Disordered Eating

• More than 5 million Americans experience eating disorders.
• 10 to 15 percent of those diagnosed with bulimia are men.
• 15 percent of young women have disordered eating behaviors or attitudes.
• Anorexia nervosa, bulimia nervosa, and binge-eating disorder affect the mind and body simultaneously. 
• 86 percent report onset of illness before the age of 20.
• Eating disorders are significantly higher (15 to 62 percent) in the athletic population than the general population.

• Repeatedly expresses concerns about being fat
• Preoccupation with food, caloric intake, and weight
• Increase in the criticism of one’s body
• Lack of self-identity, low self-esteem, and role-conflict issues
• Mood swings (irritability, inability to concentrate, fatigue)
• Extreme loss or fluctuations in weight
• Change in menstrual cycle (may include lack of cycle-amenorrhea)
• Avoidance of eating in public
• Making trips to the bathroom after large meals
• Excessive use of laxatives
• Engaging in physical activity above and beyond the requirements of training program
• Wearing layered or baggy clothing
• Bloodshot eyes, swollen parotid glands
• Hair thinning or loss
• Headaches, dizziness, numbness, and tingling down the limbs (as a result of electrolyte imbalances)
• Associated conditions of amenorrhea or osteoporosis (i.e., Female Athlete Triad)

  Those that:

• Are scored subjectively (e.g., figure skating, dance, gymnastics)
• Favor lower body weight (e.g., cross-country running, cycling)
• Require the athlete to wear body-revealing clothing (e.g., swimming, diving, running, cheerleading)
• Have weight classes (e.g., wrestling, crew, martial arts)
• Favor pre-pubertal body composition for success (e.g., diving, gymnastics)

The role of the coach.
Be sure to identify the athletes who may be at risk for disordered eating and the trigger factors that are associated with the problem.  If an athlete is showing signs and symptoms of disordered eating, refer them to a medical professional that is trained or specializes in disordered eating in adolescents.

• Educate all involved with the athletic program (including parents and officials) about the signs and symptoms of disordered eating.
• Take special care when working with athletes involved in the at-risk sports, as well as those who have weight problems.
• Avoid placing too much emphasis on body weight, leanness or size as a key component of optimal performance.
• To avoid unhealthy weight-control practices, weight modifications should be managed under the supervision of the athletic trainer or physician.
• If weigh-ins are required in the sport, have someone other than the coach perform the weigh-ins.
• Have communication and plan of action in place for managing and handling athletes with disordered eating.

• Perfectionism, compulsion, determination, control
• Lack of self-esteem
• High family expectations/family dysfunction
• High achieving
• Pressure to optimize performance
• Emphasis on thinness
• Inability to cope with stress
• Lack of sense of identity

• Decreased strength and endurance
• Decreased anaerobic and aerobic capacity
• Decreased speed, agility, and concentration
• Decreased heart rate
• Low blood pressure
• Iron deficiency
• Osteoporosis
• Electrolyte imbalances
• Death

A serious psychological disorder that includes the following behavioral characteristics:

• Weight 15 percent below average for height and age-refusal to maintain or be above appropriate weight for height and age
• An intense and extreme desire to be thin and fear of becoming fat even though the individual is underweight
• Belief that oneself is fat or overweight even when the individual is underweight
• Amenorrhea (no menstruation)
• Strong denial when confronted

Characterized by the binging on food in gross quantities followed by vomiting or use of laxatives or diuretics.  Bodyweight may be underweight, overweight, or normal.  Bulimia nervosa includes the following behavioral characteristics:

• Binge eating accompanied by lack of control and physical or emotional distress
• Purging (self-induced vomiting, diet pills, laxatives diuretics, heavy exercise) in an attempt to rid the body of the calories consumed
• Binging and purging occurs two times per week for at least three months
• Visits bathroom after meals
• Body image (self-evaluation and self-esteem) is overly influenced by body shape and weight
• Recognition that eating problem is out of control
• Depression

This condition is specific to athletes and is similar to anorexia nervosa, but without the self-starvation. Athletes with this condition will display all of the following characteristics:

• Weight loss >5 percent of body weight
• Gastrointestinal complaints
• Absence of medical illness explaining the weight reduction
• Excessive fear of becoming obese
• Caloric intake restriction

These athletes will also display one or more of the following:

• Delayed puberty (amenorrhea)
• Menstrual dysfunction
• Disturbance in body image
• Use of purging methods
• Binge eating
• Compulsive eating

“Eating Disorders Not Otherwise Specified” includes disorders that are not categorized and are less severe.  Athletes with EDNOS will display the following characteristics:

• Average Weight
• Preoccupation with body image and weight
• Guilt experienced with eating
• Absence of amenorrhea
• Absence of binge-purge eating patterns

This is serious condition that involves three inter-related conditions. These are serious, but preventable.

• Disordered eating
• Amenorrhea caused by extreme body weight loss or weight fluctuations
• Osteoporosis secondary to amenorrhea

Nova resources
www.anad.org