How Dance Teachers Can Support Dancers’ Eating Disorder Recovery
In this blog:
Eating Disorders: Basic Information for Dance Teachers
Eating Disorders in Dance
Eating disorders remain a prevalent health concern in dance. In a recent position statement, the Australian Institute of Sport (AIS) recognised dance as being one of several sports associated with an increased risk of eating disorders. Approximately 1 in 8 dancers experience an eating disorder, and 1 in 6 ballet dancers 1 . This may be related to a range of sport-specific factors, which can influence a dancers body image or their relationship with food:
A heightened focus on the body’s appearance during training and performance.
Perceived performance benefits of low body mass, such as improved jumping, transitions or mobility.
Perceived benefit of leanness in genres involving lifts, such as ballroom, ballet and contact improvisation.
Demanding training schedules, often requiring a focus on meal timing and food choices to avoid gut discomfort. This can lead to the development of food ‘rules’.
Personality traits which are commonly drawn to dance, including attention to detail, diligence, and sensitivity.
Other factors perpetuating the high prevalence of eating disorders relate to culture. Unfortunately, disordered eating behaviours are often normalised and considered necessary for maintaining leanness in dance. Studios and companies may also have close social groups, making it difficult for dancers to recognise and seek help for harmful thoughts or behaviours.
To support dancers to reach their full potential, it is important that dance teachers can recognise disordered eating, support dancers throughout recovery, and implement effective prevention.
Impact on Health and Performance
Eating disorders often make it difficult for dancers to consume enough energy to fuel performance. This leads to low energy availability (EA). Having a low EA can affect all body systems, including bone strength, cardiovascular function, digestion, immunity, and reproduction. In adolescents, low EA can delay growth and development. It can also impact cognitive function, including mood, concentration, decision-making, and co-ordination.
In addition to the direct physical impairment, low EA can indirectly affect training and performance. Performance consequences may arise from ineffective training, due to inadequate fuelling, compromised cardiovascular fitness or cognitive impairment. Dancers may also have interrupted training due to increased rates of stress fractures, extended injury recovery periods, or frequent illness. This relationship between low EA, health and performance is referred to as Relative Energy Deficiency in Sport (RED-S)2. RED-S can inhibit a dancers ability to their performance goals, and increase risk of career-limiting injury.
Eating Disorder Treatment
Following diagnosis of an eating disorder, dancers will often work with a team of health professionals to support them through recovery. Treatment teams will often include a general practitioner or paediatrician, a mental health professional, and a dietitian.
Parents or caregivers may also be involved in treatment for children and adolescents. There are many different models of eating disorder treatment, and each individual’s experience will differ. The psychological treatment is delivered by the mental health practitioner, addressing the emotion and cognitive components of the eating disorder.
Dancers are also strongly encouraged to work with a dietitian to establish a regular eating pattern, adequate nutrition for physical recovery, and a positive relationship with food.
How Dance Teachers Can Support Recovery
Many dancers will continue to participate in training throughout recovery. This can support dancers to maintain a sense of identity while they challenge their eating disorder, which may have consumed a large part of their identity. It also promotes social engagement, and enables dancers to continue building their career.
At DDD Centre for Recovery, we believe that dance teachers have a valuable role in supporting dancers throughout this challenging period of their life. That’s why we offer Nutrition Workshops for dance teachers where you can learn about dance-specific performance nutrition, nutrition-related issues in dancers and their prevention and treatment, and RED-S and eating disorders protocols so that you can feel more confident in the topics of nutrition, body image, and eating disorders, which are often not covered in detail enough in early teachers trainings.
Let’s take a look at some of the strategies that you can practice from today:
Supporting dancer’s nutrition
Promote regular eating throughout the day - particularly if dancers are attending multiple classes. This includes scheduling breaks for morning tea, lunch and afternoon tea. This will support dancers recovering from an eating disorder by normalising regular food intake, helping them implement meal plans or guidelines provided by their dietitian without feeling self-conscious.
Consider which activities are scheduled after meal times. Choosing lower intensity activities for 30-60 minutes after breaks will allow dancers to eat more fulfilling meals and avoid gut discomfort.
Dancers recovering from an eating disorder often experience feelings of over-fullness and discomfort after meals. Walking, gentle stretching, breath exercises or heat packs may help to alleviate symptoms before recommencing class.
Trauma-informed practice
Individuals living with an eating disorder are often subjected to stigma and judgement. Creating a sense of non-judgement, empathy and inclusivity in training can support dancers during recovery.
Respect the recovering dancer’s confidentially, avoiding practice which may draw attention to their diagnosis, eating behaviours, or body shape.
The dancer may experience several symptoms of low EA which impact their participation in training, such as decreased cardiovascular health, prolonged recovery from injury, gastrointestinal upset, urinary incontinence, or fatigue. While this may be disruptive to class, it is important to maintain non-judgement and allow the dancer to take a break if needed.
Medical Safety
Monitor the recovering dancer for signs of acute medical risk during class, such as light-headedness, breathlessness, or weakness.
Ensure that you have the contact details of the recovering dancer’s parents or medical practitioner available in the case of emergency.
If you are concerned about the safety of the dancer continuing to participate in training, speak to them immediately.
Body-kind practice
Adopt a weight and shape-neutral approach to choreography. For example, structuring choreographing to showcase diverse body compositions.
If implementing dress codes or costumes, provide dancers with the option to wear looser fitting garments. If exams are completed in tight-fitting garments, consider offering the recovering dancer the option to complete their exam towards the back of class, separately, or without mirrors.
Consider the necessity of mirrors in class. While mirrors can provide useful feedback, the effect of mirrorless training on motor learning is currently being explored3. Mirrors can promote body checking behaviours in class, and providing opportunities for mirrorless training may support dancers during recovery.
Role modelling
Become familiar with the concepts of weight-bias of weight neutrality, and Health at Every Size (HAES)® here.
Reflect on any biases that you may bring to class yourself, and how this may influence your behaviour around students. This may include weight-bias, body image ideals, or food rules.
Demonstrate a positive relationship with food wherever able. This may include using neutral terms to describe food, avoiding phrases such as ‘healthy’ or ‘unhealthy’, ‘clean’, or ‘bad’ when describing food.
Consider the body diversity of your teachers and staff, including shape, ethnicity, and gender representation. Role modelling inclusivity within your facility can promote body positivity for all dancers.
Boundaries
Ensure that you understand your role as a teacher. While it is important to offer dancers support during recovery, you do not need to adopt the role of a dietitian or mental health professional.
Do not attempt to counsel the dancer with education about nutrition or weight. Eating disorders are mental illnesses and cannot be resolved with logic, and must be managed by the dancers treating team.
Communicating with the team
If you would like more information about the dancer’s recovery or are concerned about their participation in training, you may wish to speak with their parents or health professionals. It is best practice to obtain consent from the dancer before any communication is made.
Resources
If you would like to know more about eating disorders in sport and the role of coaches in recovery, please refer to the following resources or speak to one of our experienced dietitians at DDD Centre for Recovery.
References:
1. Arcelus et al. (2013). Prevalence of Eating Disorders amongst Dancers: A Systemic Review and Meta-Analysis. Eur Eat Disorders Rev, 22, 92-101.
2. Interational Olympic Committee (2018). IOC consensus statement on relative energy deficiency in sport (RED-S): 2018 update. Br J Sports Med, 52, 687-697.
3. Radell et al. (2019). Mirrors in the Dance Class: Help or Hindrance. International Association of Dance Medicine & Science (IADMS).