Eating Disorders don't get talked about much. If they do, it's usually not talked about in conjunction with sports. If it is, then it's usually a really over the top dramatic Lifetime movie. But EDs are prevalent in sports; especially the ones with weight classes, weight requirements or endurance.
Prevention & Intervention
Not all EDs happen on a TV screen, to the girl your cousin's fourth grade childhood babysitter's dad knew, or to professional athletes in places far away. They can happen to anyone and you probably know someone suffering from it.
Last
week I had a peer approach me who had concerns their athlete was
suffering from an eating disorder. This coach wasn't sure if they should
address the issue and if they did, they weren't sure how to handle it. I
asked a few questions, gave my opinion and directed them to the
National Eating Disorders Association coach's handbook
which can be found here.
Luckily, early interventions like this can stop an eating disorder from
progressing and help save an athlete's life. I saw a quote while researching for this blog post that said "This is
labeled a rich
girl's disease. All young women are susceptible, but only a few
people can afford the treatment that is needed." While insurance
companies can make seeking treatment seem difficult, that doesn't mean all avenues
are completely closed for treatment. That is why education is
absolutely critical. If we can educate coaches and parents about these
disorders and catch the symptoms early on and take them seriously, then
men and women can have an opportunity to live full and happy lives.
Misconceptions
Aside from thinking eating disorders can't happen close to home, there are many misconceptions about the disease that I've encountered in my time in the fitness industry. I thought I'd take this
time to address a few misconceptions and arm fellow coaches, trainers, and administrators
with some resources to check out should they ever think an athlete
suffers from an ED.
I'm hesitant to put any pictures with this piece due to the pre-existing misconceptions of what EDs look like: they come in all shapes and sizes from small to average to large. As you read this post, make sure you arm yourself with signs to look for that aren't just related to weight.
To Have An Eating Disorder, The Person Has To Be Scary Thin
Nope.
While the media has a tendency to latch onto anorexia, eating disorders
come in many different forms. They all resolve around body weight or
body image being the individual's source of self esteem or happiness.
The mentality behind it is what makes these disorders hard to spot or
diagnosis. There are ways to monitor and spot them in your athletes.
Below are some classifications of the disorders and how to spot them:
Anorexia
is a serious, potentially life-threatening eating disorder
characterized by self-starvation and excessive weight loss. It can be
done through restriction and purging through exercise or laxatives and
dierutics. Individuals suffering from it have an intense fear of gaining
weight, have ritualistic eating habits (will only eat certain foods,
eat off a certain plate, etc), constantly talk about or prepare food but
do not eat it, and are generally withdrawn from friends or make excuses
not to go out in public. This is common with gymnasts, rowers, and
cyclists. The athlete will not be able to sustain their training and
typically you will find they are constantly tired, fatigued during
workouts, and their performance suffers drastically due to lack of
nutrients. Health risks associated with anorexia include: heart
complications, detrimental low heart rate and blood pressure,
osteoporosis, kidney and organ failure, fainting, muscle loss or
weakness, and dry hair and skin.
Bulimia is
the most common ED among athletes and most individuals suffering from it
appear to be average weight. Accoding to NEDA, it "is a serious,
potentially life-threatening eating disorder characterized by a
cycle of bingeing and compensatory behaviors such as self-induced
vomiting designed to undo or compensate for the effects of binge
eating." A common purge tactic in athletes is laxatives, diuretics, and
exercise. It's important to closely monitor your athletes training and
behaviors because bulimia recovery is successful with early
interventions.
Check out diver Shaye Boddington's story about how bulimia ended her Olympic Dream but how recovery saved her life.
