The day before ultrarunner and obstacle course racing superstar Amelia Boone hit “publish” on the blog post that echoed through the endurance-sports world and beyond last week, she almost didn’t go through with it.
“I was like, why am I doing this? I’m not recovered,” she told Runner’s World afterward.
Even after her message went live, she spent some time second-guessing her motivations.
But ultimately, Boone said, the predominant emotion she felt now that her 20-year experience with anorexia has become public knowledge is relief.
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“It’s honestly like having a hundred-pound weight vest lifted off,” she said.
Now, she no longer had to keep an important part of her life secret. She could end what she called her “selective vulnerability,” speaking a more complete truth on a topic about which she’s otherwise been forthcoming—her repeated stress fractures.
“I had this feeling of massive shame and guilt, being like—I know the reasons why I’ve had four bone injuries,” she said.
Of course, she can’t be positive of their cause, but she strongly suspects something called “relative energy deficiency in sport” or RED-S—a mismatch between intake and expenditure—was a major contributing factor: “I’ve done everything else, yet I still keep breaking.”
And, she could give others struggling with similar issues an open space, aligning their stories with those of an athlete who showed her strength not by declaring victory over anorexia, but by being brave enough to admit she’s still getting there.
Breaking the Silence—and Starting a Conversation
A few people close to Boone knew about her disorder and her decision, in April, to seek treatment through the partial hospitalization program at Opal Food & Body Wisdom, a facility co-founded by Kara Bazzi, L.M.F.T., a therapist who herself had an eating disorder as a distance runner at the University of Washington.
For many of Boone’s tens of thousands of fans and social media followers, however, the revelation came as a complete surprise. Some of that secrecy kept Boone safe as she pursued recovery.
“I’ve wanted to talk about it for a really long time, for years. But it never felt like it was the right time,” she said. “I didn’t feel right talking about it because I didn’t feel like I was doing anything to proactively recover from it.”
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After she completed treatment again—she’d gone before, including an inpatient stay right after college—she more thoughtfully considered taking her struggle public. Shame and stigma, she realized, “thrive in silence.”
“There’s a part of me that thinks, well, what is talking about it going to do? It’s not fixing anybody’s mental state,” she said. “But at the end of the day, I actually think it kind of is. You keep the conversation going.”
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The messages that poured in afterward from others with similar struggles confirmed what she already knew: She was far from alone. Experts estimate that about 1 to 2 percent of women, and up to .3 percent of men, will develop anorexia. Rates of disordered eating among runners and other athletes are likely far higher—one study found one-fourth of female college athletes had disordered eating behaviors.
All this means most runners know someone who’s affected. And while it’s often a difficult topic to broach, open conversation can indeed be the catalyst that moves someone toward seeking help or supports them in their recovery, said Lauren Smolar, director of programs for the National Eating Disorders Association.
Voicing Your Concerns
In the four years between when Bazzi realized she had a problem and when she sought treatment, only one person said anything to her. “I don’t know how my path would’ve been different had more people expressed concern, but that certainly was hard,” she said.
For this reason, she advocates speaking up. “If you’re noticing someone in your life who you care about struggling, I would err on the side of having that difficult conversation and taking that risk,” Bazzi said. “More often than not, even if somebody isn’t ready to get help or is defensive, I do believe it is an act of love.”
What, exactly, should you say to someone you suspect might have an eating disorder? Before you even head into the conversation, consider your own relationship with food, Bazzi said. If you’ve ever questioned whether your behaviors veered into dangerous territory, sharing that might reduce the chances you’ll be seen as judgmental or somehow superior (not to mention encourage you to explore your own need for support).
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Doing research about eating disorders beforehand can help, but it’s not your job to treat someone else—and also that you can’t force them to take a step they’re not ready for, said Laura Moretti, R.D., a runner, triathlete, and sports dietitian who specializes in eating disorders at Boston Children’s Hospital. Your main goal should be to let them know you’re there if and when they need you.
When you do bring up the issue, consider your timing, Smolar said. Talking to someone alone, when they’re relaxed, is likely to be received better than catching them in the middle of a group run or when they’re stressed about a work project.
