1. Eating Disorders  "Body confidence does not come from trying to achieve the perfect body. It comes from embracing the one you've already got." FUEL THE BODY YOU HAVE From the Dietitian's Desk: January 2015 Devrie Pettit, MS, RD, CD  Dove Evolution Dove Evolution

2. Eating Disorders  Eating disorders  Affect more that 8 million Americans at any given time  All forms of eating disorders can be fatal  1 in 10 people die as a direct result of their eating disorder  Males can get eating disorders but the vast majority are females

3. Signs of Eating Disorders  Social isolation.  Lack of confidence in performance.  Ritualistic eating behaviors, such as cutting food into small pieces and playing with it.  Obsession with calories.  Obsession with weight.  Distorted body image.  Wearing layers of baggy clothing to hide thinness.  Nervous at mealtime, avoidance of eating in public.  Patterns of leaving the table directly to go to the bathroom.  Running water in the bathroom after meals to hide the sound of vomiting.  Significant weight loss.  Obsession with grades.  Obsession with organization of personal space.  High emotions; tearful, uptight, overly sensitive, restless.  Signs of malnutrition.  Menstrual irregularities.  Loss of hair.  Light-headedness.  Blood-shot eyes.  Inability to concentrate.  Chronic fatigue.  Hyperactivity – compulsive exercise beyond normal training.  Decrease in performance.  Recurrent overuse injuries and stress fractures.  Depression

5. Anorexia Nervosa  People with anorexia  Restrict caloric intake for long periods of time  Deliberately starve themselves  Results in loss of body weight of at least 15%.  Intense fear of becoming obese as well as a distorted body image  Weight loss achieved by  Avoiding food  Frenzied exercise  Sometimes both

6. The following signs and symptoms are used by the American Psychiatric Association to define Anorexia Nervosa:  Intense fear of gaining weight or becoming fat, even though they are already under-weight.  Disturbance in the way a person experiences his or her body (i.e., claiming to “feel fat” even when emaciated), with an undue influence of body weight or shape on self-perception.  Weight loss to less than 85% of normal body weight.  Refusal to maintain body weight over a minimal normal weight for age and height.  Denial of the seriousness of the current weight loss.  Absence of at least three consecutive menstrual cycles.

7. Bulimia Nervosa  A cyclical pattern of binge- eating associated with some type of purging  Purging takes on different forms:  Fasting  Self-induced vomiting  Excessive exercising  Use of enemas or diuretics

8. The definition used by the American Psychiatric Association includes:  Recurrent episodes of binge eating, characterized by both of the following:  Eating an unusually large amount of food in a discrete period of time  Feeling out of control during the eating episode and unable to stop eating or control what and how much is eaten.

9. Definition cont.  Compensating for the food binge to prevent weight gain, such as inducing vomiting; misusing laxatives, enemas, or other medications; fasting; or exercising excessively.  To be bulimia  2 times a week  3 months  Evaluating self-worth according to body shape and weight.  Many individuals (up to 50%) who have been diagnosed with anorexia will also develop symptoms of bulimia.

11. The Female Athlete Triad  A term used to describe three interrelated conditions that can occur in competitive women athletes: 1. Low energy availability which may be caused by disordered eating 2. Amenorrhea 3. Osteoporosis

12. 1. Low Energy Availability  Trying to prevent any added fat in order to keep body weight low  May or may not have same psychological risk as a similar athlete with disordered eating  Can occur in sports in which a low body weight is desirable  i.e. Gymnastics, ballet, distance running, etc

13. 1. Low Energy Availability  Low energy availability + energy demands of the sport = energy deficit  Worsened in adolescence do to the energy demands of growth and development  Energy deficits force body to adapt and begin to suppress physiological functions that are associated with normal growth and development

14. 2. Amenorrhea  Absence of menstruation for 3 or more consecutive months  High energy expenditure + low energy intake = amenorrhea  This alters the secretion of luteinizing hormone (LH) and estrogen which control the menstrual cycle

15. 3. Osteoporosis  Low bone mineral density  Low estrogen secretion interferes with the females ability to store calcium in the bones  Function of estrogen is to protect against calcium loss from bone  Increases the athletes susceptibility to fractures; especially stress fractures

16.  Studies found  Amenorrhea that lasts longer than six months  Will likely have a negative effect on the athletes’ bone mineral density  Bone loss occurring at a vital time when bone density should be increasing as the athlete matures  Causes significant increase in the susceptibility of problems due to osteoporosis in the athlete in later years of life

17. Long Term Effects of the Female Athlete Triad  If not treated, the energy deficit can result in the following severe health problems (this list is not exhaustive):  Long term osteoporosis  Cardiac arrest  Electrolyte imbalance  Severe dehydration  Suicide

19. Prevention  Preventing persistent energy deficits  A healthy goal for a desired training weight of the athlete  Beneficial to the athletes performance yet not compromise health  Use body composition analysis to establish a minimum  Input from exercise physiologist, dieticians, or physicians may be recommended  A training and diet plan  Provides the adequate energy and nutrients for the athletes energy expenditure

20. Prevention of Eating Disorders  Any victim of an eating disorder must be approached and handled extremely carefully.  Referral for medical treatment is essential!  Help athletes understand restricting their food intake to lose weight will not help them  Exercise better  Look better  Enhance their overall performances  Actually results in  Depleted fuel stores  Amenorrhea  Stress fractures  Fainting  Weakness  Fatigue  Ultimately impaired performance  Some athletes may manage to do well for a while without an obvious decline in performance, but then injuries and lack of energy will catch up with them.

21. Treatment  Treatment until symptoms resolve  Decrease energy expenditure  Increase energy intake  Menstruation will return when energy balance is achieved  Depending on the length and severity of the osteoporosis there may be long term effects associated with bone health especially in the post menopausal years

22. Getting Rid of eating Disorders Eating disorders would fade if people could learn to love their bodies. As a society we must: 1. Dispel the myth that thinness equals happiness and success. 2. Discourage the notion that the thinnest athlete is the best athlete. 3. Love our bodies for what they are, rather than hate them for what they are not. 4. Emphasize fit and healthy as more appropriate goals than slender and skinny.