Eating Disorders in Female Athletes

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Eating disorders are a group of abnormal and harmful eating patterns. They are typically used in a misguided attempt to lose weight or maintain a lower than normal body weight. The most common eating disorders are anorexia nervosa, bulimia nervosa, and binge eating.

Anorexia Nervosa

Anorexia is severe weight loss and refusal to maintain body weight. It often includes an intense fear of gaining weight even if the person is under weight. Coupled with this is a negative self-image due to body shape or appearance, known as “body image disturbance.” Most females will also stop menstruating.

Outwardly, an athlete suffering from anorexia may avoid eating in public and wear baggy clothing to disguise their body. Inwardly, people diagnosed with anorexia are often in denial, depressed, withdrawn, irritable, and have difficulty sleeping. In addition, they can also experience fatigue, low blood sugar, thinning hair, and a slowed heart rate.

Bulimia Nervosa

Bulimia, defined as binge eating followed by self-induced vomiting and laxative use (purging), includes a feeling of being out of control. Dehydration, vitamin and mineral deficiencies, damage to vital organs, or blisters in the throat, are a few typical physical signs of the disease. Notably, the body weight of someone suffering from bulimia is usually in the normal range, and can even be higher than normal. Regardless, there will be obvious fluctuations in weight, both up and down. Depression and anxiety are also typical with bulimia.

Binge Eating Disorder

Binge eating is the most common eating disorder in the United States. It is similar to bulimia in that it involves recurring episodes of eating significantly more food in a short period of time than most people would under similar circumstances. However, people with binge eating disorder do not typically purge after an episode. Like bulimia, sufferers will say that they feel out of control. Symptoms include eating too quickly even when not hungry, feelings of guilt, embarrassment, or disgust. Many people occasionally overeat, and may even have feelings of guilt or embarrassment after. For this reason it is important to note that to be considered an eating disorder, the behavior has to occur at least once a week for three months.

Female Athletes and Eating Disorders

Individuals suffering from all three eating disorders can be difficult to identify. This is because they go to great lengths to eat alone and hide the behavior from others. With this in mind, it is important for the athletic trainer to understand the signs and keep an eye on their athletes. Studies show that female athletes are at the greatest risk. Perhaps this is because of the number of sports for women that emphasize slim bodies such as gymnastics, swimming, and track and field. Likewise, athletes that tend to be perfectionists, have obsessive-compulsive behavior, social withdrawal, depression, and high-achievers are at a greater risk for developing eating disorders.

Female Athlete Triad

Eating disorders in female athletes can lead to what is known as the “female athlete triad.” The triad’s three elements are eating disorders, the absence of a menstrual cycle, and osteoporosis or bone loss. Eating disorders can lead to chronic fatigue, dehydration, anemia, and decreased bone density as mentioned above. When this happens, there is less iron in the blood. Lower iron combined with less body fat can result in loss of menstrual cycles, or amenorrhea – defined as the absence of three or more consecutive menstrual cycles. In an effort to maintain menstruation, the body will begin to break down bone for nutrients. The result is osteoporosis – premature bone loss. One sign of osteoporosis in a female athlete is repeated stress fractures that don’t heal.

Treatment

Once a young person starts an eating disorder it is very difficult for them to stop. This is because they gain a false sense of control over situations that becomes addicting. Due to the severe health risks and possibility of death, it is critical to seek treatment as soon as possible. Treatment for eating disorders is different from person to person. The good news is that most eating disorders are treatable. With the help of a qualified health care professional, many people are able to recover and regain their health.

Prevention

Ultimately, prevention is best. With this in mind, athletic trainers can help by educating athletes about nutrition and weight. Helping young athletes understand that being skinnier isn’t always better for their performance can go a long way towards heading off an eating disorder. Furthermore, teaching athletes the difference between body fat and body weight helps to create a healthier self-image. Finally, coaches play a role as well, by taking the focus off body weight, eliminating group weigh-ins, recognizing individual size and shape differences, and acting on signs of eating disorders before they get worse.

Written by: Nicole Porter, MS, ATC, athletic trainer for The Center Foundation and Madras High School in Madras, Oregon. Learn more about Nicole HERE.

The Center Foundation places dedicated athletic trainers in local high schools to provide sports medicine services to young athletes at no charge to the students or their families. Learn more about our work HERE.

 

References:
  1. https://www.nationaleatingdisorders.org/ (accessed online 12/12/2018)
  2. Beals KA. Subclinical eating disorders in female athletes. Journal of Physical Education, Recreation & Dance. 2000;71(7):23-29.
  3. Pearson FC, Rivers TC. Eating disorders in female college athletes: Risk factors, prevention, and treatment. College Student Affairs Journal. 2006;26(1):30-44.
  4. Feeding and Eating Disorders. In Diagnostic and statistical manual of mental disorders: DSM-5. Washington, D.C.: American Psychiatric Association; 2013.
  5. Beals KA, Brey RA, Gonyou JB. Understanding the female athlete triad: Eating disorders, amenorrhea, and osteoporosis. J Sch Health. 1999;69(8):337-40.

 

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