Eating Disorders & Athletes When “Healthy” Goes Too Far Lisa Diers, RDN, LD, E-RYT Director of Nutrition & Yoga The Emily Program
Objectives • Participants will be able to: – Successfully identify helpful & unhelpful messages about eating & activity – Gain knowledge in how to identify potentially dangerous & disordered eating & movement behaviors in athletes – Learn key strategies in supporting & treating athletes struggling with eating disorders emilyprogram.com
Defining An Eating Disorder • What is an Eating Disorder? • Who Gets an Eating Disorder? • Is it a choice? emilyprogram.com
Eating Disorders are NOT a choice Recovery IS Possible emilyprogram.com
What is an Eating Disorder? • WHAT: Eating Disorders Such as Anorexia, Bulimia and Binge Eating Disorder- include extreme emotions, attitudes and behaviors surrounding weight and food. Eating Disorders are a serious emotional and physical problems that can have life threatening consequences. emilyprogram.com
Types of Eating Disorders DSM V • Anorexia Nervosa • Bulimia Nervosa • Binge Eating Disorder • Avoidant/Restrictive Food Intake Disorder • FEC-NEC – Atypical AN – Sub BN – Sub BED – Purging Disorder – NES ▪ Not Official ED, but commonly referred to: Diabulimia, Orthorexia emilyprogram.com
• Eating disorders affect a person physically, behaviorally, emotionally, and psychologically; including: • Dramatic weight gain or loss; or no noticeable change in wt. • Verbal preoccupation with food, weight, and shape • Rapid or persistent decline or increase in food intake • Excessive or compulsive exercise patterns • Purging; restricting; bingeing; compulsive eating; abusing diet pills, laxatives, diuretics, emetics • Denial of food and eating problems, despite the concerns of others • Eating in secret, hiding food, disrupting meals, feeling out of control with food • Medical complications, such as menstrual irregularity, dizziness, fainting, bruising, dry skin, leg cramps, hair loss, brittle hair, osteoporosis, diarrhea, constipation, dental problems, morbid obesity, diabetes, chest pain, heart disease, heartburn, shortness of breath, organ failure, and other symptoms emilyprogram.com
Why do people get eating disorders? Bio-Psychosocial Model of Eating Disorders psychology biology Stressors Food restriction Genetics Identity/self-image Physical changes Personality factors Puberty/Menopause Perfectionism neurotransmitters Depression Coping social/environmen t Cultural factors Pressure to “fit in” Normalization of dieting Media
➜ ➜ ➜ ➜ Healthy Problematic concerns Weight control Healthy eating Dieting Unhealthy Anorexia or Practices: behaviors weight Bulimia control Nervosa Physical activity Moderate Minimal Lack of, or “Anorexia behaviors: physical or excessive obsessive, athletica ” activity activity physical activity Body image: Body Mild body Moderate body Severe body acceptance dissatisfaction dissatisfaction dissatisfaction Eating behaviors: Regular eating Erratic eating Binge eating Binge eating patterns behaviors disorder Weight status: Healthy body Mildly Overweight or Severe weight overweight underweight overweight or underweight or underweight emilyprogram.com Neumark- Sztainer D, “I’m, Like, SO Fat!”: Helping Your Teen Make Healthy Choices about Eating and Exercise in a Weight Obsessed World. New York: The Guilford Press; 2005.
Who gets an ED • WHO: Eating Disorders are not discriminatory of body size, age, sex, orientation, race or economic status. Athletes • Sports that emphasize appearance, muscularity, or weight requirements (cheerleading, diving, bodybuilding, or wrestling) • Individual-focused sports such as gymnastics, running, figure skating, dance, or diving rather than a team sport like basketball, volleyball, or soccer • Endurance sports, such as track and field, running, and swimming • Training for a sport since childhood or being an athlete of elite-status • An overvalued belief that lower body weight will improve performance • An unhealthy focus on success and performance supported by those invested in the athlete's performance • Unhealthy focus/messages: LEANER, BIGGER, STRONGER, LOOK BETTER; PERFECTION emilyprogram.com
Continued… • Study of elite female runners had 16% with a classifiable eating disorder at the start of the study • Girls high school varsity sports- 18.2% disordered eating • Ohio State University- subclinical eating problems affected 19% of female athletes & 12% of males
Weight Classed Sports • Menstrual disturbance in approximately 30% of females • 85% of females attempted to lose weight • 93% of male athletes attempted to lose weight • Most common compensatory behaviour reported by athletes was dehydration (e.g., sauna, exercise in sweat suites).