Individuals
suffering from bulimia will find every excuse to continue to workout
despite injury, weather, illness, or chronic fatigue. Their self esteem
is predicated on their athletic performance. Some outward signs of
bulimia include mood swings, frequent trips to the bathroom post meals
or eating very little at meals with others only to continue to gorge in
private, swollen cheeks or jaw areas, and calluses on knuckles. The
biggest issue with bulimia is the individual's sense of guilt after
eating and when eating they may seclude themselves, eat large quantities
of food, and hide the wrappers. Individuals that constantly talk about
diets, clean eating, and cheat days should be monitored...especially on
days after they have had a "cheat day". Health risks associated with
bulimia include: digestive system irregularities, heart conditions,
electrolyte imbalances, enamel erosion of teeth, bone density loss, and
chronic irregular bowel movements due to laxatives.
Binge Eating Disorder is "characterized by recurrent binge eating
without the regular use of compensatory measures to counter the binge
eating." (NEDA). Again, these disorders stem from feelings of depression and other
psychological issues and the key word here is that they occur
frequently. These individuals are of normal or slightly heavier
weight.They suffer from the same binge eating symptoms as bulimics but
without the purging. They still suffer from intense guilt and shame
during and/or after their binge and are unable to control the binges.
Health risks are similar to those associated with obesity: diabetes,
heart disease, high blood pressure and cholesterol, gallbladder disease,
and musculoskeletal problems.
Eating Disorders Not Otherwise Specified (EDNOS or Other Specified Eating Disorders):
atypical anorexia and bulimia where the body weight may not yet be at
the point of an official diagnosis but the mentality and other symptoms
are there, less frequent binge eating disorder episodes, purging
disorder where binging is not involved, and night eating syndrome. If
something doesn't sit well with you about your athlete, they can still
be seen by a professional to ensure their symptoms do not develop into
one of the DSM-V categories (listed previously).
Disordered Eating and Feeding:
Unhealthy relationships with food don't always occur in the same manner
as the big three (anorexia, bulimia, binge eating). Something I've seen
a lot is
Rumination Disorder, where someone will chew food but spit it out, and
Avoidant Food/Restrictive Disorder where people will avoid food due to fear of vomiting or dislike of the texture. A lesser known disorder is the eating of non-food items like ice, paper, hair, or other objects known as
pica.
Muscle Dysmorphia:
these individuals look healthy to others. The battle lies within their
minds as they feel like they need to gain more muscle mass. This is
common in body builders and males. The easiest way to understand this
disorder is to think of it as "reverse anorexia". According to NEDA,
"compulsions include spending hours in the gym, squandering excessive
amounts of money on ineffectual sports supplements, abnormal eating
patterns or even substance abuse."
Learn more here
Eating Disorders Only Affect Women
While it may appear more women suffer from EDs, men don't escape the disease's grasp. NEDA estimated that 33% of male
athletes in aesthetic sports (bodybuilding, gymnastics, swimming) and
weight-class sports (jockeys, wrestling, rowing) are affected by eating
disorders. 10% of those with an ED are male. It appears males and females are equally affected by binge eating disorder (NEDA toolkit); many male EDs go unreported and there have not been as many male studies as there have been female studies.
Body builders, wrestlers, jockeys, skiers, rowers and even football players aren't immune from EDs. Lafitt Pincay was at the top of jockey rankings 7 times during his career but suffered from anorexia. 69% of jockeys surveyed admitted to skipping at least one meal a day,
using hot box saunas regularly, and cocaine/amphetamine use to lose
weight. Stefan Lund and Christian Moser, both ski-jumpers, had their careers end early due to their EDs. Since then the International Ski Federation enacted a rule that ties maximum
ski length to a jumper’s relative height and body weight.
Newsweek reported that 40% of Cornell University football
players surveyed engaged in binging and purging (a symptom of bulimia). It's also common in male athletes who transition from one sport season to another (example going from football and dropping weight for wrestling, swimming, or powerlifting). Running in sweatsuits before competitions to make weight can have a psychological toll on athletes which can carry over into their daily lives when they get stressed.
Body builders have been known to take steroids which can lead to or exacerbate "muscle dysmorphia": a condition where the individual becomes preoccupied with muscle mass and growth to the detriment of their health. Conversely some males who take steroids to enhance their athletic performance may eat more and then try to control their weight by increasing their athletic output, a sign of disordered eating and exercise bulimia.
