Female Athletes With Much to Lose : Health: The hidden scourges of anorexia and bulimia are becoming epidemic in college and even high school sports.

The starving didn’t bother Beth McGrann as much as the blood.

Starving, even for days at a time, had become automatic. All McGrann--an 87-pound college sophomore--had to do was look in the mirror, see all that fat. Her appetite would be as good as gone.

But the blood was different. The laxatives McGrann took--when she allowed herself to eat--were supposed to clean out her system, not ravage it raw. Seeing blood scared her--but not enough to make her stop.

“I wanted to weigh 80 pounds,” said McGrann, then an All-American distance runner at UC Irvine. “Every time I lost weight, I told myself, ‘A couple more pounds, a couple more pounds. Then you’ll run fast.’ ”

Until recently, McGrann--now a high school Spanish teacher--suffered from anorexia nervosa, an eating disorder characterized by distorted body image, self-starvation and a severe preoccupation with thinness.

Although many women become caught up in society’s pressure to be thin, there is growing evidence that anorexia and bulimia--the binge-purge syndrome--are becoming epidemic among female athletes. The American College of Sports Medicine says studies have shown that 15% to 62% of female college athletes have eating disorders. Some experts believe the percentage is even higher.

And increasingly, colleges and even high school coaches--often a source of pressure for young athletes to stay thin--are being challenged to address the issue.

“It’s a tremendous problem,” said Ocean View High cross-country coach Beth Chilcott, who is helping to organize a series of coaching clinics around Southern California next year that will include a discussion on eating disorders.

“I found out years later that we had kids on our team who had problems with food,” Chilcott said. “It’s not always as easy to spot as people think.”

Although many eating disorder cases are thought to be triggered by physical or emotional abuse, experts say sports-related anorexia and bulimia stem from the athlete’s fundamental desire to succeed. That motivation, coupled with the “be-thin-to-win” mentality prevalent in such weight-conscious sports as gymnastics and distance running, can lead to trouble, experts say. Especially if the initial warning signs are ignored.

Because much of the research is based on college athletes, less is known about how widespread eating disorders are in high school or junior high. Prevention, experts say, needs to take place as early as elementary school.

“The general medical profession doesn’t have a great awareness about eating disorders,” said Rosemary Agostini, a Seattle physician and chair of the American College of Sports Medicine Women’s Task Force.

“But we have 10-year-olds out there putting themselves on diets. They go to the doctor, and the doctor might not understand the problem.”

As a high school runner, McGrann was concerned about keeping her weight down, but her mother’s continuing insistence that she eat kept her healthy.

That changed in college. While competing at the NCAA track and field championships in 1987, McGrann, then a sophomore, noticed that most women in the long-distance events were extremely lean. She concluded that thin equaled success.

“I was 96 pounds at the time,” McGrann said. “But I stepped on the starting line feeling like 200.”

UC Irvine Coach Vince O’Boyle assured McGrann she did not have a weight problem. But it was too late. She was already convinced. McGrann started dieting gradually, at first, but then more severely. By her senior year, she kept only a large pitcher of ice water in her refrigerator. She said she was racked with guilt after eating a stalk of celery.

When the team ate dinner together the night before a competition, McGrann would join in, but later compensate with laxatives. On a road trip to San Luis Obispo, McGrann didn’t have laxatives, so she sneaked out of her hotel room in the middle of the night to buy some. Each time she weighed herself, she became convinced she needed to shed one more pound.

“It became such a mind battle,” McGrann said. “Deep down inside, you know it’s wrong. But if I didn’t reach that weight, it would be quitting. And to quit, even to save your life, would be failure.”

Sandie Fernandez, a gymnast since age 6, fell into a similar pattern. Fernandez said she quit gymnastics at 17 because she could no longer deal with the constant dieting and pressure to retain a little girl’s figure. But the pressure stayed with her.

A ballet dancer and cheerleader in college, Fernandez felt remorse over gaining so much as a quarter of a pound. She had heard of people who forced themselves to throw up after eating, but she had never before considered it.

