Sevenoaks teacher Sarah Eversfield joins Sevenoaks Sport & Wellbeing with a series of her Full of Fire interviews and this month interviews sports and eating disorders dietician, Renee McGregor, who offers her advice on eating disorders and RED-S, a condition that can affect athletes.
Renee McGregor is a bestselling author and leading performance and eating disorder specialist dietitian with over 15 years experience working with elite athletes, coaches and sports science teams to provide nutritional strategies to enhance sport performance and manage eating disorders.
She has delivered nutrition support to athletes over the last Olympic and Paralympic cycles, and regularly works with high performing and professional athletes that have developed a dysfunctional relationship with food.
She regularly works with young people and founded the #TrainBrave campaign, aiming to inspire more athletes to share their stories and raise awareness of the risks of eating disorders and RED-S.
Renee speaks with real personal depth about her own experiences with an eating disorder and gives advice for teenagers that might have friends experiencing these issues, and parents with children at risk. She also talks about the importance of fuelling properly for sport.
You’re a leading sports and eating disorder specialist. Can you explain what your job is? What do you do?
Fundamentally, I’m a sports dietitian. So my first and foremost role, I guess, is to help individuals fuel properly around their training so they can get optimal performance. But sadly, a lot of individuals end up having quite a dysfunctional relationship with food and exercise. And often when this becomes more extreme than that can start to affect not only their performance, but also their health. So I specialise in this particular area of helping athletes of all levels and all ages, because it can happen at any stage. And both men and women to I suppose, have a better relationship with food and exercise. So they can go back and become sustainable athletes.
You’re considered a leading authority on RED-S. Can you explain what RED-S is and the work that you do?
So RED-S stands for Relative Energy Deficiency Syndrome. And so basically, what it means is that there’s just not enough energy going into the system for the work that the individual is doing now. Within sport, it means an individual is not fuelling themselves sufficiently to be able to train appropriately and maintain their biological processes.
So what happens is, if you don’t put enough energy into the system, then the body will always prioritise movement and shut down important biological processes. This affects performance, it can affect your periods, it can impact bone health and result in fractures and serious injuries – serious health issues.
Do you think that girls and boys who are young athletes who are doing sport at a high level get enough information about how to fuel themselves properly?
No, not at all. Some people assume not having a period is a normal part of being a sporty teenager! I have seen boys in cycling, running and triathlon who were stunting their development.
So there’s definitely not enough information. And the other thing with youth sport is that it’s highly competitive. The England vest is dangled in front of someone and it changes them – they need to prove themselves; they need to do more than the next person; it’s competitive. And then comes that inability to manage expectation, which then drives those extreme behaviours. And that often means that those individuals never make it to the England team because they become injured and sick. I’ve lost count of the number of junior athletes I’ve worked with where that has happened.
And so I feel very strongly that sports for young people should be very much about participation and enjoyment and fun.
How do you think that young athletes and their parents or coaches should be educating them to fuel properly and to understand it?
I suppose it’s not necessarily about understanding fuelling (although that’s important), it’s about understanding sense of self. It’s about the fact that your sport is great. And it’s really important for you, but actually, it’s just a part of you. It’s not all of you. Sport can be something very easy to fixate and focus on, in a great way but sometimes in an unhealthy way. And I think it’s more about providing psychological support for juniors. Sport is fun. And it should be part of a lifestyle rather than the thing you need to prove your worth.
How do you feel about the effect of social media on eating disorders and nutrition? You’re a scientist but there are lots of voices out there and influencers that are not coming at it from a scientific background. How does that feel? And how how do you have to react?
The difficulty is that often the people that are not credible, or qualified, have the biggest following because they tend to sell something more like they’ll sell the very fact that they’re very beautiful, or that they have an amazing lifestyle or, you know, they’ve overcome something personal that they have shared with the world. And so everybody wants to know more about them. Social media can be disingenuous; you know, people will say something or promote something on social media. And then the reality behind the scenes is completely different. And I suppose it’s very hard for young, impressionable individuals to appreciate that, because in their eyes, these influencers are so inspiring. And it makes me cringe at times, because I think, if only you knew, that person doesn’t actually have her period. And she looks like that.
