1. Eating Disorders and Disordered Eating Among Athletes

2. Overview Definitions, diagnostic criteria Prevalence
Factors unique to athletes
Warning signs
Intervention

3. 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)
BMI – standardized measure of weight relative to height
>18 considered underweight
85% of normal for weight and height

4. MALE’S ATTRACTIVE
Female’s Ideal
Female’s Current
Female’s Attractive

5. “Reverse anorexia”

6. 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
Binge eating – eating in a discrete period of time an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances. A sense of lack of control over eating.

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

8. Anorexia Athletica
Subclinical eating disorder frequently found in athletes
Individuals within 5% of expected body weight
Fear of becoming fat
Restriction of food to <1200 kcal
Compulsive exercise
Amenorrhea
Occasional binge/purge
1200 kcal not nearly enough for level of activity (1-hr walking 500 kcal)
After 2-3 hour practice spending additional 2-3 hours in gym

9. Female Athlete Triad
Disordered eating  amenorrhea (decreased estrogen affects bone density)  weak/brittle bones  increased risk of fractures and slower recovery
Women in 20s w/ brittle bones of 70/80 y.o.

10. 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: ______________________________________________________________________________

11. 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
20 years ago standard sample designer dress was size 6/8. Now it’s a size 4.
Images in “fitness” magazines present narrow view physical ideal
Ideal body part file (clipping pictures of desired body parts)

12. 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

13. 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)
No difference in BMI btwn women w/ and w/o amenorrhea, but sig. diff. in body fat between those w/ and w/o amenorrhea

14. 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)
Thin-build sports – distance running, gymnastics, swimming, diving, figure skating, wrestling, lightweight rowing
Mandatory weigh-ins, body fat measurement (may push for single digit)
May look at winner and believe if thinner will perform better. Told this by coaches. May improve performance at first, but performance declines over time. Taping “Thin wins” to fridge.
Risk of binge eating in sports requiring bulk (e.g., football)

15. 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
“Athletes are driven personalities, completely focused as people pleasers, almost obsessive-compulsive. People who have addictive tendencies, gravitate toward athletics.”
Note: No all athletes have addictive personalities

16. Factors Unique to Athletes
Stress of being in the spotlight
Balancing multiple role demands
People on campus know who you are
Time demands of practice, games, etc. Desire to enjoy other aspects of college harder due to time demands

17. 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

18. 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

19. Warning Signs Attitudinal Dichotomous thinking
Denial of eating problems
Perfectionistic standards
Harsh self-criticism
Self-worth determined by weight

20. 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.

21. 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

22. 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 athlete’s health or put athlete at risk for injury.

23. Intervention: What Not to Do
Don’t question teammates or talk to them about the athlete. Talk directly to athlete
Don’t ignore the problem. Intervene
Never conclude that an athlete just isn’t trying hard enough to overcome an eating disorder
Don’t try to keep the problem hidden or try to deal with it yourself. When in doubt about how to intervene, consult, consult, consult…

24. Intervention: What Not to Do
Don’t get into a power struggle about whether there is a problem.
Don’t be deceived by excuses.