“I just got tired of starving,” said Fernandez, who grew up in Texas and now lives in Corona del Mar. “One day I went crazy and ate. I decided to regurgitate it. I thought, ‘Wait a sec. This is awesome! I can eat and get rid of the food.’ ”

But Fernandez’s discovery quickly developed into a habit she could not break. Bingeing and purging became addictive, she said. Her thoughts were almost constantly focused on food. Yet she didn’t think she had a problem.

“I got to the point where I was spending my whole life either in the kitchen or the toilet,” Fernandez said. “But the denial part of me said, ‘Oh, you could stop if you wanted to. . . . ‘ “

Anorexia and bulimia can lead to a variety of health problems including kidney damage, electrolyte imbalances and irregular heartbeat, which can lead to cardiac arrest--and death.

Repeated vomiting can cause erosion of tooth enamel as well as internal bleeding from inflammation of the esophagus. Because victims of bulimia often are highly secretive and ashamed of their behavior--some go years without being discovered--the disease can lead to severe depression, even suicide.

Eating disorders--along with intense training, low body fat and stress--can lead to amenorrhea, or absence of menstrual cycle. That, in turn, can lead to osteoporosis--rapid, irreversible bone loss. Together, the three medical disorders make up what experts now define as the female-athlete triad.

Although some female athletes consider the lack of a period a blessing--or even a proud symbol of fitness--the consequences can be severe. Seattle physiologist Barbara L. Drinkwater, one of the country’s leading researchers on amenorrhea-related bone loss, said some amenorrheic female athletes in their 20s have the same bone density as women in their 70s or 80s.

These women are more likely to suffer stress fractures or broken bones. A young woman running a Seattle half-marathon collapsed 20 yards short of the finish, Drinkwater said. Her femur had snapped in mid-stride. Another suffered a broken leg simply by striking her thigh against a hurdle.

“A lot of these girls are going to have consequences that last a lifetime,” Drinkwater said--”if they make it that far.”

Fernandez said it wasn’t until she started throwing up blood that she considered the harm being done to her body.

“The first time I saw blood, I was really scared,” she said. “I started crying. I was like, ‘What am I doing to myself?’ I wanted to stop but I couldn’t. I had to get it out. When it happened again, I went, ‘Oh, blood,’ and kept going. It’s almost like I got numb to it.”

The stories--of college swim teams getting together for pizza-and-purge parties, of calorie-depleted cross-country runners passing out in mid-race, of ballet dancers eating Kleenex to stave off hunger--continue to frustrate the growing number of physicians and psychologists who believe more must be done to educate athletes, and perhaps more important, the coaches who advise them.

Athletes who decide to cut red meat, saturated fats and sweets from their diet might simply be seeking a healthier lifestyle. But when it broadens in scope--elimination of all meat, dairy products, fats and so on--or when the athlete becomes obsessive about reaching a desired weight, it could lead to destructive eating patterns.

Agostini, the Seattle physician, said coaches sometimes exacerbate the problem by trying to act as nutritional counselors when they actually know very little about the subject. Athletes are better off if coaches refer them to qualified professionals, she said.

“With a lot of athletes, your coach is your everything,” Agostini said. “But many times, it’s the coach who is (at fault) by providing wrong or misleading information.”

Julie, who requested that her real name not be used, said she became bulimic soon after graduating from a local high school, where she played soccer and ran track and cross-country. Julie said she always loved participating in sports, but her increasing obsession with thinness led to athletic burnout, depression and, eventually, a suicide attempt.

“When you have to get into such a little uniform, it’s a very body-conscious thing,” she said. “I got to the point where my entire focus was on losing weight.”

She believes her coaches in high school were never aware of her problem. Those in college, she said, generally looked the other way. “I think deep down, coaches are into winning,” she said. “I think they think if (their athletes) can just get through this season, they can deal with the problem later.”

Agostini said coaches who require routine weigh-ins for their athletes and demand they maintain a specific weight can trigger eating disorders. Some coaches tease or ridicule those who fail to meet their target weights. In one case, a college coach made his athlete wear a Miss Piggy T-shirt. In another, a coach posted the names of his female runners--along with their body fat percentages--in the men’s locker room.

