Eating Disorders in Athletes
Written by: Tx State intern JD Muraida
Athletes are a uniquely vulnerable population when it comes to eating disorders and disordered eating. This is due to the relationship between how their nutritional intake affects their athletic performance and their training schedule. It is key to understand the risks athletes face in providing them support and coaching before their condition may require long-term recovery.
1. 13.5% of athletes struggle with an eating disorder.
45% of women and 19% of men have been diagnosed with an eating disorder.
2. These percentages may be higher as they do not consider the men and women who have not been diagnosed.
The rate of suffering from an eating disorder is higher amongst high school athletes (7.3%)
3. What are the signs?
Distinguishing eating disorder behaviors in athletes is difficult as they are often glorified regardless of the sport. What these behaviors may look like is the idea of obsessing over the number of calories consumed, fueling your body with healthy foods, training for hours outside of practice, and working out for hours to burn calories consumed.
While eating disorders have dangerous consequences for all, it presents itself differently with athletes. Athletes who suffer from eating disorders are at a higher risk for developing Relative Energy Deficiency in Sport, also known as RED-S. This occurs when the amount of energy released is more than the amount of energy (calories) consumed. The result of RED-S is compromised systems such as, bone health, immune health, cardiovascular health, metabolism, menstrual function, protein synthesis, and psychological health.
4. An athlete who may be suffering from anorexia nervosa may show signs that look like:
Fixation of their body weight and/or body image
Distorted body image
Counting calories
Exhibits fear of gaining weight
Fixation of nutritional contents of food
Skipping meals or declining meals
Not eating in front of others
Communicating food rules
Unusual food behaviors
Unable to concentrate for long periods.
Unable to keep up with training; tired often.
Most athletes who are diagnosed with anorexia nervosa often participate in sports that focus on aesthetics like dance, gymnastics, figure skating, wrestling, boxing, and equestrian. Unlike anorexia nervosa, bulimia nervosa involves the engagement of binge eating in a short period of time followed by purging, fasting, or excessive exercise after eating to burn calories consumed. What behaviors should I look for?
Eating large amounts of food at one time followed by interruptions like frequent trips to the bathroom.
Secretly eating
Hiding food in various places
Fixation on body weight and body image
Eating beyond fullness
Expresses shame or guilt around food
Purchases diuretics and/or laxatives regularly
Drinking coffee to keep from eating.
Scars on knuckles (this is caused from the blunt force of purging to the back of their teeth and stomach acid)
The long-term effects of eating disorders in athletes can be severe as their energy output requires proper nutrition in order for their body to function optimally for performance. The consequences that can occur if an athlete suffering from an eating disorder goes untreated:
Increased risk of injury
Metabolic imbalances
Inability to perform resulting in retirement from sport.
Impaired judgement and aerobic functioning
Loss of menstrual cycle resulting in fertility issues.
Increased risk of heart failure.
Bone loss and muscle loss
Ulcers
Tooth decay and gum disease
Increased risk for depression and anxiety
Impaired thyroid function
Death
Treating eating disorders in athletes does not look any different than treatment in non-athletes. The most important aspect of treatment is to prioritize the athlete over their sport. Treatment takes time and it takes commitment from the athlete to be effective. An athlete cannot commit to recovery along with commitment to their sport at the same time. It may be difficult for the athlete to take time off from their sport, but in doing this, it increases their likelihood to return to the sport safely. Prioritize the athlete over their sport and encouragement around their health and their future in a sport they are passionate about will take them to the finish line of recovery. It will take a team (family, friends, teammates, and coaches) to provide support during this time.
Resources:
1. Ghoch, M. E., et al. (2013). Eating disorders, physical fitness, and sport performance: a systematic review. Nutrients, 5:12.
2. Conviser, J. H., Schlitzer Tierney, A., Nickols, R. (2018). Essential for best practice: treatment approaches for athletes with eating disorders. Journal of Clinical Sports Psychology, 12.
3. Conviser, J. H., Schlitzer Tierney, A., Nickols, R. (2018). Assessment of Athletes with eating disorders: essentials for best practice. Journal of Clinical Sports Psychology, 12.