Allie Ostrander’s Radical Transparency

This article originally appeared on Womens Running

Note: this article includes discussion of eating disorders and eating disorder recovery. To seek help for yourself or a loved one, please reach out to the National Eating Disorders Association.

The video opens on Allie Ostrander, clad in a cutoff t-shirt and hyperventilating. It's June of 2021 and Ostrander has a message for her fans. The words are delicate, though, and fear is palpable. She pauses, breathes deeply, and begins to speak.

"Yesterday marked five weeks, for me, of intensive eating disorder treatment," says the professional track runner and three-time NCAA steeplechase champion. At the time, she is in a partial-hospitalization program, and "eating disorder" is a diagnosis she has never shared publicly before. But her silence is about to end: the YouTube video will eventually amass 93,000 views.

Nearly two years later, 26-year-old Ostrander continues to take fans along for the ups and downs of recovery. Her outspokenness trickles into her professional career, as she recently signed a new sponsorship contract with NNormal, a company that supports her mental health advocacy in addition to her racing career. Her openness introduces an important question for athletes, coaches, and anyone involved in the sport of running: what role does transparency play when it comes to eating disorder treatment and prevention?

Eating Disorders and Runners: The Facts

Eating disorders are common in endurance sports. Studies suggest that up to 47 percent of elite runners may suffer from clinical eating disorders. Far from "fad diets" or "phases," eating disorders are serious, life-threatening mental and physical illnesses. Though research is evolving, the best available evidence shows that they stem from a complex overlay of social and psychological factors. What we do know for sure is that eating disorders do not discriminate. They affect people of all genders, races, ethnicities, ages, religions, sexual orientations, body shapes and weights. The earlier an athlete (or anyone) seeks treatment, the greater their likelihood for recovery. And treatment can be dire: eating disorders rank second, only to opioid addictions, as the mental health condition with the highest mortality rates.

Over the years, various professional runners--such as Mary Cain, Molly Seidel, and Amelia Boone--have shared their stories and raised awareness. Mary Cain's 2019 New York Times op-doc launched somewhat of a #MeToo Movement for sports--athletes sharing their experiences, not only with eating disorders, but also with coaches and programs that cultivate unhealthy behaviors. Still, in a sport ripe with disorder, Ostrander's decision was unique: she shared her story in the early throes of treatment.

"I was feeling pretty alone," Ostrander reflects. "I had heard stories of people who had gone through recovery and come out the other side stronger. But I hadn't heard anything about the middle-of-the-road details--where things got hard, where they struggled. All I had heard of was the rainbows on the other side." Of course, Ostrander clarifies, recovery is individual, and she would never fault an athlete who chooses not to share.

Kylee Van Horn, a sports-oriented registered dietitian nutritionist (RDN) and founder of FlyNutrition, who specializes in working with athletes in eating disorders and low-energy availability recovery, believes transparency can serve a positive role in recovery.

"Everyone's eating disorder journey is personal and unique," she says. "Some may find it triggering [to share] or get caught up in the comparison trap," which may impede recovery. Overall, athletes must ask themselves: is sharing now supportive of my recovery? If the answer is yes, the outcome is almost always positive--for the athlete, and for their fans."

Paula Quatromoni, DSc, RD, an associate professor of nutrition at Boston University, agrees.

"Those who share their stories often say that it helps them stay motivated for recovery," explains Quatromoni, who is also the chair of the Health Sciences Department at Boston University. "This transparency saves lives when it educates and builds awareness...It allows some to recognize their own behaviors as problematic and leads them to seek help." However, seeking help is only the beginning.

A Long Process

Runners often speak of eating disorder recovery like they speak of race day. For both, we assume a clear start and finish. As fans, we know a common story: a young athlete struggles with various injuries. Perhaps they drop away from competition for a bit--maybe months, maybe years. When, or if, they return, the athlete shares that they underwent eating disorder treatment. Just like in a race, we think, finished, done. As runners, we know mile markers. We know race distances and water stops. We plan to dress for rain, for snow, or for sun. Though eating disorder recovery involves none of that--there are no neatly measured courses or clear finish lines.

"It's such a strange misconception," reflects Ostrander. "That if someone goes to treatment, that means they're recovered. Or, if someone's body changes, that means they're recovered. But it's one of the more difficult mental illnesses to recover from."

Difficult, indeed.

According to the Center for Discovery, 60 percent of individuals who undergo professional eating disorder treatment will make full recoveries. In other words, 40 percent don't recover, or don't fully recover. And this statistic does not account for the folks who never receive professional help.

Furthermore, eating disorder professionals disagree on what "recovered" even looks like, and whether to use that term. "People don't usually say 'I am recovered from an eating disorder.' They say 'I am in recovery' because it is a perpetual state that people move in and out of," Quatromoni told Women's Running. "They continue to deal with it pretty much the rest of their life, but they've learned how to manage the thoughts and manage the impulses."

Regardless of the term you use, reaching a healthy state is possible. It requires work. It requires time. But after all the work and time--after all the ups, downs, wrong turns, and curving roads--the person each athlete is meant to be awaits. And that person is always worth it.