Certainly, pressure to be thin can come from more subtle sources--peers, parents, society in general--but when it comes from an athlete’s coach, the effect is often amplified.

“Athletes are so motivated to do well anyway,” Agostini said. “They’ll do anything to please the coach, anything to be the best.”

While many coaches have become more educated about eating disorders, others have little interest--or even deny it’s a problem.

O’Boyle of UC Irvine said when giving coaching clinics, he introduces his discussion on eating disorders by saying, “Now I know none of you want to hear about this, but. . . . “ The denial, O’Boyle said, is frustrating, comparable to the days when coaches ignored the issue of performance-enhancing drugs.

“We’re brushing this off like we did the drug issue. Coaches say, ‘No, we don’t have that problem here.’ Well, dammit, they do.

“I’ll be the first one to tell you I hate reading about the drug issue,” O’Boyle said. “But I cannot live in a closet. It’s the same with this. Coaches don’t want to learn about it. They won’t take the time to read a book or call a doctor. They see little Sally and say, ‘Oh, sure she’s real skinny, but that’s just because she’s a tiny little girl.’ They don’t look beyond that. They don’t understand the problem. They don’t even try.”

Gary Wilson, women’s track and cross-country coach at the University of Minnesota, said he believes coaches generally are more cognizant of the issue than they were five to 10 years ago. Others, especially on the high school level, are not.

“There are still some coaches out there that are wacko. They have no clue what they’re doing to kids,” Wilson said. “They’re putting kids on the scale and flat-out saying to a kid who might be 5-6, 114 pounds, a kid who’s already performing really well, ‘You would really run better if you were 100.’ Others are basically turning their back on it, saying: ‘I know she’s got a problem, but gee, what can I do? She’s running so fast. . . .’

“You’re going to see someone five, 10 years from now get sued for that. Someone’s going to push a kid over the edge.”

Two-time Olympic distance runner PattiSue Plumer said male coaches--and males in general--have little concept of how weight plays into a woman’s self-esteem. They can’t understand, Plumer said, how eating can mean more than satisfying one’s biological needs, or how an offhand comment about weight gain can trigger psychological disaster.

“They just want you to be thin,” said Plumer, who was anorexic in high school. “So they casually say, ‘. . . Get that fat off your butt! How do you expect to run fast?’ To them, it’s that simple.”

Plumer, who at 15 went from 110 to 90 pounds and experienced amenorrhea and hair loss, said she got to college and soon realized many of her Stanford teammates had eating disorders. Plumer said one teammate overdrew her checking accounts to such an extent that Plumer and the other runners thought she had a drug problem. As it turned out, the woman was bulimic and spending all her money on food.

Plumer refused to socialize with her teammates--”I knew how easily I would get caught up in that psychology,” she said--but still remained semi-obsessive about food and thinness. It wasn’t until five years later, on a overseas trip with several top runners, that Plumer realized she had to separate herself once and for all from an eating-disorder mentality.

One of the runners on the trip, a woman in her 30s, never came close to finishing a meal, Plumer said. The woman’s skin had an unhealthy pallor. Her face looked haggard and worn. “I saw someone who was 30 who still couldn’t sit down and eat a meal,” Plumer said. “I saw myself in that behavior. It scared me so much.”

O’Boyle, who coached the U.S. women’s cross-country team at the World Championships earlier this year, said thinner athletes might excel for a year or two, maybe more, but poor nutrition will eventually catch up with them. It requires more than skin and bones, O’Boyle said, to improve year after year, whether it be in high school or on the world-class level.

Olympian Lynn Jennings, three-time defending world cross-country champion, is muscular. Suzy Hamilton, an Olympian and nine-time NCAA champion from the University of Wisconsin, has 14% body fat--twice that of some female runners. Both women say eating consistent, well-balanced meals is as much a part of their training as the miles they run.

