Date: April 25th, 2018
About Dr. Kate Bennett
Dr. Kate Bennett is a PsyD psychologist at Athlete Insight in Denver who specializes in sports performance and eating disorders among athletes. You can see her vast array of qualifications and experience on her website. I asked her to be on the podcast because eating disorders and disordered eating behaviors run rampant in the climbing community, and I wanted her to chime in to give us a little perspective.
Strength to weight ratio is important in our sport, but we sometimes take our desire to be lean to unhealthy extremes. I see it in my nutrition practice, among my friends, and even within myself at times. We’re brainwashed by society into thinking that we need to be super lean – often unhealthily lean – to look good, but our sport makes us take that even further.
I talked to Kate about the eating and exercise behaviors she considers unhealthy in athletes, what to look out for in yourself and your friends, and how to approach someone if you think they might have a problem. This was a super informative and honest interview that will help people identify eating disorders and disordered eating behaviors in themselves and people around them.
Dr. Kate Bennett Interview Details
- Disordered eating behaviors to watch out for
- Why having an off-season in climbing is important for health
- Physical signs and symptoms of an eating disorder
- Difference between eating disorder and “disordered eating behaviors”
- How disordered eating affects mental health
- Why athletes have a leg up on non-athletes for healing eating disorders
- Behaviors of “orthorexia”
- How to approach someone you think has disordered eating
Dr. Kate Bennett Links
- Website: www.livetrainthrive.com
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Neely Quinn: Welcome to the TrainingBeta podcast where I talk with climbers and trainers about how we can get a little better at our favorite sport. I’m your host, Neely Quinn, and one announcement before we get into this interview: that is I’m taking about 10 new clients for nutrition right now. I took about 30 on last month and have been having a really good time working with people on their nutrition.
I’m helping people with their energy levels, getting them to fuel properly for performance and seeing some pretty impressive performance gains just from fueling properly. I’m seeing a lot of people have more energy, their digestion is clearing up, they’re leaning out, and they’re just feeling better overall.
If you want to work with me you can go to www.trainingbeta.com/nutrition-coaching and all of my services are on there. You can find out more about me as a nutritionist and as a person and I would love to help you with your athletic endeavors, your health goals, and your weight goals.
Which brings me to the topic of today: I asked Kate Bennett to be on the show. She is a psychologist and she specializes in sports psychology as well as eating disorders for athletes. I thought she would be a perfect person to talk about this issue that we have in the climbing community where we want to be as lean as possible because it is true that the strength-to-weight ratio is important to an extent as climbers.
I think that a lot of us take it to a sort of unhealthy place. I myself am included in this. I have fallen victim to the idea that I need to be leaner, leaner, leaner, you know? While I try to do that as healthily as possible it does affect my self image, it does affect what I eat, and I’m being really honest with you guys right now because this is something that I think is really important and I think it affects a lot of us, men and women. If we let it go too far it can affect our health a lot.
It can affect women in that they’ll stop getting their periods, they’ll get osteopenia or worse, they can have problems with their heart. Men can maybe have low testosterone, they can start to have energy deficits and other things. Kate will talk all about that and she’ll also talk about the differences between eating disorders and disordered eating behaviors, what we can look out for in ourselves and how it can affect our lives mentally and physically, and how to approach people if you think they might have a problem.
I’m going to stop talking and I’m going to let Kate continue this. I’ll talk to you on the other side. Enjoy.
Neely Quinn: Welcome to the show, Kate. Thank you very much for talking with me today.
Dr. Kate Bennett: Absolutely. Thank you so much for having me on.
Neely Quinn: Yeah. Can you tell me a little bit about yourself?
Dr. Kate Bennett: Yep. My name is Kate Bennett. I’m a clinical sports psychologist here in Denver, Colorado. I have my own private practice, Athlete Insight, and what I do is I actually split my practice into two segments. One part of my practice is pure performance psychology, so helping athletes thrive in competition settings or training settings where confidence or resiliency might become an issue. I help athletes build mental skills and present the best versions of themselves athletically when it matters most.
The other part of my practice is actually a clinical aspect and I specialize in the treatment of athletes with eating disorders. I have a book chapter on that so that’s definitely a passion of mine and something that I’ve pursued professionally to be able to allow athletes to be the best version of themselves both athletically as well as mentally and physically.
Neely Quinn: You are the perfect person that I wanted to have on the show. I’m so glad that we’re talking because as climbers, as you know, we have a lot of performance psychology questions and issues, as every athlete does, and I think that eating disorders are rampant in our sport.
Can you tell me about the kinds of athletes that you typically work with?
Dr. Kate Bennett: When you say the kinds of athletes I see that split into two questions. Demographically I work with athletes as young as 10 and as old as 65. The majority of my population is high school and young adult college student athletes, and then I also work with a lot of professional athletes, so the demographics kind of span the age spread and really I work with anybody who’s motivated and really wants to excel in regards to being the best version of themself personally as well as athletically.
The other part of that question is what sports do I work with? My background is actually in cycling so I work with a lot of endurance athletes but I also work with ball sports, I’ve worked with climbers, I’ve worked with more [unclear] sports like figure skaters and gymnasts and so when you say, “What kind of athlete do I work with” it’s really an eager and motivated athlete. Age is just a number to me, it’s really more of the mindset and willingness to get some work done that’s important to me.
Neely Quinn: Got it. Okay. And you’re in Denver, right?
Dr. Kate Bennett: Yes.
Neely Quinn: Okay.
Dr. Kate Bennett: I’m in Denver but I have athletes worldwide. I do a lot of online work so I’ve got a lot of people who show up in my office every day but I also have people who we meet over Skype or Google Hangout or that sort of thing, so I’m not limited by location.
Neely Quinn: Okay, which is cool because if somebody wanted to work with you after listening to this podcast they could do that, no matter where they are.