From there, it’s all about the approach, Moretti said. Avoid anything that can be construed as judging or accusatory. Use “I” statements and focus them on behaviors: “I noticed you haven’t been eating with the team, and you always used to enjoy that. I’m worried about you.” “You don’t seem like yourself lately. Is there anything you want to talk about?”
Ask what you can do to support that person. If you like, you can offer suggestions—for instance, helping them find a treatment provider who specializes in eating disorders, Smolar said. (NEDA’s website is a great place to start looking.) But letting them take the lead and tell you what they need, or don’t, often works best.
Prepare yourself for the fact that the person might feel angry and defensive or deny anything’s wrong. Try your best to stay calm, and say something like: “Okay, that’s good to know, just wanted to check in.”
Reflecting anger back can close the door on any future conversations. “If you’re staying neutral,” Bazzi said, “you’re putting yourself in a position to be a safe person in the future.”
In the end, as Boone realized, you don’t have to overcomplicate the conversation.
“I think the things that are always helpful are people who really just check in,” Boone said. “‘Hi, how are you doing? I noticed you’ve been a little off lately or a little different lately.’ Not fishing for answers, just being there for someone.”
She remembers once, a couple of years ago, when her chiropractor looked her in the eye and asked that simple question. “I knew internally that I was really not doing well,” she said. “But even that phrase, without anything else, really made me think.”
Though her decision to seek treatment was ultimately self-directed, statements like these lodged in her mind, reinforcing her decision.
What Not to Say
Of course, words have power in both directions; comments from others can also discourage someone in need from seeking treatment. For example, Morretti said, it’s not helpful to overgeneralize—saying things like, “everyone counts calories,” or “it’s normal for runners not to get their periods.” Even if your goal is to minimize that person’s distress, you may inadvertently delegitimize their need for support.
Boone recalls a particularly destructive conversation with an ex-boyfriend to whom she’d had the courage to disclose her history.
“He said, ‘Oh, you have an issue with food? So does every other woman, you’re not unique, get over it,’” she said. “For a very long time, I shut up about it. I was like, well, I guess everybody has this, so I shouldn’t make a big deal out of it.”
Weight is another topic to eschew. For one thing, eating disorders come in all shapes and sizes—even anorexia, which once required a low body mass index for diagnosis, no longer carries that criterion.
“You can’t necessarily tell that someone’s struggling just by the way they look,” Moretti said. Besides, pointing out someone’s weight loss can inadvertently reinforce their behaviors and drive them deeper into their disorder.
Finally, avoid suggestions about what they should—or shouldn’t—be eating. Boone said she got plenty of unsolicited advice after her injuries.
“People were like, you should go on the all-carnivore diet or you need to be Paleo or stop eating Pop-Tarts,” she said. “No, what I needed to do is just eat plentiful, appropriate amounts. A diet is not the solution to an eating disorder, you know?”
Support Through—and Beyond—Treatment
While friends and family may be the first to notice a problem, others can be taken by surprise when someone in their life reveals they’re in recovery or are going to treatment.
Your first, and most important, reaction should be to listen. “Let them talk, and show that you care through your non-verbals,” Bazzi said.
From there, it’s fine to admit you feel awkward or aren’t quite sure how to respond. Reaffirming that you care about the person, and will be there to support them, goes a long way in reducing the isolation that often accompanies a mental illness like an eating disorder.
“The main thing is just holding space for them,” Boone said. “I see you. I hear you. I’m here for you.”
Another message that may be helpful: acknowledging their bravery. Seeking help isn’t easy, and recognizing that can bolster the person’s confidence in their choices.
“You might say, ‘I don’t understand everything about this, but I can imagine it’s really difficult, and I think it’s great that you’re putting this time into dealing with it,’” Moretti said.
The need for support doesn’t end when someone seeks treatment. Boone said during her time at Opal, she appreciated the friends who sent simple texts letting her know they were thinking of her. And now that she’s facing the next phase of recovery, she knows she’ll need ongoing support.
“Often the hardest work is actually when you’re out of treatment,” Moretti said. True recovery can take months or years.
