Author: Monika Saigal

Research confirms that the prevalence of eating disorders and disordered eating (ED/DE) is significantly higher among dancers than the general population, with especially high rates of ED/DE among ballet dancers.[1,2] Without proper detection and intervention, ED/DE can have devastating effects on a dancer’s performance, career, and physical and mental health, but fortunately these serious issues are preventable and treatable.

Eating disorders are complex conditions caused by biological, social, and psychological factors. Some of these factors, such as genetics, cannot be changed, but other risk factors for ED/DE are modifiable. Psychotherapist, Dawn Theodore, and I had the honor of presenting at the IADMS Annual Conference, 2019, on the role of language in the prevention and treatment of eating disorders. Specifically, we discussed the ways in which the language that dance educators, medical professionals, and dancers themselves use can impact modifiable risk factors for ED/DE such as dieting, body image dissatisfaction, perfectionism, and rigid thinking. What follows is a brief summary of language recommendations related to nutrition, weight, and body image. Dawn will expand on these topics, including addressing the importance of language in the studio setting, in the next IADMS Newsletter.

Dieting is one of the most common and preventable precursors to developing an eating disorder. Unfortunately, because dieting has become so normalized in our society, it is often not recognized as problematic. Even worse, dancers may be encouraged to diet by peers, teachers, company leadership, and even healthcare providers. Dieting is far from benign. In addition to contributing to the development of ED/DE,[3] dieting can lead to nutrient deficiencies and negative energy balance which can negatively impact a dancer’s health and performance, independent of eating pathology. Dieting is also linked to lower self-esteem, increased body image dissatisfaction, and weight gain.

Dancers need to be educated on the harms of dieting and given tools to recognize potentially harmful eating practices, which is especially important and challenging in the shape-shifting diet culture landscape. Dieting should be strongly discouraged and ideally “diet talk” and “fat talk” would be prohibited in the studio and at home. In cases where a restricted diet is medically indicated (e.g., a gluten free diet for celiac disease), dancers should be referred to a dietitian with a specialty in eating disorders as well as experience in working with dancers.

Dancers will likely encounter an abundance of misinformation about food and nutrition during the course of their training and career. A particularly problematic trend is the dichotomous labeling of food and eating habits as good/bad or healthy/unhealthy, which is inaccurate and contributes to stress and anxiety around eating. This approach does not consider differences in the individual needs of dancers or account for how socioeconomic status, culture, race, and other factors contribute to food choice and health. In addition, when foods are believed to be bad or unhealthy, dancers may feel pressure to compensate for these choices by engaging in harmful behaviors.

Nutrition education is often beneficial for dancers, but given the high risk for ED/DE in this population, using untrained and unqualified professionals to deliver such education may be more harmful than helpful. Giving out generic and general nutrition information (e.g., fill half your plate with vegetables) without considering and understanding the potential impact should be avoided. Numbers-based nutrition discussions (e.g., calories, grams of fat, etc.) should be used with extreme caution with dancers, especially given the prevalence of perfectionism in this population.

Using neutral language is critical to helping dancers develop a healthy relationship with food. An all-foods-fit approach that neither moralizes nor villainizes any food choice is recommended. Rather, the nutrition value of foods can be viewed on a spectrum. Armed with appropriate nutrition knowledge and guidance, dancers can be taught to tune in and listen to their own body’s cues to help guide their food choices.

Current aesthetic standards in dance undoubtedly contribute to body image dissatisfaction, harmful weight control practices, and eating disorder risk. Increasing diversity in dance would have a substantial positive impact on the health and wellbeing of dancers. However, this type of systemic change is not likely to occur in the immediate future. In the meantime, and at the very least, language and practices that reinforce the harmful message that there is only one type of acceptable “dancer body” must cease.

Studies have found that perceiving oneself as having a weight higher than “ideal” is associated with negative health outcomes including increased depression, stress, and physiological dysregulation, regardless of whether the perception is accurate.[4,5] Although this research is not specific to dancers, it supports the recommendation that dancers should not be encouraged to lose weight. Not only is this practice linked to the opposite of the desired outcome (i.e., weight gain rather than weight loss), it is harmful to a dancer’s physical and mental health.

Weighing dancers in the school, studio, or company setting and imposing weight or body fat requirements is strongly discouraged. Positive reinforcement of weight loss is also harmful, no matter how well meaning the intention. It may be helpful to remember that you cannot tell if someone has an eating disorder based on appearance alone and most dancers with eating disorders will appear to be of “normal” weight.

If necessary, to measure a dancer’s weight in a healthcare setting, consent should be obtained and great care taken to determine how the data will be assessed, used, and discussed as well as the best weighing practices. The language used to discuss weight is critical. Although it is beyond the scope of this article to discuss weight stigma in sufficient detail, it’s important to note that terms such as “overweight” and “obese” are stigmatizing and weight stigma is linked to poor health outcomes.

Finally, helping dancers cultivate and practice self-compassion may be a valuable antidote to the eating disorder risk factors discussed in this article. In fact, self-compassion is associated with multiple positive benefits including less disordered eating; improved body image; less anxiety, depression, and perfectionism; and improved eating habits. [6,7,8] Self-compassion is also a valuable tool for all of us involved in the training and care of dancers, as we evaluate the impact of our own language and behaviors and consider how we can change what we say and how we say it, to help prevent eating disorders and promote overall dancer health and well-being.

References

1. Arcelus J, Witcomb GL, Mitchell A. Prevalence of Eating Disorders amongst Dancers: A Systemic Review and Meta-Analysis. Eur. Eat. Disorders Rev. 2014;22(2):92-101.
2. Ringham R, Klump K, Kaye W, Stone D, Libman S, Stowe S, Marcus M. Eating disorder symptomatology among ballet dancers. Int J Eat Disord. 2006;39(6):503-508.
3. Shisslak CM, Crago M, Estes LS. The spectrum of eating disturbances. Int J Eat Disord. 1995;18(3):209-19.
4. Daly M, Robinson E, Sutin AR. Does knowing hurt? Perceiving oneself as overweight predicts future physical health and well-being. Psychol Sci. 2017;28(7):872-81.
5. Himmelstein MS, Incollingo Belsky AC, Tomiyama AJ. The weight of stigma: cortisol reactivity to manipulated weight stigma. Obesity. 2015 Feb;23(2):368-74.
6. Kelly AC, Vimalakanthan K, Miller K. Self-compassion moderates the relationship between body mass index and both eating disorder pathology and body image flexibility. Body Image. 2014;11(4):446–53.
7. Neff KD. Self-compassion, self-esteem, and well-being. Soc Personal Psychol Compass.2011;5(1): 1-12. 
8. Sirois FM, Kitner R, Hirsch JK. (2015). Self-compassion, affect, and health-promoting behaviors. Health Psychol. 2015;34(6):661-69.