Dr. Kate Bennett: Absolutely, yeah.
Neely Quinn: How can people find you?
Neely Quinn: How long have you been doing this?
Dr. Kate Bennett: Let’s see – I started my practice about five years ago. Prior to that I actually worked at an eating disorder treatment center so I really got to know the in’s and out’s of eating disorders. My goal was if I was going to be a specialist in the treatment of eating disorders, I really needed to understand the illness from the most basic level as well as kind of the intensity of it and the severity of it so I did that for about three years and then I decided it was time to launch my practice. I came out to do my private practice and work with athletes on an outpatient level versus the intensive treatments and programs in a hospital setting.
Neely Quinn: So you’ve seen both sides of things.
Dr. Kate Bennett: I have, yes.
Neely Quinn: Every side of things, really.
Dr. Kate Bennett: Yeah, for better or worse. It can get really ugly. This illness can be really nasty but I love helping people overcome it and athletes are super motivated so I would say they’ve got something that a non-athlete doesn’t have when it comes to overcoming an illness like an eating disorder.
Neely Quinn: What do you mean by that?
Dr. Kate Bennett: When you work with athletes, they know what it means to be successful and they know what it means to work hard and they know what it means to be willing to suffer for something greater than what they’re already doing. Ironically, those same traits are what allow for somebody to be set up for an eating disorder. Perfectionistic, hard working, self-sacrificing, people pleasing, all those same traits that allow athletes to excel athletically are also kind of the same exact foundation that it needs to develop an eating disorder.
Within that, athletes have a history of being successful doing something other than harming themself so a non-athlete – I’ve had non-athletes say to me, “Well gosh, this is the first thing I’ve ever been good at in my life. Why would I give it up?” Athletes can say, “Well I love being a competitor. I love being an athlete. I love being on top of a rock wall and knowing exactly how far I’ve come,” so they have a sense of success outside of the illness and that gives them a lot of motivation to get back to healthy.
Neely Quinn: Yeah, that’s true. I’ve never thought about that. Can you tell me a little bit more about a typical athlete that comes into you who’s working with eating disorders?
Dr. Kate Bennett: It really kind of comes in two ways: they either come in the door – because if I’m working with an adolescent or young adult – typically they show up because their weight has dropped down, their parents are concerned, the pediatrician has noticed a downward trend in their weight, regardless of the fact that they’re growing or developing. In that population, typically what happens is – and this is typically any eating disorder – it’s a well-intended effort to improve one’s health.
You get a 17 year old athlete who decides they want to lose some weight and eat a little bit healthier. They start eating healthier, they cut out processed this and they cut out these sorts of fats and whatever they want to call junk food, and by way of elimination they all of a sudden become orthorexic. Orthorexia is an obsession with healthy eating. Then all of a sudden they start to get praise for, ‘Oh my gosh you look so good. You’ve lost weight. What have you been doing?’ and they get really attached to this idea of the praise they’ve been getting for the lower weight and the restrictive eating patterns they have and then they all of a sudden are anorexic and they never chose anorexia, they just fell into it with a really simple idea of wanting to be a healthier person.
I typically see a lot of junior or senior adolescent girls who show up into my office that way. They just thought they were eating healthy and eating “clean” and all of a sudden they became orthorexic and fell into the anorexia.
The other times is athletes just want to cut weight and they they really work hard to manage their weight and because they exist on that fine line – and I’m sure we’ll talk about that more in regards to using disordered eating behaviors to really pursue excellence and perform at the highest level – but something may happen in life, whether it’s a bad coach/athlete relationship, something where the coach is a little bit verbally abusive or whatnot but the relationship there is traumatic, or a life event happens like a breakup or a death or a loss or something along that line. It can basically kind of trip the athlete over the line and send them into a full blown eating disorder.
Then, typically those people either end up in treatment and they end up in my office or they realize they’ve got a really big issue and they show up in my office trying to avoid a higher level of care and really wanting to take their lives back.
Neely Quinn: What is it about those stressful events that push people over into eating disorders? A lot of times people think, ‘Oh, I’m super stressed out.’ What happens is when people get stressed out is they eat more. It’s not that people typically think of it as: then I will be restrictive if something stressful happens. How does that play out?
Dr. Kate Bennett: When you think restrictive, I’m thinking more anorexia. When you think about restriction it’s as much about restricting the food as it is restricting the emotion, right? When people feel like they have control of their life through restricting food, and all of a sudden their emotions feel more managed, then they become more obsessively compulsive with restricting the food. They put all of their energy into that restriction and that control over food and then they don’t have to slow down and think about what they’re thinking or feeling or the stress involved in their life.
That really is what kind of perpetuates the illness, this sense of anxiety that feels unmanageable. But if they restrict or if they manage and control their food in a certain way, they feel like life is manageable. As soon as they start to change those patterns it creates a sense of anxiety that feels uncomfortable or unfamiliar or overwhelming, and at times it can feel like they can’t control it or they can’t manage it so they have a really hard time interrupting those behavioral patterns.
Neely Quinn: This is the typical – that was just for anorexia? Or what other eating disorders would fall into that?
Dr. Kate Bennett: Bulimia. Bulimia is you eat a lot and then you purge, so what can happen is this is when what you said about when people feel stressed and they eat a lot, well it can be like – oh my gosh, with athletes it may be that I restrict all day long because I’m trying to lose weight or I’m trying to get down to a more competitive weight, then the evening they start binging because they haven’t eaten enough. They eat a ton in the evening and they feel ashamed or embarrassed or they’re worried that they’re not going to meet their goal so then they can either throw it up, they can use laxatives, they can use exercise to purge that type of food, so that would be kind of the other end.
Really, it’s still that same idea of using their relationship with food to try to manage the emotions or the anxiety that might otherwise be overwhelming.
