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Eating Disorders Among Athletes
Erin M. Dougherty
April 30, 2001
Susan is a long distance runner who was at the top of her sport in high school and was even given a scholarship to college. When she got to college she realized that the competition was much steeper and she was no longer the best. Susan did not know how to handle this, she was used to being at the top. She started working out more often and even cut back on what she was eating. She was sure that this would improve her athletic ability. She thought she was doing nothing wrong, her coach had said her speed was increasing so she continued with her new routine. Susan proceeded to do this for a while, increasing her running and decreasing her eating. Pretty soon she was not eating at all and running three times a day for extreme amounts of time.
Over time her athletic ability began to diminish. She was getting slower and when they lifted weights she was becoming weaker instead of stronger. Some of her teammates had noticed how thin she was and began to talk, they knew she had an eating disorder. When they confronted her, she denied it and made excuses for the way she was looking. She then tried to hide what she was doing by not eating with the team and wearing baggy clothes. This went on for a long time until everything came crashing down. Susan was at a big race and feeling very weak, but she raced anyway. While running up a hill she passed out and landed on her hip fracturing it. When she awoke she was in the hospital with a cast. The doctor had told her that she had passed out from dehydration and malnutrition; because she had not been eating her bones were not receiving calcium. The result of this was the fractured hip, this was because her bones were in the same state as an eighty-year-old woman, and Susan was only twenty-one.
Eating disorders are becoming increasingly common among athletes.
Athletic participation may hide the signs of an eating disorder because of the expectations that exist within athletics (Lemberg/Cohn 78). Studies have shown that athletes, as a group, appear to be more at risk for eating disorders that the rest of the population. There are many factors that contribute to this theory. One is thought to be because so much emphasis is put on the body. Individuals involved in sports such as distance running, ballet, gymnastics, wrestling, figure skating, and bodybuilding, which require a lean body mass for best performance, are at a higher risk for developing an eating disorder than an athlete in another sport. In addition to the leanness factor, there are other aspects of a sport that can contribute to an eating disorder. The mere competitiveness of the sport, its emphasis on appearance, the amount of stress put on the body, and emphasis on individual instead of team success (31-32). As discussed et al. (1992), an examination of the known risk factors for eating disorders suggests that athletes might be at an increased risk since they often train in an environment where emphasis is placed on leanness. They exist in a highly competitive culture in which the manipulation and control of body weight/fat is thought to be essential for both performance and appearance (Burke/Deakin 289). Female gymnasts and distance runners are shown to have the least amount of body fat of all women athletes. This creates a great deal of pressure to remain thin. Gymnasts and runners present the highest rate for developing and eating disorder, twenty to twenty-five percent go on to become bulimic (Yates 66). It is hard to say whether athletes engage in eating disorders or eating disorders engage in athletes. Naturally when someone puts so much pressure on his or her body weight, the individual becomes very compulsive about it.
Most people would assume that only female athletes suffer form eating disorders. Although studies have shown that female athletes are more prone to eating disorders than males, there are still some males that suffer from the disorders. Only five to ten percent of males experience eating disorders and this does not include the amount of males who suffer from sub-clinical eating disorders. Females and males normally have different reasons behind their eating disorder, but both tend to have the same personality traits. They are usually characterized by high self-expectations, perfectionism, persistence, and strenuous exercise (Lemberg/Cohn 32). Males usually become overly active instead of developing a classic case eating disorder. They tend to become obsessed with body weight for better physical performance instead of body image as in females (Yates 105). It is seen more in sports such as bodybuilding or weightlifting that emphasize appearance and individual performance. Women tend to decrease their food intake and/or increase exercise that may lead to a state of physical deprivation. The deprivation then begins to contribute substantially to the clinical picture. Females tend to become far more introverted, depressed, and obsessional (141).
Only a portion of athletes studied go on to develop a full-blown eating disorder. Athletes with disturbed eating and exercising practices far outnumber those who meet the strict diagnostic criteria for eating disorders. As pointed out in Clinical Sports Nutrition, the use of definitions of eating disorders should be challenged, both in the detection and treatment of individual athletes with problems as well as in the interpretation of studies of the prevalence of eating disorders in athletic groups. Dealing with the clinical entities of anorexia nervosa and bulimia nervosa fails to recognize a great many sub-clinical
problems such as preoccupation with food, obsessive thinking about weight and disturbed body image. It is particularly at the sub-clinical level that the distinction between disordered eating and the jealous pursuit of diet and training to optimize sports performance becomes blurred (Burke/Deakin 288). There are several unusual diets that athletes use to lose weight. Some of which include fruits only, herbal supplements, or totally cutting out all fats and/or meats. Then there are the more popular methods of anorexia, and bulimia such as laxatives and diet pills. There is also always the over-exercising factor to consider. Large sweat loss prose a risk to an athletes health by inducing severe dehydration, impaired blood circulation and heat transfer, leading to heat exhaustion and causing a person to collapse (Brouns 4). Many athletes do not eat enough food to provide enough energy, or kilojoules, to accommodate their activity level. This is a major problem that reduces resting metabolic rate, which leads to unhealthy muscle loss. Low kilojoules diets slow down weight loss and are followed by a more rapid weight gain in the long run (Burke/Deakin 286-287). What is good or bad for you has a lot to do with the other foods a person eats. No matter how good a food is for the body it is not healthy to consume too much of it, just as it is not healthy to totally cut something out of a diet. Each nutrient is essential for one thing or another and it is impossible to think that a person can do well athletically if any nutrients are totally eliminated from his or her diet. Some athletes will totally avoid eating animal products thinking it will give them more energy and help lose body fat, but they are wrong. Some fat, called essential fat, is required for the brain, nerves, bone marrow, heart tissue, and cell walls. Female have approximately twelve to fifteen percent of total body weight as essential fat. This
fat is used for reproductive organs and is associated with breast tissue (Benardot 101). Inadequate protein intake induces protein loss, especially of muscle, and eventually a negative nitrogen balance and reduced performance (Brouns 15). Anorexia Athletica, a form of anorexia nervosa, including caloric restrictions, fear of weight gain excessive exercise, sometimes even the use of laxatives, and diuretics or self-induced vomiting is common among some athletes with a disorder (Lemberg/Cohn 80).
