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Athletes and Eating Disorders: A Parent's Guide
General Findings with Athletes
Preventing Eating Disorders with Athletes

Athletes and Eating Disorders: A Parent's Guide

1. Weight loss. Many teens beginning a sport lose some weight. However, if the amount seems to be large, it is helpful to see if the athlete is still in his or her growth curve. During development, there are individual differences in growth. Your youngster's pediatrician keeps track of this development and usually has plotted an individual growth curve. Thus, the pediatrician can determine if the athlete has fallen below his or her usual growth curve.
2. Re-setting of weight goals. Since the majority of adolescent girls (and perhaps boys) diet at some point, it can be difficult to determine if a small weight loss is an early sign of an emerging eating disorder. In addition, many teenagers lose weight when they first begin an active sport and become part of a team. If your teenager decides to lose a modest amount of weight, does so, and is satisfied there is probably no problem. On the other hand, if the initial weight goal is achieved and the person resets his or her goal to a lower weight, it may indicate a problem.
3. Amenorrhea. If your daughter loses her menstrual periods, take it seriously. Although stress of physical exercise can cause amenorrhea, loss of menses can also be an early sign of an eating disorder. Irrespective of the cause, amenorrhea during adolescence is dangerous (thinning of the bones and bone fractures).
4. Excessive exercise. Although this can be difficult to judge, if your teenager exercises more than is expected by his or her particular sport or particular level in that sport, discussion with your teenager or with the coach may be warranted. For example, if the athlete is part of a basketball team and the coach expects the participants to run a mile two days a week and your teen runs two miles every day, this could be a problem. On the other hand, an elite athlete in training for a marathon may be exercising many hours a day.
5. Inappropriate dieting behavior. If your teenager is in a group of athletes who are following extreme or unusual dieting practices, this requires your attention. If more than one athlete in his or her group has an eating disorder, there may be undue emphasis on dieting by the coach or by the group in general. Use of Fat Burning Aids, laxatives, or diuretics is also hazardous to a teenager's overall health.
6. Negative comments by coach or trainer. If you learn that the coach has made negative comments about the weight, shape or performance of any of the athletes in the sport, it is wise to schedule a meeting with the coach and ask him or her to refrain from such comments. Also, many coaches of elite athletes have received training about eating disorders. For example, the USA Gymnastics sponsors education programs for coaches to teach them about eating disorders and how to prevent them in their athletes. It is helpful to determine if the coach has participated in these educational endeavors. If you suspect that the coach is making comments to the athletes that are derogatory, it can be helpful to attend a few practices or competitions to assess the attitudes of the coaches.
7. Use of exercise to purge. If the teenager exercises regularly after consuming food, he or she may be using exercise to burn up calories. This may be a form of purge behavior.
8. Intense use of exercise or pursuit of a sport after a significant disappointment. For example, if your teenager was usually quite sociable, but then her boyfriend broke up with her, and she no longer sees her friends, but devotes many hours to daily exercise, this may be a problem.
9. Avoidance of tasks of adolescence. If the athlete becomes preoccupied with exercise such that they are no longer socializing, achieving in school, or engaged in the process of emancipation from parents, then exercise may have become an inappropriate solution to a problem in one of these areas of development.
10. Athletic performance and weight loss. The belief that weight loss per se will improve athletic performance is incorrect. Genetic endowment, muscle mass, and motivation are the three factors that most influence performance. If the athlete or coach believes that ever-increasing weight loss will continue to improve performance, this may place the adolescent at risk for an eating disorder.
11. Unrealistic sport achievement expectations. Although it is helpful to encourage an athlete who has the potential to become an elite athlete, it is counterproductive and perhaps dangerous to encourage an athlete who is not able to become an elite athlete to try to do so. A realist appraisal of the athlete's potential by parent, coach, and athlete will decrease the likelihood of a severe disappointment later.

From Eating Disorders: The Journal of Treatment and Prevention, Vol. 7, No. 3 Written by Pauline Powers, M.D.

General Findings with Athletes

• Female athletes present with more eating-related problems than non-athletes, especially those athletes in sports emphasizing thinness.
• The NCAA verifies that "no sport should be considered exempt from participants susceptible to an eating disorder."
• Study by Dr. Craig Johnson and NCAA:

Of 562 female athletes - -

58% are at risk for developing an eating disorder

9% warrant professional attention

Of 833 male athletes - -

38% are at risk

1% warrant attention

Identifying Athletes with Anorexia Nervosa

Physical Symptoms of Athletes with Anorexia Nervosa

1. Amenorrhea
2. Dehydration, especially in the absence of training or competition
3. Fatigue beyond that normally expected in training or competition
4. Gastrointestinal problems (i.e., constipation, diarrhea, bloating, postprandial distress)
5. Hyperactivity
6. Hypothermia (cold intolerance)
7. Lanugo (fine hair on face and arms)
8. Muscle weakness
9. Overuse injuries
10. Significant weight loss beyond that necessary for adequate sport performance
11. Stress fractures
12. Weight significantly lower than necessary for adequate sport performance

