When I first read Mary Cain’s story of disordered eating, encouraged by her coach, I was sad. But I wasn’t horrified, because I wasn’t surprised. In fact, I was a little relieved to find that an amazing runner like Mary struggled with some of the same challenges I did.
The more I follow Mary’s story, the more I see an opportunity for women’s healthcare to improve.
A Systemic Problem in Women’s Athletics
It’s easy to blame Alberto Salazar. Mary notes that it was easier to come forward after he was banned from coaching. What’s more, most news articles now refer to Mary’s (and other’s) experience as abuse. But if we blame Salazar, or even Nike as a whole, we are missing the point. Because Salazar isn’t necessarily evil, and a system doesn’t need to be abusive to be harmful.
As an example, here’s my story of how I associated running with weight loss.
My coaches weren’t obsessed with weight. At least, not consciously. But my female coach was very very thin. And the best runner on the team had an eating disorder. It was common knowledge. Coaches knew. She was eventually banned from the team until she gained weight. What did she do? She began sneaking out of her house at night to run. And she was then let back on the team, and brought us to States – a reward for her dedication, in the eyes of us younger runners.
Who’s to Blame for Poor Women’s Healthcare?
My coaches were by and large wonderful. I owe them so much. But alongside the excellent coaching they gave me, they also taught me (as a teen girl) the societal values they themselves followed.
In other words, Mary Cain’s story is not about a single coach. And it’s not about Nike. It’s about:
- the society we live in that believes weight loss and health are the same
- the difficulty of understanding two things at once (e.g. a country with both an obesity epidemic and disordered eating)
- women’s healthcare lagging far behind men’s
If we can address these three issues, we can improve women’s healthcare.
Separate Health and Weight Loss
It’s astonishing how often health care professionals confuse weight loss with health. And while yes, there is an obesity epidemic in the United States, and yes, obesity contributes to an overwhelming number of healthcare issues, thin does not always mean healthy. Plus, not everyone needs to lose weight.
In fact, there are many reasons people lose weight that are not healthy at all. Cancer treatments, eating disorders, stress, and many other health problems cause weight loss. Since weight loss is also tied to social hierarchy (particularly for women), women’s healthcare is unlikely to improve unless we stop assuming skinny means healthy.
Accept Two Ideas at Once
Part of the reason we struggle to understand weight loss as a not-always-good thing is because it means accepting two ideas simultaneously:
- Being overweight causes health problems
- Not everyone needs to (or should) lose weight
Hans Rosling, a Swedish physician and data enthusiast, speaks about the need to understand that two things can be true even if they seem opposing. For example, we have both an obesity epidemic in the US and a problem with eating disorders. Or, women’s healthcare is better than it was, and still bad.
Yet issues like RED-S, which Mary Cain is now speaking out about, happen exactly because of two problems at once. You can be athletic yet unhealthy. And when that happens, your body will canabalize itself.
How Can We Improve Women’s Healthcare?
This brings me to a hope for the future. I believe we can continue to improve women’s healthcare. For example, we can:
- Improve health literacy around the world
- Approach systemic healthcare change from within the system
- Believe women
Perhaps more than anything, we can continue to learn. We must, as a society, learn more about women’s health. We must continue to learn about health in athletics. And we must continue to question our assumptions, and listen to those who come forward to teach us.