Abstract
Eating disorders present health promotion professionals and health care providers with the most complex cultural, social, genetic, emotional, and behavioral syndromes of our time. Whether from the acute threat of bulimia or the chronic disease risk of overeating, the lives of families, and the health of workplaces and communities are affected alongside those struggling with addiction. Social learning theory shows the powerful impact those with “admired status” can have on improving social and behavioral practices. In this interview with Olympian Jessie Diggins, and in this review of her book “Brave Enough,” readers will find that Diggins checks all the boxes that renowned scholar Albert Bandura had in mind as instrumental for adopting modeled behaviors.
Jessie Diggins is an inspiration for many reasons that have garnered her well-earned acclaim and admiration. In the 2018 Winter Olympics in Pyeongchang, Diggins and her teammate Kikkan Randal became the first American cross-country skiers to win a gold medal. With the publication of Diggins’ book “Brave Enough,” 1 (written with Todd Smith) an autobiography that offers equal measures of edification and astonishment about the makings of an elite athlete, I’m confident readers will find many more reasons to admire Diggins. As much as I found the chapters detailing her training regimens to be breathtaking, pun intended, it is her lucid and poignant writing about her struggles with bulimia that compel me to recommend her book to the readers of this journal. There is an evocative paradox that runs through this young woman’s courageous journey as Diggins shares a moving story, where her uncommon strength is regularly juxtaposed against a deep awareness of her personal vulnerabilities. She offers intimate and raw details that help us appreciate the power of addiction, the differences between lapses and relapses, and the imperative for tailored and dynamic approaches to treating addiction.
When Diggins is not otherwise consumed by the outlandish training and racing schedule of a professional athlete, she serves as an Ambassador to the “Emily Program,” one of our nation’s renowned eating disorders clinics. 2 Her goals are as simple as they are ambitious: to reduce the stigma that comes with living with an eating disorder and to challenge our cultural norms related to body image. During our interview, Diggins occasionally noted that she does not consider herself an expert in eating disorders; nonetheless, I felt her hard won insights about addiction showed her to be an itinerate peer educator.
In “Brave Enough,” she returned often to descriptions of the “pain cave.” It’s that unbearable state (for most humans but not for Diggins) where you are so oxygen starved and glycogen depleted that you are skirting the border of unconsciousness. There is no intended drama to Diggins’ inevitable collapses at the finish line; rather, it shows how thoroughly she has conditioned her mind to compete against a body running on empty. So, it’s likely no coincidence that her descriptions of how often her eating disorder ravaged her body and spirit are no less gruesome to read. Her finely honed emotional intelligence about addiction came through clearly when she answered my question about why she never equated the pain cave of an endurance athlete to the pain of living through bulimia. Diggins said:
I guess the reason I never compared the emotional pain of my eating disorder to the pain cave was because going into the pain cave during a race was always a choice. You had the option to stop the race if you wanted to; I could just start walking. With my eating disorder I did not feel that. I didn’t feel like I could stop; I didn’t feel like it was a choice. I wasn’t willingly going into the pain cave for the greater good of a personal best time. It felt like I got dragged in. That’s why that metaphor does not pop up in the book, because to me the pain cave is something that is a choice, and this felt like I was completely out of control. And that, I think, is a very common thing for people struggling with an eating disorder to feel.
Diggins’ empathy and sobriety about the interaction between eating, self-esteem, the pernicious sides of sports culture, and America’s inveterate societal expectations always seem fully present in her book, and I appreciated her seriousness about such throughout the interview to follow. On the other hand, Diggins is cheerfully self-aware of the cheerleading role she has played on her teams since her formative years in the sport, and she is indeed quick with smiles and fun to talk with.
In her book, Diggins shares that she does not think she excels at technique or benefits from natural ability or has a body uniquely suited to cross-country skiing. Instead, she feels deep down that her success relates to her scrappiness. To be sure, her writing bespeaks an unrelenting capacity to demand more from a body screaming to stop. It’s this mix of humility and determination that may explain why her unassuming ease in sharing her vulnerabilities and struggles is otherwise belied by a stunning portfolio of accomplishments in her chosen profession. Before her history making performance in the 2018 Winter Olympics, Diggins was the first American to win 4 World Championships medals in cross-country skiing. She placed eighth in the overall and sprint rankings in the 2016 World Cup. In the 2017 Nordic World Ski Championships, she won a silver medal in the freestyle sprint and bronze in the classic team sprint. 3 More than her accumulation of top honors, it’s likely the “made for prime time” spectacular finishes that make her this sport’s most recognized superstar. Whether you are a cross-country ski fan or not, the broadcast of her closing sprint to pass Sweden’s Stina Nilsson to win by 0.19 seconds is the stuff of mysticism and immortality.