Neely Quinn: This is big stuff.
Dr. Kate Bennett: It is, yes, it is.
Neely Quinn: We’re talking about the end result, like an actual eating disorder, but I feel like a lot of climbers and people in general are a little bit not quite there but they do have some behaviors that are questionable. Can we talk about those? What are disordered eating behaviors to look for and why?
Dr. Kate Bennett: Yeah, absolutely. That’s what I love to do is really help people understand the difference between the pursuit of performance excellence and then an actual eating disorder clinical diagnosis.
With athletes it’s pretty common to track your food. It’s really common to either avoid certain food groups at certain times of the year or to weigh your food, measuring your body composition, taking weights, maintaining food logs. Those are all pretty typical behaviors, however, when somebody starts to develop more of an eating disorder this can fall under the umbrella of anorexia but not quite the severity of being that ill, so like you were saying the sub-clinical issue or the sub-clinical population. People start to get emotionally attached to it.
If all of a sudden something disrupts their plans where they’re really on track to eat a certain way and exercise a certain way and train a certain way, and then all of a sudden they have a surprise visit from a family member and the family member wants to spend all day at Rocky Mountain National Park. This person just gets super angry or irritable or overwhelmed because their emotional well-being is dependant on the structure and rigidity in their meal plan. That definitely would be a concern of mine.
Likewise, if somebody would just be rigid and inflexible from day to day so they eat the same exact thing every single day because it’s too overwhelming or too scary to try something different, or if they know that if they do exactly this then their weight is exactly this way so they start to lose a sense of joy and pleasure in life and it becomes more robotic. Certainly you know people who engage in the typical behaviors of restricting without a clear purpose and without the ability to stop restricting.
In cycling it’s common to try and get down to a race weight and you maintain for 6-9 months of the year and then in off-season, healthy cyclists are able to let the controlling nature of the relationship with food go and enjoy off-season and come back and get disciplined again when their season starts. Somebody who has that more eating disorder related issue maintains that rigidity year-round. They don’t care about their periodization, they don’t care about what part of the season it is, they know that they need to have that rigidity and that control over their food every single day to feel good emotionally.
Likewise, people who are maybe using stimulants to try and influence their body weight, so diet pills and that sort of thing, those are concerning to me because people can become psychologically dependent on those.
There’s behavior like chewing and spitting, so people who chew the food to get the taste and flavor of it but they spit it out because they don’t want the calories related to that type of food, that would be concerning to me.
Some people who are really focused on just needing to burn calories, they have a hard time sitting down so they’re always moving, they’re always going, they’re always doing something because they feel like they need to be productive and continue to maintain that kind of activity level to maintain the strongest or the healthiest version of their life in their head.
That’s kind of all food-related stuff and then obviously there’s the purging, the vomiting, the laxatives, and those sorts of things. Those don’t have to be clinical, right? Somebody can say, “Well gosh, I went to a birthday party last night and I ate way too much so I came home and I threw it up.” It’s when people become psychologically dependent on it that it becomes the issue.
On the flipside of the coin and what is less talked about is the relationship with exercise. We know that exercise and restriction or bingeing/purging types of behaviors can go hand in hand with an exercise dependency. Athletes who have to get their workout every single day and if they aren’t able to get their workout in or their training in they get irritable or they get moody, they get angry, or they find a way. I’ve had athletes who’ve had exercise dependency and I’ll say, “Hey, what happens when you’re traveling with your family?” “Well I’ll wake up and I’ll work out before anyone else wakes up. I’m not going to let travel or a family vacation or life events interfere with my training.” Again, because people start to become psychologically dependent on it.
Athletes can be really great at following their training plans. Somebody who doesn’t believe in rest or recovery? That would be very concerning for me because we know rest and recovery is a critical component of actually getting stronger and physically performing better.
We can kind of look at that piece of it. What does the relationship with working out look like? What does their relationship with rest and recovery look like? Do you have an off-season? If people don’t take an off-season, that would definitely be a concern of mine, again because they’re attached to the movement and they’re no longer focused on being the best athlete they can be. They’re now focused on being the best exerciser that they can be.
Neely Quinn: You know, that brings up a good point for me because with climbers we typically have climbing gyms and then we have our season outside, or seasons, so we’re kind of always in season whether we’re climbing in the gym or outside. I don’t know how different that is with cycling but we also don’t really have coaches in general, unless we’re kids, so we’re always on season in our minds. It makes all of these things like: yeah, people are doing them all of the time because they don’t know when to actually stop. Like, there’s no stopping point.
Is there any advice that you have about that?
Dr. Kate Bennett: Yeah, absolutely. You know, when you think about basic periodization and training overload and adaptation and those sorts of concepts, we know that the body needs to slow down at some point annually to be able to actually recover from the year’s training, the year’s stresses, to get better and stronger the next year. I would say for people to just kind of look at life and figure out what’s the busy season of life? Or what’s the period where I don’t want to be as active?
Climbing, for some people, that’s maybe just around the holidays because they want to spend more time with families, naturally, so that becomes an easy 6-8 weeks to slow things down and do some more recovery or off-season type of activity. For some people it may be that they have a big family vacation planned in the summer so they just know, ‘Maybe I’m going to be mountain biking and hiking with my kids or my family or my partner more so than I’m going to be actual climbing.’
I would say just kind of look at your life and see where it makes sense to take a 6-8 week recovery period, and it doesn’t mean that you sit on the couch doing nothing. It just means that you alter the activity so that your body is able to recover from the stresses of climbing specifically and really then come back in a stronger version of itself as you rebuild for the following season. You can build your own season. That definitely is a subjective idea for each climber.
Neely Quinn: Yeah, and that’s for the exercise part of it. Is there anything that you would suggest for, not letting go, but sort of easing up at certain times of the year on food and stuff?
