From left, Alexis Fairbanks, Samantha Strong and Heather Caplan founded the nonprofit Lane 9 to raise awareness of eating disorders in the sport of running. (Katherine Frey/The Washington Post)

Whenever Alexis Fairbanks lost a race, she would look at the girls who finished ahead of her and think: They were smaller, thinner — they had the ideal runner’s body type, of course they beat me. And each time this happened, Fairbanks went home convinced that to be successful in running — a sport defined by seconds — she needed to lose weight. She was willing to do anything to get there.

But if anyone had asked Fairbanks in high school or early in college if she struggled with disordered eating, she would have denied it. She didn’t look the part, Fairbanks reasoned. And in fact, the more she restricted her diet, the more weight she gained.

“I was like, ‘Well, I’m not even good enough to do this right,’ ” said Fairbanks, a former collegiate middle-distance runner.

But what Fairbanks dismissed as her way of trying to get a competitive edge was actually a years-long journey with disordered eating from which the 26-year-old D.C. resident is still recovering. Studies in Europe have found the prevalence of eating disorders is higher among athletes, especially in sports that emphasize lean bodies such as running.

“Sport itself does not cause eating disorders,” said Riley Nickols, director of the Victory Program at the McCallum Place eating disorder treatment center in St. Louis. “But certain aspects of a sport can heighten vulnerability and an individual’s risk.”


Mario Fraioli, pictured left in a 2015 cross-country race, lost 20 pounds while struggling with disordered eating early in his professional career. “I didn't have 20 pounds to lose,” he said. (Camron Shahmirzadi)

Sharing her story helped Fairbanks move onto the road to recovery. Early last year, she co-founded the nonprofit Lane 9 Project with fellow runners Samantha Strong, 23, and Heather Caplan, a 31-year-old registered dietitian, to educate others and provide a virtual community where those with similar experiences can find support. After she shared her story, multiple teammates from college reached out, letting her know they went through the same thing.

Fairbanks and her co-founders want to remove stigmas, debunk stereotypes and spread awareness about the severity of eating disorders. They believe the sporting world — including coaches, athletic personnel and runners themselves — has much to learn.

“I still have people tell me, ‘You’re a 20-year-old woman, this is normal. You’re supposed to feel self-conscious about your body,’ ” said Strong, an ultramarathon runner and former collegiate triathlete. “With Lane 9, we tell people, ‘No, you don’t have to live with this. You can love and cherish and support your body — nutritionally, physically and emotionally — and do so in a healthy way.’ ”

They aren’t alone in their efforts. Nickols, who works with athletes of all levels seeking help with eating disorders, has given talks at colleges about the best practices and recommendations for coaches when assisting struggling athletes.

“I think anyone involved in athletics knows firsthand that eating disorders are active in the sport culture,” he said. “It cannot be ignored. Just like the recent attention to concussions in the last five years, this is a serious issue.” In 2007, researchers at the Norwegian School of Sports Sciences found that about 47 percent of elite female athletes in sports that “emphasized leanness” had clinically diagnosed eating disorders compared with 21 percent of women who were not elite athletes.

The pressure to look a certain way can lead to a distorted body image, and this mind-set is common among endurance athletes who are clinically diagnosed with eating disorders or struggle with disordered eating, defined as subclinical eating disorder behavior, according to National Eating Disorders Association chief executive Claire Mysko.

“A lot of these behaviors can be validated by the community itself,” Mysko said. “If you talk to elite athletes, there is obsessive thought around food and weight and intense training, and there’s very little questioning of that.”

Weight, Nickols said, is only one of about 40 factors in sport performance, but there is an underlying belief among runners that lighter means faster. And while a correlation between body weight and speed exists, Nickols warns that this can be a slippery slope toward an eating disorder and that any improvements in time, however brief, can negatively ­reinforce destructive behaviors.

Adhering to a restrictive diet and arbitrary weight goals can have both short- and long-term effects. Even if athletes see their times drop, doctors warn about the damage a low-calorie diet, purging or binge eating can do to a person’s body, all of which can cause an individual’s energy level to drop or lead to growth and development issues, depression, and impaired judgment.

Parents and running coaches are not always equipped to identify the risk ­factors or support those struggling with eating disorders. Drew Wartenburg, a professional running coach who was the director for cross-country and track and field at the University of California at Davis for six years until 2014, said that the training he received on eating disorders was minimal and agrees with Nickols that creating a dialogue to confront the issue would help. But he added that, as in the case of concussions, where the coach’s role doesn’t extend to giving baseline testing or assessing injuries, there is only so much a coach can do.

“I had received some training recognizing and confronting eating disorders, and we had some tools, but there were very [few] prescriptive things like, ‘Here is a check list of what to do and what to react to’ that I’m aware of,” Wartenburg said. “It’s not like a first-aid course, where every couple of years you get recertified.”

To help fill that gap, the sports community is educating those within its ranks who have medical expertise. In 2014, the International Olympic Committee developed a new tool to help medical professionals, such as team physicians, evaluate an athlete’s health to determine if they are in a state of low-energy availability, which is defined as “a mismatch between the athlete’s energy intake (diet) and the energy expended in exercise.” The relative energy deficiency in sports (RED-S) clinical assessment tool also serves as a guide for when sport participation should be modified or withheld completely from at-risk athletes, who may be suffering from heart issues, low bone density, or abnormal hormonal or metabolic function.

The RED-S tool is considered an important advancement in understanding high-risk athletes because it includes men in its evaluation. While the conversation around eating disorders and athletes has traditionally focused on women, male runners can suffer the same consequences.

Disordered eating was Mario Fraioli’s “dirty little secret.” After graduating from Stonehill College in Massachusetts in 2004, Fraioli wanted to lose weight before taking his competitive running career to the next level. He counted every calorie that went into his body and calculated how he was burning it. He estimates that he lost 20 pounds in a few months. “I didn’t have 20 pounds to lose,” Fraioli, 36, said.

When he eventually admitted to himself he had a problem, Fraioli had no idea whom to consult. He knew of no other male runners who had gone public with this illness.

“I think men are more reluctant to speak out about something they are struggling with, especially something as serious as an eating disorder,” he said. “The underlying theme is fear. The fear they’re not going to get help, fear of what other people might think about them, fear of what it might mean about their ­reputation.”

This fear concerns clinical psychologist Melody Moore of Dallas, who reminds her patients that, according to the National Institute of Mental Health, the most fatal mental disorder is anorexia nervosa. ­Anorexia patients die not just of complications from starvation but from a high rate of suicide.

Sometimes runners see weight loss as a competition, said Moore, who founded the nonprofit organization Embody Love Movement in 2013, which focuses on empowering women and girls. “They think, ‘Oh, I have to be the thinnest. I have to lose the most weight.’ I tell them, ‘The only way to win at this is to die.’ ”

When U.S. track and field standout Lauren Fleshman first joined the professional ranks, she went online and discovered that the world record holder in her event was the same height. Fleshman was determined to be the same weight. She stepped on the scale nearly every day and adopted a restrictive diet. She was never diagnosed with an eating disorder but said she most likely would have been labeled “high-risk” had she seen a medical ­professional.

It wasn’t until she “threw that number out the window” that Fleshman began to race well. “You can’t look at someone else’s picture or bio and apply it to yourself,” said Fleshman, a 36-year-old former all-American at Stanford and U.S. Olympic trials qualifier. “All you can do is find what works for you.”