Eating Disorders: Signs, Screening, Confronting
Research indicates that athletes, especially female athletes, are at greater risk for developing eating disorders (ED) than non-athletes of similar age. There are many reasons for this, but a frequent element is believed to be pressure to be lighter or leaner in order to excel at their sport. Coaches, health professionals, and parents have important roles to play in the prevention, identification, and management of disordered eating and eating disorders in athletes.
The spectrum of disordered eating behaviours ranges from mild to life-threatening. Clinically recognized anorexia nervosa or bulimia nervosa are the most severe forms. However, subclinical conditions, generally called disordered eating (DE) can also have adverse health consequences and may potentially lead to a frank ED.
Contributing factors that may increase the likelihood of ED/DE amongst athletes:
- Early onset of puberty;
- Participation in judged, weight-classified, and endurance sports;
- Psychological stresses and excessive physical demands of training and competitions;
- Striving for unrealistic body composition standards;
- Perceived pressure to lose weight (from society, coaches, family, friends, etc.);
- Perfectionists – "Type A" personality;
- Personality prone to depression, unnecessary worrying, and the "all or nothing" attitude;
- Having a history of troubled family or personal relationships;
- Feeling confused about their sexuality or feeling like they are unable to communicate their feelings and their truth;
- Traumatic social event(s) in the athlete's life that may feel out of their control (e.g. starting at a new school, parents divorcing, moving, etc.).
- Bingeing and/or purging, food restriction, prolonged fasting;
- Use of diet pills, diuretics or laxatives to control body weight;
- Food preoccupation; relentless avoidance of dietary fat and/ or carbohydrates, plus other abnormal eating behaviours;
- Body shape dissatisfaction and/or fear of gaining body fat;
- Distorted body image;
- Excessive exercise beyond the regular training program.
Warning Signs of an Eating Disorder or Disordered Eating
Many of the signs and symptoms below do not by themselves identify or diagnose an ED. Nonetheless, the greater the number of warning signs observed, the greater the need to explore further.
- Striking weight loss or weight gain; significant fluctuations in body weight;
- Preoccupation with food, calories, body weight; criticizing personal body weight;
- Changes in the athlete's usual eating behaviours (e.g. by declaring to be vegetarian);
- Use of diet pills and/or laxatives;
- Going to the bathroom frequently after meals; bloodshot eyes; smell of vomit after bathroom visits;
- Obsessive physical exercise beyond the training program;
- Wearing layers of loose fitting clothing;
- Avoiding social activities with teammates;
- Excusing self from food-related activities, (e.g. skipping "team" meals);
- Mood swings; depression; low self-esteem;
- Irregular or absence of menstrual cycles; stress fractures; overuse injuries; sleeping problems;
- Reduced and/or inconsistent performances in training and/or competition (decrease in strength, power, endurance, and/or recovery).
If the coach suspects that an athlete may be suffering from an ED/DE, the coach should first confidentially discuss the matter with the athlete. The steps outlined further describe how to approach an athlete with a suspected ED/DE.
- In a private, confidential meeting the coach discusses with the athlete their observations of the athlete's changes in attitude, behaviour, health and/or performance. Noting athlete's loss of weight should be avoided as this reinforces their behaviour.
- The coach assures that the athlete's role on the team is not in jeopardy and that the health of the athlete is the primary concern.
- The coach contacts an eating disorders clinic or multidisciplinary team which includes a physician, psychologist, and dietitian to let them know of his/her concerns or to seek advice on the matter.
- The coach provides the multi-disciplinary team contact information to the athlete to suggest where they can get confidential professional help.
- If the athlete is less than 18 years of age, their parent(s) will need to be informed of the potential health concern.
- If the athlete denies that a problem exists, the coach should continue to insist that the athlete receive professional evaluation. This insistence may necessitate intervention by the athlete's family members and/or training privileges could be limited until the athlete agrees to seek professional advice.
Eating disorders can be successfully treated; however, professional help is almost always necessary. The treatment for an eating disorder should be multi-disciplinary to include psychological, nutritional, and medical intervention. It may be necessary for the athlete's family member(s) and/or coach to attend treatment sessions with the athlete, especially if the athlete is less than 18 years of age.
An ED will not simply go away if ignored. Action must be taken when evidence of an ED seems apparent. Athletes need to understand that their bodies are susceptible to change, especially during adolescence. Natural weight gain will occur as their bodies mature. Coaches must also be aware of these changes with puberty, along with the fact that young women often feel a great deal of societal pressure to be thin and may be bothered by comments about body weight, appearance, and body composition.
Coaches may not be able to prevent all ED/DE among the athletes that they work with, but coaches are powerful role models and have a strong influence on their athletes. Coaches should be able to recognize early warning signs and symptoms associated with ED/DE. If the coach suspects an athlete may be suffering from an ED, the coach should act quickly to refer the athlete for appropriate medical, psychological, and nutritional intervention.
For more information on disordered eating in athletes, here are some valuable resources:
www.nedic.ca – Canada's National Eating Disorder Information Centre. The NEDIC site offers resources and contact information across Canada.
Once you have found a health professional to assist in recovery for your athlete, refer the athlete to a dietitian, in particular, if you can find one who has experience in disordered eating.