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How can we decrease the number of eating disorders among athletes?


Introduction

Types of Eating Disorders:

I wanted to start by providing a little information on some types of eating disorders.  When I refer to “eating disorders” I am talking about all of these not one specific.  

Anorexia nervosa: 

Typically affects people in teens or early twenties and tends to affect more women than men.  Anorexia nervosa is when someone restricts calories, constantly monitors food consumptions, and avoids eating.  

symptoms: 

  • being considerably under weight 
  • restrictive eating patterns 
  • an intense fear of gaining weight 
  • a relentless pursuit to be thinner 
  • low self- esteem
  • distorted body image 
  • obsessively working out
  • obsessively thinks about food 

Bulimia nervosa: 

Typically affects people in teens or early twenties and tends to affect more women than men.  Bulimia nervosa is when a person typically purges on excessive amounts of food in one sitting and then attempts to purge.  Common purging behaviors include vomiting, fasting, laxatives, diuretics, enemas, and excessive exercise.

symptoms: 

  • recurring episodes of binge eating with a lack of control 
  • recurring episodes of purging to relieve calories and to prevent gaining weight 
  • a low self-esteem 
  • body image issues 
  • a fear of gaining weight 
  • body weight fluctuates or is low 

Binge eating disorder: 

Binge eating is one of the most common eating disorders (especially in the United States).  This disorder happens more equally among men and women and often times develops during adolescence but can develop at any point in life.  This is when people binge on large amounts of food during one sitting with a lack of control.  People who binge eat don’t restrict calories and don’t purge.  

symptoms: 

  • eating large amounts of food during one sitting 
  • feeling a lack of control during binge episodes 
  • feeling a stressed, guilty, or distressed about the binge episode 
  • not using purging behavior 

Purging disorder: 

Purging disorder is when people purge after eating in attempts to induce weight loss.  The difference between purging disorder and bulimia nervosa is that bulimia is followed after a binge session whereas purging is not connected to binging.  

symptoms: 

  • self induced vomiting 
  • misuse of laxatives or other medication 
  • excessive exercising
  • fasting 

Male Eating Disorders:

I wanted to state plain and clear that men having eating disorders is a real thing. It is not a “female disease” or “female struggle” despite what you might here. Men are actually more likely to get an eating disorder in sports and are less likely to get help for it. Men only make up 5-10% of anorexia cases are male but out of that percent around 45% of them are involved in “an occupation or athletic team in which control of weight is important for good performance”. Wrestlers and boxers often go on diets in order to make weight class or go on “sweat jogs” in order to lose water weight. In addition, 70% of male jockeys often skip meals in order to lose weight. The point of me telling you all these statistics is to try to convince everyone that male eating disorders are very real. There is such a stigma around a man with an eating disorder that most never get the help that they need. In addition, eating disorders in present themselves a little differently. So, below are the symptoms typically present in a male with an eating disorder. I strongly encourage wrestling, rowing, running, jockey, dance, and figure skating coaches to read the symptoms and actively look for them in your athletes. Typically, men need more encouragement and support when it comes to eating disorders because of the stigma.

symptoms in male athletes:

  • concern with muscularity and weight
  • gay and bisexual males are at higher risk
  • being over weight prior to the eating disorder
  • obsessive exercise and training
    • sports at highest risk are gymnastics, running, jockeying, wrestling, boxing, bodybuilding, dancing, and swimming
  • body image dissatisfaction
  • men are more likely to have bulimia nervosa than anorexia nervosa
  • men with eating disorders often have other mental illnesses such as anxiety, depression, or substance disorder
  • eating disorders in men can be to gain or lose weight
Men get eating disorders too

The Facts:

  • In a study of division 1 athletes over ⅓ of females athletes report symptoms and attitudes that put them at high risk for anorexia nervosa 
  • Athletes are more at risk it they play a sport that emphasizes appearance, weight requirements, or mascularity 
    • Gymnastics, diving, bodybuilding, or wrestling 
  • Sports that have a focus on individuals rather than the entire team 
    • Gymnastics, running, figure skating, dancing or diving
  • Endurance sports 
    • Track and field, running, swimming
  • Male athletes are also at risk but primarily sports which put a large emphasis on athletes diet, appearance, size or weight requirements
    • Wrestling, bodybuilding, crew, and running
  • Mortality rate between 3.6-9.9%
  • 5-10% of anorexia cases are male but 45% of males with anorexia are involved in “an occupation or athletic team in which control of weight is important for good performance”
  • Male athletes are at higher risk for eating disorders than female athletes
  • Sports where lower body fat can be an advantage are at higher risk
    • For example distance running  
  • Non-traditional male sports are at higher risk 
    • For example figure skating and diving 
  • Sports where the male athletes have to “make weight” 
    • Boxers and rowers are likely to engage in disorderly eating, extreme food and fluid restriction, and “sweat runs”
    • Male jockeys- 69% skip meals often, 30% induce vomiting, and 14% abuse laxatives

The Inextricable Tie Between Eating Disorders and Endurance ...

What athletes need to know…

  • Allow for rest (every athlete should have at least one day of rest or light activity per week)
  • Know about nutrition and how many calories you should be eating to maintain a healthy body weight
  • Be aware of the signs
  • Monitor your body weight
  • Female athletes need to make her amenorrhea doesn’t happen (when a woman stops having her period for 3 months or more)
  • know where to go for help
    • a parent
    • a coach
    • athletic trainers

Stories From Athletes

How Coaches Can Help Detect Eating Disorders:

I would like to preface these points by saying that eating disorders are more difficult to pick up in athletes, because often it is not that an anorexic athlete is not eating at all.  Rather it is typically that an anorexic athlete is not eating enough.  For example, a runner that is running a minimum mileage of 6 miles days (at least 600 calories) should not be eating light salads for every meal.  Below are some suggesting I have for coaches on how to detect eating disorders. 