Dr. Kate Bennett: Yeah, so off-season. The off-season is where physically and mentally you get to let go. You get to take a deep breath and say, “That was a lot of fun and next year’s going to be even more fun and now I’m just going to catch my breath.”
To be an athlete it takes a lot of focus and a lot of drive and determination. The off-season is as much about the psychological recovery as it is the physical piece so when I think about food, the off-season is just that natural period to let yourself enjoy whatever food you want to enjoy and not be worrying about weight and performance and competition and those sorts of pieces of it.
What happens when people eat intuitively? As an athlete we tend to think, ‘I need to eat at this time and this time and this time,’ and it becomes pretty scheduled and systematic just based on workouts and needing to fuel and get the nutrition that you’re “supposed” to get in your body. As a human being we have a very intuitive sense to be able to enjoy food and to be able to regulate food on our own. In off-season, it may be, ‘Oh awesome, I didn’t let myself eat pizza and ice cream and whatever and I didn’t drink this much beer.’ Whatever it is for that athlete.
When they come in-season the body is going to naturally fall into a little bit more structure because if you’re eating a ton of food and then trying to go workout it doesn’t feel good. People naturally fall back into their regular patterns that allow them to excel athletically, but likewise in the off-season, if you eat a bunch of pizza the night before you’re not going to wake up and crave pizza the next day. The body is going to say, “Hey, I’ve had enough of that type of food.” You may wake up and crave produce or fruits and vegetables or a salad or something like that.
The body has an amazing ability to tell us what we actually need, we just get too much in our heads about what we think we need and we lose touch with the reality of what our body actually wants.
Neely Quinn: Yeah, I feel like what happens to a lot of people is intuitive eating starts to not even be possible.
Dr. Kate Bennett: Right.
Neely Quinn: But that’s something for therapy, right?
Dr. Kate Bennett: It is, yes, I’m very good at helping people figure that out. Kids are a great example. I have a young daughter. She’s a toddler and she loves to eat sweets but she also likes to eat vegetables and fruits and if I give her a cupcake and some chicken and some peas and corn and an apple – I don’t know, whatever – she’ll eat a little bit of all of it. She doesn’t just eat the cupcake because it’s a cupcake. She doesn’t have this emotional attachment to a cupcake. She enjoys bites of her cupcake and then she’ll eat a piece of her chicken and then she’ll have some more of her cupcake and then all of a sudden she’s eating peas and carrots and ranch.
When you think about a young kid, they don’t have the emotional attachment to food and they’re the best indicators of what intuitive eating actually looks like. They don’t have rules about what they should eat or how much they should eat, they just take bites and enjoy all of everything on their plate.
Neely Quinn: And then it’s us and we’re like, ‘Eat all your food.’ [laughs]
Dr. Kate Bennett: Yes. Parents get emotionally attached to how much their kids eat. Yes, that is true.
Neely Quinn: Which brings me to another question. A lot of my clients end up coming to me and they’re rewarding themselves with food or they’re punishing themselves with food. I think that that’s something that comes a lot of times from childhood, where we’re like, ‘You did a good job. Here, let’s go get ice cream,’ or something like that. People will do a big workout and they’ll be like, ‘I’m going to have an 1800-calorie milkshake now,’ without even knowing that it’s 1800 calories, or whatever. They gain weight doing that. Do you want to talk at all about food reward?
Dr. Kate Bennett: Absolutely. It’s funny because food is a source of joy and pleasure. If somebody is saying, “Well gosh, I did this big workout and now I get to go have this giant milkshake,” and they eat all of it, it probably tells me that they need to be eating more throughout the day. If their tank is that empty that they’re rewarding themselves and then gaining weight from the reward, they’re probably not fueling their bodies well enough throughout the day in general. They can change that pattern.
But when we think about food it definitely is a source of joy and pleasure, but there’s other things in life that can also be a source of joy and pleasure. It’s the emotional attachment to food that becomes the issue. If it feels like, ‘Gosh, I have to restrict then I get to reward myself with food,’ then that tells me there’s probably an unhealthy dependence or psychological attachment to food. We really need to work on, ‘What are other sources of joy?’ ‘Well gosh, I did this crazy hard workout and now I can go out and hangout on the patio and enjoy the company of my partner or my friends,’ or ‘I did this crazy hard workout and now I’m going to go for a bike ride tomorrow because I know I got my workout in and tomorrow I want to do something a little different and just do something pleasurable and enjoyable, where I don’t have any numbers or expectations attached to it.’
Joy and pleasure can also be art and creativity. It can be being able to go out and socialize. People/athletes need to think about, ‘What else brings me joy and pleasure?’ It’s not just food but it’s the psychological attachment to food that becomes important in those moments.
Neely Quinn: Why is that important? You went through all those really great examples of behaviors that we should be aware of and all of that, and I think that a lot of people probably listened to that and they’re like, ‘Yeah, I do that sometimes,’ or ‘Yeah, I do those three things.’ What’s wrong with that? Why is there something wrong with that?
Dr. Kate Bennett: There’s not, necessarily. That’s a great question. I’ll use myself as an example. Here I am, this clinical sports psychologist, specialized in the treatment of eating disorders. If I’ve had a tough day at work or whatever, life is hard and I’ve got a toddler and if it was just a really hard day in life, I may say to my husband, “I need to eat emotionally tonight. I want to eat ice cream.” We’ll joke about it and laugh about it but the intention, for me, is the emotional reward for putting up with a hard day or kind of getting through a tough day, and that isn’t bad. What becomes problematic is when people are unaware of their intention behind it, right?
We can eat emotionally and we can enjoy food in that way and we can use it as a reward or a relief after something really hard, but it’s important that we do it intentionally. If all of a sudden I don’t even know that I’m eating emotionally, then all of a sudden I might start bingeing and I’m unaware. That can become kind of a landslide or a snowball effect down into more of a clinical diagnosis.
