By: AusDancersOverseas (Dr. Stephanie Potreck, MD, RNutr (Sport) )

With recent revelations by the BBC about body shaming and unqualified nutrition advice at The Royal Ballet School in London and Elmhurst Ballet School in Birmingham, it’s worth looking into the reasons why the dance world still hasn’t gotten on top of these problems.

'Still' because it’s neither a secret nor anything that isn’t quite common in dance.. They’re rampant and have been for many years and decades.
Both schools are located in the United Kingdom, but they are no exception. Over the past 5 years, scandals broke in many places: Basel, Zurich, Bern, and Lausanne in Switzerland, Vienna in Austria, Berlin in Germany, Ballet West in Scotland - to name only a few.

This blog post is not going to be another one of those ’How to spot an eating disorder in a dancer’ or ’What you can do if you think one of your dancers struggles with their relationship with food’. We’ve had so many of such blog posts, and yet, we’re faced with what seems to be the highest prevalence of eating disorders ever, in dance, but also the general population. In saying that, it appears raising awareness the way it’s been done hasn’t really helped, or has it? That’s why today, I challenge you to look at disordered eating, eating disorders, and the ’ideal’ of a prepubescent or preternaturally slender body in dance in a way you most likely haven’t before.

Are you ready?

Could it be that the effects that disordered eating and eating disorders have on the human psyche have helped shape the dance world as we know it today? Let me explain:

Around the time of WWII, Hilde Bruch, a German-born American psychiatrist so often rang the alarm bells that eating disorders make the person affected appear to be ’the perfect student’. That is even before George Balanchine demanded to see bones on his ballerinas. But what do these two have to do with each other?
It’s still a widespread belief that dancers need to restrict their food intake to ‘look the part’; but in reality this couldn’t be further from the truth - on a scientific level. Recent research (Keay N, AusDancersOverseas, Francis G, 2020) has - not for the first time - shown that the prevalence of under-eating/disordered eating and eating disorders in the dance population is still alarmingly high, and even reinforced. Out of 247 dancers in their study, 71% of female dancers and 43% of male dancers stated that being cast for a leading role would favour someone of lower weight.

Furthermore, 44% of female dancers and 32% of male dancers reported that they had been told to lose weight at some point in their training or professional career, most often by teaching staff or directors. 83% of dancers were influenced by social media in trying to lose weight, with 30% of female dancers and 14% of male dancers saying that this was a constant influence.

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So, how could we blame young dancers for trying to be the thinnest they can in order to fit into those ’ideals’ that still seem to be almost omnipresent? The data presented is lived experience of dancers of all genres (with a focus on ballet though), and these are the very dancers that require treatment for disordered eating and eating disorders at the time being. The outdated Balanchine ideal of dancers with bones is still present in many studios today. And the narrow-minded idea that only the lightest dancers can ’make it’ sees countless young, incredibly talented dancers fight themselves for much of their teenage and young adult lives.

What for? And what happens to a young and still developing brain to constantly hear that their body isn’t ’right’ for dance or that they should lose some weight? During adolescence, the human brain is both its most impressionable and its most vulnerable. Adolescence today is defined as the time between 10-24 years of age. This time window is characterised by remarkable brain plasticity, i.e. the ability of the nervous system to change its activity in response to stimuli. Tell a young dancer they’re not enough and their brain will pick up on it. Telling it once can be enough to let the situation spiral out of control.

Eating disorders often appear to be puzzling, for they have a physical expression but are classified as mental illness. Food rarely is the problem though, but the environment a dancer grows up in is. Oftentimes, they’re too young to be able to cope with situations they’re confronted with - in other words, they have a lack of coping mechanisms in a world that feels unmanageable/out of control for them. Controlling food intake then is something that gives them that much-needed feeling of control. And this feeling is heightened when the control leads to ’desirable’ (in the eyes of the dancer or their environment) outcomes, e.g. being cast for a significant role, getting more attention in class, being told ’you look better now’ or the all-time favourite ‘keep doing what you’re doing because it’s working.’

Knowing now that young dancers are so vulnerable in the often relentless dance environment, we need to ask how the preference of a prepubescent body is playing into the hands of power imbalance in the dance world. Wouldn’t (or shouldn’t) every teacher, director, or choreographer normally really be worried about some of their students having a mental condition that also affects their physical health? And as it’s so many, shouldn’t we expect everyone to have gotten tired of that high number of dancers with serious health conditions?