For more information please check out:
https://www.nationaleatingdisorders.org/research-males-and-eating-disorders and
http://www.sportsnutritionworkshop.com/Files/27.SPNT.pdf
It's The Sports' Fault
No
it isn't. But it is important to note that "athletic competition can create psychological and physical stresses that
can increase the risk of athletes developing eating issues, whether or
not the sport is an aesthetic or weight-class one." (NEDA tool kit). Athletes from subjective (gymnastics, diving) to objective sports (football, lacrosse) can have an eating disorder. While it may seem more prevalent in athletes that compete in weight classes or with weight restrictions, muscle dysmporphia or bulimia is prevalent in football
players, lacrosse and soccer players, and even body builders.
But at the end of the day, eating disorders are mental diseases and should be treated as
such. There is generally a psychological, social, or relational
pre-existing condition before the individual even begins to play their
sport (ex: low self esteem, physical or sexual abuse). Sometimes the sport is being used as an outlet for other stressors and if the individual is triggered, then they are more likely to use that sport excessively. This is why it's important to know your athlete as an individual and to make sure you know about outside stressors so you can be on the look out. A lifetime of physical health and happiness is more important than a performance victory; give your athletes decreased training loads or a break if you suspect they are stressed and using the physical activity to their detriment.
More information can be found here
As you read this post, remember that I'm not against weight classes or
sports at all; I love and support athletics. This issue with all of
these disorders lies within the athlete's psyche and brain due to some
underlying issue. This post is meant to serve as a guide for coaches.
Some things deemed dangerous with certain sports, such as hot box saunas, are absolutely fine so long as athletes are monitored.
Eating Disorders Only Affect Teens and Young Adults
While there have been no clinical studies on older females, the presence of an ED does not diminish with age.
"An online survey as part of the Gender and Body Image Study (GABI),
published in the International Journal of Eating Disorders, found that
there is no age limitation to disordered eating. The survey found eating
disorder symptoms in 13% of women 50 and above over the past five
years, with over 70% reporting they were attempting to lose weight. The
study found that 62% of women felt their weight or shape had a negative
impact on their life." Those numbers mirror the statistics in younger populations.
Many times untreated disorders carry over into middle age or older populations. When the stress of a family life, marriage problems, career changes, menopause, and the prevalence of plastic surgery combine, EDs can reemerge or develop. Many females interviewed were hesitant to admit they suffered from an ED or one of the EDNOS because they felt that was something younger women had and that they should have grown out of it. With the onset of menopause, the loss of the menses is not noticed so it can be harder for some doctor's to spot. Some women resort to strict calorie counting or bulimia while others constantly fluctuate from one diet to another wreaking havoc on their metabolism. To read about a forty year old's bulimia recovery story please read
this article and to read one 50+ woman's ED journey read
this article.
It's important to monitor older athlete's behaviors because the health risks associated with the disorders are even greater. Older populations have a harder time coming back from ED complications and their bodies are less resilient; there are
"greater numbers of gastrointestinal, cardiac, bone and even dental effects of eating disorders as women mature." For more information please visit Danielle Gagne, Ann Von Holle, Kimberly Brownley, Cristin Runfola, Sara Hofmeier, Kateland Branch, Cynthia Bulik,
Eating
Disorder Symptoms and Weight and Shape Concerns in a Large Web-Based
Convenience Sample of Women Ages 50 and Above: Results of the Gender and
Body Image Study (GABI), International Journal of Eating Disorders, Wiley-Blackwell, DOI: 10.1001/eat.2201 and this
AARP article
Missing Periods Is Normal In Athletes
It's not. It can be a sign of exercise induced
amenorrhea: menstrual dysfunction for 3 or more months which mean it is completely absent or irregular. Occasionally it is accompanied by stress fractures and low to low-normal bodyweight. Amenorrhea can lead to irreversible bone density loss and and is caused by the
body being under too much stress: from excessive training, under
recovering and failure to take in enough nutrients. Deficiencies in calcium and vitamin D are prevalent and if the condition is left untreated could result in an inability to have children. The National Collegiate Athletics Association surveyed over
2,800 coaches about EDs in 2003. Only 19% of male coaches and 26% of female coaches knew about it.
