She was running more than 100 miles a week, a skinny girl in shorts and a sportsbra, with the endurance of the Energizer bunny. At the peak of her collegiate career last year, Anna posted some of the fastest 5-kilometer and 10-kilometer times among Division III NCAA competitors nationwide. But during this time, the young athlete (whose real name is withheld to protect her privacy) struggled quietly with an eating disorder. Eventually, bulimia affected her performance - and her times slowed markedly.
As any Olympian could attest, top physical form is a must - and it requires strict regimentation of everything from training schedules to diet. But for some elite athletes, like Anna, the drive for a lithe, lean body results in an obsessive preoccupation with food and body image that can lead to eating disorders.
Concern has been highest in women's gymnastics, a sport where 59 percent of competitors have eating disorders, according to one 1994 study. But elite athletes in other sports grapple with eating disorders too - in an effort to present judges with toned, streamlined physiques, or to maximize efficiency in endurance events, or to qualify for certain weight categories. Awareness of the problem is growing, but few sports are taking vigorous, systematic steps to counteract it.
New evidence indicates that eating disorders may be more prevalent among athletes than in the general population. A study in the late 1990s of all elite Norwegian athletes found that 20 percent of the women had an eating disorder, compared with 9 percent of the Norwegian populace, the Clinical Journal of Sport Medicine reported in 2003. The study also found that men competing in endurance sports or weight-class events showed a high prevalence of eating disorders.
"The ability to work toward a goal, to sacrifice present satisfaction for future reward, is what makes you good at athletics ... and good at starving yourself," says Angela Guarda, assistant professor of psychiatry at Johns Hopkins Medical Institutions.
Many experts agree that the very attributes that produce athletic success - notably strict discipline and perfectionism - can also lead to eating disorders such as anorexia (severely curtailing food intake) or bulimia (bingeing and purging). In both cases, affected athletes become obsessed by what they eat and how they look.
"You'll do anything, you'll go to extremes to just keep doing whatever's working," explains Anna. The more weight she lost, the faster she ran. Though there were some danger signs, such as cessation of menstruation, she was convinced that her eating habits were the key to better results.
In sports like wrestling and lightweight rowing, where competitors weigh in before each contest, "group think" may also help promote unhealthy eating patterns. If a majority of athletes on a team take drastic measures to qualify for low weight categories, a culture develops that perpetuates the problem, says Dr. Antonia Baum, a psychiatrist at George Washington University Medical Center. Once eating disorders become part of the culture of a sport, she adds, it is hard to persuade individuals of the need to change their behavior.
The problem is not new in athletics.
"As far as we can tell, the focus on dieting, body image, and resulting disordered eating has been around for quite some time," says Elizabeth Applegate, author of "Encyclopedia of Sports and Fitness Nutrition." "The issue is that so many athletes - as little as 10 years ago - didn't talk to their coaches about it."
When Anna's coaches finally spoke to her about her weight loss and eating habits, she was not receptive. "Nobody could have said anything to make me stop. I had to figure it out for myself." Though she would throw up most of what she ate, she didn't think she was doing anything wrong.
Finally, Anna reached a crisis. "I got to the lowest low and I just thought, 'I can't do this.' Unfortunately, that's what had to happen for me to realize what was going on."
She has started working with a new coach - one who'd been an elite athlete herself and who'd also battled an eating disorder. "I really listened to her, and it just clicked then. [What she was saying] made so much sense to me." Now, Anna's running has improved and she says she feels better than ever.
USA Gymnastics, the US Women's Tennis Association, and UK Athletics (Britain's track and field association) are among the groups with coaches' education programs to help stem eating disorders. But awareness of the problem among coaches varies widely, and whether an athlete gets help may depend largely on the perceptivity of a coach or trainer.
When it comes to her athletes and food, head coach Suzanne Yoculan takes a forthright but sensitive approach. She discusses "food obsession" frequently with gymnasts on her women's team at the University of Georgia, which has won several NCAA championships. She also requires each one to stay within six pounds of her target competition weight - and if an athlete goes above or below that 12-pound limit, she is not allowed to practice with the team.
Ultimately, the athletes themselves need to take responsibility for maintaining a physique that can execute gymnastic feats, says Ms. Yoculan. "If they can't handle [that responsibility], they shouldn't be in the sport."