Psychological and Behavioral Characteristics of Athletes With Anorexia Nervosa

1. Anxiety, both related and unrelated to sport performance
2. Avoidance of eating and eating situations
3. Claims of "feeling fat" despite being thin
4. Compulsiveness and rigidity, especially regarding eating and exercise
5. Depression
6. Excessive or obligatory exercise beyond that required for a particular sport or coach
7. Exercising while injured despite prohibitions by medical and training staffs
8. Insomnia
9. Obsessiveness and preoccupation with weight and eating while being at a low weight and engaging in minimal eating while being at a low weight and engaging in minimal eating
10. Resistance to weight gain or maintenance recommended by sport support staff
11. Restlessness - relaxing is difficult or impossible
12. Restrictive dieting, especially when self-imposed and unnecessary for, or detrimental to, sport performance
13. Social withdrawal from teammates and sport support staff, as well as from people outside sport
14. Unusual weighing behavior (i.e. excessive weighing, refusal to weigh, negative reaction to being weighed)

Physical Symptoms of Athletes with Bulimia Nervosa

1. Callus or abrasion on back of hand from inducing vomiting
2. Dehydration, especially in the absence of training or competition
3. Dental and gum problems
4. Edema, complaints of bloating, or both
5. Electrolyte abnormalities
6. Frequent and/or extreme weight fluctuations, especially with resultant mood fluctuations (i.e. mood worsens as weight goes up)
7. Gastrointestinal problems
8. Low weight despite eating large volumes
9. Menstrual irregularity
10. Muscle cramps, weakness, or both
11. Swollen parotid glands

Psychological and Behavioral Characteristics of Athletes With Bulimia Nervosa

1. Binge eating
2. Agitation when bingeing is interrupted
3. Depression
4. Dieting that is unnecessary for appearance, health, or sport performance
5. Evidence of vomiting unrelated to illness
6. Excessive exercise beyond that required for the athlete's sport
7. Excessive use of the restroom
8. Going to the restroom or "disappearing" after eating
9. History of sexual abuse
10. Self-critical, especially concerning body, weight, and sport performance
11. Secretive eating
12. Stealing, especially when items taken are related to bulimia (i.e. food, laxatives, etc.)
13. Substance abuse - whether legal, illegal, prescribed, or over-the counter drugs, medications, or other substances
14. Use of laxatives, diuretics or both that is unsanctioned by medical or training staffs

Reference: Thompson, Ron and Roberta Sherman. "Helping Athletes with Eating Disorder" Bloomington: Human Kinetics Publishers; 1993.

Preventing Eating Disorders with Athletes

• De-emphasize Weight - The simplest way to de-emphasize weight is not to weigh athletes or not to stress weight by commenting on it. Emphasize the person rather than the person's body. But instead of emphasizing weight or body fat composition in the physical realm, we might more appropriately focus on physical conditioning and strength development. If the focus must be on enhancing speed or quickness, first pursue training strategies together than weight loss. Place more emphasis on the mental and emotional components of performance.
• Eliminate Group Weigh-Ins - Public weigh-ins can create considerable psychological discomfort. We believe that group weigh-ins may create more competitiveness among women athletes with regard to thinness. This competitiveness may increase the likelihood that particular individuals resort to pathologic means of controlling weight. Any coach or athletic trainer who routinely weighs athletes either publicly or privately should seriously consider why weighting is necessary. In many ways, body fat measurements may create the same turmoil and difficulty as weighting, so the same cautions apply to measuring body fat composition.
• Eliminate Unhealthy "Subcultural" Aspects - Sometimes the pathogenic weight loss measures that athletes use have almost become an accepted par of their sport. The epitome of this type of thinking occurs in wrestling. Some wrestlers seem to view the dehydrating techniques they use as a sign of toughness that sets them apart from other athletes. Coaches can play an important role in changing these attitudes and behaviors that have more to do with tradition, myth, and subcultural than with factual information relating to sport performance. Coaches need to be very clear and direct about he acceptability of training strategies and techniques. The coach needs to be aware that most athletes are simply trying to improve their performance and will try almost anything to accomplish that goal.
• Treat Each Athlete Individually - We must temper our expectations to account for individual differences. This is true when we are working with any aspect of an individual, but it is even more important when we are concerned with an aspect of an individual that is largely out of the individual's control. Weight and weight loss are prime examples. An individual's weight is determined largely by genetics, and this does not change. More room for individuality exists in the psychological realm.
• Controlling the Contagion Effect - This term refers to eating disturbances spreading from one athlete to another. Many athletes learn from their teammates. Unfortunately, what they learn is not always helpful. However, if sport personnel de-emphasize weight and thinness, perhaps it will be reflected in the athletes' thought, attitudes, discussions and behaviors. We hope that this de-emphasis teamed with giving athletes better information on nutrition and health will help control the contagion effect of eating disorders.
• Reducing Competitive Thinness - In many ways, competitive thinness has little if anything to do with sport and more to do with the contagion effect just discussed. We know that in the non-athlete population considerable competition exists regarding thinness among women. As with the contagion effect, competitive thinness can be reduced if the significant individuals who work with athletes put less emphasis on thinness and give the athletes more helpful information about eating, weight, and performance.
• Assistance From Governing Organizations - The individuals who govern amateur and professional sports apparently accept that drug use is dangerous and steps are needed to control it. Many amateur and professional sports now engage in drug testing. The importance these governing individuals have assigned to the dangers of steroid use is evidenced by the fact that athletes caught using these substances are usually suspended from competition. Perhaps we need a similar approach to managing dysfunctional eating practices and pathogenic weight control measures in athletes.

Reference: Thompson, Ron and Roberta Sherman. "Helping Athletes with Eating Disorder" Bloomington: Human Kinetics Publishers; 1993.