Nutrition

Dancers and Eating Disorders – Warning Signs and Helpful Resources

July 8, 2019 by 4dancers

We are pleased to bring you an article by Dawn Smith-Theodore MA, MFT, CEDS – dancer, teacher, and for the last 20 a psychotherapist with a specialization in eating disorders, based in Los Angeles. She brings her knowledge and her own personal experience with these concerns to her work, and has authored the book “TuTu Thin — a Guide to Dancing Without an Eating Disorder“. She has presented internationally on this topic. This is an important concern in the dance world –please pass it on! – Jan Dunn, Dance Wellness Editor

by Dawn Smith-Theodore, MA, MFT, CEDS

When you suffer from an eating disorder, you live with the mantra, never enough. Whether it’s the number on the scale that could always be lower, or feeling as though you can never get enough food when binging, or when you believe you can never exercise enough, this concept remains a familiar thread in the life of someone who suffers from an eating disorder.

There is always someone better standing next to you in the mirror—someone with a better physique or a higher extension or more perfect feet. The critical mind works overtime, and can inhibit dancers from being able to perform their best at auditions and even in class. Not all dancers develop eating disorders, but research shows that they are 20 times more likely to than the general population.

Many dancers struggle with either an eating disorder or disordered eating in order to achieve the body desired by teachers and choreographers. Instructors play an important role in bringing out the feelings that tell the story of dance. Dancers need constructive criticism to improve technique and strive to be the best they can, but someone who has the predisposition for an eating disorder can hear the critique as an affirmation in their head that they’re just not enough. To help a dancer recover from an eating disorder, teachers, families and even the dancer must work together to understand and address the critical voice that says, never enough.

A common theme among dancers, whether they have eating disorders, disordered eating, body image concerns, or the basic belief that it’s never enough, is that they need to control the size of their body in order to dance. Each dancer perceives a message that their ability as a dancer is not enough, and that they also must have a perfect body. Yet truth be told, it is possible to navigate through struggles with body image, eating disorders, and the boundless desire to dance.

The dance world does not create the eating disorder, but it is part of the recipe that leads to an eating disorder. It is perhaps ironic that the same certain personality types prone to developing an eating disorder (such as the perfectionist) will also pursue a dancing career. For example, someone who is a perfectionist may really like that trait about themselves, because it’s the same aspect that drives them to be as good as possible at everything they do. A hard worker does the work that’s needed to accomplish a task and be satisfied with their work, but the perfectionist will never be happy unless they’re the best.

The problem is that perfect does not exist. We are humans, so we are not perfect! This is the cycle that keeps someone with an eating disorder stuck, while they strive for the impossible dream of perfectionism.
There is a dangerous line where perfectionism becomes problematic and the dancer begins to lose perspective. The dark side of perfectionism begins when a dancer believes that they are never good enough. No matter what they do, they never measure up. The dancer who has crossed that line believes that they must never make mistakes. The feelings that ensue are those of shame and guilt, because they are not living up to the expectations of others.

They become hypercritical of themselves and always feel that they could be doing better. The thoughts become very black and white. If they aren’t perfect, they are a failure. The thoughts and drive for perfectionism is taken to the extreme, and the dancer begins to spin out of control. Dancing may no longer be enjoyable. The love that the person once had for dance starts to fade away. The occupation with weight begins to be what the dancer can control since they feel out of control in their dancing, or of what others think of them. The eating disorder is a distraction and a way to escape the fear that they won’t succeed as a dancer.

The signs of an eating disorder can be very discreet. It may be difficult to recognize an eating disorder in oneself or a loved one. It may also be easy to hide an eating disorder (at least at first) from friends and family members.

Some Warning Signs:

1. Weight loss
2. Obsession with food, weight, and calories
3. Isolation from friends and family
4. Frequent trips to the bathroom after meals and snacks
5. Food disappearing from the kitchen
6. Changes in mood…extreme irritation and agitation
7. Wearing baggy clothes to cover the body

As a dancer concerned about your body, you might start a diet with the intention of losing a few pounds, but it can quickly become a downward spiral of deception. Obviously, not everyone who goes on a diet develops an eating disorder. There are many reasons someone develops an eating disorder. No one chooses to have an eating disorder – but there is a choice to recover.

Education about eating disorders is key for the dancer and their families. Early detection can be very helpful in the success or the treatment of any eating disorder. Your dance teacher and dance studio should understand the benefits of healthy body image. Since you probably spend hours at the studio, the first person to notice any changes could be your dance teacher. Many times, dancers spend more time with their dance teacher and dance friends than they do with their family and school friends. It’s important for those in the dance community to look out for one another and support a healthy lifestyle.