“At our level, you need all the strength you can get,” said Hamilton, a Malibu resident and volunteer assistant men’s track and cross-country coach at Pepperdine. “You can’t mess around and play those games with your body.”

Said Jennings: “I almost feel like going up to the coaches of these (anorexic-looking) athletes and saying, ‘Are you blind?’ It makes me angry. . . . When I stand on the starting line, I always feel strong and powerful. I can’t imagine it otherwise.”

Certainly, there are coaches who confront the problem. Hamilton, for instance, said her high school coach many times had the team run a couple of miles to the ice cream store, get ice cream and then walk back to school. Other examples:

* Sandi Carter and Earl Towner, Laguna Beach High cross-country coaches, spend hours discussing proper nutrition with their runners. Carter said her daughter, Kendra, now a freshman at UC Berkeley, developed stress fractures that plagued her high school running career. She believes the fractures may have been the result of Kendra’s diet--one that, for nearly a year, consisted of mainly plain baked potatoes, bagels and rice.

* O’Boyle asks his female athletes to keep a daily log charting not only how they feel and how many miles they run, but whether they lost any menstrual blood that day--and if so, chart how much on a 1-to-4 scale. He said he got the idea from the British national team.

* Brian Sherbart, San Clemente High cross-country coach: “I think 99% of all girls will say they have to be thinner than they are. We talk about (weight issues) as a team constantly. If I see someone losing weight, I will definitely talk to them. It’s something that can lead to tragic results.”

Drinkwater, the physiologist, said it is important to remember that sports do not lead female athletes into eating-related problems. But reckless ideas about weight loss--and irresponsible coaches--do. If a coach suspects a problem, he or she should not attempt to solve it, but refer the athlete to a professional who can, Drinkwater said. Only then, she said, can recovery begin.

McGrann, who sought counseling only after O’Boyle repeatedly insisted, said a new outlook and a three-year break from competition has helped her to overcome her obsession. Although she sometimes has to fight the impulses of anorexia, she now knows it is more important to be healthy, inside and out.

Fernandez, now undergoing psychological counseling, said if she could do it over again, she would certainly participate in sports. But she would never again risk her health in an attempt to improve her performance.

“Before, I kept saying, ‘I don’t care what the costs are--I’ll cross that bridge when I come to it,’ ” Fernandez said. “But now I’m frightened. I want to be able to have children. I want to be healthy when I get older.

“I don’t want to be falling apart.”

Eating Disorders: Toll on the Body

Female athletes apparently suffer more from eating disorders than other women. Some women engage in self-starvation; others binge and purge. While far more women than men are believed to suffer from eating disorders, the side effects for both can be devastating. A look at what happens to the body, who’s affected and how to identify the problems:

Effects

Anorexia nervosa: Anorexics eat extremely little, often go days without food

Hair loss

Gaunt, hollow facial features

Shrunken breasts

Dry skin

Bruises

Sharply protruding bones; limbs reduced to sticks

Cold and blue hands, feet

Delayed puberty: Pre-adolescent females fail to menstruate and develop breasts at normal age. In males, testosterone levels might remain low, lead to impotence.

Menstruation: Hormone levels drop, alerting the body that it cannot support a fetus. Menstruation becomes irregular or stops completely. Can result in temporary or permanent infertility.

Premature bone loss: Susceptibility to stress fractures and osteoporosis.

Mood changes: Impatience, irritability, depression, suicidal tendencies.

Also: Insomnia, constipation, sensitivity to cold, kidney failure, abnormally low heart rate and blood pressure.

*

Bulimia nervosa

Often described as the binge-purge syndrome. Effects are similar to anorexia, with additional complications:

Gastrointestinal problems: Esophagus, stomach, salivary glands and throat irritated by persistent vomiting.

Damaged or discolored teeth: Gastric acids erode enamel.

Lung irritation: Choking while vomiting causes food particles to lodge in lungs, causing inflammation.

Chronic loss of body fluids: Depletes blood potassium, sodium and chloride levels, resulting in muscle spasms, weakness, irregular heartbeat and kidney disease.