It is mesmerizing to watch the insane-looking burst by Diggins which is captured fittingly by the CBS announcer who also seems to be losing his mind as he screams, “HERE COMES DIGGINS! HERE COMES DIGGINS!!” 4 Of her amazing surge with 150 meters to go, Diggins writes: “I swung out wide, upping my tempo to the highest gear I possessed. I gave every ounce of energy I had left and then dug deep to pull out even more.” Diggins is often asked what thoughts are occurring to someone about to make Olympic history. No epiphanies according to Diggins who wrote: “I can only remember one thought, and it echoed around inside my head. Go! Go! Go!” It was this gritty and spellbinding finish that led the Team USA athletes to select Diggins as our US flag bearer at the Olympics closing ceremony.
As someone who has competed in citizen races for decades, most often Mora Vasaloppet’s 25 K (and my finishes have been anything but ceremonial), I anticipated being a bit star struck during this interview. Instead, talking with Diggins felt like skating a freshly groomed trail with a breezy tailwind. She’s brainy and delightful. My first question for Diggins relate to “collective well-being,” a concept from one of this journal’s award-winning research papers. It is a construct that argues that well-being and agency may be more a function of a group than derived from the usual focus on individual attributes.
Like any people-centric organization, sports teams are fraught with egos, individual differences, and conflicts, yet your book regularly celebrates the connectedness, power, and inspiration behind a team. Health promotion researchers study the psychological benefits of collective well-being, and leaders try to understand how to better access the power of groups. What’s the source of your focus on team dynamics over individual achievement?
Yes, there are many different factors. First, we really invest in the idea that we are one team, although we largely are an individual sport. The event we won the gold medal in happened to be a team sprint, but 90% of our World Cup races are individual events. But as a team, we focus on the idea that we represent the United States together, we train together, and we lift each other up. We support each other so that we can go out there and represent our home communities—all the little kids who want to be skiers, all the people that support us—we want to represent them well as a group. When you buy into the idea that you are a part of something bigger than just you, that’s very important. Being part of a group makes it easier to take the individual stumbles or hardships that will definitely occur along the way. Whether that is not being picked for a team or whether you have a poor race or even crash in a race, things are going to happen that do not go as planned. But when you have bought into this big idea of a group, you may have a bad day but you know “I helped train my teammates all summer, I encouraged them, I was pointing out techniques, I inspired them, and they inspired me,” and so when they have a great day, that reflects well on me, and when I have a great day that reflects well on them.
The verbiage that has trended during the Coronavirus pandemic has been that “we are all in this together.” In your book, you offer a lovely, heartfelt tribute to your teammate Sadie Bjornsen. She was undoubtedly disappointed she did not get picked to race with you in the sprint, yet you felt “she had been skiing every step alongside me in that race.” You felt she made the “ultimate sacrifice and contribution…for our victory.” How does Sadie’s sacrifice relate to your views about leadership in groups and being in it together?
Something I share often is that leadership is not always “Rah Rah, follow me!” We need some of that sometimes, but there are so many other forms and types of leadership. Sadie had the ability to say, “I’m going to put my own dream crushing moment aside and be there for the team and for my teammates and I’m going to support them in every way.” That is leadership and it is the kind that is hardest to come by because it takes incredible strength from the inside. One thing people always ask is why we don’t have a team captain. Or that ask me, “who is the team leader?” I always say nobody is because everybody is. It is everyone’s job to show up every day and find a way that they can contribute. Maybe you’re an extrovert or maybe you’re an introvert and maybe your form of leadership is noticing when someone is having an off day and saying, “hey, I noticed you’re not yourself, do you want to talk about it?” That’s also leadership; taking the initiative to fix something in a group, even if it’s a little one-on-one interaction. I think it’s super important to recognize all those forms of leadership.
One place you’ve exerted your leadership is as an ambassador for the “Emily Program” and through your work to destigmatize eating disorders. In “Brave Enough,” it’s clear you are studious about the nature of addiction. You reflect on denial, not admitting you had a problem to yourself, and on stigma, being ashamed to admit your problem to others. How were the two related?
