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Eating Disorders in Athletes

Eating Disorders in Athletes

By: Dr. Amanda Martin and Dr. Suresh Chapalli

Eating disorders are prevalent in sports and in the adolescent age group. Eating disorders are conditions defined by abnormal eating habits that may involve either insufficient or excessive food intake to the detriment of an individual’s physical and mental health. Bulimia nervosa and Anorexia nervosa are the most recognized. Eating disorders can lead to serious health problems both physical and mental. Sometimes, it can even be life threatening. As athletes are getting back to school and sports this year, we need to be mindful of eating habits and what to look for with eating disorders.

IT’S JUST A PROBLEM FOR FEMALE ATHLETES RIGHT? Eating disorders are more common in adolescent female athletes. However, there has been a recent increase in male athletes, especially in anti-gravity sports.

WHAT’S THE BIG DEAL ABOUT DIETING TO MAKE A WEIGHT LIMIT OR PERFORM BETTER? Athletes with eating disorders can have frequent medical problems and mortality rates as high as 5.9%. It is also reported that athletes are more prone to injury, have a shorter sports career and frequently have inconsistent performance.

Anorexia nervosa is a disorder in which people may have: • Intense fear of becoming overweight despite being underweight • Irritability, emotionally labile, depressed • Menstrual irregularities or loss of menstruation (amenorrhea) and soft, downy hair present on the body (lanugo)

Bulimia Nervosa is characterized by episodes of: • Binging – large quantities are consumed in a rapid, out of control manner • Purging – eating until the point of discomfort and inducing vomiting or using laxatives • Low mood, menstrual irregularities, unhealthy focus on body shape and possible dental problems

HOW TO SPOT IT Eating disorders are difficult to identify as they are often kept secret. Most young athletes can also be in denial. Identifying these disorders in athletes is particularly challenging as the athlete will normally be lean compared to the general population. Body mass index (BMI) can be unreliable in diagnosing eating disorders in athletes. Some sports organizations promote the use of the 5-item ‘SCOFF’ questionnaire to identify these problems.

1. Signs of decreasing performance 2. Lack of interest in normal things 3. Loss of menstruation/or delayed start of menstruation 4. Loss of hair 5. Frequent illness

HOW TO APPROACH THE PROBLEM An athlete with a possible eating disorder should be approached early, directly, supportively and confidentially. Multimodal approaches involving coaches, the athletic trainer, the team physician, a psychologist/psychiatrist, and most importantly, families, will give the best results. In resistant cases sometimes an athlete will need to leave the sport if counseling and treatment fails.

Sports organizations, governing bodies and professionals who work with athletes should undertake the responsibility of identifying the athletes at risk and educating them. Athletes should be encouraged to consume a healthy and nutritious diet. Food should be a fuel for performance and not restricted during training. Guidelines can help! The American College of Sports Medicine has guidelines detailing the nutritional and coaching practices to be adopted when managing eating disorders that can help identify and approach eating disorders.