As a physical therapist and nutritionist who works with dancers, I would like to commend Gaynor Minden for launching this necessary campaign, "Eat Right. Respect Your Body. Dance Forever." These three short sentences encapsulate powerful directions and are true words to live by. Each one is dependent upon the next.

Our modern society is one obsessed with image and thinness. One only needs to watch television, open a magazine or visit a store to experience the onslaught of the multi-billion dollar dies industry. Ironically, as a society, we have never been as overweight as today. We set an impossible body ideal and in doing so, set people up to fail. Over the past three decades, increasingly thin body ideals were directly correlated with an increased incidence of eating disorders [1].

However, the media is not the only culprit. There are often chemical, psychological, sociological, and environmental reasons for the development of an eating disorder. In the ballet world, there are often extreme pressures to maintain a thin body shape. Line is everything.

In a study by Garner and Garfinkel, it was found that in an environment in which thinness per se is necessary for success (ballet schools and modeling agencies were studied), the rate of anorexia nervosa is about ten times greater then that of the general population [2]. When Garner and Garfinkel added another dimension to their study, it was found that it is the combination of strict requirements for thinness along with the highly competitive environment of the ballet school that significantly increases the risk of eating disorders.

More disturbing still were the results of a widespread study published in the International Journal of Eating Disorders [3]. It studied disordered eating in professional ballet companies across North America and Western Europe. Results showed that 15% of the Americans and 23% of the Europeans questioned had anorexia nervosa, while 19% of the Americans and 29% of the Europeans reported having bulimia. Along with these shocking results came the interesting fact that there were no cases of either anorexia or bulimia among black dancers. The black dancers reported greater body image satisfaction. This suggests that there may be ethnic group differences that contribute to body image. It was also noted that most of the anorexic dancers were from more competitive national dance companies.

In a study by Schnitt et. al., modern dancers were studied to determine the incidence of anorexia nervosa (bulimia was not studied) [4]. It was determined that the modern dance subjects did not show anorectic attitudes as frequently as ballet dancers, despite being nearly as thin. There could be several reasons for this difference. The professional pressures put on modern dancers are often not as great as those placed on ballet dancers. Also, most modern are trained through university programs that offer broader experiences rather than professional ballet schools which tend to be more insular and ballet-centric.

Digesting the results of the aforementioned studies, we are reminded that factors influencing eating disorders are as complex as the people who suffer from them. We as directors, patrons, teachers, therapists, doctors, parents, and friends of dancers need to improve upon the existing environment. We need to take a collective stance against the pressures to be too thin. We need to promote a healthy body image in order to have healthy dancers.
We also need to be aware of the warning signs and be able to get the dancer to the appropriate help as quickly as possible. In many situations, serious eating problems persist far too long without notice.

Visible Characteristics of Anorexia Nervosa
Behavioral signs:
-Restricted eating
-Odd food rituals (i.e. counting bites of food, cutting food into tiny pieces, preparing food for others while refusing to eat)
-Intense fear of becoming fat
-Avoidance of situations where food will be present
-Strict exercise regimes
-Wearing baggy clothes to hide weight loss
-Binge eating
-Use of laxatives, enemas, or diuretics to get rid of food
Physiological signs:
-Weight loss
-Cessation of menstruation (amenorrhea)
-Pale complexion
-Often feels cold
-Fainting spells, dizziness
-Distended abdomen
Psychological signs:
-Mood swings
-Withdrawn
-Perfectionistic tendencies
-Insecurity
-Self-worth based on what is consumed
-Distortions

Visible Characteristics of Bulimia Nervosa
Behavioral signs:
-Binge eating
-Sneaks food, secretive eating
-Preoccupation with food
-Self-hatred when too much food is consumed
-Bathroom visits after meals
-Vomiting, laxative abuse or fasting
-Extreme exercise routines
Physiological signs:
-Enlarged salivary glands, bloated cheeks or broken blood vessels under the skin
-Frequent sore throats
-Tooth decay
-Complaints of muscles aches
-Weight fluctuations
Psychological signs:
-Mood swings
-Self-loathing and self-criticism
-Self-worth determined by food choices

If left untreated, eating disorders can cause a myriad of medical complications and at their worst, the loss of life. Your life is important. An eating disorder can thwart a successful life and career, interrupt your thinking, steal hours, chances and opportunities. We want to see you dance forever, so…eat right and respect your body.

References:
1. Lucas et al., "50-Year Trends in the Incidence of Anorexia Nervosa in Rochester, MN: a Population-Based Study," American Journal of Psychiatry, 148 (1999), pp. 917-922.
2. Garfinkel and Garner, Anorexia Nervosa, pp.112-117.
3. L.H. Hamilton, J. Brooks-Gunn, and M.P. Warren, "Sociocultural Influences on Eating Disorders in Professional Ballet Dancers, " International Journal of Eating Disorders, 4 (1985), pp. 456-478.
4. Schnitt, et. al., (1986). Anorexia Nervose and Thinness in Modern Dance Students: Comparison with Ballerinas. Annals of Sports Medicine, 3 [1], pp. 9-13.