This is our presentation at the Academy for Eating Disorders (AED) International Conference on Eating Disorders (ICED) on The Role of Lack of Diversity, Equity, and Inclusion in Ballet (6/12/21).

1. z
Learning from the Past and Present to Shape
the Future of Eating Disorder Prevention and
Treatment in Dancers
The Role of Lack of Diversity,
Equity, and Inclusion in Ballet:

2. DISCLOSURES
All presenters have no commercial relationships to disclose.

3. z
Hope
for the
future
Evaluating
the current
status quo
Perfect
Storm
Moderated
discussion
Special
Guest:
Misty
Copeland
Video
content

4. z
Before we get going
Interactive Zoom feature: curated
chat questions addressed at the end
PPT handout available (pdf) +
NYTimes Article
CEU requirements: please complete
evaluations

5. z Meet your panelists
Sasha Gorrell, PhD
Moderator
Fumi Somehara
Dietitian
Monika Saigal
MS, RD, CEDRD-S,CDN
Heather Hower
MSW, LICSW, QCSW, ACSW
Misty Copeland
American Ballet Theatre

6. z
“Perfect Storm” of Ballet and
Eating Disorder (ED) Risk Factors
Culture of Thinness, Aesthetic Ideals, Dieting,
and Eating Disorder Development
Heather Hower, MSW, LICSW, ACSW, QCSW
Faculty Research Associate, Brown University, School of Public Health,
Hassenfeld Child Innovation Institute
Faculty Associate Specialist, University of California San Diego,
Eating Disorders Center for Treatment and Research

7. z
Ballet Culture of Thinness, Aesthetic Ideals
§ “Perfect storm” of risk factors for the development of ED
§ Ability to attain + maintain thin body shape directly
affects roles + job status
§ Constant struggle to push bodies to the limits
§ Low weights, potential injuries + aesthetic ideals while
maintaining strength, flexibility + stamina

8. z
Dieting Behavior and ED Development
§ Weigh ~10-12% under ideal body weight
§ Dancers report dieting behavior; those with lower energy availability
are at elevated risk for injuries and/or medical complications (e.g.,
menstrual dysfunction, decreased bone density, cardiovascular
health, etc.)
§ Dancers report higher levels of "drive for thinness” and body
dissatisfaction, compared to non-dancers
§ May be particularly important in contributing to development of ED

9. z “Ideal” Bodies Restrict Diversity Across Contexts
§ Traditional “ideal” dancer = thin, White female
§ Exclusion of different body types, races; extra pressure to assimilate
§ Males are a much smaller %, mostly White, with few non-White role models
§ Restriction of diversity in ballet companies à restriction of diversity in research
§ Focus on White females, child-adolescent range
§ Point prevalence dx consistent with Anorexia nervosa (AN)
§ Higher lifetime prevalence of Eating Disorder Not Otherwise Specified (EDNOS)
§ Lack of diversity in companies affects what we learn through research + is reflected
in lived experience

10. z
Lived Experience
§ Video One
§ How has your involvement in ballet impacted your relationship with
food and/or your body?

11. z
Eating Disorder (ED)
Prevention Efforts in
Ballet
What’s working and what
needs work?
Monika Saigal, MS, RD, CEDRD-S, CDN
Private Practice, New York, NY, USA

12. z
ED Prevention
Three areas of focus:
§ Education
§ Early identification & intervention
§ Systemic factors that increase ED/DE risk
Recommendations based on clinical experience, lived experience, research,
& feedback from dance community

13. z
Education
§ Specialized trainings for dancers, teachers, staff, parents, dance
medicine providers
§ Nutrition
§ Body Image
§ Harms of dieting and RED-S
§ Coping skills
§ Resources
§ ED/DE Identification and intervention

14. z
Education
§ Given by qualified professionals
§ Mandatory
§ Paid time for professionals
§ Ongoing/multi-session
§ Interactive
§ Focus on improving physical & mental health, performance (not weight)

15. z
Early Identification & Intervention
§ ED protocol for studio/school/company
§ Designated person to confidentially share concerns
§ Referral list of ED specialists
§ Yearly screenings at minimum
§ ED/DE beliefs/behaviors
§ Weight changes
§ Desire for weight change
§ Food restrictions/dieting
§ Menstrual history/changes

16. z
What needs work: systemic risk factors
§ Body image dissatisfaction
§ Teacher influence
§ Body shaming
§ Language
§ Mirrors
§ “Uniform”
§ Thin ideal

17. z
What needs work: systemic risk factors
§ Preference for ultra-thin physique
§ Weighing dancers/weight talks
§ Lack of diversity in body type & size, race, etc
§ Consistent messaging – talks/statements vs
§ Hiring
§ Casting
§ Promotions
§ Fueling/hydration breaks encouraged

18. z
Lived Experience
§ Video Two
§ What change(s) do you want to see in ballet?

