Eating Disorders In Endurance Athletes With Dr. Kate Bennett | Koopcast Episode 74

trail and ultra runners what is going on what's happening welcome to another episode of the KoopCast as always i am your humble host coach Jason Koop and on the podcast today we welcome dr kate bennett who's a clinical sports psychologist as well as has an expertise in treating endurance athletes who are suffering from eating disorders and this is a topic that throughout my coaching career i have not wanted to touch with a nine foot pole i've always felt that this is best dealt with by the experts and so i wanted to bring one of those experts into the arena into the KoopCast today in dr bennett and we discuss a whole host of different aspects revolving around eating disorders including what the difference between disordered eating and an eating disorder is and how at times with certain athletes disordered eating can be compatible with that particular athlete's goals we also talk about the very taboo subject of athletes body image as well as what an athlete support network can do friends family coaches colleagues to help support an athlete that happens to be going through an eating disorder i really had a lot of fun and i learned a lot from this conversation with dr bennett dr bennett and i go back maybe 15 years as coaching college so much so

that during the course of this conversation i realized i was getting a little bit too chummy with her and i forgot to address her by her proper and well-earned title as dr bennett so dr bennett i apologize to you in advance of this podcast airing i will not make that mistake again but in all honesty dr bennett has a great book that is coming out in the fall of 2021 that i happen to receive an advanced copy of it's a book that i'm going to put in my personal library as well as is used as a resource for our upcoming coaches all right here we go i'm going to get right out of the way here's my conversation with dr kate bennett to to like start out with we're gonna so we're gonna discuss what can be viewed as kind of like some touchy subjects and if you can't tell from my hesitancy i mentioned this to you in the email beforehand talking about eating disorders is something that i've like very consciously steered away from and i get asked to write articles on this and produce content on it and stuff like that all the time and i've always said no and it's not for like lack of me trying to understand things because i genuinely try to and network with experts and things like that but one of the things that i realized that when i x that when i network with experts is that i really don't know this space very well and i and i and i feel if i start to you know comment or opine on it that i'm somehow gonna i'm like super

paranoid that i'm gonna go awry and so it was really kind of comforting for me to hear or read in your manuscript that when you go through a very prototypical like clinical education in this area like you have gone through that helping athletes manage eating disorders is not something that it's not a big part of the curriculum correct it's not a part of the curriculum at all it's not a part of the curriculum and i was really surprised to hear that so why i mean i know that was the that was a big motivating factor for you to to start to compile a manuscript and put this book together but like classically why is that because we we have all seen we're both athletes we live in the athletic populations and we see all of these examples in lay literature across podcasts athletes kind of come out with their stories and things like that of them suffering from some type of eating disorder so why does that like fundamentally why does that discrepancy exist between what we see and the reality of like the training that you would go through so um it's it really is uh the results of two separate worlds so as you know coming i came up in this coaching world in the sport world and in that world you really learn about physiology and nutrition and performance-based subjects in the clinical world where you learn about eating disorders

you don't learn about the sport world and so it really is focused on mental health and mental illness and treatment issues and so um truly it's a reflection of my career has been that i've stood in both of these worlds and i've stood professionally in both of these worlds and so that's where i'm trying to bridge this gap because there's the sport world that doesn't have any clinical training and then there's this clinical world that doesn't have any awareness around athletes and their lifestyles and how they experience their worlds the messages they get regarding nutrition and health um the expectations of what they should and shouldn't do with their bodies to achieve performance excellence and and so it really is is that there's one world that's focused on healing mental illness and there's this other world that's focused on performance excellence and helping athletes achieve their greatest outcomes whatever those are um but rarely do they cross over and then the kind of the bridging is sport psychology but sport psychology traditionally doesn't focus on clinical issues and so when you when i went to school for my master's in sports psychology it it was about only performance based um tactics and techniques it wasn't about mental illness we read at the dsm which is the diagnostic and statistic manual so we knew about disorders but we were never trained to treat them so kind of the population that's supposed to bridge our gap doesn't always have clinical training and so for sport psychologists or sport psychology performance enhancement consultants they have to go on and get their clinical training to actually be able to treat mental illness huh that's such a fascinating setup and one that i didn't i mean i kind of had

like the curtain peeled back for me just in my professional career but i never really knew what those educational pathways kind of looked like so we're going to have a discussion that's very specifically focused towards eating disorders in an athletic population and i think one of the things that's going to come out of this conversation is that the way that we look at this and the way that we treat and help support those athletes in some cases and you're going to be the expert here in some cases are much different than you would treat a general population but before we even get into any of that and this is my my paranoia that i was speaking about earlier kind of coming through are there any like statements or efforts of full disclosure that we need to go through in advance and i'll throw out the first one that i am not trained in this area i'm not a clinical psychologist i rely on the experts whenever i have to whenever i have to interface with athletes that are dealing with this with these issues but you as the expert are there any other efforts of full disclosure that we have to go through before we start to dive into this um i mean when i think of disclosure i the only thing i can think of and it's more of a caveat is is just because somebody's listened to this podcast it does not make them an expert um whether it's identifying a treatment but you know really i think sometimes people like to listen a little bit and then they think they know a lot about it and so truly i think you know this is going to be informative but it certainly is not going to be all encompassing thank you for that i think that's really well taken

k and just because i am doing this podcast is not going to make me an expert either so just because you're listening you're not an expert let's throw that out there all right so let's let's set it up who who are the who are your i'm either going to use the word clients or athletes and i might use them interchangeably so what do you prefer um i i actually use three terms i use clients athletes and i actually use patients as well since i'm a trained doctor okay um but clients i usually think of kind of as a business exchange some people prefer that so we we can just do more athletes if that's our common term thank you for that i hate the word client whenever i'm talking in athletic terms because i think the exact same thing it's such a transactional relationship so we'll use athletes okay so why don't you go over really quickly what are the types of athletes that you most commonly see in your scope of practice so i actually have a really broad range with regards to both the type of treatment or the type of services i provide as well as the athletes i see um so from age range i i've seen as young as eight year olds as old as 65 70 year olds so kind of the full spectrum where i really do a lot of my work are adolescents college student athletes um kind of 20 something professional athletes where really it's kind of sports is really the large part of their life or the biggest part of their identity um within that then my practice is split where i've got one side of my practice i just do for pure performance enhancement so i work with athletes worldwide who just want support

