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Nutrition Conditioning, Inc. Disordered Eating- Prevention, Recognition and Action The 15th FINA World Sports Medicine Congress jointly-sponsored by the.

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Presentation on theme: "Nutrition Conditioning, Inc. Disordered Eating- Prevention, Recognition and Action The 15th FINA World Sports Medicine Congress jointly-sponsored by the."— Presentation transcript:

1 Nutrition Conditioning, Inc. Disordered Eating- Prevention, Recognition and Action The 15th FINA World Sports Medicine Congress jointly-sponsored by the American College of Sports Medicine and Indiana Sports Corporation

2 Heidi Skolnik MS,CDN, FACSM Giants Football Team School of American Ballet Women’s Sports Medicine Center at HSS Columnist, Men’s Health Contributing Editor, SELF Magazine On-air contributor; ESPN2’s Cold Pizza

3 Nutrition Conditioning, Inc. Disordered Eating Define Disordered Eating vs. Eating Disorders Prevention and risk reduction Red Flags: how to identify a swimmer who maybe susceptible or already entrenched Intervention suggestions and a model of treatment

4 Nutrition Conditioning, Inc. SPECTRUM of Behaviors, Thoughts, Feelings DE Anorexia Everything in between May or may not be ‘sub clinical’ Bulimia

5 Nutrition Conditioning, Inc. How Prevalent? Estimated over 5 million Americans 5% females and 1% of males have anorexia nervosa, bulimia or binge eating disorder »Position of ADA For female collegiate athletes estimates range from 11-32% for sub clinical DE. Athletes are at greater risk for DE compared to non- athletes. - Affenitio,2203

6 Nutrition Conditioning, Inc. CHARACTERIZED by Preoccupation with food, energy intake and body weight Body weight dissatisfaction Distorted body image Undue influence of body weight on self- evaluation “Feeling” fat Reduced intake or inconsistent intake of energy, fat, and protein

7 Nutrition Conditioning, Inc. GROUP ACTIVITY: Close your eyes… (do not think about cookies for the next 30 seconds)

8 Nutrition Conditioning, Inc. CHARACTERIZED by Compulsive exercise esp. to burn calories- Exercising even when injured and against advice of team Dr., coach, trainer… Menstrual dysfunction Bone injuries Trouble recovering form injuries

9 Nutrition Conditioning, Inc. Performance hurt by Low energy/fatigue/staleness Reduced strength Reduced stamina (but not at first) Altered body composition Preoccupation- lack of concentration Isolation Shame, guilt Increased risk of injury (overuse injuries)

10 Nutrition Conditioning, Inc. Medical Implications of long term energy and nutrient deprivation Increased risk –Clinical eating disorder –Limited recovery from injuries –Breakdown and overuse injuries –Amenorrhea (reduced testosterone) –Osteoporosis –Psychological stress

11 Nutrition Conditioning, Inc. The FEMALE ATHLETE TRIAD Disordered Eating Amenorrhea Osteopenia/porosis

12 Nutrition Conditioning, Inc. DE Eating Osteo- porosis/ penia Amenorrhea Ovarian Hormone Production Hypoestrogenemia Nutrition Calcium Energy DE, Amenorrhea and Osteoporosis

13 Nutrition Conditioning, Inc. Amenorrhea Theories of Amenorrhea Body Fat % Energy Drain Hypothesis Exercise Stress Theory Poor nutrition

14 Nutrition Conditioning, Inc. AMENORRHEA Cessation of period three or more consecutive months or failing to have menstruated by age 16

15 Nutrition Conditioning, Inc. OSTEOPENIA/ OSTEOPOROSIS Bone density formed until age 25-35 Lifetime issue Increased risk for stress fractures

16 Nutrition Conditioning, Inc. ENERGY DRAIN Stress fractures occurred more often in dancers who had restrictive eating patterns (see below for a partial list) EVEN when matched for menstrual history and bone density!!!! less fat more low-calorie food skipping meals lots of “rules” around eating over exercising

17 Nutrition Conditioning, Inc. Boys at risk too Body dysmorphia to triad –Testosterone and hormonal levels off –Especially at risk- runners, crew, diving…

18 Nutrition Conditioning, Inc. What Causes Disordered Eating? Biosocial ….multifactorial DE GeneticMedia Female Athlete Role Conflicts Self-esteem Societal/ family Body Image Disturbance

19 Nutrition Conditioning, Inc. Often underlying, or additional diagnosis going on: –Mood and Anxiety Disorders –Depression –Obsessive Compulsive Disorder –Personality Disorders –Substance Abuse Disorders

20 Nutrition Conditioning, Inc. WHICH COMES FIRST? Is there a progression from body dissatisfaction to an eating disorder? “...fluctuations in ED symptoms over time are best predicted by body image” -Rosen “ Body image therapy by itself decreases eating guilt and binge eating.”