When it comes to how best to support someone over the long haul, many of the same guidelines apply. It’s generally okay to ask how treatment is going—expressing genuine human concern, Moretti said.
But again, steer clear of discussing appearances. Even if restoring weight was a part of someone’s treatment, innocent-seeming phrases like “you look healthy” can be heard as “you’re getting fat.” Instead, reinforce the positive changes you see in behaviors and personality, Moretti said. Think: “It’s so great to see you with a smile on your face.” “I missed your sense of humor; it’s wonderful to hear you cracking jokes again.”
What about eating with a person in recovery? Sharing meals can provide both accountability and community, Bazzi said. But resist the urge to turn into the food police. Eating is stressful enough, and the more you can keep the conversation off what’s on the plate, the better. Avoid bringing up any of your own hangups—whether you’re starting keto or flirting with going sugar-free—and don’t make too many special requests when ordering at a restaurant.
Another offering Boone would rather pass up is outside input on her exercise habits.
“I’ve had a number of people tell me that I need to get out of the sport, or stop running, in order to recover,” Boone said. Answering that question was one of her primary motivations for seeking treatment. While each runner is unique, she and her treatment team decided “my relationship with running is one that can continue, though I’m mindful that I need to be constantly curious around it.”
Changing the Culture
While Boone realizes eating disorders are rooted in complex genetic and psychological underpinnings, there’s no doubt the current culture surrounding dieting and weight contributes, she said. Shifts in language and approach similar to those sensitive to people in recovery, writ large, could make an impact in minimizing the shame and stigma that stand in the way of recovery, she believes.
For one thing, Boone has made it a rule of thumb never to comment on anyone’s body size. “I don’t even care if you think of a compliment,” she said—after all, what if a person shed pounds because they’re struggling with cancer?
The overemphasis on size and numbers on the scale narrows the definition of health, complicating the process of seeking treatment and recovering. “If we can make a concerted effort to not talk about it as much, I think it would really benefit society in general,” Smolar said.
The problem—and the need for change—is even greater in sport, Boone said. “In the running world, you’ve seen this—people feel like they have free rein to comment on runners’ weights. We have to stop this.”
The habit of labeling foods “good” and “bad,” “healthy” or “unhealthy,” also does all of us a disservice, Moretti said. “You set yourself up to feel guilty for eating those foods even if you don’t have an eating disorder.
Boone also hopes that, by admitting she couldn’t white-knuckle her way through recovery alone, she fights the perception that seeking help is equivalent to weakness. Athletes often wait longer to seek treatment because they’re used to setting goals and powering their way to achieving them, Bazzi said. But in this case, early intervention by a specially trained professional has significant benefits for long-term recovery.
And while it might seem intimidating at first to open yourself up to another person, even a mental health professional, sharing your struggles offers the additional benefit of community. “In my own personal opinion, we all just want to be connected and seen and heard,” Boone said. “The more we can relate to others through our struggles and our just our humanness, the easier it gets. You don’t feel so alone.”
If you are struggling with an eating disorder and are in need of support, please call the National Eating Disorders Association Helpline at 1-800-931-2237. For a 24-hour crisis line, text “NEDA” to 741741. Warning signs of disordered eating and RED-S include, but aren’t limited to: drastic changes in eating or exercise habits or in weight; preoccupation with weight, counting calories, or restricting food groups; avoiding eating around others, or other secretive behavior around food; lack of flexibility around eating and workouts; menstrual irregularities in females; fractures and other injuries; anxiety and depression; gastrointestinal issues
Editor’s note: This article was updated since its publication to clarify that Amelia Boone’s treatment at Opal Food & Body Wisdom was a partial hospitalization program, not a full inpatient program.
Cindy is a freelance health and fitness writer, author, and podcaster who’s contributed regularly to Runner’s World since 2013. She’s the coauthor of both Breakthrough Women’s Running: Dream Big and Train Smart and Rebound: Train Your Mind to Bounce Back Stronger from Sports Injuries, a book about the psychology of sports injury from Bloomsbury Sport. Cindy specializes in covering injury prevention and recovery, everyday athletes accomplishing extraordinary things, and the active community in her beloved Chicago, where winter forges deep bonds between those brave enough to train through it.