For me it’s really about intention. Why am I doing it? Why do I want to have this special food reward at the end of the day? The thing is, when I do it intentionally I don’t do it the next day. It really comes down to awareness/mindfulness, this idea of being aware of the present moment in time versus mindlessness, or automatic pilot of, ‘I just pick up a milkshake on my way home and I don’t even know why and I don’t even enjoy it. I just eat it and then I move on with my day.’ and there’s no satisfaction but there’s also no awareness there. That kind of becomes that slippery slope for people.
Neely Quinn: What about the people you were talking about who have an emotional attachment to their meal plan? Like, they can’t have their plans changed because they need to be where their food is so that they can eat exactly the same food and all that. I think that there are some people who can relate with that and what is wrong – not wrong, but tell me the potential end-game for that, where it could lead. What is wrong with that?
Dr. Kate Bennett: When I think about the emotional attachment to food, it really becomes problematic in two ways. From a performance standpoint, if I’m super attached to my food and my meal plan emotionally, and I’ve got a competition tomorrow and I feel like I didn’t eat exactly how I was supposed to today, my confidence goes in the toilet. From the sports psychology perspective, if my confidence is built on my ability to complete my meal plan perfectly then my confidence is variable. There’s no stable foundation for it. That’s the performance aspect in regards to: well this doesn’t help.
I work with cyclists and I’ll say, “How are you feeling about this big race coming up?” They’ll be like, ‘Well this is good and this is good and my numbers are good, my sensations are good, my weight’s a little high.” My point is: yes, cycling is a power-to-weight sport so I get that piece of it but if we’re saying, “My weight’s too high and my race is tomorrow,” then you’re already giving your confidence to a number that you can control but you can’t control exactly. The confidence piece is a big problem.
The other piece is if people get really attached to their meal plans, they can lose out socially. They can start to become isolated or they’re the person – and I’m not saying this has to be a bad thing but if they skip out on barbeques in the summer or going out to eat with friends after a competition because they need to eat exactly what they need to eat to feel good about themself.
That goes back to that idea of managing anxiety. It would be too anxiety-provoking to go to a barbecue with friends and just eat whatever was there. It might be too anxiety-provoking to go to a restaurant with friends after a competition because they’re not sure that they could order anything on the menu. They feel [unclear] when they miss out socially and they start to isolate themselves. Then that kind of perpetuates the anxiety and the disconnect so then it becomes more of a psychological issue in regards to missing out on important pieces of life.
Neely Quinn: Then at the very end stages of it – I mean, you’ve seen it in in-patient clinics. What are those people like?
Dr. Kate Bennett: To put it really honestly, their perception of life is incredibly distorted. I’ve had patients tell me, “Well, I’d rather die than gain 10 pounds.” It’s really sad to hear somebody say that but actually mean it. To them, this idea of gaining weight is so terrifying that they would rather just be dead. That’s kind of the extreme end.
When you think about anorexia and bulimia, they are medical conditions. Most people don’t think about anorexia being the number one psychiatric killer among mental illnesses but it is because it’s as much a medical condition as it is a psychological condition. It gets really serious really quickly when the illness escalates, but it’s also funny because every person’s body is unique and so while some person may have been struggling with anorexia or bulimia for years and have no medical complications, somebody else can develop a really rapid onset in six months and all of a sudden, their electrolytes are off, they’re having heart arrhythmias where they have to be hospitalized in an actual medical hospital because their heart is so unstable and people are worried that they’re going to have a heart attack in their sleep.
That is kind of the severity of it, medically-speaking, but when you look at the quality of life, these people are typically pretty isolated. They maybe are still doing really well at school, at work, but their relationships are suffering because people start to disengage with them when they see that they’re starving themselves or they see that they’re harming themselves. People don’t know what to say so that might just disengage or step away. Or there’s a lot of conflict. People get mad at them because they can’t change the behavior.
It’s funny because people say, “Why don’t you just eat this slice of pizza?” Or, “Why don’t you just eat the cake? You need it. You need to gain weight.” That psychological battle is so big and the anxiety is so huge they can’t just eat it. It really is as much an emotional illness as it is a food and medical-related condition.
When you say, “How bad does it get?” People die from anorexia. People die from bulimia. They throw up their electrolytes, their electrolytes get out of whack and are unbalanced, and then the heart stops. It gets to the point of death if it’s untreated. Those certainly are serious conditions but, like I said, somebody can escalate pretty quickly and have medical conditions really quickly and they’re just unaware of it. They don’t have support people around them or knowledgable people around them to make sure that they get the help that they need right away.
Neely Quinn: I think that a lot of us have seen friends go through phases where they lose a lot of weight. I mean, I certainly have, where I have wanted to say things to people to help but it’s so taboo. We don’t know how to approach it. Can you give us some advice about when and how to approach people who we think might have a problem?
Dr. Kate Bennett: Absolutely. The number one key is to make it your own problem. Neely, if you were my friend and I thought, ‘Oh my gosh, you’re struggling with something,’ if I came up and I said, “Gosh, you’ve lost some weight and I think you might have an eating disorder,” you would probably turn your back to me and you’d start avoiding me, straight-up. You wouldn’t want to talk to me.
Neely Quinn: Yeah.
Dr. Kate Bennett: But if I was to go up to you and say, “Hey Neely, gosh I’m really concerned. I’ve been watching you and I noticed you seem a little bit disconnected or you seem less present in our conversations. I notice that your weight has maybe dropped. Is everything okay?” Now you’re responding to my concern and my emotion versus me pointing my finger and saying, “You’ve got a problem.”