with their their performance and they really want to be able to excel um one of the most common calls i get is from endurance athletes who say i train hard and i work hard and i show up on race day and it doesn't show up and and truly it's about they don't they don't know how to suffer in in a race situation and they really start to feel like they're compromising their training by not performing to the best of their ability so i do a lot of work around suffering and confidence and resiliency and how to really believe in oneself in any given day whether it's a training day or a performance day and then the flip side which is what we're talking about is my clinical work and so i'm a specialist in the treatment of athletes and eating disorders but i also treat anxiety depression i do a lot of trauma work around um you know whether that be kind of more big t trauma trauma like sexual abuse or war but i also do a lot of what is considered small t trauma so that could be a crash on a bike or a car bike accident something like that where people are like i should be able to get over this it's not a big deal but their brains don't always allow them to just get over it and so i do a lot of trauma work as well and how much this is me satiating my own curiosity and for full disclosure here how much does your what i'll call like your classic work in sports psychology kind of cross over with either the big t or the little t work that you do with athletes big t trauma or little t trauma right yeah um so actually when i do trauma specific work i do do the skill building so when i when i do performance enhancement work i really work um from a curriculum a mental skill building and i build a

toolbox of skills to help athletes be able to develop skills to think confidently and to respond resiliently um with trauma i actually use a totally different treatment protocol called emdr eye movement desensitization and reprocessing it's actually what i wrote my dissertation on and that is designed to treat trauma and it allows the brain to verbally or non-verbally process um the trauma and essentially what happens is when we have a trauma it gets stored in our midbrain our limbic system which is the most animalistic part of the most primitive part of our brain and then when we think about a healthy memory of a trauma so somebody who maybe has crashed their bike at a high speed or somebody who has been hit by a car um the the more adaptive type of trauma is stored more in the cortex in the frontal lobe and so emdr allows the body to non-verbally work through this and it's kind of the way i describe it is it's kind of watching the a movie of your life and your brain just works through it and you're not talking and there's a lot of silence um but it's incredibly powerful and it allows athletes to resolve their trauma so i usually start with that and then we go to the skill building if they're still struggling with confidence when they get back out there whatever it is they do can you uh take it just a brief moment and and go over for the listeners what an emdr treatment kind of like looks like like somebody who comes in and actually experiences that type of treatment like what like what actually is it so emdr there's the normal intake

where you gather all the information right that's the standard part the difference is is when somebody comes in for an emdr session like the desensitization and reprocessing that's what it's called basically we sit like ships passing in the sea so we you would sit like you are to me but to my side and i would sit right here so we sit very close in proximity which has been interesting during covid trying to figure out how to do this um but then so the original was eye movement so literally you would follow someone's fingers back and forth and and that bilateral stimulation crossing over the the meridian of the brain would allow the brain to start to process um i actually use attack audio equipment so headphones and then there's these little buzzers you hold in your hand and they alternate and so we create um it's guided it's very much a guided protocol so we answer standard questions every time and then i just say go with that and i turn on this this little box that i have this tack audio equipment and it alternates either by the sound in their ears or the buzzers and their hands go back and forth and their brain just starts to process and we follow the brain i observe the body and how the body's responding to whatever memories they're working through and i check in with them every i would say 30 to 90 seconds kind of depending on how the body's responding and we just keep going through that until more positive memories start to come up and resolutions apparent are they talking through the memories at this point or are they just like visualizing it visualizing they sit silently and they only talk when i stop and ask what's going on interesting um we'll put a link in the show notes

to your thesis is that okay yeah okay uh listeners can kind of reference that i think i think that's that's absolutely fascinating it's going to be a little bit too much in the weeds for for our discussion though okay so let's let's center things back here um we started out with this notion that in an athletic population eating disorders and disordered eating can be viewed at differently as opposed to a normal population and and one of the concepts in your book that i found really fascinating is this aspect of of radical acceptance of some of those ideas i want you to like take the reins on this one and go through why that is different in those two populations and how we should view the difference between disordered eating and an eating disorder specifically within athletes right okay so um just start to start with the term so eating disorders refers to a clinical diagnosis right so that's anxiety nervosa bulimia nervosa binge eating disorder this new category called osped other specified feeding and eating disorder which is those are kind of the people who have anorexic tendencies or bulimic tendencies um but they don't meet full criteria for one of those other diagnoses um so what can happen is is athletes when they're pursuing excellence whether that's you know for you know just basic uh you know master's athlete or rec level athlete or somebody who is you know an elite athlete international stage type

athlete um what all athletes want to do when they're serious in their sport is they want to get to the best they can be and in a lot of sports that's about optimizing nutrition and in some sports that's about optimizing body composition as well and so a lot of athletes will start to um manage their food differently they might start to take out certain types of foods a big thing is they start to eat clean or they go on a keto diet or the caveman diet right like whatever diet you want to pick they they start to read and listen to podcasts and they decide this is going to be the greatest diet for me in the clinical world this idea of starting to take food groups out of their diet this idea of starting to count calories and measuring food and tracking food those are all disordered behaviors and so when somebody has anorexia you look at those and you see those behaviors as maintaining a mental illness fitness for athletes they can do these things and be psychologically healthy so they can track their food they can weigh their food they can meticulously monitor how much they're eating on a given day as they prepare for a race and then the race passes and they stop doing it or their season's over and they go back to eating a cheeseburger and fries at no big deal and so it really is about this flexibility where athletes purposely choose these behaviors to optimize performance and to try and excel athletically when somebody has an eating disorder they use these behaviors to maintain their mental illness and so they stay stuck in these behaviors they can't ebb and flow out of them there's no flexibility

