Eating Disorders

Many female athletes will feel the pressure to look a certain way or be a certain weight. This pressure can cause many to cut calories and limit food intake in an effort to cut weight. Because of this pressure, many fall into unhealthy patterns of food intake and develop long-term eating disorders.

Eating disorders are mental disorders. Of all mental illnesses, they have one of the highest mortality rates. Eating disorders, like other disorders, impact your quality of life negatively. As mentioned before, they stem from concerns about body, food, and weight. These concerns lead to people starving, fasting, overeating, purging, or excessively exercising in order to look and weigh a certain way.

MAIN TYPES OF EATING DISORDERS FOUND IN THE ATHLETIC SETTING

Anorexia nervosa: a serious life-threatening disorder characterized by deliberate starvation. Restrict food or binge eat and purge food.
Bulimia nervosa: a serious life-threatening disorder characterized by recurring binge eating episodes followed by self-induced vomiting or purging to control weight.
Eating Disorder Not Otherwise Specified (EDNOS): Eating disorder does not meet the criteria of the strictly defined ones mentioned
Anorexia Athletica: Subgroup of athletes that don’t meet anorexia of bulimia criteria. Under EDNOS
Orthorexia: Cutting an increasing number of food groups and has an increasing concern about the health of ingredients.
Compulsive Exercises: Exercising to the point that they significantly interfere with important activities, at inappropriate times or settings, when the individual is injured or not healthy for exercise
Diabulimia: Increasing neglect of diabetes

The progression from healthy to an eating disorder is often subtle and unnoticed because the person in this cycle is so focused on their appearance. It often starts with healthy dieting with leads to extreme weight loss methods to speed up results, then it moves to dehydration and ends in clinical eating disorders.

Female athletes, especially young athletes, are highly susceptible to fall into the cycle and develop eating disorders. Females in body-focused sports have some of the highest rates of athletes who have developed eating disorders. These sports include gymnastics, ballet, figure skating, and diving. Sports that promote the idea that leaner is better are also at a greater risk of falling into eating disorders. Eating disorders among female athletes are not limited to these sports, many females across the board of all age groups suffer from anxiety about their body and fall into eating disorders. Though eating disorders are dangerous all around the condition and consequences of them among athletes are often more dangerous than in the general population.

90%

of eating disorder cases occur in females under the age of 26

27%

of female athletes have an eating disorder

62%

of women in weight class and aesthetic based sports are estimated to have an eating disorder by the National Eating Disorders Association (NEDA).

Many athletes might not rank as having a clinical eating disorder but have an undiagnosed form of one. This is broadly labeled as Anorexia Athletica. Anorexia Athletica is the restriction and reduction of energy intake (food) to reduce body mass while continuing to perform at a high level. This creates a deficit in energy levels and in females can lead to amenorrhea, the prolonged loss of the menstrual cycle. Amenorrhea causes all sorts of hormonal imbalances and compromises the body’s ability to protect itself. Read more here.

RISK FACTORS FOR EATING DISORDER

Holding the idea that losing extreme weight will improve performance
Genetic history of addiction
Traumatic life experiences
Abuse
Society and peer pressure
Fear of failure or performing well

To prevent eating disorders among athletes it starts with the coaches. Coaches need to be educated about eating disorders and symptoms. They also need to be aware of the way in which they coach. Coaching that is positive and focuses on the athlete as a person rather than negative and focuses on the performance is a major way to prevent eating disorders. Focusing on the success of the athlete rather than their body weight and shape also benefit athletes’ mindset. By emphasizing that the body is something that an athlete should take care of a coach can build a healthier mindset around eating, body weight, and image. Making a realistic schedule and goals will help prevent burnout and teach them that life happens and it is not the end of the world if one practice is missed. Not creating insanely high expectations and pressure benefits athletes’ mental state.

Signs of eating disorders

Anorexia nervosa

Refusal to maintain body weight that is above the minimally normal range for weight and height class (<85 percentile)
Intense fear of gaining weight or becoming fat, they are underweight though
Amenorrhea
Experience their weight unlike reality, view themselves as bigger than they are
Lanugo (fine hair of body and face to help keep the body warm
Effects of amenorrhea

Bulimia nervosa

Hard to detect in athletes as purging can be masked and aligned with intense training regimen keeping the athlete in denial
Purging done by vomiting, laxatives, diuretics, fasting, excessive exercise, medication.
Have general eating disorder signs
Esophageal tears
Gastrointestinal issues- diarrhea/constipation
Dental cavities
Calluses on hands