The first thing really is: hey, I have this problem, I’m concerned, I’m worried about you, can we talk about it? The person may blow it off. You may say, “Oh, I’m fine, Kate. Don’t worry about it,” but in a couple of days you’re sitting down eating and you’re eating an apple and I’m having a sandwich after we’ve spent all morning climbing. I can say, “Well gosh. I’m sitting here and I’m watching you and I know you’ve been working out all day with me. You’ve been climbing all day with me. I can’t help but worry that your body’s not getting the nutrition it needs.” You may blow it off again but kind of that caring confrontation, that idea of ‘this is my problem and you’re responding to my problem’ typically will open the door.
It may be that you’re still not willing to say, “Well yeah, I’ve got anorexia,” and it may not be anorexia, right? It might just be early stages of some disordered eating and you may defend it. “No, I’m just trying to cut weight. I want to be a little bit lighter for the season.” “Okay, well if you ever want to talk about it, I’m here for you,” or “Here’s something that I read the other day. Would you read it and maybe see if it might relate to you?”
I think giving resources and ultimately knowing – if you’re in a professional position – you can say, “Well here’s somebody you can talk to. Please just call them,” and hold them accountable to it. A couple of days later, “Hey, did you call Kate? What did she have to say?” Then, now there’s some accountability there but it is really hard because there’s a lot of denial that goes into this illness. It’s something that kind of is socially acceptable and praised for a community of people being able to cut weight, maintain low weight, have a lot of control. People can envy that but on the inside if someone is having a problem they might not want to talk about it because at the end of the day, eating disorders and mental illness goes against the athletic identity.
Athletes are strong and they’re resilient and they’re confident and they’re in control. An eating disorder is the antithesis of that. They’re not actually in control. They’re controlling their food but they can’t stop controlling their food so they’re no longer in control. People often associate mental illness with weakness and I don’t think it’s weakness. I mean, to starve yourself takes a lot of strength and a lot of focus and determination, but it really conflicts with that athletic identity so it can be really hard for athletes to admit they’ve got a problem and they need some help.
Neely Quinn: It’s also a fine line, because there’s one athlete in the climbing world, she’s extremely strong and famous in our world. Her name is Alex Puccio. She lost a bunch of weight and became extremely ripped and was called-out for it publicly by a commentator at a competition, saying that she was getting injured so much because she was malnourished. I talked to her about it and I asked her, “Do you have your period? Are you eating?” She seemingly is a healthy person who doesn’t have an eating disorder.
Would you say there are any physical signs that you would look for specifically to figure out if somebody has a problem before – well, definitely calling them out publicly but – confronting them?
Dr. Kate Bennett: [laughs] I would never call someone out publicly. I think that’s just unfair.
Neely Quinn: I do, too.
Dr. Kate Bennett: There is this thing called the Relative Energy Deficiency in sports. A long time ago, back when I was in college, in grad school, I actually coached cycling so that’s kind of where I get my sports physiology background. There’s this thing called the Female Athlete Triad and that was this relationship between bone health, menstruation, and nutrition. If an athlete was “malnourished” – and when you say malnourished I think starvation but malnourished can definitely be you’re just not taking in enough for your body to be able to menstruate. What happens when the body’s not getting enough nutrition, reproduction is low on the body’s survival list so it just shuts-down reproduction all-together and that’s why women stop menstruating.
Well then, we know estrogen contributes to bone health so if you’re not menstruating then we know that absolutely your bone health may be impacted. If there’s one thing that I really hope your listeners hear today it’s that being amenorrheac, so not getting your period, is maybe normal but it’s not healthy and it actually is really concerning in regards to bone health. So I hope any of your amenorrheac female listeners hear that. It’s maybe normal but it’s not healthy and it’s a huge cause for concern.
The other thing is that we know that birth control, oral birth control, does not protect bone health. Back when I was an athlete it used to be, ‘Well gosh, I’m amenorrheac. I’m an endurance athlete. It’s totally normal. Go get on the pill, get your period back and you’re normal.’ We now know and research shows that oral birth control does not protect our bones. Even though you’re menstruating, your bones still are at risk in that situation. I think that’s one of the most important things anybody hears today.
Going back to RED – Relative Energy Deficiency in sports – that basically is the updated version of the Female Athlete Triad. What happened was the IOC – the International Olympic Committee – came together and said, “We know that men suffer from energy deficiencies, too. It’s not just women. Just because there’s not a period involved doesn’t mean that these men can’t be compromised.”
We know that energy deficiency – so taking in too little in relationship to how much you’re expending – doesn’t just in fact affect the reproductive health. It affects our immune health. We can get sick more often. It affects our cardiovascular health. It can interfere with our heart’s health. Our GI health is a big one. People who are restrictive tend to complain a lot about either stomach upset, like they get really bloated because they’re taking in too much fiber, or they’re constipated and they’re not able to go to the bathroom enough. GI health is really impacted by the energy imbalance as well as psychological health: anxiety and depression.
When we’re looking at young athletes, they’re thrown off their girth and development curve, which is obviously really concerning. Blood health, endocrine health – the whole body can be affected by malnourishment or this energy imbalance.
When I’m looking at an athlete, sure, they may be a super lean, ripped version of themselves but it comes down to: what do your labs say? Are you menstruating? Have you gotten a DEXA Scan before and if so, what does that look like because I’ve got 20-year olds who are D1 athletes with osteoporosis. Age doesn’t protect people from the effects of malnutrition or energy imbalances.
Neely Quinn: That’s a big deal. The DEXA Scan is just something that – do you want to tell them what the DEXA Scan is?
Dr. Kate Bennett: Yeah, so the DEXA Scan is a bone scan. It basically is a scan from head to toe and it assesses the bone density of an individual and they have markers of standard deviation to go from healthy to osteopenia – which is an indication of some bone loss – to osteoporosis which is an indication of basically swiss cheese bones. You start getting holes in your bones.
Neely Quinn: You’re saying that you have 20-year olds who have osteoporosis?
