Akiko Suzuki ordered a steak dinner at an airport restaurant on her way home from a figure skating competition in Croatia. Not long after the meal, she walked into a bathroom and vomited in the toilet.
It was the spring of 2003. Suzuki, who was 18 at the time and still competing on the junior circuit, told herself it was a reaction to eating red meat for the first time in months. But the incident turned out to be a harbinger of something more serious.
Her appetite dwindled after she returned home. During her first weeks as a student at Tohoku Fukushi University in Sendai, her weight dropped from 48 kilograms to 40.
That’s when she realized she had anorexia.
Suzuki, who is 160 centimeters tall, eventually reached a low of 32 kg.
“I had a flawed way of seeing my body,” she tells The Japan Times. “I’d compare myself to international skaters. I couldn’t make my arms and legs longer like theirs, but weight was the one thing I could control.”
Eating disorders are serious mental health conditions and are more common among athletes, especially women. Although estimates vary, studies show athletes are two to three times as likely to meet the criteria for eating disorders as nonathletes.
Two of the most well-known eating disorders are anorexia, a form of self-imposed starvation, and bulimia, which consists of cycles of binge eating followed by purging.
In Japan, the health ministry estimates that about 245,000 people have an eating disorder, though some studies indicate the number may be even higher. About 5% of patients die, either from medical complications related to malnutrition or by suicide.
It can be hard to spot the signs of an eating disorder, particularly in the early stages, because patients tend to hide their problems from those around them.
Being afraid to eat
As a perfectionist and athlete in a judged sport where aesthetics matter, Suzuki had long had a complicated relationship with food. She feared gaining weight, looking fat and having that affect her performance.
She was often praised for her discipline, for eating only healthy foods, turning down sweets and sticking to her nutrition plan. But the compliments about her body came with an unspoken pressure to maintain a silhouette that people admired.
At home, she was also the “good girl.” As Suzuki grew up, her parents’ expectations grew with her. That turned out to be a double-edged sword, both empowering and burdensome.
She remembers feeling hungry during her teenage growth spurt, but snacks were forbidden because her weight was controlled. Once, her mother scolded her after finding a pastry wrapper tucked in her school bag. By her senior year of high school, she had stopped eating meat, believing that it couldn’t be part of a healthy diet.
When she left for college, the structure fell away. For the first time she decided when, what and how much to eat. She often hid in the library during lunch breaks to avoid cafeteria food.
She worried that people were judging her: Am I thin enough? Does my weight define my worth? Will they think I’m making poor food choices?
“I was told that my ideal weight is 47 kg, and I naively believed that. I don’t even know where that number came from,” Suzuki says. “I made sure I ate every day, but only things like yogurt, tofu and leafy vegetables. Rice and udon were my main sources of carbohydrates, but I was eating kiddie-sized portions.”
She began experiencing many symptoms associated with anorexia: feeling cold, poor blood circulation, insomnia, dizziness and hair loss.
People with eating disorders live with persistent and unhealthy thoughts about food that can lead to eating dangerously too little or too much. Yet many never seek help, in part due to wide misconceptions that the disorders stem from weakness or a lack of willpower.
“I didn’t tell anyone because I didn’t want to be told to just eat more,” Suzuki says. “People don’t get it. They assume eating is easy. It’s not like I didn’t want to eat. By the time my coach started worrying, I was skin and bones. He suggested that I take a break from competition, so I went to live with my parents and sought professional help.”
Her mother, well-meaning, told her she could quit skating, but Suzuki says it felt like a “death sentence” because the sport meant everything to her.
Through many long conversations with her mother, she eventually found her path to recovery and went back to school. She had been away from the ice for eight months.
After the airport incident, it would take Suzuki three years before she could touch meat again. When she finally did — a cold pork shabu-shabu salad — she felt as if she had reached the other side. When she began incorporating animal protein back into her diet, she had fewer chills and more energy.
Suzuki returned to competition for the 2004-05 season and went on to skate in two Winter Olympics: Vancouver in 2010 and Sochi in 2014. She retired that March after earning a lot of hardware, among them two silver medals at the Four Continents, one silver and two bronze at the Grand Prix Final, and one bronze at the world championships.
Dissatisfaction with body image, though, is only one cause of eating disorders in athletes. Aya Nishizono-Maher, a professor at Tokyo’s Meiji Gakuin University who studies the issue, says psychological and socio-cultural factors also play a role.
“The pursuit of thinness isn’t the only thing that causes an eating disorder,” she says. “Athletes, particularly those with a sport-first mentality, are vulnerable to developing eating disorders because they are under unique pressures. Body image ideals and the power dynamic between coaches and female athletes can also perpetuate them.”
According to Nishizono-Maher, eating disorders are more prevalent in aesthetic sports such as gymnastics and figure skating or in weight-sensitive sports like boxing and wrestling. But disorders can emerge even among those who play team sports, like soccer and basketball, often fueled by the strain of teammate rivalries.
Among the warning signs, Nishizono-Maher adds, are shifts in social behavior. When someone who used to be outgoing starts avoiding group meals to eat alone, trains solo for prolonged periods or spends a lot of time in the bathroom — it may be a sign of a larger problem.
Drowning feelings with food
Boys and men make up less than 5% of eating disorder patients in Japan, according to the Japan Association for Eating Disorders (JAED). But the figure is likely higher, as many cases go undiagnosed and untreated.
“The gender split for binge eating disorder is much less pronounced, with up to 50% of cases occurring in men,” says JAED President Mari Hotta-Suzuki. “Men are more likely to have a desire to gain muscle and get lean for peak performance than to be thin and look good.