19. z
Diversity in Ballet
Or a lack thereof …
Fumi Somehara, Accredited Practicing Dietitian
Founder of DDD Centre for Recovery, Sydney, AU

20. z
Ballet's Lack of Diversity
Body is THE expressing vehicle in ballet – there are no texts nor words.
Lack of Diversity in ballet is a complex issue: historical origin, artistic tradition,
racism, weight bias, socioeconomic status, cultural policy, education, funding,
management and governance.
§ Financial barrier
§ Aesthetic demands placed on dancers to succeed
§ Audience limitations
§ Leadership limitations

21. z
Ballet's Lack of Diversity
Financial barrier
§ Approx. US$120,000 to raise a professional ballet dancer
Aesthetic demands placed on dancers to succeed
§ White European aesthetic – non-White dancers are still demanded to fit into this 'shape'
§ Submissive body ideals for female dancers
§ Dance students: 89.8% White; 4.08% Asian; 2.04% Multiracial; 2.04% Hispanic or Latino; 2.04% Black or
African American
Audience limitations
§ 80% White; two-thirds Female; Household income >$150,000
Leadership limitations
§ 75% of artistic directors, and 79% of the work is choreographed by, male
§ Dance Theatre of Harlem (US, est 1969); Ballet Black (UK, est 2001); Bangarra Dance Theatre (AU, est 1989)
§ Karen Brown became the first Black director for ballet company (Oakland Ballet Company) in Aug 2000
§ Ella Havelka was the first Aboriginal woman to join the Australian Ballet in 2013

22. z
Lived Experience
§ Video Three
§ What are some examples of good change(s) you’ve seen, or what
gives you hope that change is possible?

23. z
Moderated Panel Discussion

24. z
NYTimes
§ "Right now, many dancers — like the rest of us — are living with
slightly different bodies. Marika Molnar, a physical therapist and
director of health and wellness at New York City Ballet, said she
thinks the dancers she works with look great at the moment.
“Maybe they’ve gained five pounds, but they look fantastic,” she
said. “I don’t know how that’s going to translate onto the stage
and a tutu, but they all look terrific now, very healthy.”

25. z
NYTimes
§ “We accept that the white body can be anything and everything,”
said Theresa Ruth Howard, a former dancer who writes and
speaks about equity in ballet. “For a white ballet dancer, physical
shortcomings — bad feet, a little bit tight, a little bit turned in —
they get to be that.”

26. z
NYTimes
§ “I think the aesthetic for ballet will probably go back to the way it
was because they have to fit into their costumes,” Molnar said.
“Those costumes are expensive.” In ballet, this is a serious
concern; dancers are known to get parts based on whether they
fit a costume. “But I don’t really know,” Molnar continued. “I think
it would be fun to see if they can maintain the level of their
physical activity and not have to lose so much weight and look
emaciated.”

27. z
Sasha Gorrell: Sasha.gorrell@ucsf.edu
Heather Hower: Heather_Hower@Brown.edu
Monika Saigal: monika@msnutrition.com
Fumi Somehara: fumi@dddcfr.com.au
Panelist Contact Information

28. z
Acknowledgements
Thank you to our interviewees who generously shared their
lived experience (alphabetical order):
Ai, Arianna, Ashley, Brooke S, Brooke B, Elena, Grace, Jo,
Kaela, Kai, Kayle, Kelsey, Nan, Sam

29. z
Acknowledgements
Thank you to Tatiana Strauss for her assistance with video
compilation and editing
With appreciation for the following colleagues :
Nikki Estep, RD; Elizabeth Holm, RD; Walt Kaye, MD;
Stephanie Knatz-Peck, PhD; Laura Moretti Reece, RD; &
Christina Wierenga, PhD