You can help create a healthy atmosphere by helping to educate others about the importance of a healthy self-image as a dancer. If you hear another dancer or teacher talking about diets, bad foods, or negatively about their body, try talking about how important our bodies are as dancers.

If you suspect another dancer or a loved one has an eating disorder, you want to approach them with love and curiosity. Perhaps the individual won’t admit to the problem, but they know that you are noticing and concerned. This may cause them to want to be more open with you.

Strive to be the best dancer you can be. Care for your body as it is your instrument. Proper nourishment and sleep are very important. Compete with yourself and don’t constantly compare yourself to others. Dance for the enjoyment of what you do. Allow yourself the motivation to achieve realistic expectations. Allow yourself the pleasure of recognizing your accomplishments. Being a dancer is something very special. Do not let the allure of being perfect or not enough steal your love of dance from you.

Helpful Resources:

The following organizations offer more information on eating disorders, as well as referral lists for doctors, dieticians and therapists in your area.
· Academy for Eating Disorders (AED)
· National Association of Anorexia Nervosa and Associated Disorders
· Families Empowered & Supporting Treatment of Eating Disorders (F.E.A.S.T.)
· International Association of Eating Disorders Professionals (IAEDP)
· National Eating Disorders Association (NEDA)
· Overeaters Anonymous (OA)

Dawn Smith-Theodore, MA, MFT, CEDS is a former professional dancer, studio owner for 25 years in Los Angeles, and psychotherapist for the past 20 years specializing in the treatment of eating disorders. She is the author of a book about dancers and eating disorders, “TuTu Thin… A Guide to Dancing without an Eating Disorder” featured in Dance, Pointe, and Dance Teacher Magazines. Dawn has written for Pointe Magazine and is an international speaker. Dawn is recovered from Anorexia Nervosa and feels passionate about educating the dance world to help the prevention of eating disorders. Dawn is co owner of Cross Pointe Dance and Head to Pointe Wellness Workshops for Dancers.

To learn more about Dawn and her work, visit her website.

Healthy Eating: Vegetarian & Vegan Diets For Dancers

February 17, 2019 by 4dancers

I’m pleased to bring you an article on healthy eating for vegetarian and vegan dancers from a longtime IADMS colleague, Derrick Brown, M.Sc. A lifelong dancer, teacher, and choreographer, Derrick is currently co-program manager and lecturer in Dance Science at the University of Bern, Institute for Sports Science, in Bern, Switzerland. He also works in the Netherlands, as a research fellow at the National Centre for the Performing Arts, and as a guest lecturer in health at ArtEZ University of the Arts, and the Coronal Institute of Occupational Health, People and Work – Academic Medical Center, Amsterdam.

For dancers who choose a vegan diet there is often a lack of information that applies specifically to dance. Derrick is working to remedy that situation, and we are pleased to share his knowledge with you.

– Jan Dunn, Dance Wellness Editor

by Derrick Brown, M.Sc.

Is it just a hype?

Click, zoom in, swipe up, left, or right on any social media platform and eventually you will come across someone extolling the dangers of meat and touting the virtues of a plant-based diets. At first glance you might believe that the entire world has gone ‘green’. However in a study published recently (see below) that researched 334 dancers from 53 countries, we can see that of those who opt for plant based diet, only a minority are emerging when compared to those who also consume animal products. Vegetarianism provides a catchall term for a variety of diets, which exclude the consumption of some, or all-animal products.

Contrary to popular claims, appropriately designed and managed vegetarian diets contain foods nutritionally sufficient for health, well–being and physical performance. Vegetarian dancers can meet their protein needs from primarily or exclusively (vegan) plant-based sources when a variety of these foods are consumed daily and energy intake is adequate.

However, the quality and timing of dietary intake is of key importance to meet the physical demands typical of high intensity, intermittent types of dance styles. Poorly planned, calorically restrictive and nutrient poor diets confer a host of deficiencies that diminish health and ultimately performance.

The current recommendations for dancers’ diets are:

– 55 % carbohydrate

-20–30% fat

-12–15% protein.

This recommendation is based on an omnivorous diet and is an acceptable start point for all dancers across different dance styles. Below are some simple examples that may aid dancers who opt for partially or all plant-based diets.

High-quality carbohydrates are the way to go. [Read more…]

Healthy Bones For Dancers

February 11, 2016 by 4dancers

by Selina Shah, MD, FACP

Our bones are important because they serve as the foundation on which we are built. Bone is living tissue that contains blood vessels; proteins, including collagen; and cells that are actively maintaining healthy bone. Bone also contains many minerals, the most important of which is calcium.

Building Strong Bones

We have the best chance of building our strongest bones when we are young — because the rate at which we form bone is higher than that of losing bone up until about the age of 30, when peak bone mass is reached. After peak bone mass is reached, we starting losing bone at a higher rate than we form it. The majority of the mass of our bones forms between the ages of 11 – 14 in girls and 13 – 17 in boys. The more bone mass you have by the time you reach peak bone mass, the less of a chance of you have of breaking your bones, especially later in life as bone loss occurs.