*

Female Athletes: Who’s Affected

To determine the prevalence of eating disorders in student athletes, the National Collegiate Athletic Assn. in 1990 surveyed more than 800 athletic directors. Of the 872 schools responding, 93% reported having at least one female athlete with some type of eating disorder. Because of the secretive nature of the problem, experts fear the rate might actually be higher.

Percent reporting eating disorder, per sport Gymnastics: 48% Cross-country: 23% Swimming: 21% Track (running events only): 21% Basketball: 13% Soccer: 13% Volleyball: 12% Softball: 10% Tennis: 8% Diving: 6% Track (field events only): 2% *

Glossary

Amenorrhea: Absence of menstruation, defined as fewer than three periods per year. While 2% to 5% of all women are believed to have amenorrhea, experts believe the prevalence among athletes could be as high as 66%.

Anorexia nervosa: Self-induced starvation. Victims suffer from distorted body image and obsession with dieting and thinness. Believed to have a 10% fatality rate.

Binge: Consumption of mass quantities of food. Bulimics might consume 10,000 or more calories in one binge.

Bulimia nervosa: Often described as the binge-purge syndrome. Bulimics gorge on food then purge through vomiting, laxatives, diuretics, exercise and/or fasting.

Compulsive exercise: Often ties in with anorexia. Obsession with burning calories, exercising several times a day. Self-worth is defined in terms of length or frequency of exercise.

*

Do You Have an Eating Disorder?

Mark the following statements true or false:

Even though people tell me I’m thin, I feel fat.

I get anxious if I can’t exercise.

I worry about what I will eat.

If I gain weight, I get anxious and depressed.

I feel guilty when I eat.

I would rather die than be fat.

I would rather eat by myself than with family or friends.

I don’t talk about my fear of being fat because no one understands how I feel.

I have a secret stash of food.

When I eat, I’m afraid I won’t be able to stop.

I lie about what I eat.

I get anxious when people urge me to eat.

Sometimes I think that my eating or exercising is not normal.

*

Number of “true” statements:

1-3: You have a mild preoccupation with weight and appearance. Re-evaluate. Don’t lose control.

4-6: Reason for concern. Check with your doctor and an eating disorders specialist.

7 or more: You are in danger. Make an appointment right now with your doctor and a specialist for a thorough evaluation.

Sources: Cecil Textbook of Medicine; National Collegiate Athletic Assn.; Anorexia Nervosa and Related Disorders organization; National Assn. of Anorexia Nervosa and Associated Disorders; American College of Sports Medicine; Webster’s Dictionary; Dietary Guides for America

Researched by APRIL JACKSON, JANICE L. JONES and BARBIE LUDOVISE / Los Angeles Times

Whom to Call for Help

There are two national nonprofit eating disorder organizations. Both agencies provide printed materials and a list of counselors who offer free group sessions in Orange County.

Anorexia Nervosa and Related Disorders

Box 5102, Eugene, Ore.; (503) 344-1144

National Assn. of Anorexia Nervosa and Associated Disorders

Box 7, Highland Park, Ill. 60035; (708) 831-3438

*

ORANGE COUNTY

The following hospitals offer in- and outpatient treatment of eating disorders, as well as on-site support groups:

Brea Hospital

Program name: Women’s Issues

875 N. Brea Blvd.

Brea 92621

(714) 529-4000

(24-hour hot line)

Capistrano by the Sea Hospital

Program name: UCI Eating Disorders

33915 Del Obispo St.

Dana Point 92629

(714) 496-5702

(24-hour hot line)

St. Jude Medical Center

Program name: Eating Disorders

101 E. Valencia Mesa Drive

Fullerton 92635

(714) 992-3059 (24-hour hot line)

*

SOUTHERN CALIFORNIA

California Self-Help Center

(on the campus of UCLA)

(800) 222-LINK

UCLA Eating Disorders Program

(310) 825-0764

Sources: National Assn. of Anorexia Nervosa and Associated Disorders; individual hospitals

researched by BARBIE LUDOVISE and APRIL JACKSON / Los Angeles Times