Lifting a suitcase into the Uber was hard. Food was something to be carefully controlled. Running had become more like a punishment than a source of joy.
As a freshman at the University of California, Santa Cruz, Mina Hancock didn’t see these behaviors as signs of an eating disorder. Then the recently graduated cross country standout at Service High School was hospitalized in December 2021 after being diagnosed with anorexia nervosa while home in Anchorage for the holidays.
Now Hancock is part of a group of Anchorage athletes, advocates and coaches striving to educate teens about the signs and underlying causes of eating disorders so that they’re able to get help as soon as possible.
”Absolutely no one should be learning about their mental health issues when they’re being admitted to the hospital because it’s so severe,” Hancock, who identifies as nonbinary and uses gender-neutral pronouns, said in a recent interview.
In November, Hancock, along with two-time Olympian Holly Brooks, asked Anchorage School Board members to consider including a short film Brooks helped make about eating disorders among athletes as mandatory viewing for the district’s high school sports teams at the start of each season as a way to facilitate important conversations about body image, perfectionism and the kind of behaviors that can lead to eating disorders down the line.
That film, “Winning at All Costs,” is free to watch online. It was created in collaboration with the Alaska Eating Disorders Alliance and Landsick Media, a local video production company. So far, the film has been shown in a handful of classes and with coaches, though it’s not yet an official part of the health curriculum, said Anchorage School District spokeswoman Lisa Miller.
The film describes how and why athletes are at risk for eating disorders, and encourages steps like unfollowing people on social media who make you feel bad about yourself, finding people to talk to whom you can trust, and shifting away from the kind of “winning at all costs” mindset in competitive sports that can trigger disordered eating.
“In this society, we’re told that we’re only as good as our performance, our appearance. And it’s directly tied to our self-worth,” Brooks narrates in the film.
Eating disorders are defined as serious behavioral conditions that “are characterized by severe and persistent disturbance in eating behaviors, and associated distressing thoughts and emotions,” according to the American Psychiatric Association.
Nationally, about 30 million Americans will be diagnosed with an eating disorder at some point in their lives — including more than 60,000 Alaskans. Eating disorders are among the deadliest mental illnesses in the U.S., directly resulting in 10,200 deaths a year. About a quarter of those diagnosed will attempt suicide, according to national statistics.
Susan Bick, a teacher and cross-country running coach at Chugiak High School who was interviewed in the film, wasn’t initially sure that she wanted to appear in any documentary about eating disorders.
Bick is still working through her own relatively recent experience as a student-athlete at the University of Alaska Anchorage on a running scholarship that depended on her performance.
In the film, Bick explains how she was regularly weighed by coaches, and how her coach told her she needed to lose weight. That pressure contributed to her developing an eating disorder at the time.
As a coach, Bick’s approach is markedly different. She tries to impart upon her students the importance of food as fuel, and celebrating personal successes even when they don’t win a race.
“I always tell them, I want them to be proud of themselves first. And that I will always be proud of them no matter what they do. I’d love for them to be competitive and successful, but I’d rather they, like, learn to be good human beings,” she said.
For Bick, what that looks like is encouraging her students to take rest days when their bodies need it, and greeting them at the finish line of each race with a big hug no matter how they do.
“I just try to make them feel like I care about them, and make sure that they know they can come talk to me,” she said.
Bick says she wants to make sure high school coaches are educated on how to recognize the signs of an eating disorder and the dangers of putting too much focus on winning. Her students — many of whom who showed up at the Bear Tooth to watch the film — said hearing their coach’s story was illuminating and important, and helped start conversations with each other that weren’t happening otherwise.
In Alaska, in-state treatment options for eating disorders are limited, said Beth Rose, co-founder and board chair with the Alaska Eating Disorders Alliance.
Nationally, the onset of the COVID-19 pandemic has been linked to a rise in eating disorders. The unknown can be triggering for those with eating disorders, who often rely on rules and regulations to help cope with their stress, Katie Bell, an Anchorage therapist whose specialty includes treating eating disorders, told the Daily News in 2021.
Many are still suffering from eating disorders they developed during the pandemic. Alaska’s health department has limited data on eating disorders and its prevalence, state health officials say.
But state data on emergency department visits involving eating disorders among teens and adolescents — which captures just a fraction of the total number of people likely struggling statewide — shows a slight upward trend in illness that began during the pandemic has not yet dropped off.
In 2021, Alaska reported an increase in the rate of emergency visits among adolescents ages 15-24 where eating disorders were identified as a factor, compared to 2019. Those rates per 10,000 visits were: 4.9 in 2019, 5.26 in 2020, 7.03 in 2021 and 6.08 in 2022.
Anna Frick, an epidemiologist with the state health department who manages that dataset, noted that given the small numbers, it’s hard to say for sure whether that data represents a real change over time, but it’s in line with national data.
Winning at all costs
Each person interviewed for this story said it was important to note that eating disorders cut across race, class and gender — anyone can develop one, and the risk factors are varied and complex.
But athletes are two to three times more likely to develop an eating disorder than most, according to Brooks, who works mostly with young athletes as a licensed counselor. She said in a recent interview that as a mental health provider and as an athlete, she has seen eating disorders “destroy many dreams,” which motivated her to make a film that would help shed light on the problem.
For Hancock, who ran cross country and skied in high school, sports were “definitely a pretty big trigger” for an eating disorder. Wanting to win — and feeling like coaches would only really pay attention to athletes who were winning races — created a culture around doing whatever it took to be the best, they said.
“It felt like you needed to be training all the time,” Hancock said. “You needed to be having the right diet … you need to always be pushing yourself, and always doing extra.”
In endurance sports, being smaller can feel like a way to get faster, which can make food or weight gain feel like something to be avoided or controlled, Brooks explained. Making a shift in thinking where young athletes view food as fuel and energy — and eating enough as essential for their future health, strength and well-being — is key, she said.
Making hard conversations easier
Hancock’s eating disorder worsened in college, where they knew no one. The only constant was the way they were able to control food and exercise.
“I knew something was up,” Hancock said. “I knew my relationship with food was different than it used to be. I knew that something wasn’t quite right. But I genuinely did not know I had an eating disorder until I came home from my first semester of college and went to the doctor and they were like, you need to be in the hospital.”
That winter, Hancock was admitted to an acute care facility in Denver where they were treated for malnourishment, then spent five months at an inpatient eating disorder facility. They’re now in recovery.
Brooks said her hope is that the film will help facilitate conversations that have often felt too off-putting for teens, coaches and parents.
It’s those conversations that will really lead to some kind of change, even if they’re “really freaking scary” sometimes, Hancock said. That goes beyond just putting on a movie and handing out a worksheet to complete afterward.
“Creating these spaces where people can be vulnerable and people can actually talk about things in a group setting and have their feelings validated; especially in high school, where everyone just thinks that they’re alone,” Hancock said. “Because then you start talking about things and you’re like, ‘Oh, my God, no, we’re all in this together.’ ”
For support, resources or treatment options, call the National Eating Disorder Association’s toll-free, confidential helpline, 1-800-931-2237. The line is open Monday-Thursday from 5 a.m. to 5 p.m., and Friday from 5 a.m. to 1 p.m. The association also offers an online screening tool for ages 13 and up to find out if it’s time to seek professional help.
For more information about the Alaska Eating Disorders Alliance and resources in Alaska, visit their website at akeatingdisordersalliance.org.