Yeah, denial is super tied into the native stigma around bulimia and, oh gosh, it is super hard to tease denial and stigma apart. On the one hand, I did not want to admit I had an eating disorder because there was this stigma:
So, I had this very misplaced idea about the kind of people of who have eating disorders. A lot of that was just lack of education. Aside from my eighth grade health class that we were required to take, I did not know anything else about eating disorders. I had an unwillingness to be put in that category, for fear of that stigma and what I thought it might mean about myself. It is why I talk so much about it now. If we can lower the stigma and make it so it’s not scary to have a problem, then people might feel they can actually ask for help, quite a bit sooner. If I talk openly about it, I hope fewer kids say, “that makes me a bad kid.”
I definitely did not want to address the problem I knew I had because then it would mean I would have to fix it. And at that point my brain was still very much wired in to the idea that I needed this eating disorder to be good at sports, to be perfect, and to deal with my stress. I did not know having an eating disorder was my way to deal with stress, but that’s what was going on. It was my coping mechanism and it was my crutch. And so, I definitely did not want to talk to anyone about it. If you say “hey, I have this problem.” Then, someone’s going to go, “Well, how can I help? Let me help you.” I did not want the help and therefore I didn’t want anyone to know I had a problem.
who doesn’t have the self-control to just take care of themselves? What kind of person would make themselves throw up after eating? My self-image was: “I’m a good girl, I get good grades and I’m a good daughter. I can’t have an eating disorder; that’s for kids who just don’t have their life on track.”
If I focus on a goal of not doing something, that is really hard because it isn’t not an action item, it’s a negative. Instead, if my goal is to do something, that’s different.
Health promotion professionals, educators, psychologists, clinicians, and researchers read this journal. What worked and did not work for you in your interactions with mental health workers and caregivers?
To be honest, I don’t know if I have a great answer for health care providers. If someone is absolutely set against receiving help, it is very hard to give it to them. It’s that “you can lead a horse to water…” idea. You can provide all the help and resources in the world, but it’s not always evident from looking at someone that they have an eating disorder. Some of the signs and symptoms are reliant on a patient voluntarily disclosing things. Sometimes you go to the doctor and they say, “do you ever feel ashamed of your weight?” And, of course, I would never say “yes,” even though I did, because I didn’t not want them to ask me more about it, so if I wanted to hide it I could.
Suddenly, at some unidentified point in time with eating disorders, you lose control of them. You may feel like you have a lot of stress in your life, but an eating disorder makes it feel like “I can control this.” I could get rid of the food that I just ate so I was back in control. But at some point, it flipped and then it was controlling me. Until I was ready to pick up the phone and call the Emily Program, my eating disorder was very easy to hide. When I was 18 years old, my parents could not make me self-refer, so what really helped turn that around was a direct effort to reverse the stigma. For example, my parents saying
Learning that it is more genetically based, that this isn’t just a behavior choice, means no one should judge me for this. That was hugely comforting. Realizing that I had to do the work to get out of the addiction but that it is not all my fault is what lowers that isolation barrier. Health care providers should make sure that the patients, or potential patients, feel that any of their questions are ok to be asked. Maybe lead in with:
That is very, very helpful.
We support you and we love you and we think it would be great if you got help because there is nothing wrong with you. We did the research, and this happens to a ton of people, itis actually very common. You’re not a freak, you’re not alone. There’s nothing wrong with you.
Hey, I just want to provide some education and, just so you know, this is not a behavioral issue. It’s not your fault if you have an eating disorder. They’re actually very, very common. This isn’t something that is just happening to you.
Along with reducing the stigma of eating disorders, you are active in educating about healthy body image and advocating for body acceptance. Share the reaction you had and the concerns that arise when a coach told a teammate she needed to work on her “endurance athlete body.”
That comment occurred at the highest level of sports in the United States. It was very clear that what they meant was “you are not lean enough to succeed in this sport.” This was said to someone who went on to be wildly successful. So first, that coach was obviously wrong. There are so many factors in sports besides just the easily measurable numbers on a scale or your body composition. It is so easy to fixate on those little things but really, your mental toughness is probably 50% of your success in sports. That is much harder to measure, so people tend to forget about it. It was important to include that interaction in the book because people do not realize how destructive those sentences can be. People have insecurities about their own body that they might be projecting on to others without realizing it. I’ve seen many examples where coaches may not feel entirely confident in their own body or how their career ended up and they says things that make it clear that things aren’t resolved for them and they’re taking it out on their athletes.
It’s important for people to ask how a comment about someone else’s body or weight is relevant. Maybe you just don’t need to comment. If you are a health care provider, there may need to be conversations between you and your patient, but I think it’s really important to realize how clearly people can remember comments. I remembered that “endurance body” comment a long time later, very clearly, word for word. Words have long-standing effects.
