Eating Disorders and Disordered Eating in Athletes.

What are Eating Disorders? Who Do They Affect?

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Eating disorders and disordered eating exist on a continuum.  Eating disorders representing a more extreme, clinically diagnosable form of this psychopathology. In the DSM-5, which is a large book that sets out the criteria for a range of psychiatric illnesses including eating disorders several types of eating disorders are defined such as (but not limited to) anorexia nervosa, bulimia nervosa, binge eating disorder, and otherwise specified feeding and eating disorders. All types of eating disorders pose serious threats to the physical and mental health of those afflicted. Clinically diagnosable eating disorders such as Anorexia Nervosa and Bulimia Nervosa affect about 1-3% of the population and those with eating disorders are likely to also have other mental illnesses such as anxiety and depression. Eating disorders are also consistency undertreated due to a lack of understanding by healthcare professionals and due to the tendency of those suffering to keep their eating disorder a secret. Eating disorders can affect all genders, ethnicities and ages, although the most sufferers are female with common onset of anorexia and bulimia taking place in adolescence.

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What is Disordered Eating? Who Does it Affect?

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Disordered eating exists on the other end of the continuum and does not have a confirmed definition, rather it is a concept often captured as subclinical issues related to food such as restriction and bingeing and often also includes subclinical concerns with weight and shape. Disordered eating occurs much more commonly than eating disorders, and in sport it is estimated that 20% to 25% of both male and female athletes have some form of disordered eating. The rate of disordered eating has increased in recent decades.  Despite not being a clinically diagnosable disorder, disordered eating still has negative mental and physical health ramifications on those suffering. However, it is important to know that not all cases of disordered eating will escalate into a clinically diagnosable eating disorder. As with eating disorders, disordered eating can affect all genders, ethnicities and ages, although the most sufferers are female with common onset again taking place in adolescence,

 

Who is at Risk?
 

There are risk factors such as environment, genetics, and personality aspects (such as perfectionism) that create a greater likelihood for the development of eating disorders and disordered eating for athletes and non-athletes alike.

Different sports types are thought to pose lesser or greater risks for disordered eating and eating disorder development. When talking about sport and eating disorder/disordered eating, sports get classified as lean or nonlean. Lean sports are those in which a lean body weight and shape benefit performance. These are sports such as gymnastics, figure skating, or road cycling and are largely considered to have higher prevalence rates of disordered eating and eating disordered in athletes overall. Lean sports can also be categorised further as aesthetic in which a lean shape is determined to be visually appealing and therefore rated higher either by a judge. Nonlean sports would be one in which a lean weight or shape does not offer any advantage, such as football or lacrosse. Nonlean sports have a lower prevalence rate of disordered eating and eating disorders. Highest prevalence of eating disorders and disordered eating in female athletes is seen in aesthetic sports, while highest prevalence rates are seen in antigravitation sports for male athletes. 

 

Relative Energy Deficiency in Sport (RED-S)
 

When an athlete consistency consumes less calories than they expend it can lead to a syndrome called Relative Energy Deficiency in Sport (RED-S).  Relative energy deficiency leads to low energy availability for the body and mind which in turn negatively impacts health and performance. Health consequences of low energy availability are far reaching, impacting the central nervous system, the cardiovascular and endocrine system, as well as having gastrointestinal and reproductive ramifications. RED-S also has pervasive performance consequences for athletes including increased injury risk, decreased response to training, decreased coordination and more. Notably, poor psychological wellbeing can act both as a cause or a result of RED-S. Calorie deficiency due to poor nutritional understanding and intense training can result in psychological consequences such as depression. Or disordered eating or an eating disorder can cause an athlete to restrict caloric intake to a point of health and performance detriment. No matter the underlying reason, extended bouts  of low energy availability can impair health and performance.

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When Athletes Retire

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The prevalence of disordered eating is not only limited to competitive athletes. In fact, the occurrence of disordered eating has also been identified among retired athletes. Throughout an athlete’s career, the sport environment is particularly influential in shaping eating behaviours and food opinions. Specifically, in lean sports, an emphasis is frequently placed on the positive relationship between restricting what an athlete eats and performance success. This association can be quite long-lasting. Many athletes who engage in disordered eating behaviours during their competitive years continue to do so even when performance expectations end. Additionally, when an athlete retires from sport, physical activity levels significantly decrease, eating patterns become less structured, and retried athletes may begin to notice body shape and weight changes. These changes may be experienced with discontent as they contrast the body shape an athlete grew accustomed to during their competitive years. If a retired athlete is unable to accept their new body, they may adopt disordered eating behaviours in an attempt to regain a leaner body shape. Therefore, it is important to understand that unhealthy eating behaviours do not always end with athletic career termination and additional issues with disordered eating may arise from the shift out of sport. Therefore, all athletes entering retirement should be encouraged to seek support as they transition out of sport.

 

Charities for support for eating disorders:

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https://www.beateatingdisorders.org.uk/

https://mirror-mirror.org/getting-help/national-eating-disorders-organizations

 

If you are concerned about your health, please reach out to your GP for support.

This isn’t your fault. Opening up to others can help. Contact your GP or find registered help with clinical psychologists, dieticians and nutritionists.

 

Myth Busting!

 

There can be a lot of wrong advice or stereotypes that make seeking help for eating disorders and disordered eating harder. A few key facts below to remember:

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• Eating disorders and disordered eating are not a choice!

• Eating disorders can affect men and women and anyone nonbinary.

• You do not need to be thin or underweight to have an eating disorder or disordered eating. Lots of people of different sizes suffer from eating disorders and disordered eating.

• People of all ethnicities can get eating disorders and disordered eating.  