and so in either realm they're considered disordered eating behaviors in the clinical world but in the athletic context it really is about performance excellence it's about optimizing one's performance to the best of their ability knowing that nutrition and body composition can play a role so when you're like sizing up an athlete and what's going on within that athlete whether they're a patient of yours or you're just observing it i mean we've all been you know observing people either as friends as colleagues through social media in person and things like that you honed in on this flexibility component right that the athletes who that who have behaviors that would look like an eating disorder the the key between those athletes and somebody who actually has an eating disorder is they'll move in and out of those right they'll be flexible is that is that like the key thing to like focus in on when we're when we're trying to size this up yes yeah the ability to be flexible and really it's the you know the values behind it so an athlete who is using disordered eating behaviors to peak for a certain event coming up um they may say like okay i'm cutting out these certain types of foods i'm not eating processed sugar i'm not eating i'm not eating processed grains right like all the normal stuff um but then it becomes you know it's somebody's birthday party or they're on vacation and they're like i'll be fine for a week when i get back i'll go back on my plan and i'll continue to follow it people who are really more on in that eating disorder mental illness place they go on vacations and they continue to practice it they go to birthday parties and they continue to practice it they don't have

their child or their nephews or their grandparents birthday cake or anniversary cake because it would break their rules um and so there really is this rigidity they don't trust that if they break their rules that they'll be able to come back and perform to the best of their ability and so somebody who uses disordered eating to um peak and excel in a healthy way they that that flexibility but also it's about values like okay yeah i really want to do great in my event but i also realize if i have birthday cake this saturday because it's somebody's birthday nothing bad will happen to me when somebody starts to slide into the eating disorder that one slice of cake can throw off their entire season in their minds right and so they can't stop doing their rules they continue to follow their rules for fear of if i stop something terrible will happen and we see that a lot with athletes we see that and i mean i see this and i observe it and i've had athletes that are actually like that like this as well that we've had to get counseling where they have that type of rigidity and what i the way that i describe it is they're amplifying the effect of not sticking to the plan and sometimes they even do that with a workout right oh my gosh i didn't do interval number four you know and i only did three intervals or kind of whatever it is my season is lost it's the same thing with whatever dietary approach that they've done now with the why though is the on the diet side of things does it have this like big magnifying glass kind of associated with it where like i can i can usually

talk my way around listen this interval or this one workout is only one small piece of an entire training puzzle and my experience is the athletes will kind of understand that but for whatever reason that's not as translatable when we start to talk about eating and diets like it's just something that's like more like set in stone what so what what's at the root of that phenomenon or is this just in my own experience in my own head no there's truth to it you know i think part um our society our culture you know really i think over emphasizes the power of nutrition and the power of certain diets and so you know when we think about the messages we receive about food it's about you know anti-obesity don't eat these things they will make you obese and so really a lot of our nutrition messages and the diet messages are fear-based trying to instill fear in people and to encourage positive behavioral change um but beyond that you know and i think this is a really important point is there's a neurobiological component so when somebody starts to go into a starvation state their neurochemistry may be altered and so while you can say like okay it's okay you know just get back on get back on track tomorrow it doesn't matter that you went to a barbecue and you had all this amazing food your body will be fine maybe you feel sluggish but you'll be okay and then your brain your your neurochemistry is working normally but when somebody is in a state of starvation or when somebody binges a purge or somebody who just

binges you know and binge eating is actually really big among endurance athletes so we should talk about that too but this idea of um their their brain is stuck in this loop and the neurochemistry of their brain has them terrified and so it's much easier to not eat something or to avoid a situation that would make them feel as though they're going to break their rules because the serotonin and the dopamine in their brains are firing as though this is like the biggest life threat and so it's easier to avoid breaking their rules than to break the rules and deal with the chaos of the brain so they know our chemistry is that is the amplifying effect in that situation yes okay so how much does this sport culture play into this and we we have to keep in mind this is going to be primarily an ultra marathon audience but there are also other sport cultures to kind of take into consideration but we know that that has an effect on things right absolutely yeah so um you know i'm i will focus on ultra marathon and just running in general and endurance sports versus i mean there's ball sports and anti-gravity sports you know there's so many different sports and sport cultures but ultimately what it comes down to is when we exist in a culture that has certain values we start to internalize those values and so if you exist in you know the running culture or ultra running culture where there's a lot of talk about diet and nutrition and how to optimize your performance through you know really manipulating your diet and your intake then people start to internalize that of like i want to be successful too and if this is

what the successful people are saying and this is what the experts are saying then i should probably do that um but these are people who don't have a lot of education they probably don't have a lot of guidance and so they start to do it to the best of their ability with a novice level of education and the best of efforts can start to go awry um on top of that when you think about running i mean it's a thin body ideal right for as long as running's been a thing it's really been about um when we think of runners it's long and lean thin bodies and so when athletes are powerful and strong runners but they exist in a body that doesn't match the body type of their sport they really start to wonder and question can i be successful looking like this and they start to feel internalized sometimes externalized pressure to try and morph their bodies into quote unquote the ideal runner's body even though that may be far from their best body for with regards to performance okay you gave me you gave me two threads to pull on i told you this is going to be a long podcast beforehand kate you give me two threads to pull on we're going to take the first one first and that and that's that that's this aspect of influencers and how they can actually be influencers in this area and the second one is body image we're going to table that for a second everybody's going to have to just pause because we are going to talk about it's a big deal in sport but you pushed a hot button for me because i am starting to get you know my axles all grinding with a lot of the nutrition influencers you and i both know professionals in the space particularly over the olympic training center which is right over my

right hand shoulder right now and the registered dietitian community there is absolutely going ballistic trying to fight misinformation which is coming in large part due to all of a lot of these social media influencers that you mentioned have relatively low levels of education and are trying to uh they're trying to pass on their seemingly wisdom on to on to athletes what so why is this an issue right you see the manifestations of this in the actual athletes why is this such a big is such or is it just a big deal and should i calm down or is it a big issue and why is it such it is a big issue and it's a big issue because of social media right like all of the sudden social media expanded people's ability to be relevant to be popular to create a brand and so you know whether it's about dietary and nutrition information or whether it's about fitness and often it's the two right fitness influencers influencers also want to be dietary and nutrition experts because they've read some things or listen to some things um but you know i think it's really about this fact that we now have information literally at our fingertips 24 hours a day 365 days a year and none of it's filtered nobody's stopping to make sure it's peer-reviewed nobody's fact-checking nobody's creating caveats of you can do this as long as you're being followed closely by a dietitian or you

