74 miles a week, and I didn’t realize I needed to be eating more. As soon as I did that, I started getting faster,” White said. “It’s turned around how I feel about running, my performance is better than ever, and I’m healthier than I’ve ever been.”
As White’s experience demonstrates, when caught early, many of the damaging effects of RED-S can be reversed. With enough calories, athletes can begin to recover from energy deficit within days or weeks, according to the most recent guidelines from the Female and Male Athlete Triad Coalition.
White said having female trainers, and strong female athletes as role models in her life, have made a world of difference. As more women become high-profile coaches, including record-breaking marathon runner Shalane Flanagan, she hopes that more young athletes will have the support, encouragement, and resources they need to pursue elite levels of the sports without risking their mental and physical health.
Ultimately, real progress also means looking at the broader culture that links women’s value to their weight, White said.
“Running is a really interesting microcosm of our culture, that you expect women to be strong but if they get above a certain weight, they’re no good any more,” she said. “Until we change the culture of comparison, our sport isn’t going to change.”