When Being Varsity-Fit Masks an Eating Disorder

By PAUL SCOTT
Published: September 14, 2006

FOR a runner, Alex DeVinny wasn’t all that skinny on the day that she won a state track title in 2003. At 17, she was 5-foot-8 and weighed 125 pounds.

Few people watching her run the 3,200 meters in 10 minutes 53 seconds would have guessed that she had had symptoms of an eating disorder since age 9 and that she had yet to start menstruating. Her coach didn’t know. The college recruiters certainly did not know.

She was never going to run for those colleges. The summer after she won the title, Ms. DeVinny, from Racine, Wis., began to run even harder and eat even less. When she came out for cross-country in the fall, she looked frail and underweight. Her coach was concerned enough to prevent her from competing in several meets, but he allowed her to do two-thirds of her training. He never asked about her menstrual periods and did not know about her anorexia.

Ms. DeVinny sneaked in extra workouts, but her dazzling window of athleticism had already begun to close. “Her body kind of broke down during her senior year,” said her sister Gabby Fekete, 27. “She had lived on adrenaline.”

Last March, Ms. DeVinny died from cardiac arrest related to her starvation. She was 20 and weighed roughly 70 pounds.

Looking back, her coach, Dan Jarrett, questions himself. “I did not understand how someone with anorexia would be capable of making decisions that weren’t in their best interest,” he said. “I totally failed to grasp what it meant.” He is so troubled by her death that he has since quit coaching girls.

Even the best-trained psychologist can have a difficult time filtering through the deceptive acts and statements that can accompany an eating disorder. And yet coaches have long been encouraged to identify a syndrome of under-eating, known as the female athlete triad, to help athletes avoid osteoporosis, stress fractures and —in rare cases like Ms. DeVinny’s — even death.

The term triad refers to a pattern of decline that starts with disordered eating and leads to menstrual dysfunction, which can signal the loss of bone density.

Yet, according to a recent survey, even highly trained collegiate coaches are largely in the dark about the specifics of female athlete triad and how to detect it.

The survey, conducted by Kathleen J. Pantano, an assistant professor of physical therapy at Cleveland State University, found that only 43 percent of the 91 college coaches for women’s athletics surveyed could name the elements of the triad. The survey also found that 24 percent mistakenly thought that nonexistent or irregular periods were natural consequences of vigorous exercise rather than the telltale signs of nutritional deficiency. In 2003, the National Collegiate Athletics Association surveyed over 2,800 coaches about disordered eating, and found that only 19 percent of men and 26 percent of women were aware of the seriousness of amenorrhea, defined as menstrual dysfunction for three or more months.

No large-scale studies have been done on the prevalence of the triad. Dr. Anne Hoch, the director of a women’s sports medicine clinic at the Medical College of Wisconsin in Milwaukee, found in one study that the overall prevalence of the triad is high. Of 80 varsity athletes she recently surveyed at an all-girls high school, 75 percent had one or more components of the triad.

Some studies have found that athletes are two to three times more prone to suffer from menstrual dysfunction. “We know it is higher than what we see in sedentary women,” said Anne Loucks, a biology professor at Ohio University, “and highest in women who are doing the most training, and who are younger.”

Because half of an athlete’s bone mass is developed during adolescence, losing a period can have lifelong consequences for bone health, Dr. Loucks said. “We don’t have evidence that if their cycles return, their bone is going to return to normal density.”

That is why the American College of Sports Medicine urges coaches to “learn about preventing and recognizing the symptoms and risks of the triad.” Last year, the N.C.A.A. published a handbook advising coaches to look for possible signs of disordered eating, including stress fractures, cold intolerance and excessive use of the restroom. The booklet states that coaches — with “tremendous power and influence” over student-athletes — should help manage the triad. But the Cleveland study indicates that the message is not getting through.

“Nothing makes me madder than when I go to an N.C.A.A. meet and I see girls who look like a skeleton and are in a school uniform,” said Karen Harvey, a cross-country coach at the University of Illinois.

The problem may be a reluctance by many coaches — even women — to ask about menstrual cycles.

Coaches also need to know that losing the menstrual cycle is not normal. “What we know from research is that women can exercise as much as they want, they can run 100 miles a week and if they fuel themselves properly, they will have normal periods,” Dr. Hoch said.

The loss of menstruation is often a symptom of under-eating, which sometimes is a result of an eating disorder.

“Running is a magnet for eating-disorder patients and people who run to lose weight,” said John Mead, a director of the eating disorder program at Rush University Medical Center in Chicago.

For runners without eating disorders, under-eating may simply be a failure to increase calories with higher training loads. In this case, the triad is an informational problem that requires “convincing these kids they’re not going to be able to increase their weight with fruit and low fat yogurt,” said Dr. Margot Putukian, the director of athletic medicine at Princeton University. They need to eat more substantial food.

In high school, Emily Brown, 22, lost her period for six months. But lately Ms. Brown, who has increased her mileage as a member of the cross-country team at the University of Minnesota, menstruates normally. How? She eats more.

Having a vigilant coach like Gary Wilson has also helped. A team doctor asks athletes about their periods. Later Mr. Wilson also asked. “To make kids feel comfortable I’m not the first to talk about it,” he said. Amenorrhoeic athletes are referred for tests, which can include measuring bone density.

Other programs also are proactive. “I tell my athletes you need to tell me when you lose your cycle,” said Ms. Harvey, the coach at Illinois. If a runner reports they haven’t had their period in months, than they are referred for nutrition counseling and screenings, which may include blood work and bone scans. Ms. Harvey also looks for signs of an eating disorder, including brittle hair, emaciation, “always talking about food.”

But even with screenings, some competitive runners still end up suffering the consequences of under-eating. When Julia Stamps-Mallon, from Santa Rosa, Calif., was winning three state high school cross-country titles, her parents made sure she had bone scans and met with a nutritionist because they worried she would get stress fractures. She was not menstruating at the time, but she knew few runners who were. “If someone had a normal cycle, it would be odd,” said Ms. Stamps-Mallon, 27.

In college, a scan showed that her bones were thinning, and team-appointed nutritionists had her drinking Ensure to gain weight. Within a year, the base of her spinal column broke mid-run and a fall from a skateboard shattered her leg. Finally, Ms. Stamps-Mallon said, she “saw what a problem osteoporosis is.”

Wake-up calls aren’t always so glaring. Sometimes coaches have to act on a hunch if they suspect that an athlete is restricting calories. “We say, ‘We’re not going to run you if you’re not a healthy person,’ ” Mr. Wilson said. “That doesn’t mean we won’t help you. I’ll get you help and sit on the bench alongside you, but we’re not going to run you if you’re anorexic or bulimic.’ ”

Doug and Lana DeVinny wish that the coach had told their daughter not to train. When asked whether they wish they had stopped her, Mr. DeVinny is moved to tears. “We never said ‘you can’t run,’ ” he said. “We begged her, but especially after she turned 18, it just became really hard.”