What was growing up like for you? You had an eating disorder yourself.
I grew up in quite difficult circumstances, I guess, because both my parents are Indian. And I’m first generation British Indian. So I grew up in an environment where the colour of my skin was incredibly noticeable. and going to school, I was picked on I was bullied. And I’ve had some horrific experiences because of the colour of my skin.
So very early on, I learned that somehow I wasn’t good enough. And that the colour of my skin determined something about me. I wasn’t accepted, I was never enough for friendships, you know, I really struggled. And again, coming from a from an Indian family, there’s a very big value on academia. So again, I worked incredibly hard, because I wanted to please my parents, obviously. And that has become again, that was something else I took through with me all the way through into my adulthood as well that, you know, I had to achieve to prove I was worthy. So my childhood was complex.
I found growing up hard, I’m not gonna lie, I really struggled. I found it very difficult to fit in. I felt incredibly lonely.
I’ve always been very sporty. And I think sport is kind of something that really saved me. Like, I’ve always been really lucky that I’ve loved sport, but I’ve also been always quite good at sport. So I was in netball teams, hockey teams, rounders, teams, you name it. I was always in a team. And I suppose that really filled a gap for me; when I was on the hockey pitch running up and down scoring goals, nobody cared what colour skin I had or whether I went to parties, or didn’t they were just like, “Yeah, she she’s a good player”. It gave me an escapism from my life. I didn’t have to do anything. I belonged somewhere. So I suppose for me, sport has always been something that’s helped me to belong to a community.
But I did end up with an eating disorder as a teenager, as a response to all these things. You know, life felt incredibly hard, chaotic, messy. I never felt like I was good enough. And it’s not like a conscious decision. I think that’s what I want people to understand. It’s not a conscious decision. It was just, I don’t feel good enough. I feel really uncomfortable in my body. And I’m not accepted. Maybe if I was thinner, I would be more accepted. It wasn’t that conscious a decision. But I think that’s kind of what happened.
Did your parents understand what was going on? Most parents who have these situations probably don’t have much experience of eating disorders or very unhappy children or anything, how do they react?
So I went to private school. And in order for me to be able to go to the private school, my parents worked every hour under the sun. And I did get assisted places and you know, scholarships and stuff, but you still had so many additional costs. So to be honest, my parents were clueless, they didn’t know what was going on. For me. I didn’t talk to them. I didn’t know what was going on myself. I don’t think they even picked up I was unhappy, to be honest.
My eating disorder started when I was 13. And it went unnoticed, believe it or not, for a good year. I have no idea how I managed that. But I think you know, the usual tricks of wearing baggy clothes and avoiding people.
Eventually, when my weight dropped significantly to a point where it was really quite severe, I was then finally referred into an eating disorder service, which was still outpatient. But I did get the help to restore weight. And I wouldn’t say got life back on track, but it got me to a place where I was able to function again. And I could do my GCSEs. And I did my A levels, and I went off to university.
But I still was clueless. I mean, I might have been weight restored. But I had no idea why I had this deep rooted discomfort with myself, I had no idea that there was this constant negative narrative playing in my head that I wasn’t good enough. And then I constantly needed to prove myself, I didn’t know any of this, I just knew that I didn’t want to go back to that point, because it was horrific, being that underweight and feeling that cold. And I can’t even explain how desperately miserable having an eating disorder is. And I just knew I didn’t want to go back.
But I didn’t really know how to fully be okay, if that makes any sense at all. But I made it to university somehow.
Were you able to participate? If you still had eating issues and stuff like that, it must have been very difficult to join in with social situations and university life?
And that was it. It was that moment that I realised that I wasn’t still well, because I couldn’t do the 2am toasties. I couldn’t do the morning, you know, the kind of let’s go to Sunday lunch, or let’s get a takeaway. I couldn’t do any of that.
And I knew there was something wrong with me, like, fundamentally, I knew there was something wrong with me and I couldn’t work it out.
And so actually, I was very, very lucky, I ended up getting some counselling through the university, which was brilliant, and to be honest, probably what saved me from probably going back downhill, again.
