Eating Disorders and Disordered Eating Among Athletes

Overview Definitions, diagnostic criteria Prevalence Factors unique to athletes Warning signs Intervention http://vids.myspace.com/index.cfm?fuseaction=vids.individual&videoid=1519282097

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

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

“Reverse anorexia”

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.

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

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

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.

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: ______________________________________________________________________________

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)

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

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

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)

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

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

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

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

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

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.

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

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.

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…

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