Bone Health And Your Diet

As dancers, we place a lot of stress on our bones. This stress can lead to damage of bone tissue. However, luckily our body is designed to repair itself, so bones maintain their healthy structure by containing cells that remove damaged bone and replace it with healthy bone, also known as bone turnover.

In order to achieve the highest bone mass possible and to ensure healthy bone turnover, it is important for our bones to have the right ingredients. Dancers need have enough nutritional intake based on activity level, adequate calcium, and adequate Vitamin D. Without these, a decrease in bone density can occur, making a dancer susceptible to fractures and stress fractures.

Dance is a form of exercise which uses energy. This energy needs to be replaced by consuming enough healthy carbohydrates and fats so that your body can continue to function normally. Having adequate fuel is especially important for girls to ensure normal, regular menstruation. The hormones that regulate menstruation directly affect bone mass. If a dancer does not consume enough calories and fats to adequately re-fuel the body, then the hormone balance gets thrown off – which can result in a decrease in bone density.

It is not unusual to experience irregular periods (meaning periods that do not come monthly) during the first year of menstruation. However, missing your periods for months at a time or getting your period too late, may also be a sign that you are not consuming enough calories. Genetics and other medical issues could also be playing a role in abnormal menstrual cycles or later onset of menstruation. It is best to consult a physician if you do miss your period for more than 2 months, especially if this occurs on a regular basis, or if you are 15 years old and have not gotten your period. Males are also susceptible to bone loss due to inadequate energy consumption. All dancers need to consume enough calories to re-fuel the body.

Bone Density

The human body is designed to always have normal calcium levels – so if you do not consume enough calcium, it will take it from bone which again will lead to decreased bone density. The Institute of Medicine currently recommends consuming the amount of calcium based on age shown in Table 1 below. It is best not to exceed the amount of calcium shown at the upper limit column because this can increase the risk of forming kidney stones. It is best to get calcium from dietary sources such as dairy, almonds, broccoli, Brussels sprouts, and dark leafy greens, to name a few. Check your food labels and calculate how much calcium you get in a day. If you do not reach the level recommended in Table 1, then buy a supplement. Do not take more than 500mg at a time to maximize effective absorption.

Table 1: Institute of Medicine Daily Adequate Intake of Calcium

Age	Calcium (mg/day)	Calcium (mg/day) Upper Level Intake
4 – 8	1000	2500
9 – 18	1300	3000
19 – 50	1000	2500
51 – 70	1200	2000
> 70	1200	2000
Osteoporosis	1500	2500

Bone Health And Vitamin D

In order for your body to absorb dietary calcium, you need to have an adequate amount of Vitamin D. The best source for Vitamin D is from the sun. Vitamin D is formed by cells in the skin layer. Sun exposure to form Vitamin D in the skin is inhibited by sunblock and decreased by clouds and pollution. Additionally, the darker the skin color, the longer daily exposure time to sun is needed for the cells in your skin layers to form adequate vitamin D. Generally speaking safe sun exposure (no sunblock for the time allotted as long as there is no risk of skin cancer by family or personal history of skin cancer) is best obtained between the hours of 10am – 3pm on the arms and legs for a minimum of 20 minutes per day depending on skin color and the latitude in which you live.

The further you are from the equator, the less Vitamin D is formed during winter months. It is difficult to adequately consume Vitamin D from foods fortified with Vitamin D. A few foods such as Cod Liver Oil, egg yolks, salmon, sardines, mackerel, and canned Tuna are natural sources of Vitamin D. One study found that more than 95% of dancers are deficient in Vitamin D. If you cannot get enough sun exposure, the Institute of Medicine recommends the supplementing Vitamin D at the levels based on age shown in Table 2 below. Your doctor may check a blood level and recommend a higher dosage of Vitamin D to boost your levels quickly. It is difficult to become toxic with Vitamin D supplementation. Follow your doctor’s advice.

Table 2: 2010 Institute of Medicine Daily Adequate Intake of Vitamin D

Age	Vitamin D (IU)
0 – 1	600
1 – 70	600
> 70	800
Pregnancy	600

In summary, it is best to ensure adequate Vitamin D levels, calcium intake, and food intake to develop and maintain strong bones. The younger you begin, the better off you will be in the future.