can do this for three months a year but if you do it beyond that it's going to have negative or deleterious effects on your health and so we all of a sudden have these platforms to create these personal brands and people want to be relevant and they make money off of being relevant you know i don't know how social media works and instagram and all that but i know certain clicks and ads get you more for money in your pocket um but the reality is is now we've got all these people who want to be a brand and who become a brand and this becomes their livelihood or their means for success and so they're not necessarily about wanting to find out all of the nutrition or the fitness education behind it they want to continue to create followers and so it's not necessarily about am i helping my followers learn to live you know healthy lives or live without me but it's about how do i continue to have followers and how do i continue to create relevant information what do my followers want to hear because my followers might not want to hear hey it's okay to have a larger um body or it's okay to have higher body fat or you know bmi because you can still be strong and powerful people want images and so they start to sell images and they start to sell content that is desirable well it's a the social media platforms i've said this on my podcast a number of times it allows people to punch above their weight right and it allows people to punch above their weight from a knowledge perspective from an educational perspective and that can be a very dangerous thing because all these platforms are very good forward

feedback mechanisms they're just going to feed you more and more and more and so you're going to seem like a genius because you're getting more followers and things like that but we're going to table the rant for just a second the end user is the one that is ultimately harmed in this whole influencer proposition and we know that the end users are confused it's hard for them to filter through that information because youtube and twitter and instagram they don't care right they're just trying to they're just trying to make the platform sticky but if but if the end user really wants to get high quality information what would your advice to them be i know this is like a little bit of a sidetrack from our initial discussion but i think i think this is something that you've probably seen like in your in your clinic in your practice so what do you advise people like how do they find the good people to follow and to be to be influenced by so i really encourage a background check right if if you're finding somebody who you enjoy following on instagram or youtube or you know whatever it is is stop and check the person's credentials and if they don't have credentials then explore whether or not following them is actually going to benefit your health your performance your happiness your well-being because without credentials people really are just pulling to create content and like you said to have that sticky platform to continue to entice their followers to follow them but if somebody has you know education to support what they're saying then by all means continue to follow them and see whether or not

their values match your values because i think that's another piece right is internalizing the values of somebody else versus really focusing on does this platform does this influencer support the values that i want to continue to protect and that i want to continue to follow as i pursue sport and athletics huh that's an interesting aspect of background check i like that okay we're gonna do a hard pivot towards body image i promise the listeners i promise you that we'd talk about this a little bit um this is a really hard area to talk about in in sport and it seems like every three months some sportscaster on one of the major networks makes some flub and it's in particular when they're talking about women's sport whether final four is going on right now when this final four but it doesn't matter what's final four or track and field or whatever the prototypical comment is we're watching a women's sport and some commentator make some comment about the athlete's body or body type gets completely demonized on social media sometimes that is rightfully so and it it seems to have one of these prototypical positive feedback loops where it just becomes more in it just becomes something that can't be touched right but the reality is especially in high high performing sport context you have to discuss certain aspects of body image and or weight with athletes and how to how do athletes navigate that

like how do athletes navigate this need to want to perform and lose a few pounds or become whatever body type that they need to perform and not take it to the extreme where they're being overtly or overly influenced by achieving that body image or body weight goal mm-hmm so what i would recommend you know is that that's a lot to respond to yeah i know i know thoughts for a second but you know when it really comes to you know i think there's the question for the coaches as well as the question for the athletes but you know what i really encourage all athletes to do is optimize your nutrition get get with a really knowledgeable sports dietitian um somebody who your coach or somebody who a family member or a teammate knows and trusts and has success with and ask them how do i optimize my nutrition right get um get your metabolic your metabolism check them you know use a med gym to check your rmr um do a body composition testing talk to your coach about what what's my optimal training and between doing optimal training and optimize nutrition your body's going to settle where it wants to be often what happens is we think in our heads well i'm five six so i should weigh blank as my race weight and we like to identify a number as our criteria criteria for our best performance state but truly if somebody is improving and

progressing and their nutrition is optimized their body's going to lean down to where it wants to lean down to and it will learn how to hold that and maintain that and you don't stop thinking about food until you've gotten food and this is you know if you run out of fuel and you're out there and you're like oh where's the next gas station or when am i gonna get back to my car i can't wait to eat donuts or cookies right and and you want high sugar high fat foods because that's what your body's craving if you're spending all day thinking about what you're going to eat and what you can't eat and what you just ate because you're trying to lean down to a certain weight your body's bonking your body's not healthy it's not happy that's too low for it and so again athletes may have a period a short period of like oh i'm going to lean down as best as i can for this event but i know that this isn't sustainable um but if somebody's constantly daily bonking constantly thinking about food and what they can eat and they can't eat it tells them that their body composition isn't where their body's going to be healthiest but you're i mean to to put that in a nutshell you're saying focus on the nutrition and let your weight kind of come into a natural area right right yeah this is the same thing we advocate as you know right we advocate for our coaches and i was discussing this with one of my colleagues the other day i can only come up with a very small handful maybe two or three instances in the entirety of my coaching career which is 20 years hundreds of athletes at this point where i have said i want you to get down to this weight by this date and it's always been in the con in it in any of

those small instances it's always been in the context of that's what they came to me as a goal for and they were overweight over fat to begin with and they knew that they needed to lose like some more on the order of like 100 pounds we said okay we'll just go ahead and we'll set it up this way but outside of those really small you know very very very small fraction of the athletes that i've worked with i've never said a quote-unquote race weight for any athletes even the most high caliber ones i don't i don't i wouldn't do that if i worked with a lot of weight class sports though and that's where i'm conflicted right because i know with that you have to like if you want to make the 145 pound you know weight limit in weight lifting or judo or some sort of you know boxing or mixed martial arts or something like that you have to say you have to be 145 pounds by the time you step on the scale there's no avoiding it right right and so that's where that that idea of like i can do this for a short period but then i know afterwards i'm going back to you know if my body naturally wants to be 152 i go back to 152 i train 152 and then i work closely with a dietitian to bring myself down in a healthy way um you know thinking about wrestling all the all the athletes who used to work out in garbage bags and sweatpants you know like those things still happen and they're insanely unhealthy and people die from it um but when you've got somebody who can help you really carefully measure your health and well-being as you come down to that weight compete at that weight and come back up and then you can do it in a relatively healthy

