5 minute read
Eating Disorders and Body Image Concerns in Dancers
One in eight dancers experience eating disorders and this rate goes up to one in six for classical ballet dancers. This is a shockingly high rate.
Accredited Practising Dieticians Fumi Somehara and Shane Jeffrey explore the do’s and don’ts for the prevention and early detection of eating disorders and low energy availability in dancers. They previously presented on the topic at the International Association of Dance Medicine and Science (IADMS) international conference in 2020.
Eating disorders
Eating disorders are serious mental health illnesses characterised by an unhelpful preoccupation with eating, exercise and weight. Highlighting the serious nature of eating disorders, they are known to have the greatest mortality rate of all mental health illnesses, suggesting that the prevention and early detection of eating disorders is important. So where do dancers come into the picture?
In 2013 a group of researchers published a review of 33 studies analysing the rates of eating disorders in over 3000 dancers between 1966 and 2013. This review found the prevalence of eating disorders among dancers was 12.0%, rising to 16.4% among ballet dancers. Of particular note, the review found that dancers were three times more likely to develop a restrictive eating disorder such as anorexia nervosa when compared to non dancers. Interestingly, an older study from 2005 found that ballet dancers attending highly competitive schools and preparing for a professional ballet career have higher incidences of eating disorders.
At this point it must also be said that there are many other factors that influence the development of an eating disorder, such as genetics, psychological and socio-cultural factors, and that many, many people participate in dance and ballet without being at a heightened risk of developing an eating disorder.
RED-S (Relative Energy Deficiency in Sport)
RED-S can be defined as a negative imbalance between energy input and energy output that results from low energy availability and is associated with impaired performance, health and wellbeing. Common signs of RED-s can include absence of menses, poor bone health, reduced immunity, low energy levels and poor concentration. RED-s can occur in conjunction with or separate to disordered eating and eating disorders and is not always accompanied by food, weight, or body image concerns. This is an important distinguishment between the two presentations.
Facts on dancers' nutrition
One of the top 5 factors to prevent injury in dance is adequate nutrition and rest. Despite this, the current status of dancer’s nutrition is such that;
• 1 in 3 teenage dancers are at risk of iron deficiency
• 1 in 3 teenage dancers engage in disordered eating behaviours (these are risk factors for developing an eating disorder)
• Dancers with inadequate nutrition have higher incidences of injury
• The most common nutrition that’s omitted by dancers is carbohydrate
Dancers with inadequate nutrition have higher incidences of injury. To improve this situation, the authors have developed five fundamental steps for dancers to optimise their nutrition.
1. Regular rhythm
Just like in dance, rhythm is important in your eating too. Eating regularly means eating every 3-4hours and topping up fuel throughout the day. This prevents going into a state of low energy availability and RED-s and allows your body to dance at its best.
Benefits of regularity: • Improved digestion, gut function and metabolism • Stabilise blood sugar levels • Reduces the risk of binge eating • Topping up your energy reserves throughout the day Risks of not having regularity: • Inadequate energy status • Fatigue, lack of concentration • Reduced efficiency of digestion, gut functioning, blood sugar control & metabolism
2. Adequate energy and nutrition
The body can only perform at its best when it has adequate fuel, a.k.a. energy.
Benefits of adequate nutrition: • Optimum bone and muscle health • Optimum performance • Optimum recovery
Risks of not having adequate nutrition: • Greater risk of injuries • Greater risk of RED-S • Greater risk of eating disorders
3. Enjoy a variety of foods
Benefits of variety: • Greater abundance of vitamins and minerals • Reduce dichotomous thinking
Risks of not having a variety of foods: • Limited availability of certain nutrients • Greater risk of nutritional deficiencies
4. Hydrate well
Adequate hydration is often overlooked in the area of nutrition and dance performance, however it remains an important consideration in both health and wellbeing - because just like a plant, our body needs adequate water. Benefits of hydration:
• Improved performance
• Preventing fatigue
• Preventing cramp
Risks of not hydrating enough:
• Poor balance and concentration
• Overheating
• Dizziness
5. Optimise bone health
Bone health is an important consideration in dance as the bones bear significant levels of mechanical stress. This, combined with the risk of inadequate nutrition and loss of menses means that dancers, despite regular movement, can be at risk of bone loss, especially during the teenage years.
Benefits of good bone health:
• Prevention of osteopenia and osteoporosis
• Reduced Injury Risk
Risks of poor bone health:
• Increased recovery time from bone injury
• Largely irreversible bone damage
Late menarche and/or irregular menstruation increases the risk of stress fractures in adulthood. The most common factor leading to later menarche in dancers is negative energy balance. An important initiative in the prevention of eating disorders and RED-s in dancers is the implementation of a screening and prevention.
One screening tool that is both practical and easy to use is the ‘Eating disorder Screen for Primary care’ (or the ESP), a five question tool that can be useful for ruling out an eating disorder.
In particular, the best individual questions from the ESP to ask somebody to rule out an eating disorder are:
1. Does your weight affect the way you feel about yourself?
2. Are you satisfied with your eating patterns?
A “no” to question 1 and a “yes” to question 2 has been shown to be an effective yard stick to ruling out an eating disorder or eating disorder risk.
In addition to screening tools, it is encouraged that dance schools work with suitably qualified health professionals to develop a protocol for nutrition and eating disorders management, that sits within a body positive dance culture.
All illustrations: Dani Bower for One Dance UK
Fumi Somehara
Photo courtesy DDD Centre for Recovery
Shane Jeffrey
Photo courtesy River Oak Health
Further information
Shane Jeffrey
Accredited Dietitian and Sports Dietitian, Australia
www.riveroakhealth.com.au
Fumi Somehara
Accredited Practicing Dietitian, Australia
www.dddcfr.com.au
One Dance UK’s Healthcare Practitioners Directory helps find dance dieticians in the UK: onedanceuk.org/health-practitioners-directory
See an information sheet about RED-S and dancers written by Dr Nicky Keay: and about nutrition for dancers, written by Jasmine Challis: bit.ly/RED-SforDancers