Selina Shah, MD, FACP is a board certified sports medicine and internal medicine physician and the Director of Dance Medicine at the Center for Sports Medicine in San Francisco, CA and Walnut Creek, CA. She has lectured nationally and internationally on various dance medicine topics and has published papers in medical journals and books including her original research on dance injuries in contemporary professional dancers. She is the dance company physician for the San Francisco Ballet School, Liss Fain Dance Company and Diablo Ballet. She is a physician for Berkeley Repertory Theater, Mill’s College, St. Mary’s College, and Northgate High School. She takes care of the performers for Cirque du Soleil and various Broadway productions when they come to the San Francisco Bay Area. She has taken care of several Broadway performers (i.e. American Idiot, South Pacific, Lion King, Book of Mormon, MoTown, and Billy Elliot). She is a team physician for USA Synchronized Swimming, USA Weightlifting, USA Figure Skating and travels with the athletes internationally and nationally. She is also a member of the USA Gymnastics Referral Network. As a former professional Bollywood and salsa dancer,

Dr. Shah is passionate about caring for dancers. She continues taking ballet classes weekly and also enjoys running, yoga, Pilates, weightlifting, and plyometric exercise.

For Dancers: An Easy Guide To Portion Sizes

June 25, 2015 by 4dancers

by Catherine L. Tully

What you eat matters, but so does how much you eat. Unfortunately, portion sizes can be hard to estimate. Let’s face it, nobody wants to carry around a stack of measuring cups!

Luckily, there’s a fairly simple way you can ballpark portions without too much trouble, and it involves something you always have with you—your hand! Use the following to keep an eye on how much you are eating—it works quite well. (Sizes are approximate.)

1 serving of meat = the palm of your hand
1 tablespoon = your thumb, from the second knuckle to the tip
1 teaspoon = the tip of your index finger, second knuckle to the tip
1 cup = the size of your fist
1 ounce = your thumb, from the first knuckle to the tip
1⁄2 cup = loosely cupped hand

These simple measurements can help you estimate how much you are eating and keep you from overdoing it. Keep them in mind when you head out to a restaurant, or when you are preparing meals or snacks.

Dance Advantage and 4dancers have written a guide for healthy eating, studying smart, navigating dance coursework, roommate relations and more–designed specifically for college freshmen going off to a dance program. This post is an excerpt from that e-book.

Learn more about this resource and get it for yourself or someone you know here:

Dancing In The Dark – Dancers Need Vitamin D

December 26, 2013 by 4dancers

Happy Holidays to all!

Today’s article is from Dr. Matt Wyon, Professor of Dance Science at the University of Wolverhampton, in Birmingham, England, who recently wrote an article on 4dancers.org on the importance of supplemental physical fitness training in dance. We are happy that Matt, who is also the Vice-President / President-Elect of IADMS (International Association for Dance Medicine and Science) has contributed a second article–this one on how important Vitamin D is for dancers. It’s something of interest to everyone, in terms of general good health, but recent research has shown that it may be especially important for dancers. Read on!

Hoping everyone has had a wonderful holiday season, with Nutcrackers abounding!

– Jan

_________________________________________________

Dancers spend so much time indoors, with classes / rehearsals / performances, that they get little exposure to sunlight. Even when they live in sunny climates they don’t get enough sun exposure on their skin, because we automatically cover-up with sunblock.

Direct sunlight is the main way we can increase vitamin D levels in our body. We can get the vitamin from our diet, through foods such as fortified cereals, oily fish and diary – but for the majority of us this is not enough to meet our needs. This has left vast numbers of people, including dancers, deficient in vitamin D.

Why is vitamin D important? It used to be known as the “bone hormone”, important for bone growth and development, but new research has shown that it is involved in lots of other important systems in the body, including the immune system. It also plays a part in diseases such as multiple sclerosis, rheumatoid arthritis and tuberculosis.

All of this is important for everyone, dancers included —but in addition, recent research points to an important link for athletes such as dancers. There is a connection between muscle strength and vitamin D: deficient levels of Vitamin D has been linked to decreased muscle strength. In our recent study at the University of Wolverhampton (Birmingham, UK), we gave vitamin D supplements to ballet dancers and saw that jump height and leg strength increased for those on the supplementation, compared with those who didn’t take any. The group who took the vitamin D tables (2000IU a day) also got fewer injuries over the 4 month period, probably because their legs were stronger.

In summary, as a dancer you should ask your doctor to check your vitamin D levels at least once a year. This is just a blood test and doesn’t take long but could have a major effect on your stayer healthy and dancing longer / dancing stronger.

Matthew Wyon, PhD

Professor in Dance Science,

Research Centre for Sport Exercise and Performance, University of Wolverhampton, UK

National Institute of Dance Medicine and Science, UK

Photo courtesy of FreeDesignFile.com, under Creative Commons License 3.0

Some Warning Signs:

Building Strong Bones

Bone Health And Your Diet

Bone Density

Bone Health And Vitamin D

Disclosure – Affiliate & Ad Info

Copyright Notice