way if people can't do this slide right if they can't go down to the the competition weight and then come back to their healthier weight and they really struggle with that and psychologically it might not be the best sport for them and so i think there really is kind of again this value space system of what does sport bring to me but also if i have to compete at a certain weight to be competitive and that's really hard on me psychologically then maybe i need to reevaluate what it is i'm pursuing and what my goals are i like that psychological toll that you just mentioned and i think that this goes a lot hand in hand with when we're trying to optimize performance because if you're undertaking any type of activity and we just talked about weight management as being one of those activities but any type of training activity that takes a large psychological toll on the athlete a large negative psychological toll on the athlete you might as well just erase a couple of weeks of training and it doesn't matter whether that's a training prescription or a weight loss prescription or a dietary intervention or whatever if the thing that either the coach is prescribing or the athlete is prescribed or the athlete is prescribing or some person in their support network is prescribing has a larger negative psychological toll than whatever physical benefit that they're getting out of it then you might as well not do it in the first place like you always have i guess what i'm trying to say is you always have to think about the net effect of some of those actions exactly i would agree because they all compound right and a lot

of times when we're talking about weight management issues you can the confounding factor is and you're gonna have to put your coaching hat on for a little bit the confounding factor is is as a coach you can get a pretty good idea of the of the potential performance benefit from x percent weight loss because there's calculations to do that right there's kind of hard it doesn't matter whether you're cycling and you're going to you know go up a climb or running there's it's and it's pretty i'm not going to say it's i'm going to use the word easy but it's simplistic i guess is a better word it's simplistic to do right because you can run x percent weight loss you can run it through an equation and you can say i'm going to get y performance benefit and a lot of coaches and a lot of athletes will look at that and say wow if i just lose five pounds i'm going to improve 40 seconds on my 5k or whatever it is but they don't realize the other effects that go into creating that weight loss whether that's a classic energy reduction or like we were just mentioning the psychological toll of things so can can you putting your coach in your kind of clinical how can we kind of contextualize what that psychological toll might actually be when we have athletes that are going through these rounds of potentially trying to get into some sort of optimal weight that they've designed in their head or through their team or whatever yeah so um first i mean i just need to say like kind of blanket statement maybe this is what i would have but then disclosure at the start is i am an advocate for health at every

size so i don't believe weight loss is essential for anybody um and i think everybody can be excellent in their own versions and you know and so i think it's important there there are athletes who are going to show up and say i want to lose weight or i know i'll perform better if i do lose weight but i'm also an advocate for people learning how to be in their bodies as they are and how to enjoy sport and movement and be competitive in that way too you know so i just need to say that i am a huge advocate for health at every size um but going back to you know that question about can we you know kind of tally the toll of dieting and weight loss the problem becomes is when somebody starts to work on their number right so if it's if i lose five pounds to improve 40 seconds on my 5k now all of a sudden instead of focusing on um the their dietary approach and instead of feeling successful in their training and how they're improving over time each and every day when they stand on that scale that dictates their mood for the day and so if they're like oh man i'm up a pound from yesterday then all of a sudden they feel pretty crappy about themselves they feel really crummy about how they're doing and their plan and who's going to be disappointed or will they ever do it and so my concern is when people start to focus on a number on the scale their mood gets attached to that number and then that becomes the psychological tool versus if it's hey let's work with this dietitian and let's do this training plan and in your head you have your calculation and you know what you're working towards and you're

talking to the dietitian about how you're going to get there but if they're not preoccupied with that number psychologically they're not going to be impacted by it being up a pound or down a pound especially on race day like imagine if they hit their their race weight two days before and then they show up the day of and they're two pounds heavier because of natural hormone and water you know how we hold water now their confidence is going to go out the roof and so for me the number becomes that number itself having a weight becomes so psychologically impactful with regards to mood and confidence that it really um starts to hurt performance but also well-being so what you're saying is is don't tie the weight too much to the performance is kind of what i'm getting from you because that can be just as big as a of a performance barrier as anything else and we we see the same thing with workouts workouts right there's a and this is oh i think that this is a horrible workout design and i'm going to try to tie it to the analogy of the weight right where you have an athlete or you have a coach that is overtly fixed fixated on some kind of time trial-esque uh workout that they know that they need to hit it's this one key thing that's four weeks out from their event and if they do great it gives them a big psychological boost and if they do poorly it gives them you know a very poor you know psychological floor to kind of go down to i've always looked at that it's like you might as well just go to vegas if that's your training strategy right if your training strategy has this linchpin of this one

workout that is going to give you an up or down arrow you might as well just go to vegas sit down at the roulette wheel pick black or red and you'll have the same kind of result because you don't know how that thing is that how that's how that is going to go it's almost the same thing on scale because there's so much day-to-day fluctuation and if you're if you're putting too much value on that day on that daily number to tie to a theme that we talked about earlier the the fixation on that on that highly fluctuating day-to-day number affects things more than what they would naturally be affected by and it affects things for the rest of the day your workout and everything else right yeah i mean and then if you just think about how stress high cortisol levels start to impact holding weight right if you're preoccupied and stressed about having to lose weight and then your cortisol levels go up right all of a sudden now we're starting to talk about how stress is impacting weight loss and performance you know and so really if it's hey let's let's monitor weight and see what it does but let's follow our training plan let's work with you know this really awesome nutrition plan that you've got going and let's just see and they may be pleasantly surprised they may drop seven pounds before race day because they're not even thinking about it um and they're not constantly trying to restrict right because the other thing is is when people start to intentionally restrict the body gets scared and the metabolism goes down and so their body's like i don't know what's going to happen here because i don't know that i want to let any excess weight go at this time and so you know the more

they stress the more they focus on it um the more the body the mind and the body both react to that as well because when the body goes into a state of starvation it's not happy and it's trying to keep trying to force it it actually really makes it even an even stress more stressful process yeah so you know uh i'm sure you're aware one of the ways we've mentioned this a couple of times with the weight class sport athletes uh so the athletes that have to get to a certain weight in order in order to compete they have made tremendous strides in the last probably five to seven years with the whole practice of weight cutting now they still have a long way to go let's get that out of the way they're not absolved of they're not absolved of all of their issues quite yet but several years ago it was a total shit show across a lot of the different sports with all due respect to the very fine practitioners that were trying to make a big difference and if you look at it globally it was a total it was a total shit show but one of the more market changes that they made that's important for the audience here is when they had when they had those athletes go through those weight cuts they would always give them a a longer term and sometimes that was months and sometimes it was seven weeks perspective on what they should expect so that they weren't tied to this daily fluctuation as much as as much as they are naturally inclined to and i think with training that's a good analogy to to take forward as you always have to have a long-term lens on things yes and realize some days will be amazing and some days

