For all the good things that sport offers to athletes, there is also an increased risk for eating disorders. A complicated relationship between ourselves and food is characteristic of most Americans. Problematic eating habits may even be more of a norm than an exception and eating disorders are prevalent throughout our our society in general. For athletes, eating disorders may start for different reasons and sometimes be more difficult to spot, both for the athlete themselves and the people around them. In this article, let’s consider the differences between a disciplined nutrition plan and an eating disorder, the risk factors for eating disorders in athletes, some of the ways an eating disorder can hide in plain sight and few warning signs of an eating disorder in an athlete.
What is an eating disorder vs a controlled diet?
Any seasoned athlete will know that getting the best performance means having the right nutrition. There is a discipline around eating habits that is required to function at a high level of sport. Generally, this is thought to be different than an eating disorder in terms of motivations for the dietary control. In two of the most common eating disorders among athletes – anorexia nervosa and bulimia nervosa – are characterized by a drive for thinness. Athletes may have a drive for performance, which leads to control of food intake, but not thinness. However, this is a murky area. Body shape, size and performance overlap in many sports and it can be difficult to tell where the healthy performance drive stops and an eating disorder starts. In fact, many survivors of eating disorders describe the problem evolving over time – starting off innocently and becoming overwhelming, then dangerous.
Some sports require an intense focus on dietary control followed by an off season and time of ‘bulking’, or eating extra, being less disciplined with food. Bodybuilding for example will require a deliberate restriction of calories and highly limited food variety in order to achieve the muscle definition required in competition. Following the competition there is a period of recovery, weight gain. Is this the same as restricting food intake, as we would see in anorexia? Is the increase in food consumption the same as binging such as in bulimia or binge eating disorder? The answer is dependent on the extent of the symptoms – how much restriction, binging or purging behaviors – along with motivations and feelings about losing or gaining weight. Because this is not easy to tease from a purely athletic drive to succeed from a diagnosable eating disorder some have coined terms such as ‘anorexia athletica’ (more info here https://www.eatingdisorderhope.com/information/anorexia-athletica) or orthorexia (more info here https://www.nationaleatingdisorders.org/learn/by-eating-disorder/other/orthorexia) to describe people who are suffering from dysfunctional relationships with food and body that are driven by health or athletic performance. These might not meet all the diagnostic criteria of an eating disorder but carry risks to mental and physical health, all the same.
(While there are a number of eating disorders, I am referring primarily to anorexia and bulimia because they are thought to be more likely to show up in athletes. Read more about types of eating disorders here https://www.nationaleatingdisorders.org/information-eating-disorder)
There are a number of factors that are considered to contribute to a higher risk of developing eating disorders for athletes. Some these are:
1) People engaged in individual rather than team sports – activities like running, bodybuilding, figure skating, diving rather than team sports like soccer or basketball.
2) Sports where weight requirements, appearance or muscularity are a focus – such as dance, gymnastics, wrestling or weightlifting.
3) Gender of the athlete – female athletes are thought to be at higher risk because of existing pressure on women towards thinness and focus on certain appearance standards. However, men are at risk of eating disorders and there may in an issue of underreporting or clinicians not looking for eating disorders in male clients/patients as actively.
4) Level of expertise and length time engaged in sport- people that are engaged in sport from earlier in childhood and those that compete at higher levels are at increased risk of eating disorders.
Eating Disorder dismissed as a positive
In many ways, it is understandable that athletes suffer from eating disorders. The traits and abilities that are needed to succeed in sport are also part of what makes an eating disorder possible. A drive towards perfection, ability to focus intensely, being able to tolerate discomfort and ignore certain signals from the body can all be part of an elite athlete’s personality. Unfortunately, these traits are also common in those with eating disorders.
Identifying an eating disorder in an athlete can be complicated by the fact that behaviors that signal an eating disorder can be seen as ‘hard work’ and ‘discipline’. When there is not an awareness of the risks, athletes in the grip of an eating disorder can be encouraged by coaching staff and praised by peers or family for their dedication.
Therefore, it is important to be aware of warning signs, both as an athlete or anyone who supports an athlete. Some warning signs that an athlete is struggling are:
- Physical changes – noticeable changes in leanness or body weight. Other physical changes might also include constantly feeling cold, bluish fingernails, thinning hair. Fainting spells or being light headed are also indicators of a potential problem. Athletes suffering eating disorder often will have an increased rate of injury which may be due to lack of nutrition and/or over training to compensate for food intake. For female athletes, it is useful to keep the Female Athlete Triad (American College of Sports Medicine) in mind. The triad is comprised of 3 disorders, common in female athletes. These are Disordered Eating, Osteoporosis and Amenorrhea (menstruation stopping). Each is concerning on it’s own, but combined carry an increased negative impact on health.
- Social changes – People struggling with eating disorders will often start to withdraw socially, be less willing to hang out with teammates or family. An early bedtime might be to recover and prepare for tomorrow’s training. Or it may be an excuse to not join everyone for ice cream after a game, for example.
- Emotional changes – As the body and brain are deprived of adequate nutrition, mood will suffer. People may become depressed, anxious or angry. Anger is often a response when eating behavior is challenged or questioned.
- Behavioral – Looking for changes in dietary routines or habits of intense training after eating. Being stuck to certain foods and rigidly adhering to a diet, even in situations when most people might indulge a little – like cake at a birthday party or special occasions.
Reach Out For Help
Eating disorders can be dangerous and potentially deadly. So, if you identify with any of these, reach out for help. It can feel overwhelming to begin to focus on the problem, and finding solutions can feel impossible; however, you are not alone. If you need help, talk to a supportive friend or doctor, or find a therapist. Therapy offers a place to deal with the emotional issues that drive these problems. Working with a therapist can help you find confidence in your ability to cope and have a healthy relationship with food.
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If you are ready to take control of your eating disorder, you can reach out to me via my contact page.