Eating Disorder Not Otherwise Specified (EDNOS)

All criteria of anorexia are met but still has a menstrual cycle or falls within the normal weight range
All criteria of bulimia are met but the purging occurs less than 2x a week
Chewing and spitting food
Binge eating
Anorexia Athletica: Subgroup of athletes that don’t meet anorexia of bulimia criteria. Under EDNOS

Orthorexia

Inability to eat foods that they do not deem ‘healthy/pure’
Spends hours thinking about food at upcoming events
An extreme obsession to eat healthily leads to an eating disorder

Compulsive Exercises

Major anxiety/depression when unable to exercises

Diabulimia

Fears that insulin will make them fat, restrict food to lower insulin dosages

General Signs of an Eating Disorder in an Athletic Setting

Increasing fatigue
Increasingly frequent injuries
Low blood pressure, slowed heart rate, dizziness/light-headedness, abdominal pain
Behavior change: cranky, isolated, withdrawn
Bad at easy, taper, recovery days
Major focus on theirs and others’ food, eating rituals
Overtraining individually
Excessive concern with body image
Concern from peers

How to address someone with an eating disorder?

When you confront them you should be prepared to tell them the hard truth, don’t sugarcoat it, have observations to back it up, and have an expert to refer them to. When confronting them rather than accuse them of an eating disorder say that “I have noticed…” This is the best way to address them because when you say “You have an eating disorder” you are placing the blame on them, but, if you say that “I have notices…” then you place the blame on yourself. Then have observations that fit the signs of an eating disorder to back up your statement. Finally, have an expert to refer them to, this might be a counselor, a doctor, or a psychologist.

If you can tell someone has an eating disorder rather than skate around it to avoid hurt feelings, be frank. Strong boundaries need to be set to avoid enabling disordered eating behaviors. This is important because eating disorders are mental disorders that can easily turn life-threatening.

Eating disorders are so prevalent now partially because they are more recognized but mainly because of our high exposure to social media and advertisement. The advertising industry uses social media to ingrain itself further into our lives, making more money than ever off of our constant pursuit of happiness. The constant ads for the perfect body, diet, fitness plan, etc. have made the people more willing than ever to unknowingly sacrifice health for an image.

When someone is recovering from an eating disorder the people around them need to be conscious of how they talk. Talk about body image, diets, “good” and “bad” foods, or even encouragement to the ill person about their image can trigger a negative response.

STAGES OF RECOVERY

Stages of Change: cyclical process, some might go through it multiple times, you might revisit a step
Pre Contemplation: The affected might not believe they have a problem, close friends might pick up on symptoms. Gently educate the affected about the effects of the disorder and highlight the positive aspects of change.
Contemplation: The affected is willing to admit they have a problem and are open to accepting help. This phase is when a psychotherapist is helpful to gain an understanding of the eating disorder. The people around the affected should listen and not try to be a doctor.
Preparation: This stage is when the affected is ready for change. Coping mechanisms should be developed and stumbling blocks identified. Outsiders should support and discuss what their role is with the one affected.
Action: The affected is now ready to put into action the strategies they learned. They should focus on the advice of the professionals, removing triggers, and setting positive boundaries without focusing on body image.
Maintenance/relapse: The affected actively practices their new behavior and thinking, moving forwards in life. They will look at potential triggers to prevent relapse of behavior. Outsiders should congratulate their loved one’s success.

There are some things that people can do to limit their chances of developing an eating disorder. Eating disorders are often genetic but can be set off by certain things. The constant bombardment of perfect bodies, happiness-bringing diets, and fitness models causes anxiety and insecurity about our bodies. This can be the catalyst that pushes people into dieting and then over dieting, leading to an eating disorder. Ways to minimize this anxiety is to minimize access to social media. Instead, build real relationships that are healthy. To build a healthy relationship you need to be open. You need to be able to feel, regulate, and share emotions to build deeper connections. An eating disorder is a manifestation of suppressed feelings, fears, worries about not being good enough. Having healthy, deeper relationships means that you can express your emotions, likely not getting as caught up in fears about their body. Finally, the best thing that you can do is advocate for body acceptance, and healthy weight loss. When choosing what to eat, don’t feel guilty about certain foods, likely you don’t fully understand the benefits of certain foods.

This blog post from Run Fast. Eat Slow. provides many resources for people struggling with eating disorders.

THE (FEMALE) ATHLETE'S STRUGGLE

Eating Disorders