  • Examine energy level of athletes
    • an athlete with a low energy level could be because of sleep lack of sleep, lack of food, or deficient in vitamins or iron.  All these need to be addressed and are of equal importance. 
  • Go out to eat with the team and observe both watch the athletes order and how much they are eating. 
    • If the athlete orders a low-calorie meal at a restaurant that doesn’t specialize in that food could be a warning sign.  For example, if you go to a bagel sandwich place and they just eat fruit or if the team does to burger joint and the athlete orders a low-calorie salad 
    • If the athlete does not eat much, plays with their food, or offers food to other people often 
  • If an athlete fluctuates weight 
  • If an athlete avoids team events centered around food  

How to Prevent Eating Disorders on your Team:

  • Provide education on nutrition as part of practice. I recommend adding this to the preseason of all sports. This educational section should briefly go over a balanced diet which is specific for the sport they are playing (how much protein should they be eating, carbs, etc.). In addition, eat athlete should know how many calories they should be eating (this may change from preseason to normal season but each athlete should know this information).
  • A basic understanding of different types of eating disorders (anorexia nervosa, bulimia nervosa, binge eating disorder, purging disorder)
  • Male athletes need to understand that they are at risk too
  • Coaches and athletic trainers should develop a relationship with athletes.
  • Coaches need to put athlete well-being and health above success or performance
  • A supportive environment among teammates

Please Leave Comments and Feedback! 🙂

https://docs.google.com/forms/d/e/1FAIpQLSf4ief7-6Dq0QnFSbvd-XFQ06hqNhb3WL8mRfvPatyhbHzZiQ/viewform?usp=sf_link

Sources:

https://www.straitstimes.com/lifestyle/men-with-eating-disorders

https://www.bbc.co.uk/bbcthree/article/c68ae553-d125-4a58-a807-b77d15e29bf9

https://www.npr.org/2019/03/02/699733879/underdiagnosed-male-eating-disorders-are-becoming-increasingly-identified

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3289170/

https://www.nationaleatingdisorders.org/sites/default/files/nedaw18/3.%20CoachandTrainerToolkit%20-%20Copy.pdf

https://www.healthline.com/health/eating-disorders/purging-disorder

https://www.outsideonline.com/2191906/eating-disorders-are-more-common-you-think

https://www.nationaleatingdisorders.org/eating-disorders-athletes

interview with Kelly Weibe, Amy Robertson, and Liz Sanders 

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COMMENTS: 9
  1. April 23, 2020 by Kristi Conner

    This is such an interesting topic that not many people talk about! I loved how succinct and to-the-point your research was, great job!

  2. April 25, 2020 by Natalie

    Really an interesting project Anna. I hope you can share the link with some coaches you know! Congratulations on the citation.

  3. April 27, 2020 by Ona

    This is a really great project! It’s great you talked about this problem because it’s really important but not many people know about it. I really liked all the videos and images. Really nice job!

  4. April 27, 2020 by Sarah

    Hi Anna! I just wanted to come on and say I think you did a great job with this project. Giving lots of interactive things to do on this webpage made it fun to go through! Congrats!

  5. April 27, 2020 by Sasha Zitter

    Hi Anna! I really liked that you talked about how eating disorders are not just “female struggles,” and that literally anyone can develop an unhealthy relationship with food. I also like your advice to coaches on how they can create a healthier environment for their athletes. I wonder, how could I talk to an athlete friend of mine who I suspect has an eating disorder about the importance of maintaining a healthy diet with enough calories? How can we stick up for our friends in this position?

  6. April 28, 2020 by Cali Jenkins

    Hi Anna! I think you did a really amazing job on your project and you chose such an interesting and important topic! I especially liked how much stress you placed on people understanding that male athletes are also at risk for eating disorders. I really enjoyed the videos you put in but honestly the project could stand by itself with all the research you put into it. I really liked how you started the project with different types of eating disorders and the symptoms that they present so anyone looking at the project could have a baseline. You structured your project in a way that made it super easy to follow and incredibly interesting. Amazing job!

  7. April 28, 2020 by Ella Peterson

    Hey Anna! What a great project. I knew nothing about this topic coming in, but I learned a lot through your project! I especially like how you provided solutions for students to help their community. You also did a great job of dismissing the myth that eating disorders are only an issue among women. You really expanded my concepts of what an eating disorder is and how it can affect someone. Great job!

  8. April 28, 2020 by Ella Peterson

    Hey Anna! What a great project. I knew nothing about this topic coming in, but I learned a lot through your project! I especially like how you provided solutions for students to help their community. You also did a great job of dismissing the myth that eating disorders are only an issue among women. You really expanded my concepts of what an eating disorder is and how it can affect someone. Great job!

  9. April 28, 2020 by tessa

    Hi Anna! I found this a very interesting project, especially as a young female athlete. I am surrounded daily by female athletes that are conflicted about their body image, as a society and our coaches have different expectations. I have seen how it can be an everyday challenge to maintain a positive attitude about working out, lifting weights and of course eating. Another aspect that I found interesting is the presence of male athletes that also experience this struggle. I agree that society sometimes turns a blind eye and has the tenancy to categorize eating disorders as a female problem. I am impressed by how you informed everyone about this sensitive topic.

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