Eating disorders such as anorexia and bulimia are relatively uncommon compared to the commonality of overeating in America. Your thoughts on balancing the tension between not obsessing about eating while still being mindful about obesity as a prevalent risk?
Right, it is a very delicate situation because you have 2 ends of the spectrum and you have opposing needs. Using athletics for examples, I get questions from those who say “Yeah, I know you don’t need to be incredibly lean to compete but it probably doesn’t hurt if you are within a certain range of body composition.” My answer is to focus on how you feel because everybody has their own sweet spot. Everyone has their own genetically determined area where you are healthy, where you’re not going to get sick as much and you’re not going to get hurt as much and you feel good. It’s not just one number on the scale, it’s a range. For me, it’s about a 15-pound range where I feel healthy. It’s the range where I can perform, and do my job, and live my life.
Obsessing over a certain diet is not going to help because diets are not sustainable for life. Obviously, impending heart issues notwithstanding, focus on how you feel and how exercise makes you feel. Does it make you feel good, feel empowered, feel awesome when you are able to walk around the block with your kids, or when you take your dog for a run in the park, and when you go to the farmers market and have fun picking out fresh local vegetables? Does it make me feel good mentally as well as physically? We need to trend toward taking the focus away from “don’t eat this, don’t eat this, and don’t eat this.” Instead ask: “when I eat these good things or I do these good things, does that make me feel good?”
Something that I focus on with my sports psychologist is framing things in the positive. If I focus on a goal of not doing something, it is really hard because it isn’t an action item; it’s a negative. Instead, if my goal is to do something, that’s different. So instead of saying my goal is to lose 10 pounds so I’m less at risk of diabetes, the goal is that I want to get out for a 15-minute walk twice a day. Or I want to go to my farmers market and challenge myself to cook a new vegetable. These are action items that feel less like shaming and more about taking steps to do something positive. Nobody likes to feel like they’ve been given an ultimatum or that what they’re doing is wrong. But everybody likes the feeling that when they do certain things they feel better.
What have you learned from your mentors like Kikkan Randal that you hope to pass on to future leaders?
What is really unique about Kikkan is her willingness to share what she’s learned. My goal is to have teammates and training partners who are benefitting from what I’ve learned. It’s to put aside one’s ego in order to get to the ultimate end goal, to win an Olympic medal as a team.
What was clear to me from this interview with Jessie Diggins is that she’s doing her mentor Randal proud by fully and comfortably embracing her goal of sharing what’s she’s learned. And, clearly, that goes way beyond schooling athletes on the ski trails. Besides her being an Ambassador for the Emily Program (https://www.emilyprogram.com/), Diggins also advocates for the environment (https://protectourwinters.org/), for destigmatizing eating disorders (www.withall.org), and for the advancement of youth empowerment through sports (www.fastandfemale.com). And she gladly agreed to the most rarified of chances to tout her body acceptance platform via her invitation to pose for the ESPN Body Issue 2018. 5 Said Diggins in the ESPN interview: “We tend to celebrate when men show off their bodies, and then sometimes we’re judging when women do it. And I think it’s really important to say, ‘Hey, girls can be strong. Girls can have muscles.’”
Diggins shows us that we want our heroes to be nuanced, to have superpowers within reach for any of us.
Social learning theory holds that “individuals are more likely to adopt a modeled behavior if the model is similar to the observer and has admired status and the behavior has functional value.” (Bandura, 97’) Break down Bandura’s time-honored theory, and it is apparent that Diggins checks all of the boxes for the kind of social influencers and peer educators the health promotion field needs to identify and engage with. Youth struggling with eating disorders feel Diggins is like them not just because she loves sports and speed, although that is plenty cool for many. Rather, they feel the similarities that come when Diggins so generously shares her emotional warts and psychic pains, how she’s cool with modeling both her strengths and her vulnerabilities.
And what Diggins’ behaviors are we likely to adopt that have functional value? Well, I do wish I could stay in the pain cave a bit longer next time I compete in a cross-country ski race. But that is a selfish, lonely goal. Much more useful is how Diggins models for us what her parents modeled for her, the power of social connection. She is a testament to the value of knowing we’re not in this alone and that there’s nothing wrong with us that love and support can’t remedy. Diggins shows us that we want our heroes to be nuanced, to have superpowers within reach for any of us. And that 50% mental toughness that makes her so successful in her profession? If it is the Diggins brand of toughness, I’d happily take 5%. And did I mention? You simply must watch “HERE COMES DIGGINS!”