In the uneven bars final at the 1989 World Championships, Christy Henrich came within five-hundredths of a point of perfection. It was a beautiful routine, capped with a dismount perfectly stuck, and Henrich grinned as she waited for her score.

She finished fourth.

It was in this crucible — women’s gymnastics after Nadia Comaneci and Mary Lou Retton, when commentators were champing at the bit to anoint their successors, when a 9.95 out of 10 might not win you a medal — that one of the United States’ best athletes concluded she was not good enough. Between 1988, when Henrich missed the Olympic team by a fraction of a point, and the next Olympics four years later, she developed anorexia and bulimia. She left the sport in 1991 and died in 1994, at 22, from multiple organ failure caused by starvation.

Henrich’s death has been presented as a catalyst for systemic changes in American gymnastics. Looking back at her story allows us to re-examine an environment that was toxic for many elite gymnasts, to rethink the public’s limited understanding of eating disorders and to take stock of how much remains to be done to protect young female athletes. And as gymnastics has been forced to confront revelations of long-term sexual abuse and misconduct, discussions about mental health at the highest echelons of sports have become more relevant than ever.

That conversation started with gymnasts, and the topic was specifically sexual abuse. Then it was other forms of abuse and the culture of obedience that enabled them. Americans joined competitors from Australia, Britain, Canada and the Netherlands in calling out mistreatment, including weight-shaming. And then — seemingly suddenly, but far from it — the conversation was about mental health in sports of all kinds.

The progress is incomplete, and the public vulnerability of athletes such as Simone Biles and Naomi Osaka continues to be rare because it is rarely welcomed. But from some angles, it looks like a fulfillment of a reckoning that began with Henrich.

Problem ‘in the air’

Henrich’s parents put her in gymnastics classes for the same reason as a thousand other gymnasts’ parents: She was constantly climbing on things.

She made the junior national team the year she turned 14, and the senior national team a year later.

But Bo Moreno, whom she met in high school in Independence, Mo., and who became her fiancé when she was 18 and he was 19, remembers her as “just like any other teenage girl” — funny, sociable, interested in fashion, liable to call him out of the blue because she wanted to surprise him with homemade cookies, but she didn’t have vanilla extract, so could he bring some over?

“Everyone was her friend. She talked to everybody. That was one of the things that made me fall in love with her,” Moreno said. “Her outside the gym was completely different from her inside the gym.”

Inside the gym, she was driven by one goal: Become an Olympian. When she fell short in 1988, she focused even more fiercely on 1992.

In an interview shortly before her death, Henrich said her coach, Al Fong, had compared her to the Pillsbury Doughboy and pressured her to lose weight. Fong, who did not respond to an interview request sent through the gym he owns, has repeatedly denied that assertion, and said he tried to get Henrich help.

Mainly, though, Henrich attributed her eating disorders to a comment from a judge at an international competition in the late 1980s. The judge, she said, told her she needed to lose weight. So she tried to do that by any means.

This direct cause and effect is in most accounts of Henrich’s illness, and, certainly, the judge’s comment was the sort of crystallizing moment many gymnasts can point to. For Theresa Kulikowski, an alternate to the 1996 Olympic team, it was when she read that a gymnast she admired ate a low-fat diet. For Nancy Thies Marshall, a 1972 Olympian, it was when a coach called her a “fat pig,” a remark seared so deeply in her mind that she remembers where she was standing and how the gym smelled when it was uttered.

“I can tell that story, and she can tell the story of the judge,” Thies Marshall said. “But I know that it’s so much more complicated than that.”

Medical understanding of eating disorders has advanced greatly since Henrich’s death, and it is now clear genetics play a role. Abusive or simply careless comments can be triggers, but some people are more susceptible through no fault of their own.

“It has been misportrayed consistently as a disease of choice, and it’s really not at all a disease of choice,” said Dr. Stuart Murray, the director of the University of Southern California’s eating disorders program and its Translational Research in Eating Disorders laboratory. “It’s a biologically based illness that people can’t opt into, and they can’t opt out of it oftentimes.”

In the world of elite gymnastics, the problem was “in the air,” said Kathy Johnson Clarke, a 1984 Olympian who struggled with an eating disorder and who is now an ESPN gymnastics commentator. It was her teammates’ casual conversations about the laxatives they used. It was the compliments they got after being sick:

Television broadcasts and news articles, including in The New York Times, routinely included gymnasts’ heights and weights. Reporters presented tiny bodies as inherent to the sport and took note of gymnasts who deviated from that norm, however slightly: A profile of the two-time Olympic medalist Kerri Strug in 1997 used the verb “ballooned” to describe five pounds of weight gain.

“Their futures may be big, but these athletes are not,” read a 1989 Los Angeles Times article, referring to six girls training under Bela Karolyi in pursuit of the 1992 Olympic team — only two of whom made it to the Olympic Trials, and at least one of whom developed an eating disorder. It called one gymnast “the smallest, and best,” giving her height and weight before turning to “the biggest, but not the worst.”

“It’s like they’re describing livestock or horses,” said Maria Rago, a clinical psychologist and the president of the board of directors of the National Association of Anorexia Nervosa and Associated Disorders.