And I really started to understand the aspects of why I needed that behaviour around food and the need to contain myself and to be as small as possible because there was an element of I was trying to express how insignificant I felt. And also an element of struggling with being able to be independent, truly independent, and rebel to certain degree against the kind of wants of my parents, so quite complex, but then started to understand it. And then moving forward, life became much easier because I was able to kind of let go of the food rules and join in.
I still had feelings of low self-worth but I was able to start working through them.
You also really need to show yourself some compassion. So again, if you’re somebody that has this low self-worth, that will be alien to you. Like I remember when I had to go, No, I, I’ve got to be nice to myself. I’ve got to look after myself, because nobody else is going to.
So if people are going through similar things, how might they start to notice those signs, whether it is low self worth or whether it is starting to have a more troubled relationship with sport and exercise, or with food? What are the signs that maybe someone could notice within themselves, or maybe notice about people close to them?
I think for me, it’s when the behaviour affects an element of their life. So when they can’t do social activities, because they have to go training instead of the social activity or where they can’t eat out spontaneously, or where if you are continually being invited over to friends, but you take your own food with you or you know, you might notice that they suddenly change how they’ve always eaten.
I think the language people use is also really interesting. So when people say, I need to go and do my session, I need to go and do that online workout, or whatever it might be, or I need to hit my 20,000 steps a day or whatever, like, those are things I would definitely be listening out for.
Needing means that I’m, I feel like if I don’t do it, something awful is going happen to me. So it’s something I would challenge.
Obviously, you’ll start to notice changes in people’s personalities, like the more severe it becomes, the more like withdrawn they might become. You might notice physical changes as well, you may notice that they can actually become quite irritable, because they’re hungry, or they’re tired, and they’re not looking after themselves.
One of the really tricky things as a friend is trying to help. Because obviously, when someone’s in that space, they’re not listening to anybody, let alone another 13 or 14 year old. What would you advise to someone now in that situation, worried about their friend?
So something I’ve advised friends to do for friends is, is write them a letter, write them a letter of saying all this not about, I’m worried about you, whatever, just like, I really just wanted to write a letter to tell you how much I miss some of the things we used to do together, because that’s the bits that they probably don’t realise, you’ve got to remember that people go down this path, as I said,
Because usually, they don’t believe they offer anything, they usually have a very difficult relationship with themselves.
And it even if it doesn’t, right there, right, then hopefully, it’ll be something that they’ll go back to and go, actually, no, I need some help. Now, this is not right any more. At some point, most people get to a place where, like I said, it’s just unbearable. You no longer want to live that life, what started out is probably something that felt relatively easy. You just no longer want to do it because it’s so incredibly isolating.
What’s your most important lesson for parents?
It’s letting kids fail. It is really important letting them fail, but helping them to understand that they learn from that. So they’re never fearful of failing. For me that’s really important for me with my daughters. I always say to them, it doesn’t matter, we’ll find a solution – you’ll learn from it. And we’ll do something different. It’s not the end of the world.
I try to help them to understand that difficult emotions happen. We have to experience failure, loss, sadness – people are shitty, there will be people who will dislike you. And that’s going to feel like crap. But actually, that doesn’t mean you’re crap. And it’s just helping them to navigate those difficult things without wrapping up in cotton wool. Many of the girls and boys that come to clinic have been wrapped up in cotton wool. So as soon as they hit a patch of adversity, they don’t know how to handle it.
If you could go back, and if you could now, advise yourself a little bit or give yourself a pep talk to 13 year old Renee, what do you think you would say?
You know what, I wish somebody had told me that my thoughts were not facts.
I really do. I honestly honestly feel like fundamentally, if there’s one thing I can give to all the teenagers out there is that you don’t have to believe your thoughts. Because I think if I had that, then maybe I wouldn’t have believed I was as useless as I was.
And I think the other thing is that you are not valued for what you look like. You are valued for what you offer as a person. And I mean that in terms of kindness, compassion, fun, joy – it’s what’s inside. That is really important. And I think again, if I had understood that, maybe I would have gone down a different path. Who knows.
You can listen to the full interview between Sarah and Renee by searching for Full of Fire on all major podcast platforms.