30. z
References
§ Abrams A. Raising A Ballerina Will Cost You $100,000: The high price of training is keeping ballet’s top ranks from being more diverse. 20
Aug 2015. https://fivethirtyeight.com/features/high-price-of-ballet-diversity-misty-copeland/
§ Arcelus, J., Witcomb, G. L., & Mitchell, A. (2014). Prevalence of eating disorders amongst dancers: a systemic review and meta-analysis.
European Eating Disorders Review, 22(2), 92-101.
§ Artistic and Executive Leadership Report MARCH 2020. Dance Data Project. https://www.dancedataproject.com/wp-
content/uploads/2020/03/Leadership-Report-2020.pdf
§ Bar RJ, Cassin SE, Dionne MM. The long-term impact of an eating disorder prevention program for professional ballet school students: A
15-year follow-up study. Eat Disord. 2017 Oct-Dec;25(5):375-387
§ 2019-2020 Season Overview JULY 2020. Dance Data Project. https://www.dancedataproject.com/wp-content/uploads/2020/08/July-2020-
Season-Report.pdf
§ Dantas AG, Alonso DA, Sánchez-Miguel PA, Del Río Sánchez C. Factors Dancers Associate with their Body Dissatisfaction. Body Image.
2018;25:40-47
§ DataUSA https://datausa.io/profile/cip/ballet
§ Gorrell, S., Schaumberg, K., Boswell, J.F.,Julia M. Hormes & Anderson, D.A. (2021) Female Athlete Body Project Intervention with
Professional Dancers: A Pilot Trial, Eating Disorders, 29:1, 56-73
§ Janigová T. Female Dancers of Colour in the World of Professional Ballet. Thesis. 2020. Masaryk
University. https://is.muni.cz/th/hayex/BATHESIS_final_draft_Janigova.pdf
§ Kourlas, Gia. What is a Ballet Body? With performances on pause, many dancers are rethinking their relationship to weight. NYTimes,
published March 3, 2021 https://www.nytimes.com/2021/03/03/arts/dance/what-is-a-ballet-body.html?searchResultPosition=1

31. z
References
§ Lavender, J.M., Brown, T.A. & Murray, S.B. Men, Muscles, and Eating Disorders: an Overview of Traditional and Muscularity-Oriented
Disordered Eating. Curr Psychiatry Rep 19, 32 (2017).
§ Nascimento, A. L., Luna, J. V., & Fontenelle, L. F. (2012). Body dysmorphic disorder and eating disorders in elite professional female ballet
dancers. Annals of Clinical Psychiatry, 24(3), 191-194.
§ National Endowment for the Arts. A Decade of Arts Engagement: Findings from the Survey of Public Participation in the Arts, 2002-2012.
Office of Research & Analysis. January 2015. https://www.arts.gov/sites/default/files/2012-sppa-jan2015-rev.pdf
§ Ringham, R., Klump, K., Kaye, W., Stone, D., Libman, S., Stowe, S., & Marcus, M. (2006). Eating disorder symptomatology among ballet
dancers. Neumarker, K-J., Bettle, N., Neumarker, U., & Bettle, O. (2000). Age- and gender-related psychological characteristics of
adolescent ballet dancers. Psychopathology, 33, 137-142.
§ Robbeson, J. G., Kruger, H. S., & Wright, H. H. (2015). Disordered eating behavior, body image and energy status of female student
dancers. International Journal of Sport Nutrition & Exercise Metabolism, 25(4), 344-352.
§ Stice, E., & Shaw, H. E. (2002). Role of body dissatisfaction in the onset and maintenance of eating pathology: A synthesis of research
findings. Journal of psychosomatic research, 53(5), 985-993.
§ Teague J. Where are the female choreographers? A study on the gender imbalance among professional choreographers working in the
fields of classical ballet and contemporary dance. Dissertation. 2016. City University of
London. http://www.danceicons.org/_doc/FemanleChoreograohers.pdf
§ Thomas, J. J., Keel, P. K., & Heatherton, T. F. (2005). Disordered eating attitudes and behaviors in ballet students: examination of
environmental and individual risk factors. International Journal of Eating Disorders, 38(3), 263-268.