Eating Disorders and Disordered Eating Among Athletes

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Eating Disorders and Disordered Eating Among
Athletes
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Overview

• Definitions, diagnostic criteria
• Prevalence
• Factors unique to athletes
• Warning signs
• Intervention
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Diagnostic Criteria

• Anorexia Nervosa
• Refusal to maintain minimally healthy body weight
  for age and height
• Intense fear of gaining weight, even though
  underweight
• Disordered body image
• Amenorrhea (absence of 3 consecutive menstrual
  cycles)

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MALES ATTRACTIVE
Females Ideal
Females Current
Females Attractive
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Reverse anorexia
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Diagnostic Criteria

• Bulimia Nervosa
• Recurrent episodes of binge eating
• Recurrent inappropriate compensatory behavior in
  order to prevent weight gain
• Binge eating and compensatory behaviors occur on
  average twice a week for 3 months
• Self-evaluation unduly influenced by body shape
  and weight

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Diagnostic Criteria

• Eating Disorders Not Otherwise Specified (EDNOS)
• Atypical or subclinical eating disorder
• Criteria for anorexia met except amenorrhea or
  weight
• Binge eating disorder

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Anorexia Athletica

• Subclinical eating disorder frequently found in
  athletes
• Individuals within 5 of expected body weight
• Fear of becoming fat
• Restriction of food to lt1200 kcal
• Compulsive exercise
• Amenorrhea
• Occasional binge/purge

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Female Athlete Triad

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Research on the Prevalence of Eating Disorders

• Athletes appear to have a greater occurrence of
  eating-related problems than does the general
  population.
• significant percentage of athletes engage in
  disordered eating or weight-loss behaviors
• sport-specific prevalence _______________________
  __________________________________________________
  _____

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Prevalence

• Normative for young women to experience body
  dissatisfaction and desire weight loss
• Sociocultural demands placed on women to be thin
  along with pressure from sport to meet weight
  standards or body size expectations of sport
• Up to 60 (!!)of female college athletes report
  some type of disordered eating

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Prevalence and Men

• Sociocultural demands placed on men to achieve a
  particular physique along with pressure from
  sport to meet weight standards or body size
  expectations of sport
• 16 of individuals with eating disorders are
  male (increasing)
• 25 of individuals with binge eating disorder
  are male
• Gay men particularly at risk

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NCAA Study on Athletes and Eating Disorders

• 1,445 student athletes from 11 Division 1
  schools
• Females-mean desired body fat 13 mean actual
  body fat 15.4 (healthy 17 - 25)
• Females-173 had BMI 15-20
• Males-mean desired body fat 8.6 mean actual
  body fat 10.5
• (healthy 10 - 15)
• BN problems 9.2 (F) .01 (M)
• AN problems 2.85 (F) 0 (M)

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Factors Unique to Athletes

• No single cause for eating disorders
• Sport body stereotype thin-build sports
• Expectation for athletes in certain sports to
  display a characteristic body size and shape
• Fitted uniforms, body on display
• Belief that thinness enhances performance (e.g.,
  running)

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Factors Unique to Athletes

• Symptoms vs desired characteristics of athletes
• Driven personality
• Perfectionists
• People pleasers
• Obsessive-compulsive tendencies
• High pain tolerance
• Size increase due to weight training

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Factors Unique to Athletes

• Stress of being in the spotlight
• Balancing multiple role demands

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Warning Signs

• Physical
• Intolerance to cold
• Dizziness, fainting spells
• Constipation
• Loss of muscle tone
• Frequent weight fluctuations
• Impaired concentration
• Swollen salivary glands, puffiness in cheeks
• Broken blood vessels in eyes
• Complains of sore throat, fatigue, muscle aches
• Tooth decay, receding gums

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Warning Signs

• Behavioral
• Restricted food intake
• Eliminating specific foods or whole food groups
• Fear of food, avoiding situations where food is
  present
• Excuse of picky eater, despite previous
  flexible eating
• Excessive exercise
• Regular weighing
• Frequent comments about own weight, calories,
  food fat content
• Frequent bathroom visits following meals
• Moodiness
• Withdrawal from others

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Warning Signs

• Attitudinal
• Dichotomous thinking
• Denial of eating problems
• Perfectionistic standards
• Harsh self-criticism
• Self-worth determined by weight

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Intervention What to Do

• Set aside time for a private, respectful meeting
  to discuss your concerns openly and honestly in a
  caring and supportive way.
• Describe what you have seen and heard that has
  led to your concerns.
• Ask the person to explore these concerns with a
  counselor, doctor, or any health professional
  s/he feels comfortable enough to see.

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Intervention What to Do

• Arrange for regular, private follow-up meetings
  apart from practice times
• Let the athlete know that the demands of the
  sport may have played a role in the development
  of the problem
• Expect denial, rationalization, anger

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Other Intervention Considerations for Coaches

• Offer to accompany athlete to first medical or
  therapy appointment for support.
• Emphasize place on team will not be endangered by
  admitting an eating disorder
• emphasize fitness and de-emphasize weight,
  especially as it relates to performance
• avoid weigh-ins or negative comments about weight
  
• Remember that many athletes who develop eating
  disorders have been told to lose weight. Past or
  present coaches may have contributed to problem
  Coaches alone should not be making weight
  decisions...
• participation will only be cut/decreased if
  eating disorder has compromised athletes health
  or put athlete at risk for injury.

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Intervention What Not to Do

• Dont question teammates or talk to them about
  the athlete. Talk directly to athlete
• Dont ignore the problem. Intervene
• Never conclude that an athlete just isnt trying
  hard enough to overcome an eating disorder
• Dont try to keep the problem hidden or try to
  deal with it yourself. When in doubt about how to
  intervene, consult, consult, consult

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Intervention What Not to Do

• Dont get into a power struggle about whether
  there is a problem.
• Dont be deceived by excuses.