Dr. Kate Bennett: Yes, I do. Division I athletes.
Neely Quinn: Do these people look sick?
Dr. Kate Bennett: Nope. You wouldn’t even know. You might be sitting next to them on the street or see them at a park and you would never know.
Neely Quinn: What kinds of behaviors do they exhibit?
Dr. Kate Bennett: What can happen is they can have an acute or a slow-developing eating disorder but that malnutrition, that starvation – basically what happens, and this is mostly in females because this is what’s been studied, the reproduction shuts down, estrogen levels plummet, and then bone health is really compromised or affected by these people.
It can be really typical behaviors. Restricting intake or training as prescribed, or overtraining, skipping recovery workouts, skipping the active recovery days, those sorts of things. It doesn’t even have to be that drastic where somebody is in a medical hospital because they look like they’re deathly ill. It can be just a really acute bout of anorexia that malnutrition – some bodies are affected really quickly. But I’ve also got some people who have been anorexic for five or ten years and there’s no bone issue. It really depends on the individual.
When I think about rock climbing, it’s a non-impact sport. When I think about low weight, energy imbalance, and a non-impact sport so no weight bearing, that concerns me even more because the bones don’t have that constant impact to help build bone health and support bone health over a long period of time.
Cycling is similar. You look at male athletes and male cyclists. They are known to be super low weight. When you look at the Tour de France, the riders and those big tours, those grand tours, they’re super, super lean, on the rivet of unhealthy. I work with them, I know what they do, and they ride bikes all day so they’re not doing anything to support their bone health at that point in time.
Neely Quinn: Yeah. There’s route climbers and there are boulderers. I wonder if the boulderers are in better condition for that because they’re always falling. They’re falling down to the ground.
Dr. Kate Bennett: I agree. That impact can definitely help but that impact also, if they have some bone health issues, can cause a fracture. It can be either a stress fracture or an actual fracture.
Neely Quinn: Yeah. I’m assuming that, among women at least, you don’t have to have amenorrhea to also have osteoporosis or osteopenia. Could a person have osteoporosis but still get their period?
Dr. Kate Bennett: Yeah, but that’s an interesting question that I’ve never been posed. My thought is that that would be an older women, somebody who’s a bit older in life. I don’t think you would probably see that in, like, a 20-year old.
Neely Quinn: Okay, so a big red flag is losing your period.
Dr. Kate Bennett: Yeah, but then I flip that. There could be a 20-year old male with osteoporosis that we don’t know because he doesn’t get a period so then you’re looking at testosterone levels and overall health in that sense.
Neely Quinn: What are the steps that people should take? Like, if people are listening to this and they’re like, ‘Yes, I do this. I do this. I do that. Yes, I probably have some disordered eating behaviors.’ What do they do? If they go to their doctor and they want to make sure they’re okay, what do they ask for?
Dr. Kate Bennett: The very first thing I would say is labs. Say, “I really want to make sure that my labs are okay, my electrolytes are okay.” Somebody who’s pretty lean who maybe gets really light-headed upon standing or somebody who has heart palpitations or arrhythmias can ask for an EKG and make sure that their heart health is okay. I would also, females who are amenorrheac or even females who are just super low and maybe they have an irregular period, they can ask to have their estrogen levels tested to see if their estrogen is in a healthy place.
Definitely labs. I would say a basic physical would be the number one, and then if there’s any abnormalities that come out of that then advanced medical testing beyond there. That would be the number one: “Medically-speaking, am I okay? Am I healthy?” Then from there, if they’re like, ‘Yeah, if I’m okay but I really would like to change and have a bit more freedom and flexibility and enjoy my sport more and maybe even be a stronger version of myself by fueling myself more adequately but I don’t know how to do it on my own.’ Then talking to either a nutritionist or a dietician who has experience treating eating disorders and really understands that, and an awareness of it, or a therapist such as myself or somebody else who really has that experience with eating disorders.
The concern is if you work with somebody who doesn’t quite know what an eating disorder is, they may perpetuate it. They may say, “Well, that’s totally normal. That’s okay. That’s what I do. I’m an athlete, too.” They may actually normalize behaviors and further enhance the seed or really imbed that seed in somebody’s head, that they’re okay even though they know deep down that there’s something off.
Neely Quinn: Could they go into a doctor and be like, ‘Look, I’m a little worried. I want to test my bone density. Can you get me a DEXA?’ Would they do that?
Dr. Kate Bennett: It depends on the doctor. I’m able to get people regular DEXA Scans no problem because of my position and what I do but if somebody were to just walk in from the street and say, “I’m a rock climber. I’m pretty restrictive with my food. Can you check my bone health?” There may be some pushback because I’ve definitely had doctors and physicians in Boulder who have told people with osteopenia, ‘You’re fine. You’re an athlete. Don’t worry about it. It’s no big deal.’ So, it’s unfortunate and I don’t want to be critical of the medical community but they get very little training in the treatment of eating disorders and the identification and diagnosis of them. Depending on the physician or the medical provider, they may just kind of blow it off and be like, ‘Well, you’re really healthy. I don’t know what you’re concerned about.’
Neely Quinn: Okay. So we have to be our own advocates, really.
Dr. Kate Bennett: Yes, exactly.
Neely Quinn: I know you only have three minutes left but I have a couple more questions. One is: are there any other physical symptoms? Like, I know that when you get to a certain point you start growing more hair in certain parts. Is there anything else?
Dr. Kate Bennett: Yeah, so lanugo – that’s what that hair on the face is called -what happens with that is if somebody is malnourished, the body starts growing that facial hair and it’s really all over the body. It’s insulation, interestingly. The body says, ‘Hey, I don’t have enough body fat to keep me healthy so I’m going to start growing this hair to insulate me.’
That also brings up somebody who’s chronically cold. They’re always cold, their hands and their feet are cold, they just can’t get warm and it’s 85, 95° in the summer and they’re still cold. That would be a huge indicator.