will be terrible but it all averages out if you stay consistent and take care of yourself okay we're gonna we're gonna make a hard turn here and come back to an area that that you taught that you talked about the very beginning of podcast and this is this aspect of binging which is uh which well i'll let you take the floor is this prevalent in endurance sports and maybe we can try to define it first and then what are the like recognized consequences of this and how should athletes go about trying to avoid this this this issue right so um it is very prevalent in endurance sports and um you know endurance sports as well as anti-gravity sports something like climbing where strength weight ratio also matters um but you know oftentimes when people think of binging or a binge eating disorder they think of larger body individuals who have quote-unquote no discipline right there's all these stigmas that go against binging and people who are in larger bodies and what that must mean about them um but the truth is i've worked with a lot of really lean athletes like you would look at them and think that they are in their prime type of lean athletes muscular low body fat performing really well who binge daily or regularly weekly um seasonally from time you know throughout it ebbs and flows throughout their season and so binge eating disorder is the presence of binge eating binge eating is this idea of you can't control the intake you can't stop the intake and so it might be that you start with eating dinner um but you find that you're ravished and all of a sudden you know i don't want to say it has to be

exactly like this but then all of a sudden instead of just eating two slices of pizza you end up eating the whole pizza and then you eat a bag of chips and then you eat the carton of ice cream like that type of binging sometimes people describe a binge um but a binge for some people and i see this a lot with endurance athletes is look i have a meal plan and i have an allotted amount of food i'm allowed to eat and if i eat beyond my allotment it becomes a binge no binge is feeling out of control um you can't stop yourself you eat to the point of being physically uncomfortable um there's a lot of shame around it there's a lot of physical discomfort there's no actual medical complications to date that have been measured or recorded but it's more the emotional toll of oh my gosh how did i let myself do that and also the physical toll of okay maybe if i was up till midnight bingeing last night there's no way i'm going to wake up at 5 a.m and do my workout or maybe i'm just not even do my workout at all today because my body is trashed from what i just put in it last night the problem with binging and what i really see with regards to endurance athletes is they restrict all day and so they just don't eat enough all day long and then they get to the evening and their bodies are starving for good reasons because they've really stressed their bodies through life through workouts through undernourishment and that's what triggers the binge and so really for binge eating um i think it's actually probably quite common among endurance athletes i don't know how many talk about it but it's it's a regular conversation in my office um but really it's about if i can start to eat more consistently and adequately throughout the day then from you know the nutritional standpoint

from the metabolic standpoint my body's not craving all of this extra food and then it doesn't trigger me into the binge you know and certainly there's the neurobiological piece of it as well with regards to how the neurotransmitters are firing but often i mean i would say nine times out of ten it really is about i've been restricting all day long i restrict all day every day and that continues to perpetuate the binge cycle what's the genesis of the restrictive all day long piece of it though um well one of the biggest ones is intermittent fasting oh god you're you're starting to trigger me now okay okay keep going so i mean we're gonna we're gonna bring this back up by the way we're gonna bring up fasting and all this kind of stuff in a little bit because you you started it fair um but i mean intermittent fasting i think is the easiest one to show right this idea of like well i don't eat till noon but before noon i go and i do my training workout and then i go do life and i do this mat and i start eating at noon well your body is already ravishingly hungry by that point and people say i feel better doing this and i i enjoy doing this but what's going on is they end up typically binging in the evening during their okay period when they're allowed to eat but then that can really trigger you know real binges true binges with regards to the psychological disorder of not being able to control the intake um so a lot of it is is athletes who like to eat less earlier in the day um and then they they basically have this goal or this hope that well i'm not going to binge today but when your body's starving and you've got this behavioral pattern um it's hard not to binge right

i mean i've got athletes who tell me they white knuckle it they're clenching their teeth they're they're brushing their teeth trying to get the taste of food out of their mouth before they go to a binge they're getting out of their homes and they just can't stop it because their bodies are so hungry and psychologically but part of what goes on from a neurobiological perspective is it's the anticipation of the binge that's really rewarding so it's not so much the binge that's enjoyable but the anticipation of the binge that gets really exciting um when you think about a lot of ultra and endurance athletes they're kind of adrenaline junkies right and so their their brains are already kind of fired to look for these high stake kind of high um payoff types of events and so there's also that piece where they're they are already have maybe a bit of an addictive or a bit of a mindset that really looks for these really exciting things to go for right and and then the binge is something really exciting to think about once you're in it it's not fun nobody's ever told me they enjoyed the binge yeah but the anticipation of the binge can be really enjoyable for some people so in the ultra endurance community there's been this kind of phenomenon over the last several years where athletes will undertake nutritional and training interventions very specifically to try to enhance their their fat oxidizing capacity and so and some of those are they try to go on fasted runs sometimes they do a dietary manipulation sometimes they'll do a two a day you know training session so they're

training with low carbohydrate availability there's a big there's a big range of all these different all all these different strategies you know you touched on the intermittent fasting one which has become which has had the spotlight put on it both in athletic circles and i'll also say in popular circles because of all those social media influencers that we mentioned earlier that we won't throw under the bus for those of you not watching the youtube version kate's got a shitting grin on our face and is not in agreement here um but um so i've always had i've always had an issue with these strategies from a fundamental physiology standpoint first and then the consequential ramifications of it that you have to deal with second so fundamentally i look at the strategy to say okay endurance athletes are great fat burners in the first place trying to double down on something that you're already really good at is not something that i would put it is not something that i would make a linchpin of somebody of an athlete's training program i want to that could kind of we could have a whole another podcast on that and i have had actually podcasts podcasts about that we don't need to talk about that a little bit too much but how can athletes who don't exhibit disordered eating when they get into these types of strategies unbeknownst to them start to fall into like your practice right where you see them at the tail end of