This isn't exactly a subject a male coaches want to approach with female athletes. I suggest a team doctor or same gendered trusted confident regularly ask female athletes about their cycles. That will open the door for discussion. If an athlete misses periods, and is not pregnant or suffering from a pituitary condition, they can do a few things to try to get their cycle back:
(1) Decrease training volume 10-15%, (2) Increase calories 10-15%, (3) Increase calcium, (4) See a doctor and nutritionist. In addition to meeting with a nutritionist, x-rays and bone scans to measure bone density and check for stress fractures should be performed and maintained regularly.
For more information please check out: Warren MP, Chua AT.,
Exercise-induced Amenorrhea and Bone Health in the Adolescent Athlete. Annals of the New York Academy of Sciences, 2008 and
http://www.olympic.org/hbi.
Living Off Stimulants Is Ok
Caffeine.
Most athletes drink it pre-workout. It's not uncommon to see energy
drinks or Starbucks cups near a training facility or practice. That's
not a problem. It is a problem when that athlete hasn't eaten much that
day and is regularly using the stimulant because of that. Excessive caffeine consumption in
athletes needs to be monitored for a host of reasons. Caffeine can act
as a dieuretic and helps disordered people feel "full". Excessive
amounts can lead to increased heart risks especially in a population
whose side effects of their ED includes heart complications. Part of
recovery and treatment programs have provisions to ween patients off of
caffeine due to it's harmful effects to their bodies and psyche.
Compounds in caffeinated products can inhibit absorption of calcium, B12,
iron, magnesium and a host of other important vitamins and minerals.
Source ,
Holly Pohler,
Caffeine Intoxication and Addiction, The
Journal for Nurse Practitioners, Volume 6, Issue 1, January 2010, Pages 49-52,
ISSN 1555-4155, http://dx.doi.org/10.1016/j.nurpra.2009.08.019.
(http://www.sciencedirect.com/science/article/pii/S1555415509004991), and Striegel-Moore,
R. H., Franko, D. L., Thompson, D., Barton, B., Schreiber, G. B. and Daniels,
S. R. (2006),
Caffeine intake in eating disorders. Int. J. Eat. Disord.,
39: 162–165. doi: 10.1002/eat.20216
Someone Else Will Talk About It
Tell that to the 10% of ED people who have died from their disease's complications. That statistic makes EDs one of the leading causes of mental illness deaths. In 2005, 20 year old college runner Alex DeVinny passed away from a heart attack due to starvation.
Her story can be found here. Gold medalist rower Bahne Rabe and gymnasts Helga Brathen and Christy Henrich
died from anorexia complications.
EDs are not something you can pass the buck on. Silence destroys lives. If you even have an inkling that an athlete may suffer from a disorder, speak up. These diseases love secrets and isolation. The more dialogue you engage your athlete in, the less room the disorder has to hide.
As a coach, you are in a position of great power and influence over your athletes. When coaching athletes focus not on weight but on performance. Do not reward unhealthy behavior such as diuretics, under or over-eating, malnutrition, lack of sleep, or substance abuse among other things. Be cognizant of your words and behaviors about body image and weight around the team. If your sport requires weigh-ins like wrestling, power lifting, or weightlifting, do regular weigh-ins to monitor athlete health and do so in an open and friendly environment. Never make any kind of comment about your athlete's size; if you want an athlete to move up or down a weight class, please consult a trained professional on whether this is feasible, how to do it, and what to say/not to say to your athlete.
Do not berate your athlete if you suspect they have an ED or if they tell you they are seeking treatment for one. Approach a nutritionist or professional with any questions you have
before talking to the athlete to ensure you handle the situation tactfully. Take them aside, not in front of others, and tell them your concerns. If they insist they don't have a disorder, simply tell them you hope not but the only way for everyone to be sure is to undergo an examination and some test by a healthcare professional. If you have cause for alarm, then usually something is not right and needs to be addressed.