After Henrich essentially stopped eating, she competed in a televised event and, Moreno recalled, “the first thing the announcer said was: ‘Look at Christy Henrich. She’s slimmed up. She looks great.’”

After Henrich’s death, many in the news media seemed to blame her for succumbing to her disease. They attributed her eating disorder to the judge’s comment alone or to a lack of common sense on her part: “Irrational Obsession Consumed Her Talent, Her Life,” read a 1994 Associated Press headline. The Los Angeles Times said that she “gave in” to anorexia and that “no one could save Henrich” because she “could not save herself.”

The idea that Henrich could have lived if she had only been stronger, experts say, is unscientific and harmful.

“She hated it as much as everyone else did,” said Moreno, her fiancé. “She didn’t want to be like this, and that was the hardest part and most tragic part about watching it.”

In 1993, Henrich explained to a reporter from her hometown paper, The Examiner, that she experienced the illness as a malevolent force separate from who she was and wanted to be.

“It feels like there’s a beast inside of me, like a monster,” she said. “It feels evil.”

A transformation delayed

In the shock that followed Henrich’s death, many broadcasters stopped listing gymnasts’ weights in television chyrons, and the United States Gymnastics Federation — the sport’s governing body, now known as U.S.A. Gymnastics — hired Thies Marshall to create an athlete wellness program.

Designed with experts and other former gymnasts, it included a referral network for eating disorder treatment; a curriculum for coaches that covered nutrition, biomechanics, sports medicine and sports psychology; and a mentoring system to pair national team members with former members who could serve as confidantes.

But U.S.A. Gymnastics cut the program’s funding around 2000, and the system regressed. Martha Karolyi — the wife of Bela Karolyi, who, in the journalist Joan Ryan’s 1995 book, “Little Girls in Pretty Boxes,” had been publicly accused of abusive training methods — was installed as coordinator of the women’s national team. Centralized training camps were established at the Karolyis’ ranch, where the team doctor, Larry Nassar, would molest athletes for years. At those camps, numerous gymnasts have said in recent years, the Karolyis forced athletes to train on serious injuries and created an environment in which gymnasts were afraid to be seen eating more than small quantities. The Karolyis have said they were unaware of Nassar’s behavior, and their attorney has denied the abuse allegations against them.

Around the time Nassar was exposed in 2016, U.S.A. Gymnastics asked Kulikowski — the 1996 Olympic alternate who now runs a mindfulness and meditation practice — to update the program’s wellness manual.

A spokeswoman, Jill Geer, said U.S.A. Gymnastics did not publish the new manual but adopted many of its suggestions. She said that, among other things, U.S.A.G. now requires national team members to get annual sports physicals; ensures that medical staff review the results of those physicals for warning signs of disordered eating, such as irregular menstruation; and provides athletes, coaches and parents with educational materials about body image and healthy eating. It also hired a chief of athlete health and wellness in 2019.

Al Fong, who still coaches elite athletes at his gym, Great American Gymnastics Express, has acknowledged that some of his methods were too harsh. Two gymnasts who worked with him more recently than Henrich — Katelyn Ohashi, who trained at GAGE until 2009, and Brenna Dowell, who trained there through 2016 — said he rarely mentioned weight.

But even as some coaches improved, and public scrutiny of gymnasts’ bodies became less explicit, the culture that contributed to Henrich’s death endured.

After Ohashi moved to Texas in 2009 to train with Valeri Liukin — known for coaching his daughter, the 2008 Olympic champion Nastia Liukin — she described a deep-seated climate of shame in which she and her teammates would play “games” to decide whether to eat that day. Liukin would sometimes blame Ohashi’s weight if she fell in practice, she said, or he would simply look her over and instruct her to run for 45 minutes. Other times, she recalled, he said she looked like she had swallowed an elephant.

Liukin — whom multiple gymnasts have accused of similar behavior, The Orange County Register reported, and who until recently was a candidate to take over the women’s national team — did not respond to a request for comment sent through his gym, World Olympic Gymnastics Academy. Geer said he was no longer being considered for the U.S.A.G. job.

Elite athletes from other sports, including figure skating and track and field, have also spoken out in recent years about abusive environments that they say fostered eating disorders and other mental health issues.

But while Henrich struggled not to be defined by or blamed for her illness, today’s athletes are much more empowered to speak up for themselves, and are more often treated as fully formed humans when they do.

News coverage, while far from faultless, has shifted its focus to athletes’ voices. Much of the coverage of the figure skater Gracie Gold’s eating disorder and depression, for instance, focused not on dramatic descriptions of how little she ate but on the roots of eating disorders and the challenges in treating them.

Athletes such as Biles and Osaka have led the way in shifting the conversation around mental health — while emphasizing that failures at the top have left them to carry burdens that should not be theirs, and that if reforms are not to be restricted to helping those at the pinnacle of their sports, they need to be systemic.

“You have very public examples of role models who are much more in control,” Thies Marshall said. “Women can look to those role models and say, ‘I don’t have to put up with this.’”