it and all of a sudden they go from a perfectly healthy athlete to somebody that you've got to like dig out of the hole i mean does that does that actually happen that is 99.9 of who i seriously that much yeah so it's not so i guess what i'm trying to do is i'm trying to make the distinction for people who are like looking at something like intermittent fasting or whatever that are that are already like in this disease circle right but what you're saying is is the practice can catalyze somebody who is who shouldn't see you right you're saying that practice actually catalyzes that person from going from a normal healthy person to somebody who ultimately is seeing you and getting treatment from you yes i mean and to go back to your you know your example of going to vegas it kind of is like playing rule up because some people can do this right and psychologically they'll be totally fine and other people do it and they jump on the eating disorder wheel before they even realize what's going on and that i mean that is truly who i see nobody ever says i chose to have anorexia and so i started doing this right and it was always um you know it's either i started this diet or i wanted to improve my strength to weight or my power to weight and here i am three years later with binge eating disorder um you know sometimes as a coach told me to lean down here i am with anorexia right so it's never that anybody actually chooses an eating disorder but what they choose is to try and manipulate their dietary intake to change their body shape

which for some athletes turns out okay and for some athletes it doesn't turn out okay okay but nobody ever chooses the eating disorder they choose the behaviors to try and excel and it becomes a perfect storm for some athletes when we think about risk factors there's the genetic risk factors of somebody who has a family member who had an eating disorder before them that increases their risk so if somebody's got a parent with an eating disorder do not play with it like it's just you're playing with fire it's going to blow up in your face um you know so it can be genetic predispositions um temperament personality predispositions so high achieving people pleasing hard working like when we think about the typically very successful athletes those very traits are the same exact traits that it takes to manage and handle anorexia people pleasing high achieving self-sacrificing disciplined um um so personality plays into it life events so if somebody's like oh i just went through a divorce and i'm getting into ultra running and i'm going to give everything i have to try and become my new self right as they're dealing with this emotional chaos on the side they may not pick an eating disorder but they may end up in an eating disorder or parents divorce you know so life events influence it as well so there's all of these sport risk factors that athletes face just with regards to body ideals and um discussions around nutrition and dietary science and and the you know just even being in the world the sport culture that normalizes being amenorrhea normalizes bradycardia and all these

things that the culture just holds but then they've got all of the other life influences as well with various genetic predisposition and life stressors and um temperament personality traits relationships and so it the athletes really face i would say we often think of athletes as having like more resiliency because of their success and experience in sport but even though they have more experiences and success and a stronger sense of self they also face more risk factors so when when they throw the ball on the table and it rolls and it lands red it turns out bad it's a wheel by the way not a table oh sorry you'll spend a lot of time gambling that's okay but kate i mean this has been this has always been one of my biggest issue with people who play nutritionists that don't have a classically trained background in it is they don't know what type of fire that they're playing with and especially when it comes to these very restrictive types of diets whether it's ketogenic diet low carbohydrate diet in intermittent fasting we can run through the whole deal if you haven't had this classical type of training and even when you have it is at to your point that it's seemingly almost random it's very hard to discern when you're going to use an intervention with an athlete and it's going to positively benefit them you're going to achieve this outcome that you want to achieve that you know they're going to oxidize more fat or whatever the goal is without consequence or there is a bad

consequence to it and it's i mean it is really hard to i've always had this sense and it's good to hear you say this it's always it's it's almost impossible to distinguish on the front end who's going to be in what category or whatever whatever part of the spectrum i hate to put people in buckets like that or wherever they're going to lay on the spectrum right so this brings me to my last piece and they're going to be listeners out there and they're also going to be coaches out there and this is for for myself we all want to help right we and we see and we observe people and you we we've all been through this like ah this person we need to get them help that person we need to get them help this other person we need to get them help or whatever this is normal that is normal we're going to normalize this and we've all been right and wrong in all of those categorizations right i've looked at it i've looked at athletes and say no they're fine and it turns out five years later they weren't i've totally made that wrong call i've made right calls as well and i feel that it's almost just totally totally random right for the people out there that they're out there that are listening how can they help how can they observe something whether they're a coach or a friend or a colleague or whether how can they help or when can they decide when they need to come in and intervene so you know i think one of the biggest things is is really challenging the stigma around mental illness i mean within the athletic population there's so much belief that i'm an athlete i'm supposed to be mentally tough i'm supposed

to be mentally strong i'm supposed to be resilient i'm not supposed to have any problems that people pleasing high achieving temperament and personality style versus normalizing like hey if you have an off day it's okay or hey you know if you're struggling with your body image i'd rather know that you're struggling then assume everything's okay and you're just doing this crazy diet because you want to be a great athlete you know so i think for coaches for athletes to really normalize that mental health affects everybody it doesn't matter who it is um athlete non-athlete weight class sport endurance sport ball sport eating disorders don't discriminate they affect people of all shapes and sizes genders races ethnicities sport types they really don't discriminate against anybody so i think really one of the big things is is being open to having conversations and normalizing that this could happen to anybody and it doesn't mean that you're good or bad person or did anything right or wrong but it really is you know it's that perfect storm so many things come together that create and ignite this fire that can be really devastating for people both with regards to their immediate health but also their long-term health and well-being um i think another thing is really checking our own implicit weight bias because i mean it's this it's even been studied in clinicians who treat eating disorders i mean there there's weight bias when we think about our culture and our society that we've grown up in there's a lot of belief about thin bodies are good and healthy and um successful and larger bodies are not good and not healthy and not successful and so we already have these implicit weight bias that we need to be aware

of and be aware of what messages are we passing on because even though you may think that i am totally accepting of a athlete in a larger body but if you continue to talk about how losing a little bit of weight might help them right there's your own implicit weight bias being put on that athlete same with dietitians right this idea of like oh well you're at 22 body fat if we got you down to 18 you'd be amazing that's a weight bias being put on this person that may or may not be struggling and if they are struggling to hear their coach and their dietitian say like yeah you're right your body's wrong we need to change it that starts to influence their psychology and their experience of their body you know so being aware of our own implicit weight bias and being really sensitive of if the athlete's bringing it up and if the athlete's asking me about it and how to change it then maybe i'll bring it up but also talk about the dangers of what might happen if we start to play with this versus assuming that athletes want to have these conversations and assuming that athletes want to meet these body ideals that are perpetuated in sports i think really just being aware of implicit weight bias is so important as we continue to learn about ourselves and the athletes we work with for athletes learning how to speak up you know one of the largest things is this athletes don't have anybody that they talk to about their hard days they don't talk to any about anybody about what's going poorly in their lives and realizing that you don't have to be tough all of the time whether it's a friend or a family member a teammate a coach right people will filter that and say like oh i think i think this is a little too much i think