Plus, the alternative to recovery is far too dangerous. Eating disorders overlap with Relative Energy Deficiency in Sports (RED-S), a condition characterized by insufficient input to match output energy, missed periods, and recurrent bone injuries. The potential impact of RED-S includes decreased metabolic capacity, dangerously low heart rate and blood pressure, long-term heart damage, GI disorders, poor immunity, worsened mental health, and a heightened risk for suicide. To decrease such outcomes and encourage runners to stick with recovery, we must set clear expectations about the process.

Enter athletes like Ostrander.

In lieu of the road race, she suggests another metaphor for recovery: "They say it takes half the time of a relationship to get over that person," she explains. "Well, an eating disorder is like a really abusive relationship. If you're in an eating disorder for 12 years, like a lot of people are, like I was, you can expect full recovery to take five or six years, or more."

Here lies another rarity of Ostrander's story: she continues to bring fans along for the journey, even though she never treats recovery as the central facet of her personality. In her college days, Ostrander gained a following not only for her talent and work ethic, but also for her humor. In 2019, after winning her third NCAA steeplechase title, she told an ESPN reporter about the brutal race conditions: "I'm so hot right now. And not like in the attractive way. I feel like I'm really low on the scale in that department."

Now, on Ostrander's social media, she intermixes mental health content with zany reels and photo dumps. She speaks of challenging herself with foods she previously feared, like ice cream, and competing at the U.S. Olympic Trials in 2021 during the early days of recovery. She adopts a miniature dachshund, Georgie, and invites fans along for the car ride to get him. She completes a three-mile uphill time trial and brings fans into the pain cave, too. She dances, laughs, and competes in arm-wrestling matches with her partner ("It's like I'm on iCarly and someone keeps hitting the 'random dancing' button," she writes). Here lies that specific brand of vivacity and quirk that fans have come to expect of Ostrander. Only now, it's interspersed with mental health advocacy.

An Inaccessible Process

Importantly, Ostrander's recovery story is just that: her story. To truly treat eating disorders with the attention and transparency they deserve, we must be clear about their breadth. Contrary to the common eating disorder narrative--that they affect small-bodied, white women--these illnesses can affect anyone. And the expectation that athletes with eating disorders "look a certain way," only harms those who don't fit the stereotype.

"Many people in certain demographic groups--persons of non-female gender, people of color, people in bodies that don't appear thin or 'sick enough,' those in the LGBTQ+ community--are missed or invalidated," explains Quatromoni. All athletes face impediments to eating disorder care. Many athletes don't recognize their own behaviors as disordered, but rather consider them signs of dedication. Further, much shame surrounds mental illnesses, and many coaches and athletic programs overlook, even promote, disordered eating. For athletes of the demographics listed by Quatromoni, these barriers are compounded by bias.

In the future, Quatromoni hopes eating disorder screenings will become the norm in athletic programs. With such tools, eating disorders could be detected in an equitable, unbiased way. Even so, access barriers would remain. Currently, few health professionals are trained in eating disorder care, and eating disorder treatment remains unaffordable and not well reimbursed. "Simply put, 'accessible to all' feels like an unattainable goal right now," says Quatromoni. "Because access to care is insufficient, inequitable, extremely costly, and challenged by discriminatory practices."

Is There Hope?

Take the statistics on the prevalence of eating disorders in runners, and the prospects for recovery. Add up the widespread health consequences of RED-S, and the barriers to detection and treatment. It's hard to not feel dejected about the state of eating disorder recovery for runners. But one should not despair completely.

Recent years have brought an influx of media attention to the topic of eating disorders and athletes. Lauren Fleshman's Good For a Girl, a dual memoir and reckoning on the harmful systems that impact women runners, reached the New York Times bestseller list in early 2023. Research into eating disorders and RED-S has also increased in recent years. Notably, the Stanford FASTR (Female Athlete Science and Translational Research) Program, launched in 2022, aims to close the gender gap in sports science research, empowering women to learn about their bodies and grow into lifelong athletes. Furthermore, an organization called Project Heal is working to break down systemic, healthcare, and financial barriers to eating disorder treatment.

For Ostrander, progress came in the form of a contract and a sleek collection of trail running apparel. This February, she signed with her new sponsor, NNormal. When announcing their partnership, the brand identified her as a "content creator, mental health advocate, and world-class athlete."

"I've spent the past two years building an identity for myself that isn't athletics-centered," she says. "I wanted a brand that supported me in that."

Far beyond writing a pithy tagline, NNormal will support a mental health project of Ostrander's choice--an agreement that's built into her contract. NNormal joins a growing list of outdoor footwear and apparel brands placing a premium on athletes' social impacts and personal wellbeing. At least on paper (and often in practice) these companies challenge the win-at-all-costs, performance-or-bust ethos of more traditional contracts with an intent of partnering with individuals who are more than just athletes.

Creating a sporting environment where eating disorders are rare, and recovery is accessible, may seem like an infeasible goal. Though certain realms of research, media, nonprofit and for-profit work provide some assurance. Perhaps most encouraging of all are the individual athletes sharing their stories and pushing for a better culture. At the end of her June 2021 YouTube video, a teary Ostrander says, "I do not want the next generation to feel the way that I feel." As she and other runners continue to share the realities of eating disorder recovery, we move closer to granting that wish.

For exclusive access to all of our fitness, gear, adventure, and travel stories, plus discounts on trips, events, and gear, sign up for Outside+ today.