Many of these problems are a result from the athletes not being educated enough in nutrition. It is not just the athletes fault. The coaches and parent do not know enough about the athlete either. Studies have shown that seventy-nine percent of the athletes surveyed chose their coach as an important source of nutrition information. This is not good because another study reported that coaches were not, as a group, one of the most educated people surveyed (Leaning 23). Those who are more knowledgeable in nutrition may be better able to evaluate fads and can better distinguish between fact and misinformation (25). Fitness oriented people should be informed by professional organizations about the factors affecting food selection, food intake, nutrition utilization, and the needs of active people (Brouns 8). Restricting diets lead to a lot of physical problems. The body has different components each with its own purpose and density. The energy needed for a sedentary adult is significantly lower than what is needed for a
person engaged in intense physical activity. For this reason athletes must increase their food consumption instead of decreasing it (10).
The results of eating disorders could include numerous consequences. Loss of muscle mass and functions, inadequate glycogen stores, depression, impaired
tolerance to cold, and endocrine abnormalities are just some. Restricting diets can also affect athletic performance including decreasing endurance, strength, reaction time, and speed (Lemberg/Cohn 83). Low calcium intake can stimulate osteoclast recruitment and increase bone absorption. Malnutrition may also cause a decrease in bone turnover and result in bone loss (Brouns 79). Females run the risk of developing reproductive problems. The list includes irregular periods, but also includes more serious things such as oligomenorrhea and amenorrhea. Low estrogen production increases a girl s risk for osteoporosis, which leads to fracture risk. In order to maintain a normal menstrual cycle a women needs seventeen to twenty-two percent body fat (Benardot 101). Binging and purging can lead to tooth decay because of the acids in the stomach constantly coming up. A dentist is often the first person to discover that a person is bulimic for that very reason.
There are many directions a person can take to help someone suffering from an eating disorder. The best way is to say something before it becomes serious. That way the person will be aware that you are watching them. There are numerous signs of anorexia to look for including, significant weight loss, fear of gaining weight, recurrent stress fractures, in females irregular periods, growth of fine hair on the face and arms, inability to concentrate, hyperactivity, and wearing baggy clothes to hide thinness. The signs of
Bulimia are a little different, they include swollen glands and bruised fingers due to inducing vomiting, feeling a lack of control over eating habits, bloodshot eyes, disappearance after meals, ability to eat enormous amounts of food without gaining weight, and compulsive exercise and depression (Burke/Deakin 287-288).
Once someone is sure that an athlete is suffering from an eating disorder there are many steps to be followed to ensure that the person obtains the most help. The first step is to approach the athlete with the problem gently, showing concern for their behavior. Do not come out and accuse him or her of an eating disorder; it will scare the person and put them in a state of denial. Give the athlete a chance to feel comforted with someone who can help. No one is going to come right out and admit that he or she has an eating disorder; it takes time (Benardot 103). Avoid any mention of his or her eating habits, concentrate on other life issues. Point out how tired or unhappy they have seemed lately and ask if there is anything they want to talk about. Offer the athlete a list of some professional resources that they might be interested in checking out. Do not try to solve the problem alone. It is more complex than eating and exercising. It becomes a psychological issue. Share concerns with others such as coaches, parents, teammates, and friends (Clark 6). Most importantly, be patient. The healing process can take a long time and the person may also experience many setbacks. Some athletes may be able to do well for a while without any obvious alteration in their performance, but eventually the injuries and lack of energy will catch up with them.
Many athletes believe that restricting their food intake to lose weight will enhance their athletic performance. Ironically, restricting food in attempt to improve performance
can actually result in serious problems and even impair athletic performance. A great deal of this pressure and preconception about weight control has much to do with the environment and athlete is surrounded by. The fierce competition an athlete goes through puts them at a greater risk than a normal person. The constant battle with food endangers
an athlete s physical and mental health and overall well-being. Unfortunately, too many coaches, parents, friends, and teammates shy away from the thought of someone who seems so happy and content could be struggling with such a stressful, self-imposed disorder.
Benardot, Dan. Nutrition For Serious Athletes. Published Champaign, IL: Human
Brouns, Fred. Nutritional Needs For Athletes. West Sussex. England: John Wiley and
Sons Ltd. 1993
Burke, Louis and Vicki Deakin. Clinical Sports Nutrition. Sydney, NY: McGraw-Hill
Book Co. 1994
Clark, Nancy. How To Help An Athlete With An Eating Disorder, Independent
Rowing News. 62 (1999): 33-36
Leaning, Marie Gwenda. Nutrition Knowledge, Food Practices, and Sources of Nutrition
Information of University of Delaware Athletes. May 1990
Lemberg, Raymond and Cohn, Leigh. Eating Disorders: A Reference Source Book.
Phoenix, Arizona: Oryx Press. 1999
Yates, Alayne. Compulsive Exercise and the Eating Disorders. New York, NY:
Brunner/Mazel Publishers. 1991
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