 

Often time social media and diet culture pushed on these platforms can make us feel worse about our bodies and about our food intake. There are lots of confusing and damaging messages out there. Below are some social media accounts who are body positive and showcase a healthy relationship with food, body image, and mental health.

 

Instagram Accounts to Follow: (if under 18 please check with parents/guardian for permission)

 

• Positively Present

• Anna Sweeney

• Nudenutrionrd

• Theawkwardyeti

• IsaRobinson Nutrition

• The eating disorder therapist

• Howmental

• Dr.christina_

• Haleydrewthis

• Aolanow

• Ladieswholaunch_

• GeorgieBuckley_dietitian

• Boydposipanda

• Laurathomasphd

 

 

If you are keen to learn more about eating disorders in athletes the course below offers the following CPD: This new online CPD course provides information and guidance for sports professionals on the identification and management of eating problems among athletes. This evidence-based course has been carefully designed to improve sports professionals’ awareness and knowledge about eating problems among athletes. It aims to equip learners with the confidence and skills needed to identify potential eating problems among the athletes they work with. The course includes resources and tips for coaches and other sports professionals to guide them through approaching, supporting and facilitating the recovery of athletes with potential eating problems.

https://store.lboro.ac.uk/short-courses/ncsem/online-courses/disordered-eating-in-athletes

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Key Research Papers/Sources

 

Association, A. P. (2013). American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders: Diagnostic and Statistical Manual of Mental Disorders (Fifth Addi). Arlington, VA, US.

 

Buckley, G. L., Hall, L. E., Lassemillante, A. M., Ackerman, K. E., & Belski, R. (2019). Retired athletes and the intersection of food and body: A systematic literature review exploring compensatory behaviours and body change. Nutrients, 11, 1395. https://doi.org/10.3390/nu11061395

 

Drinkwater, B., Loucks, A., Sherman, R., Sundgot-Borgen, J., & Thompon, R. (2005). International Olympic Committee Medical Commission Working Group Women in Sport. Position Stand on the Female Athlete Triad. International Olympic Committee.

 

Greenleaf, C., Petrie, T. A., Carter, J., & Reel, J. J. (2009). Female collegiate athletes: Prevalence of eating disorders and disordered eating behaviors. Journal of American College Health, 57(5), 489–495. https://doi.org/http://dx.doi.org/10.3200/JACH.57.5.489-496

 

Hawkins II, R. C., & Clement, P. F. (1980). Development and construct validation of a self-report measure of binge eating tendencies. Addictive Behaviors, 5(3), 219–226.

 

Hudson, J. I., Hiripi, E., Pope Jr, H. G., & Kessler, R. C. (2007). The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological Psychiatry, 61(3), 348–358.

 

Klump, K. L., Bulik, C. M., Kaye, W. H., Treasure, J., & Tyson, E. (2009). Academy for eating disorders position paper: eating disorders are serious mental illnesses. International Journal of Eating Disorders, 42(2), 97–103.

 

Krentz, E. M., & Warschburger, P. (2011a). Sport-related correlates of disordered eating: A comparison between aesthetic and ballgame sports. International Journal of Sport Psychology, 42(6), 548–564. Retrieved from http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=psyc8&NEWS=N&AN=2012-03633-003

 

Krentz, E. M., & Warschburger, P. (2011b). Sports-related correlates of disordered eating in aesthetic sports. Psychology of Sport and Exercise, 12(4), 375–382. https://doi.org/http://dx.doi.org/10.1016/j.psychsport.2011.03.004

 

Mountjoy, M., Sundgot-Borgen, J. K., Burke, L. M., Ackerman, K. E., Blauwet, C., Constantini, N., … Meyer, N. L. (2018). IOC consensus statement on relative energy deficiency in sport (RED-S): 2018 update. British Journal of Sports Medicine.

 

Nattiv, A., Loucks, A. B., Manore, M. M., Sanborn, C. F., Sundgot-Borgen, J., & Warren, M. P. (2007). The female athlete triad. American College of Sports Medicine position stand. Med Sci Sports Exerc, 39(10), 1867–1882.

 

Petrie, T. A., Greenleaf, C., Reel, J., & Carter, J. (2008). Prevalence of eating disorders and disordered eating behaviors among male collegiate athletes. Psychology of Men & Masculinity, 9(4), 267–277. https://doi.org/http://dx.doi.org/10.1037/a0013178

 

Sundgot-Borgen, J, & Torstveit, M. K. (2010). Aspects of disordered eating continuum in elite high-intensity sports. Scandinavian Journal of Medicine & Science in Sports, 20(Suppl 2), 112–121. https://doi.org/http://dx.doi.org/10.1111/j.1600-0838.2010.01190.x

 

Sundgot-Borgen, Jorunn. (1993). Prevalence of eating disorders in elite female athletes. International Journal of Sport Nutrition and Exercise Metabolism, 3(1), 29–40.

 

Sundgot-Borgen, Jorunn. (1994). Risk and trigger factors for the development of eating disorders in female elite athletes. Medicine & Science in Sports & Exercise.

 

Sundgot-Borgen, Jorunn, & Torstveit, M. K. (2004). Prevalence of eating disorders in elite athletes is higher than in the general population. Clinical Journal of Sport Medicine, 14(1), 25–32.

Sundgot‐Borgen, J., & Torstveit, M. K. (2010). Aspects of disordered eating continuum in elite high‐intensity sports. Scandinavian Journal of Medicine & Science in Sports, 20, 112–121.

 

Thompson, R. A., & Sherman, R. T. (2010). Eating disorders in sport. Eating Disorders in Sport. Retrieved from http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=psyc7&NEWS=N&AN=2010-09077-000

 

Tylka, T. L., & Subich, L. M. (1999). Exploring the construct validity of the eating disorder continuum. Journal of Counseling Psychology, 46(2), 268.