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Athletes and Eating Disorders

Athletes and Eating Disorders

Sports have been an amazing vehicle in which one develops strength, self esteem, and skills that translate into proficiency in life and the business world. Sports also offer protective factors for young athletes facing many pressures from their culture. They have opportunities for skill development, which improves self-esteem; they have strong social supports through their team; and they experience positive effects of exercise on their mood.

At the same time, athletes have many risk factors that make them susceptible to disordered eating patterns and eating disorders. The perfectionist, goal oriented, success-at-any-cost attitude that make athletes so driven and capable on the field, are also common characteristics of those vulnerable to eating disorders. Research suggests that as many as 30% of athletes experience sub clinical eating disorder symptoms. A recent study of NCAA trainers found that 91% of them believed that they had encountered an athlete with an eating disorder.

Specific sports where athletes must ‘make weight’ or maintain a certain size put athletes more at risk. These sports include: gymnastics, swimming, diving, rowing, bodybuilding and wrestling. In addition, sports such as track, diving, figure skating and dance also increase risk, as they focus on appearance, as well as on the individual, rather than the team.

One of the challenges is that an athlete can at first maintain good performance and success in school while struggling with a disorder. An athlete may be able to function at a high level, but often there is significant disturbance in thought and mood (and eventually health) as a result of disordered eating behaviors.

In her book “Age is Just a Number,” Dara Torres writes, “The worst part of my bulimia was its psychological effect. Sure, I had no energy in the water, and my face was bloated…But the real problem was that I lost my mind. I was extremely dark and moody…Pretty much all I thought about during college was what I ate, what I wanted to eat, what other people ate, what I’d need to do to get rid of the calories I’d ingested, how much exercise I got, and how I would look in my swimsuit when I mounted the blocks.”

Even if a full eating disorder does not emerge, there are important physical consequences to calorie restriction in some athletes. According to Dr. Kate Ackerman, MD, MPH, internist, endocrinologist and sports medicine specialist, athletes may believe they are improving their performance by being leaner, but often they compromise not only performance, but health. “I see a lot of patients with injuries that are brought on by their lack of caloric intake. This not only takes them out of training and competition, but also impairs their healing process.” 

Dr. Ackerman is one of the leading experts in the female athlete triad, a condition involving the interrelated symptoms of disordered eating, menstrual irregularity and low bone mass. Although the exact prevalence of the Triad is unknown, studies have reported disordered eating in up to 62% and amenorrhea in up to 66% of female athletes. The basic premise is that when an athlete eats too few calories, it causes brain hormone levels to change, disrupting signals to the ovaries to produce estrogen. Estrogen is key to bone development, and without it, bones don’t develop properly or maintain optimum density. This is particularly important in adolescent girls, as 90% of peak bone mass is attained by age 18, with only mild gains up to age 30. This means that disrupting the menstrual cycle during adolescence and early adulthood has a profound effect on bone health.  Sadly, there are many team cultures that unofficially “promote” dieting and even loss of one’s period. Dr. Ackerman states, "For young women, the menstrual cycle is like another vital sign. When it's disrupted, it let's us know that something unhealthy is going on. Whether it's a condition like polycystic ovarian syndrome, or a situation of energy deficit, it's important to see a doctor to help to determine the cause of disrupted periods and to return the body to its optimal balance for peak performance."

Given the shame and secrecy that accompanies eating disorders, it is not surprising that fewer than 28% of those with eating disorders seek treatment. Of those treated with empirically supported treatments, only 40% are shown in research to maintain lasting freedom from symptoms. This makes the case for both prevention efforts and early detection.

Participating in sports creates a wonderful opportunity for young men and women to develop strong friendships, confidence, and skills. In today’s culture where there are so many strong messages about appearance and body size, it can be hard for young people to navigate their way to a healthy body weight.  It is important for teammates, parents, coaches, and trainers to be educated about the negative impact disordered eating patterns can have on athletes.

For additional information on athletes with eating disorders, refer to the following resources:

Position Statements:

American College of Sports Medicine: The Female Athlete Triad

National Athletic Trainers’ Association Position Statement: Preventing, Detecting, and Managing Disordered Eating in Athletes

NCAA Coaches Handbook: Managing the Female Athlete Triad

University Athlete and ED Policies and Protocols:

Azusa Pacific University

Ohio State University

University of Detroit – Mercy

Websites:

International Olympic Committee - Body Image and Athletes - 4 Videos

American College of Sports Medicine

Association for Applied Sport Psychology

Female Athlete Triad Coalition

National Collegiate Athletic Association

Sports, Cardiovascular and Wellness Nutrition

Related Publications:

Sports Nutrition Guidebook (Nancy Clark)

Disordered Eating Among Athletes: A Comprehensive Guide for Health Professionals  (Katherine Beals)

Helping Athletes with Eating Disorders (Ron Thompson and Roberta Sherman)

Eating Disorders in Sport (Ron Thompson and Roberta Sherman)

Exercise Balance (Pauline Powers and Ron Thompson)

Beauty Mark: Body Image & the Race for Perfection (DVD)