21 Nutrition Conditioning, Inc. Esquire magazine Poll: 54% would rather be run over by a truck than be fat. 67% would rather be mean or stupid than fat. Esquire magazine, Feb 1994

22 Nutrition Conditioning, Inc. The Health of University Athletes Attitudes, Behaviors & Stressors l 267 athletes: 56% men, 44% women l 86.4% White, 7.5% Black, Native American 6.4%, Hispanic 1.9% & Asian American 1.5% l 67% men & 84 % women within acceptable weights l 32% of men & 8% of women in high-weight range l 27 varsity athletic teams (football, baseball, basketball, swimming,, gymnastics, wrestling & diving) *Selby et al, College Health, July 1990

23 Nutrition Conditioning, Inc. Male Student Athletes’ Perceptions of their Weight Acceptability

24 Nutrition Conditioning, Inc. Female Student Athletes Perceptions of Weight Acceptability

25 Nutrition Conditioning, Inc. HIGH RISK PROFILE Perfectionist Compulsive Swimming is his/her identity Depression Success (esp. early success) Siblings who excel; family expectations high

26 Nutrition Conditioning, Inc. HIGH RISK PROFILE Thinks “All or None” or “Black and White” Never complains Does not express feelings; family is not expressive Pleaser Poor Body Image

27 Nutrition Conditioning, Inc. RED FLAGS

28 perfectionism “The greatest risk factor for DE attitudes for females was perfectionism, which crossed all athletic divisions.” -Hopkinson,2004

29 Nutrition Conditioning, Inc. RED FLAGS Poor Body Image Wrapped in towel and last into the water Wearing baggy clothes or clothes to hide body Talking negatively about self and body, often Compartmentalization of body (dislike of particular body parts)

30 Nutrition Conditioning, Inc. Unhealthy Eating Practices Deprivation Fasting Skipping meals Uneducated “Vegetarian” Diuretics, laxatives, vomiting Rigid food patterns

31 Nutrition Conditioning, Inc. Unhealthy eating is Eating when not hungry Continuing to eat after your body feels full Feeling out of touch with your body’s hunger or fullness signals Bingeing or eating excessive amounts of food at one time. Eat differently when alone than with others.

32 Nutrition Conditioning, Inc. PREVENTION: OK- you may not control all influences in the world but can help to create a climate and culture within your team  Focus on function  Strength and conditioning  Energy intake and nutrition: fueling for performance  Hydration  Rest and recovery

33 Nutrition Conditioning, Inc. PREVENTION:  Eliminate weigh ins, body composition testing and comments about weight  If you must measure- do so only as a reference measure as part of overall physical/conditioning exam at start or end of season-NOT as a weekly/ongoing assessment—DO NOT GIVE OUT IDEAL NUMBERS

34 Nutrition Conditioning, Inc. PREVENTION: Avoid comments about appearance, good or bad  Comment on swimming: “your stroke looks strong” or “that was a great set” –No body talk language –No comments on weight  Focus on strength and conditioning, technique, and sports psychology which all play key roles in improving performance (not controlling body type)

35 Nutrition Conditioning, Inc. Prevention “Discipline and boundary setting have always been within the realm of coaching responsibilities, as is teaching life lessons like sensitivity. “Coaches Quarterly, USA Swimming, Disordered Eating.” Create a culture: teach the team that negative talk is not acceptable  Each swimmer can be a leader by choosing what to talk about, which conversations to participate in and which to walk away from.

36 Nutrition Conditioning, Inc. It Takes A Great Person To Make A Great Swimmer I Love Swimming HydrationCommunitySleep Mental prep FamilyTrainingFriendsSchoolNutritionSpiritual Source: CQ:USASWIM Encourage outside activities that create a greater sense of self

37 Nutrition Conditioning, Inc. INTERVENTION: how to approach a swimmer you suspect has an eating disorder With empathy Without judgment With concern With observations With suggestion of next step With follow-up If a policy exists- with facts about policy…first step is A, B, C…..

38 Nutrition Conditioning, Inc. CALORIC NEEDS High volume training : 5,000 – 6,000 calories per day (17.5 km/d) Females may be more economical swimmers resulting in a lower caloric need (@ 1200 less= 3800-5000 c/d) THE RESTING ENERGY EXPENDITURE in one study found female swimmers to have higher values than elite female runners in training, soldiers during clod weather and altitude raining, and mountaineers climbing MT Everest!!! (less than the Tour de France cyclists and cross country skiers)

39 Nutrition Conditioning, Inc. Malnutrition!!! Due to negative energy intake and high physical stress -results in REDUCED IMMUNE FUNCTION, increased risk of illness and infection ESPECIALLY DURING PERFORMNACE TIMES when there is the added stress of rehearsals

40 Nutrition Conditioning, Inc. Screening –Height –Weight Highest. Lowest, Current (perceived ideal) –Menstrual history First Current patterns (regular or missed - if so, how often)

41 Nutrition Conditioning, Inc. Screening –Attitudes/beliefs What foods do you like? Are there any foods you avoid? –Patterns How many meals do you eat a day? How long before practice do you eat? Do you eat/drink during practice? After? –Exercise intensity, frequency Is the athlete training in addition to assigned conditioning and practice?

42 Nutrition Conditioning, Inc. TREATMENT: Team Approach Patient MD Psychologist (if meds indicated) Psychiatrist (specializing in ED) Nutritionist (specializing in ED) [Nurse] [Trainer] [Parent] [Coach can be on a ‘health and well-being committee’ that creates policy but not on actual treatment team


44 Nutrition Conditioning, Inc. IN CONCLUSION Disordered eating is a spectrum of behaviors, actions and feelings that can hurt performance and compromise the health status of a swimmer Red flags include talking about food a lot, rigid rules around eating and body dissatisfaction

45 Nutrition Conditioning, Inc. IN CONCLUSION Intervention should begin with stated observations and a plan for “treatment” A treatment team should involve an MD, nutritionist, therapist, patient, nurse and/or trainer.

46 THANK YOU! Heidi Skolnik

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