Weight Classed Sports emilyprogram.com
Weight Classed Sports emilyprogram.com
What it Means to RDs • Our profession needs to have a sensitivity to eating disorder treatment • What are our own beliefs & biases on food, weight, shape, appearance, performance? • So much praise for athletes; Extremism = success Can you tell if it’s healthy or disordered? • Know when it’s time to refer – parents/coaches/MD • Consult with ED Dietitian specialists • Eating disorder treatment is HARD work • So are other major treatments – It’s Hard work. It’s challenging. There are sacrifices. • It works! emilyprogram.com
Objectives • Participants will be able to: – Successfully identify helpful & unhelpful messages about eating & activity emilyprogram.com
Helpful or Not? • OK Team- see how Sally performed yesterday? Stellar. Sally – tell everyone what you’ve been doing. Especially how you changed your diet. • Your body works for you. Not the other way around. You want to be on top, push harder- maintain control. • You know your body. Eat what works best for you and helps you perform. Your body will tell you what to do. emilyprogram.com
Helpful or Not? • You don’t need to worry about how or what you eat! That’s the bonus of competing, you can eat whatever you want. You'll burn it off in practice! • If you would cut some weight, you’d be faster. Only 5 pounds. You’d shave at least 3 seconds off your time. • Whatever you're doing, keep it up! emilyprogram.com
Helpful or Not? • Wow. You look great! • Excuses, don’t want to hear them. Complaints, Not Interested. • There are many things that can be done to improve performance. What are your goals? • Your Examples? emilyprogram.com
Objective #2 • Gain knowledge in how to identify potentially dangerous & disordered eating & movement behaviors in athletes emilyprogram.com
When Healthy Has Gone too Far Signs & Symptoms • Avoidance of water or excessive water intake • Preoccupation with one’s own food • “Perfect” Eating - (orthorexia) • Preoccupation with other people’s food • Ritualistic eating and/or avoidance of certain foods • Excessive concern with body aesthetic • Decrease in performance, especially when combined with other signs • Prolonged or additional training above and beyond what is required for sport (e.g., extra sit-ups and laps, extra workouts) emilyprogram.com
When Healthy Has Gone too Far Signs & Symptoms • Athletes on the team reporting concern about an individual • Decreased concentration, energy, muscle function, coordination, speed • Increased fatigue and perceived exertion • Longer recovery time needed after workouts, events • Difficulty with days off and tapering • More frequent muscle strains, sprains, and/or fractures • Slowed heart rate and low blood pressure • Reduced body temperature and increased sensitivity to cold— cold hands and feet • Complaints of light -headedness and dizziness • Gastrointestinal complaints such as nausea, constipation, abdominal pain and fullness • Poorer interaction with coaches/teammates • Perfectionism • Increased impatience, crankiness • Increased isolation emilyprogram.com
Objective #3 • Learn key strategies in supporting & treating athletes struggling with eating disorders emilyprogram.com
Key Strategies • In private setting communicate care and concern “I am concerned….” • Be a listener. Let them know you are there whenever you need them • Don’t pass judgment/Be a compassionately Curious • Reinforce- weight doesn’t determine performance outcomes. Performance does. • Athletes want to perform. Food= performance fuel emilyprogram.com
Key Strategies • Make tough calls. Sometimes it works to stay in the sport. Sometimes it doesn’t. • Support your athlete- if your athlete had a broken leg- how would you handle it? Why is this different? • Avoid body/food comments • Support their Recovery Meal Plan • Collaborate with ED RD • Continue to follow-up/check-in emilyprogram.com
Key Strategies • Get an Assessment/ Refer • College Campus Resources • School Counseling Resources • Involve parents • Assess your clients/teams emilyprogram.com
Team Activity: Food & Wt. Messages • What Messages do you • What messages do you receive about Food? receive about weight and Performance? emilyprogram.com
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