Eating Disorders and Dance
In response to supporting Eating Disorders Awareness Week (EDAW) 2022, a national, annual campaign that aims to educate people on the realities of eating disorders, this weeks’ offering for Wednesday Wisdom is less about offering wisdom and more a reflection on the prevalence of eating disorders amongst dancers and the need to consider the impact this has both on their bodies (physically and psychologically) and on their dance training.
Research suggests that dancers have a three times higher risk of suffering from an eating disorder than the general population (Arcelus, Witcomb & Mitchell, 2013). Dancers are, by virtue of their training and the art form, very body conscious and body aware; spending long hours practicing, most often either in front of mirrors or in front of others, and thereby routinely scrutinised by both self and others. A link between perfectionism and eating disorders has been consistently found in dance research (Anshel, 2004; Neumarker et al., 2000; Thomas et al., 2005), with Penniment & Egan (2011) finding perfectionism and exposure to both thinness related learning (TRL) and thinness and restrictive expectancies (TRE) to be risk factors in relation to eating disorders. One can see that if dancers apply high levels of perfectionism both to their dance practice and to a drive for the ideal body shape/image, it’s easy to follow how this, combined with the additional sociocultural pressures of thinness inherent in the dance profession, has the potential to create an ideal breeding ground for eating disorders to emerge. In response to these findings and assertions from research, we at Blommaert Ballet School know we are not alone, and indeed believe there is mounting support in the sector, towards promoting the athletic physique within all ballet contexts.
There have been two national inquiries into dancers’ health and injury in the UK, Fit to Dance? And Fit to Dance 2; the first carried out in 1993 and the second in 2002, the aim of which was to present a comprehensive picture and ‘raise awareness of the key factors affecting dancers’ health, and bring together views and recommendations from the worlds of dance, sports and medicine’ (Laws & Dance UK, 2005, p.6). In 1993 15% of respondents reported being on a diet, compared to 23% specifying a ‘weight-reducing diet’ in 2002. Reports of having had an eating problem in the last 12 months dropped in 2002 to 16%, compared to 21% previously, leading the researchers to question whether dancers were dieting more responsibly or whether they were simply ignoring potential problems in line with body image becoming more of an issue in society in general. The 2002 report found:
Where people have given details of eating problems, a large number of these were of anorexic (30 specific mentions) or bulimic experiences (29 specific mentions) during their teenage years, often while training. Other dancers specified over- or comfort eating and some said they were bingeing or restricting their diet in an effort to control weight. Several dancers admitted to an obsession with food and weight, and experimenting with ‘fad’ diets.
(Laws & Dance UK, 2005, p. 39)
Taylor and Estanol advise that eating disorders ‘lie along a continuum made up of varying degrees of unhealthy behaviour related to body weight and appearance’ and these behaviours have the potential to ‘threaten your psychological, emotional and physical health’ (2015, p. 244, 245). Eating disorders are often accompanied by low self-esteem, depression, anxiety, obsessive compulsive thoughts and behaviours, and ‘an eerie detachment from reality, and, in extreme cases, dissociative disorders’ (2015, p. 245).
The daily energy requirement for everyone is the sum of two factors: the basal metabolic rate and the active metabolic rate. The first refers to the energy required for every day vital functions, the latter is that which is required for physical activity and exertion. Simmel advises that ‘depending on the intensity and the dancer’s age, gender and physical condition, one hour of dance burns between 250 and 600kcal. If the quantity of energy consumed by one’s diet corresponds to the energy required, body weight will remain constant: input and output are balanced’ (2014, p.189).
The effects of eating disorders on one’s body and dance training can be significant in the extreme. If the body lacks adequate nutrients required for energy and repair in extreme cases it will switch to catabolic metabolism where the energy deficit causes the body to feed off muscle and fat stores in order to fuel the critical metabolic and cellular processes. Simmel describes it as ‘removing material instead of building it up – effectively, the body shuts down and energy levels sink close to zero’. She also advises that ‘the physiological consequences remain visible for years to come’ (2014, p. 190). A lack of adequate nutrients also has an effect on bone health; the body must take minerals from the bones in order to meet the body’s needs; resulting in the bones becoming thin and susceptible to osteoporosis, stress fractures and injury. A lack of oestrogen often results from extreme weight loss and this is also a contributing factor in relation to osteoporosis. In female dancers this may also cause amenorrhea (the absence of periods). Dancers may experience dizziness, nausea and suffer from low blood pressure as both heartbeat and breathing become slower. The potential for injury becomes critical.
The work of Taylor and Estanol (2015) (listed below in the references) provides an excellent resource to help dancers develop the psychological skills and resilience necessary to work towards overcoming unhealthy behaviours. They advocate developing a balanced and realistic perspective of your dance practice, and advocate using positive self-talk, mental imagery and relaxation techniques in order to reduce anxiety and the potential for depression and eating disorders. Appropriate goal setting and working within a healthy and supportive task-based (as opposed to ego-oriented) climate can all be beneficial. Supportive relationships are essential in cultivating optimism, good self-esteem, and the ability to recognise, accept and work within one’s limits.
Should you, or someone you know require help and support it is essential to reach out and not to struggle alone. Below are details of sources of support:
BEAT (beatingeatingdisorders.org.uk) is the UK’s leading Eating Disorder Charity. Should you require help and support in relation to eating disorders you can call the BEAT helpline on 0808 801 0677.
You can also gain more information about disordered eating by visiting the BEAT website: www.beateatingdisorders.org.uk
There you will find excellent links to their online resources: https://www.beateatingdisorders.org.uk/get-information-and-support/get-help-for-myself/downloads-resources/
These include a GP First Steps Leaflet, designed to help get a quick referral to an eating disorder specialist; A Guide for Friends and Family, offering guidance as to how to approach discussing the subject and supporting someone with an eating disorder; and a Tips Poster to help with spotting the first signs of symptoms of an eating disorder.
Anshel, M./ H. (2004). Sources of disordered eating patterns between ballet dancers and non-dancers. Journal of Sport Behavior, 27(2), 115-133. https://psycnet.apa.org/record/2004-14513-001
Arcelus, J., Witcomb, G. L., & Mitchell, A. (2013). Prevalence of eating disorders amongst dancers: A systematic review and meta-analysis. European Eating Disorders Review, 22(2), 92-101 https://doi.org/10.1002/erv.2271
Laws, H., & Dance UK. (2005). Fit to dance 2: Report of the second national inquiry into dancers’ health and injury in the UK. www.danceuk.org
Neumarker, K., Bettle, N., Neumarker, U., & Bettle, O. (2000). Age- and gender-related psychological characteristics of adolescent ballet dancers. Psychopathology, 33(3), 137-142. https://doi.org/10.1159/000029135
Penniment, K. J., & Egan, S. J. (2011). Perfectionism and learning experiences in dance class as risk factors for eating disorders in dancers. European Eating Disorders Review, 20(1), 13-22 https://doi.org/10.1002/erv.1089
Simmel, L. (2014). Dance medicine in practice. Routledge.
Taylor, J., and Estanol, E. (2015). Dance psychology for artistic and performance excellence. Human Kinetics.
Thomas, J. J., Keel, P. K., & Heatherton, T. F. (2005). Disordered eating attitudes and behaviours in ballet students: Examination of environmental and individual risk factors. International Journal of Eating Disorders, 38(3), 263-268. https://doi.org/10.1002/eat.20185