Brittle nails or somebody who has callouses on their hands from throwing up could be an issue. Acid reflux for somebody who frequently throws up. Losing hair/hair loss could definitely be a symptom.
I mentioned earlier that lightheadedness upon standing. This is an interesting one because athletes are known to have low resting heart rates, right? We train so much, we’re physically conditioned, our bodies are strong and healthy but when your body is malnourished your heart rate is actually really low as well so being honest with yourself and if you know you’re pushing your body too hard, it may not be that you’re well conditioned but that you’re actually malnourished and your heart rate is really low. That definitely would be another one.
Those are the big ones off the top of my head.
Neely Quinn: Okay, and then last question with the last minute. The whole thing with us and with cyclists is being lighter, in our minds and in truth sort of, is better for climbing. What is your experience with athletes like climbers? Does it make sense? Is it actually true that being skinner is going to be better?
Dr. Kate Bennett: It’s true to an extent. I feel like that’s kind of an all or nothing question where people like to draw this absolute conclusion of: because I’m in an anti-gravity sport, being lighter is better. Yes, that is true, right? It is true also for a cyclist that if they weigh less and have the same power, they’re going to go up a hill faster. That is true but it’s not absolute because everybody has a unique genetic makeup.
The “skinniest” version of myself, and I prefer lean, the leanest version of myself may not look like the leanest version of yourself. Everybody needs to respect that their bodies have different genetic makeups and just because we have these sports stereotypes of, ‘This is what a climber looks like. This is what a cyclist looks like. This is what a swimmer looks like,’ doesn’t mean that that person’s body is meant to look like that.
People really have to slow down and say, “What’s the strongest version of myself? The skinniest version of myself may not be the strongest version of myself.” That can be both physically – because if you push your body too low you start to lose strength, you’re not recovering as well from your training, you’re not getting the adaptations, your endurance goes down because you’re not able to sustain as much, your glycogen stores are low, your focus is impaired, so even though I may be the skinniest version of myself I might not physically be the strongest version of myself. Then mentally, if I’m super attached to food and kind of structure and rigidity, then I may be anxious, I may be a little bit depressed, but I’m also not going to focus as well, I’m not going to be able to push myself as hard and I may not enjoy it as much. Most certainly, my confidence is going to be impaired so I’m not either the physical, strongest version of myself and mentally then I’m probably not the strongest version of myself.
The climbers need to ask themselves: do I want to be the skinniest version of myself so I look the part or do I want to be the strongest version of myself so I have the most fun and I’m the best competitive or the most excellent version of myself, where it really matters and counts for me.
Neely Quinn: Yeah. That’s a great place to leave off. Thank you, very much. I know you have to go. I really appreciate your time.
Dr. Kate Bennett: Yeah, thank you so much for having me. If there’s follow-up questions people can certainly shoot me an email. I’m happy to follow-up and answer whatever questions people may have or if you ever want to have me back on to continue the conversation, let me know.
Neely Quinn: I actually would love that. Thank you.
Dr. Kate Bennett: You’re welcome.
Neely Quinn: Alright, well have a good one. I’ll talk to you soon.
Dr. Kate Bennett: Okay, you too. Bye Neely.
Neely Quinn: Bye.
I hope that interview with Doctor Kate Bennett was helpful and that you enjoyed it and maybe learned a couple things. You can find her at www.livetrainthrive.com or, like she said, you can email her at firstname.lastname@example.org.
I think that what she had to say was super useful and helpful to get some of us the perspective that we need. Hopefully I’ll have her on again.
My two cents on the topic is: I do work with people who have these issues. With nutrition comes emotions. We have sort of an emotional relationship with food a lot of times. What I tend to do with people is just inject as much reason into the conversation as possible because it can get super muddled with emotion, like why we’re eating the amount we’re eating, what we’re eating, and so we get down to the nitty gritty with the motivations for what you’re doing.
For instance, I have a client right now who wants to be really lean. She already is really lean but she wants to look leaner and she’s climbing the strongest she’s ever climbed in her life. She still wants to be lean because we’ve been brainwashed into thinking that, like I said, the leaner we are the better we’re going to climb, even though she has this evidence that she is climbing really strong.
My job is just to remind her of that and tell her that what she’s thinking isn’t logical and that she knows that when she’s leaner she doesn’t feel as good, she’s not as powerful, so it’s all about the way that she looks. We all have this ideal so then we have to go into: why do you want to look that way? Who is it going to appease? What are these emotions that are underneath it?
It’s a long conversation and it can be difficult and challenging for both of us, but it can lead to a different perspective and clarity on the topic. That’s my job, is just to try to bring reason into the conversation. I think that’s what we can do for ourselves, too, or just talk to somebody about it so you can get a third party that’s objective about your situation. It’s helpful for me, it’s helpful for my friends, it’s helpful for my clients, so hopefully just talking about this stuff can help you if you have some issues with eating as well.
Coming up on the podcast I have Meagan Martin tomorrow. I’m going to be interviewing her tomorrow and then I’ll publish that next week. I love that girl and hopefully we won’t giggle our entire way through the interview. After that, the next week, I’ll be in Vegas so I won’t be doing a podcast. I will be celebrating my birthday in Las Vegas with some of my friends. I’ll go climbing a couple days, go to a show, and that’ll be really fun.
The last thing I want to let you know about is that we have a Facebook group that’s all about training for climbing. It’s gotten pretty busy in there. There’s some big names that contribute to it sometimes and I would love to see you in there if you have questions about training or if you have knowledge that you want to share about training. You can go to www.trainingbeta.com/community and that will direct you over to the Facebook group so hopefully we’ll see you in there.
Thank you very much for listening all the way to the end. I really appreciate it and I’ll talk to you next week.