What are eating disorders?

Anorexia nervosa, bulimia nervosa, binge-eating disorder and EDNOS (Eating Disorder Not Otherwise Specified) are clinically diagnosed psychological illnesses affecting health and performance. Restricted food intakes, episodes of binge eating, as well as distress or excessive concern about body shape or weight, poor self-worth, and feelings of guilt or control are commonly associated with eating disorders. Abnormal eating patterns may vary from mild to serious and some may fall outside the clinical definitions. Health care professionals, coaches, and personal trainers should not ignore athletes with disordered eating behaviours and should recognise that a collaborative team approach to managing the athlete is essential.

Eating disorders have been associated with athletes at all levels of sport and in both male and female athletes. At times, eating disorders may be undiagnosed or concealed due to the intense physical and mental stress that athletes endure in their training and competition cycles. Sports performance usually drops in athletes with eating disorders due to poor nutrition and poor mental function. If untreated or undiagnosed, eating disorders can have serious medical outcomes.

Risk factors for eating disorders

There are a number of factors that increase the risk of developing an eating disorder in both athletes and non-athletes. These include:

• Gender
• Genetics
• Biological factors
• Personality traits (e.g. high levels of sensitivity, perfectionism, negative self-evaluation)
• Dieting (especially yo-yo dieting)
• Traumatic life events

Sportspeople also have a number of unique traits or pressures that increase the risk of developing an eating disorder including:

• Desire to optimise performance
• Involvement in sport that emphasises physical appearance, size or leanness for performance
• Increased body awareness, which may exacerbate body image concerns
• Personality characteristics often prized in athletes (competitive, perfectionist, disciplined)
• High stakes associated with winning (and losing)
• Injury as a trigger for the onset of an eating disorder
• Influence of parents, coaches and fellow athletes

In addition to the above risk factors, some sports are associated with an increased risk of eating disorders. These can be broadly classified into three categories:

• Appearance sports (e.g. gymnastics, synchronised swimming, figure skating, ballet dancing)
• Low body fat sports (e.g. distance running, triathlon, body building)
• Weight category sports (e.g. light-weight rowing, combat sports, jockeys)

Medical & Performance complications

The impact of eating disorders can be long lasting and devastating to the individual, their families, and their performance. Poor nutrient and energy intakes can result in a number of medical complications including:

• Dehydration is common in people that restrict food and/or fluids
• Vomiting and use of laxatives can result in electrolyte imbalances increasing the risk of heart problems and kidney damage
• Amenorrhoea (loss of periods) and low bone density, which increases chance of stress fractures that can significantly hamper training and competition
• Reduced muscle protein and low glycogen stores
• Erosion of tooth enamel, sore and damaged throat, and pancreatitis are often seen in sufferers of bulimia

Treatment approaches

Eating disorders are very serious and potentially life threatening and having a non-judgemental approach is always helpful. It’s important to never punish or abandon an athlete or dismiss them from the team for an eating disorder. A multidisciplinary team is needed to manage an athlete with an eating disorder, including a sports physician, psychologist, sports dietitian, coach, and the family of the athlete. Treatment can be challenging and prolonged, and may require hospitalisation in severe cases.

Risk reduction strategies

Athletes, coaches and trainers must be realistic when setting weight loss goals (both amount of weight lost and time frame). Dieting, weight loss, and pre-event diet superstitions or rituals do not necessarily mean the athlete has an eating disorder however there are signs and behaviours that should not be ignored, including:

• Rapid weight loss
• Weight loss below ideal competitive weight
• Constant referrals to being, or feeling, fat when often the reverse is true
• Competitive nature with other athletes about their size or weight
• Weight loss or high training loads that continue into the off season
• Excessive exercise over and above the recommended training load from the coach
• A distracting preoccupation with food, fat, calories/kilojoules, carbohydrate, etc.
• Secretive eating or disappearing after meals or snacks to the toilet or shower
• Weakness, dizziness, headaches or fainting, with no apparent medical cause
• Denial that anything is wrong (e.g. no reason for weight loss or other behaviours)

Summary

Eating disorders adversely affect sporting performance and life-long health and wellbeing. People working with athletes need to understand the warning signs and risk factors associated with eating disorders and implement risk reduction strategies in their environment. Eating disorders are serious and need a multidisciplinary team approach for correct diagnosis and proper treatment. The sooner help is sought, the sooner the athlete begins their road to recovery.

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