you should probably find a therapist or a counselor to talk to but realizing that talking about emotional struggles and life hardships is a really important part of healing as well so an important part of success because if you continue to run with these burdens and these hardships it's really hard to let them go and let them exist in the past and be present with what's right in front of you so you know i think for athletes realizing that vulnerability is actually a source of strength versus a source of weakness yeah and this is what kind of putting my coach mentor hat on this is what i tell our coaches all the time is you make your money when things aren't very good it's easy to like be a cheerleader and when you know the when you're when your ftp or your uh fitness chart is like always going vertical and one day is better than the next and you're setting pr's left and right that's easy coaching like nobody anybody can kind of do that but when things are kind of down in the dirt and athletes lose or they get injured or have to deal with an eating disorder or whatever else is out there that's where coaches can kind of really make their interdisciplinary money because they have to play a role in kind of in all these areas um so where would you send somebody like me you know me we've known each other for a long time right i'm always looking to like up my game in certain areas and i've been on this podcast before uh with uh somebody who you might know up in the front range area justin ross um who's given me a lot of resources on the sports psychology thing because that's a that's a that's a that's a sword that i need to continually sharpen

because i didn't grow up in that in that area specifically within your domain kate if i wanted to like up my game up my coaching game in your area of expertise where should i go so um like if you mean literally where should i go there is a conference every year called eating disorders in sport which is really about um just educating people bringing the um sport culture and the clinical culture together right bringing our communities together to allow them to better understand athletes better treat athletes um you know there are some basic online resources through ncaa has some basic information that they share if people just want the basic there are certainly you know um also ask which is association for applied sports psychology they have like a little handbook or treatment manual i can't remember what it's called i contributed to that several years ago um so there are resources out there um but truthfully i what i encourage coaches to do specifically is or you know people who are in the sport world dietitians athletic trainers physical therapists get to know a clinician in your area right because part of it is having a really strong referral and a consultation somebody who you can call and say hey this is what i'm seeing this is what i'm witnessing what do you think and because if your gut saying something's wrong there probably is something there and it'd be nice to have a clinician to be able to bounce it off of who says like oh i think you're fine or send them in let me do a consultation with them and we'll talk about it and realize that for every person that you consult on you may they may

do consultations and the person shows up and they they play it cool and everything's good and oh yeah i i'm flexible and i eat birthday cake and i go out to dinner with my friends and then all of a sudden you know we realize that they keep getting these overuse injuries and they keep getting stress fractures and we're like something's just not adding up right and so you bounce it off again but i think having resources in your community um that you can bounce people off of bounce athletes off of is really important just to be able to have that second opinion um certainly there are books out there my book will be out there within the next six to eight months that'll be a resource that i really intended for everybody and so that's something that even gives people a basic idea of what this field entails but i mean ultimately i'm a psychologist i love relationships i think having relationships having people to consult with and bounce things off of is really important just to ensure that truly the athletes are thriving under your care and your support for athletes if they're up go ahead oh no no i was gonna say i'm so glad that you mentioned that because that's that's one of the linchpins that we use is just build out your professional network because you're never gonna no matter how many conferences you go to and you know certifications that you get and things like that you're never going to be as good as the people who do it for a living every single day and you've got to have it all right um so that's that's a very that's a point very well taken kate you mentioned your book you can absolutely plug your book here this bond this podcast will never have any sponsors but for people like you you can plug the crap out of

the book that's coming out and by the way for the listeners kate gave me a preview of the book i read it over the last couple days i read about 50 of our last couple days and i skimmed the rest of it it's something that i will have in my library that's sitting over my right hand shoulder here along with a lot of the other reference materials i have it's also something that i'll recommend to our coaches it is really good it's something that i wish i had when i was a 21 year old coach and kate and i met for the first time because it's something it's so true it's so i didn't know i needed it at the time i didn't know i needed that education at the time but now i wish i kind of had it so what's the name of the book when can people get their hands on it the book is treating athletes with eating disorders and it's due to be published this fall so fall of 2021 october november timeline is currently our timeline okay i'm laughing because listeners will know i'm going through the process of writing the second edition of my book and the timeline has definitely been flexible so the fact that your timeline is flexible it goes along with the theme of things um if there's a link i'll absolutely include it in the show notes and then when it comes out i'll plug it kate i hope i wish you the best with it uh and it is it is it is a really good resource good job good job doing it and what i what i will say is as a consumer a lot of different groups will find value from it athletes coaches clinicians the whole range can pick it up it's a pretty easy read it's also a technical read at the same time which is a really hard thing to blend um uh but but it but it'll serve a broader community uh as opposed to

just the clinicians correct yes i tried to write it to be a resource for everybody and truly i tried to write it so you don't have to read the whole book cover to cover you can read the book and open it up and read certain sections that are more relevant or of interest to you awesome well i look forward to coming out i know you look forward to getting it off your plate and seeing it seeing it or print um anything else you want to say kate before we say before we say goodbye to listeners no i thank you for your time this was really enjoyable and you know truthfully i just encourage people to be curious whether it's an athlete running and they're like maybe some of that stuff related to me or some some of that i'm curious about bounce it off your phones bounce it off your coach bounce it off the dietitian you're working with to see whether there are issues there um you know because curiosity is really what allows people to heal but also allows people to to practice flexibility because if they realize that oh maybe there is something there they can start to work on changing it before it becomes a full-blown clinical issue i love it be flexible people don't be so rigid we need that across a lot of different areas of life so that's a perfect place to leave it okay thanks for your time we'll bring you back on the podcast soon maybe when the book comes out how's that sound okay sounds good thank you so much all right folks there you have it there you go thank you to dr bennett for coming on the podcast today as always i learned a lot links to everything that we discussed are absolutely in the show notes good luck on your book launch you guys go and check out that book when it

hits the shelves in the fall of 2021 and hopefully we can bring kate back on or dr bennett forgot about that we can bring dr bennett back on the podcast when that book comes out because i learn a lot each and every time i get to discuss this very interesting topic thank you to all the listeners and as always we will see you out on the trails