Not in the dance world …

Disordered eating (DE) and eating disorders (ED) with resulting mal-/undernourishment of the brain affect not only physiological processes but also actions, reactions, thoughts and emotions. Dancers don’t need to be severely underweight or completely restrict their food intake for their brain to suffer the consequences of mal-/undernourishment: Cutting out food groups, eating irregularly or skipping meals is already enough for the brain to develop the signs and symptoms of an insufficiently fueled brain.

Any behaviour around food with the goal to keep a mature/maturing body childlike also affects the sense of self as well as sense of coherence (resilience), and theory of mind (understanding others and their intentions or desires). Many people with disordered eating/eating disorders find themselves in a position of reacting, not acting - and the inability to react is perceived as a loss of control. For their environment, though, exactly that makes them appear to be 'perfect student', as they show submissiveness, subjugation, and defectiveness (the belief they’re 'wrong' - whether it’s what they do or how they look).

Additionally, the brain develops partly based on the environment it is growing up in. So, are we really surprised that a young brain then picks up on the ’thinness-ideal’ or the idea that there are body types more favourable for dance than others?
The constant focus on dieting, often paired with self-loathing, leaves literally no headspace to see someone’s environment for what it is; it increases isolation, and therefore makes abuse easier. It goes as far as young, pre-professional dancers entering full-time training absorbing and mirroring a culture of abuse, unreasonable behaviour, negativity, stereotype bias, and harassment because that’s all their brains got energy for. Or, as we call it in science, these behaviours are secondary consequences of an under-/malnourished brain.

But wait, how come they develop such excellent dance skills but their brain takes the toll of not having its energy needs met? The sensorimotor network responsible for the body performing and controlling motor tasks develops earlier than other networks. End of story.

Constant dieting paired with relentless environments are the most effective way to keep future generations of incredibly talented young dancers quiet and tractable. And that is how the art form of dance is meant to remain forever? Why? Name one good reason - one that does not include taking away someone's basic human right to be healthy.

In the light of all those scandals mentioned (and all those I did not mention), how often have you asked yourself how it had been possible that the ongoing abuse seemed to go unnoticed? Knowing now how undernourishment of the brain can cause psychopathologic reactions (=inadequate reactions in relation to the environment), e.g., not speaking up when a teacher tells a student in front of the class they would cut away half of their thigh if they had a knife, you now know why.

I invite you to change the narrative and nurture future generations of dancers. We have so much to make up for.

Literature (selection)

Arcelus J, Witcomb GL, Mitchell A (2013). Prevalence of eating disorders amongst dancers: a systematic review and meta-analysis. Eur Eat Disord Rev. 2014 Mar;22(2):92-101. doi: 10.1002/erv.2271

Keay N, AusDancersOverseas, Francis G (2020). Indicators and correlates of low energy availability in male and female dancers. BMJ Open Sport Exerc Med. Nov 26;6(1):e000906. doi: 10.1136/bmjsem-2020-000906. eCollection 2020.

Pfeifer JH and Allen NB (2021). Puberty initiates cascading relationships between neurodevelopmental, social, and internalizing processes across adolescence. Biol Psychiatry. Jan 15;89(2):99-108. doi: 10.1016/j.biopsych.2020.09.002. Epub 2020 Sep 9.

Mitchell SB, Haase AM, Cumming SP (2020). Experiences of delayed maturation in female vocational ballet students: an interpretative phenomenological analysis. J Adolesc Apr;80:233-241. doi: 10.1016/j.adolescence.2020.03.005. Epub 2020 Mar 22.

Mitchell SB, Haase AM, Cumming SP (2022). On-time maturation in female adolescent ballet dancers: Learning from lived experience. The Journal of Early Adolescence. Feb; 42(2):262-290.

Treasure J and Cardi V (2017). Anorexia Nervosa, Theory and Treatment: Where are we 35 years on from Hilde Bruch’s Foundation Lecture? Eur Eat Disord Rev. May;25(3):139-147. doi: 10.1002/erv.2511.

Potterton R, Richards K, Allen K, Schmidt U (2020).. Eating disorders during emerging adulthood: A systematic scoping review. Front Psychol. 2020 Jan 31;10:3062. doi: 10.3389/fpsyg.2019.03062. eCollection 2019