No game or match is more important than your athlete's health. If they refuse to seek or comply with treatment, consider taking them out of the game, practice, or match until they comply; reiterate you are doing it for their safety and that you want them healthy and back to performing with the team. If they have to sit out for a while during treatment, and if allowed by their professional team, give them an assistant coach role so they are included and still able to help without feeling stigmatized. You create the environment your team lives in.
Resources
There are local resources you as a coach or administrator can turn to for guidance:
National Eating Disorders Association is a great resource for help and guidance.
Visit their website here
Call their toll free, confidential hotline Monday- Thursday between 9:00 am and 9:00 pm and Friday between 9:00 am-5:00 pm at 1-800-931-2237 and have a
"Click To Chat" free service on their website
Counselors, nutritionists,and therapists: In addition to guidance counselors and services provided by schools and universities, a list of therapist can be found here
http://therapists.psychologytoday.com/rms/prof_results.php?state=MS&spec=9
Mississippi treatment centers:
Pine Grove Behavioral Health and Addiction Services
2255 Broadway Drive
Hattiesburg, MS 39402
www.pinegrovetreatment.com
A Bridge To Recovery
361 Towne Center Blvd
Suite 1300
Ridgeland, MS 39157
www.abridgetorecovery.com
COPAC, Inc.
3949 Highway 43 North
Brandon, MS 39047
www.copacms.com
Famous Athletes Who Battled EDs
Fortunately with proper intervention and guidance athletes have been able to overcome their disorders. Cathy Rigby
, the
first American female to win a World Gymnastics medal, and 9 time gold
medalist Nadia Comaneci had bulimia but have since become staunch
advocators for reforms in their sport.
Nadia Comaneci
CrossFit
Games competitor Talayna Fortunato suffered from bulimia and disordered
thoughts but has since gone on to advocate against it and is a
multi-time Games competitor.
Fortunato's before and after
Mia St. John, a Lightweight Champion of the World boxer and mixed martial artist, overcame a battle with anorexia.
Ice
skater Jamie Silverstein suffered silently with anorexia for 5 years
before seeking treatment. She sat out for a while but eventually came
back to compete in the Olympics and is now known as the Grinning Yogi at
her yoga studio.
Iron Lesson
This is a topic that is absolutely near and dear to my heart.
I first battled with it as a youth but fortunately I had a coach who did all of these things. All the girls always wanted to be at the bottom of their weight class and we could only have a max number of lifters and 2 max per weight class. I remember before one meet I was severely under my weight class (we were monitored often) and he asked me how everything was going; every day after that he always made a trip to my lunch table and looking back it was make sure I was eating. Told you coaches can be tactful. It was made very clear that not eating and diuretics were simply unacceptable; we had a duty to report to Coach if we knew any of our team mates were doing that. I recall a very prominent lifter was hospitalized before our Regional powerlifting meet and he refused to let her lift for health reasons. I remember seeing people on other teams running around to sweat weight off, some trying to water load before weigh ins, others trying to maneuver locks or weights in areas they don't belong (that was illegal and no one ever actually succeeded from what I saw). Things you don't realize aren't normal when you grow up in the sport. I've previously written about how it took me years to realize how strong I was was not equated with my self worth (
Strong Is Not The New Skinny).
I've worked with many athletes and I've stepped in a few times when I saw the inklings of ED behaviors. I called parents and took necessary precautions. My personal stance on weight classes is that every individual is different. Some athletes I have can fluctuate in weight safely and without issue. Others can't. I don't push or emphasize weight classes; I want my athletes healthy and if they cut, then they are going to do it safely. I get my cutting athletes weighed in first and immediately after, I am handing them food and drinks to rehydrate. They get annoyed sometimes but they perform well and it's necessary.
As a coach, you have a responsibility to your athlete. Don't let them become a statistic.
Contact Information
Facebook.com/amber.sheppardc
Instagram @amber_mswlc
Msbarbell.com
Email: amber.sheppardc@gmail.com