“For both men and women, obsessive-compulsive disorder, perfectionism, anxiety, low self-esteem and social anxiety are risk factors linked to eating disorders.”
In men, the signs can be even harder to detect. Eating disorders among male athletes often go unnoticed because nothing looks wrong on the outside, and many symptoms are easier to hide under the guise of what is considered “normal” behavior for their sport.
Takahiro Fujii, a boxer-turned-MMA fighter, knows this firsthand as he spent a large chunk of his 20s going on wild eating binges.
In combat sports, weight-cutting — the rapid shedding of kilos to meet class limits — is routine. At 162 cm, Fujii fought in three weight classes between 48.9 kg and 52.2 kg. He says the pressure to make weight and deliver results was suffocating, leading to six-hour sauna sessions, “sweat runs” wearing many layers of clothing, and extreme food and fluid restriction.
One time, when he was 500 grams over the limit, he bought a sewing kit on his way to the weigh-in venue and tried to drain blood from his arm with a needle. He gave up after a few unsuccessful attempts.
Whenever he felt stressed, which was often, he would make sudden convenience store runs to get bagfuls of snacks. He would binge until he felt sick, then force himself to vomit. This behavior started when he was 23 and continued for several years.
“I got so good at it, I was bragging to everyone that I knew how to purposely throw up,” Fujii says.
He never sought medical treatment but at 25 he diagnosed himself with bulimia and depression, four years into his professional career. It’s actually very common for people to have co-occurring mood and eating disorders, but Fujii didn’t know that at the time. Depression drained his motivation, dulled his sense of taste and even robbed him of the ability to differentiate colors.
“I had to lose 7 to 10 kg in the week prior to weigh-in. It was so hard,” Fujii says. “Boxers risk eye injuries, brain damage and even death. I was always nervous and terrified before fights. I was anxious about losing. It was like going to a battlefield. So I used food to numb painful feelings.”
He adds that many combat fighters don’t know they have an eating problem. “Even if they knew, they don’t want to be seen as weak so few people will admit it. When fighters talk about cheat days and cheat meals, to me that’s a red flag.
“I used to stuff myself with high-fat, sugary comfort foods. I felt guilt every time I ate. The guilt was so strong, it made me want to die.”
Eventually, running away felt like his only escape — and it worked.
Longing for the mountains, Fujii left his sport and moved to Nagano Prefecture to work on a farm. During his two years there, he used his days off to go climbing and trail running. Surrounded by nature, he began to heal. He rediscovered the joy in eating.
“I can’t pinpoint one reason, but I recovered when I was 29 or 30,” he says.
By 2019, however, watching his peers win belts and headline title fights stirred jealousy. Fujii returned to Tokyo, rejoined his gym and took a new approach. Working closely with a trainer, he focused on breathing, posture and body mechanics. That year, he became a nationally ranked boxer.
Four years later, in 2023, he transitioned from the boxing ring to the MMA cage. Now 36 and weighing 60 kg, Fujii still fights, but without cutting weight. He keeps himself close to his fighting weight, eats three square meals a day and says he has never felt healthier.
Supporting the recovery process
An athlete may have their own reasons for developing an eating disorder — genetics, environment, peer pressure, life changes or something else. There is no single way to prevent them, but Nishizono-Maher believes ditching outdated mindsets is a start.
“For example, gymnasts are weighed before practice and fat-shamed in front of peers,” she says. “I think there’s less of that nowadays, but that has got to stop. Criticizing someone in front of the entire team, forcing them to take responsibility and imposing collective punishment can also be a psychological burden.”
While prevention is crucial, early intervention can be more important and lead to better outcomes.
“A coach shouldn’t be monitoring an athlete’s eating disorder treatment. They should leave that to health care professionals,” Nishizono-Maher adds. “We need to create a culture that normalizes the idea of seeking mental health services, and teams should know how and when to refer an athlete for further medical care if necessary.”
Among her tips for approaching an athlete who may have a disorder is to express concern in a caring, nonjudgmental way and offer to help them find resources and treatment options.
Now 40, Suzuki skates in ice shows and works as a choreographer, television commentator and public speaker. She guesses she weighs about 49 kg — she’s not sure because she only weighs herself once a year at the gym — and considers herself fully recovered.
She draws on her own experiences to support athletes going through similar struggles, reminding them they don’t have to suffer in secret.
“I want to give people some hope I know recovery has no guarantees, but I am living proof that anorexia is beatable,” Suzuki says. “I stopped believing only thin is beautiful. Aside from skating I work with a personal trainer and do Pilates now, and I’m trying to build muscle. I don’t have a scale at home. I hope athletes understand that a healthy body is more than a number on the scale. The scale can’t tell you how well you can perform.”
Fujii, meanwhile, reflects on the years spent in quiet misery, fear and shame. He often wonders: Are eating disorders the cause of loneliness, or does loneliness create eating disorders?
“There were people around me — my manager, my trainer, the boxing gym owner — but I didn’t tell them I had bulimia because I didn’t think they would take me seriously. I thought they would laugh it off. I didn’t think I would get the support I needed,” he says.
He thinks the right environment, along with the right people, can make a big difference.
“That’s where sports can do better,” he says. “Coaches and trainers should keep athletes from falling into the mindset of feeling trapped with no way out.”
For Fujii, recovery isn’t a straight line. He no longer weighs himself daily or obsesses over his body, but understands there’s no guarantee of a happy ending when it comes to mental health.
“I wish I could say I have 100% confidence that I will never relapse, but I don’t know, that’s the thing about being human,” he says. “There is no magical solution.”
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