Surprising Types (and Signs) of Eating Disorders in Athletes
Looking beyond anorexia, bulimia and binge eating.
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“The message we get from the fitness industry is that your body is the problem, and it’s your job to fix it,” says Gillian Goerzen, author of The Elephant in the Gym: Your Body-Positive Guide to Writing Your Own Health and Fitness Story (Winchelsea Media, November 2018) and owner of the Super You Studio. This pressure can be even more pronounced in athletes — and in the fitness professionals who train them. In fact, according to the National Association of Anorexia Nervosa and Associated Disorders, some of the hallmarks of a successful athlete — mental toughness, commitment to training and pursuit of excellence — can easily slide into asceticism, excessive exercise and perfectionism, which are signs of anorexia nervosa.
In her recent interview for the Concordia University, St. Paul, blog, Goerzen also shared that she, like many fitness professionals, understands this deeply. “From hating her body at the age of 5, it took more than 20 years, an eating disorder, an Ironman and becoming a mom to finally uncover the kinder, more compassionate approach to health and fitness that she teaches today,” her bio states. Today, the Vancouver Island native draws on her personal experience and professional training in kinesiology, yoga, personal training, group fitness and other exercise modalities to provide health and fitness coaching both in person and online. However, having been an athlete who faced an eating disorder, she adds, does not make anyone an expert in the subject.
A Guide to Lesser-Known Eating Disorders in Athletes
Though many people think they are familiar (at least generally) with eating disorders — particularly anorexia nervosa, bulimia nervosa and binge eating — these are just a few of a wide range of behaviors to watch for. Below are just four types of lesser-known disorders that fitness professionals should know about when working with athletes.
Atypical Anorexia Nervosa
Surprising Factor: Anorexia Can Happen at Any Weight
Most people picture patients with anorexia nervosa as very underweight, but that is not always the case. According to a 2019 study, one-third of all people admitted for eating disorder treatment are at normal weight or above. The study followed a group composed mostly of women ages 12 to 24 who had just lost about 30 pounds over 15 months.
More than half of the group fell into this higher-weight category, with a diagnosis officially known as atypical anorexia nervosa. This carries the same symptoms as anorexia nervosa, including restriction of food intake, intense fear of gaining weight and a “disturbance” in the way they view their body. However, the group with a normal-to-high body mass index showed greater damage to their health — both physically and mentally. The study suggests this may be because of the added trauma of stigma or teasing.
The take-away here: Just because an athlete does not look underweight does not mean they are not at risk.
Surprising Factor: There Is Such a Thing as Eating “Too” Healthfully
Healthy eating is key to performance improvements in sport and exercise. Orthorexia, though, is proof that too much of anything can be undesirable. The National Eating Disorders Association defines it as “an obsession with proper or ‘healthful’ eating,” though it has yet to make it into the DSM-5 (the diagnostic reference guide of psychiatry).
The NEDA notes that some common characteristics of orthorexia include compulsive reading of food packaging, cutting out an increasing number of food groups without a medical reason (e.g., food allergy), being unable to eat foods that do not “measure up” to certain health criteria, and being unusually interested in food overall, including future meals, food blogs and what other people are eating.
Because it is so restrictive, orthorexia may result in malnutrition, so it may impact the body similarly to anorexia nervosa. Obviously, it also may impact the athlete’s performance in sport.
The Female Athlete Triad
Surprising Factor: Men Are at Risk for Something Similar
In an opinion paper from The American College of Obstetricians and Gynecologists, the female athlete triad is described as having three components: 1) taking in insufficient calories (with or without disordered eating), 2) the stopping or disruption of menstruation and 3) low bone density. Recently, experts also have identified a condition called relative energy deficiency in sport (RED-S), which shares many of the same signs but is used to describe both men and women. According to a clinical assessment tool in the British Journal of Sports Medicine, signs of RED-S include decreased muscle strength, endurance, training response, coordination and glycogen stores; increased injury risk; depression and irritability; and decreased concentration and impaired judgment.
Clearly, some of these topics can fall outside the realm of discussion on the sidelines of a game or even in the locker room or gym. Fitness professionals who do not delve deeply into the participants’ lives beyond sport may not be aware of some of these symptoms.
Surprising Factor: It May Be a Sign of an Eating Disorder
Also known as exercise addiction or compulsive exercise, exercise dependence has been associated with eating disorders and (in women) perfectionism. While this had been previously noted in women, a 2019 study also found this to be true for male cyclists, triathletes and long-distance runners.
Exercise dependence is characterized as a craving for physical training, an inability to reduce exercise to non-excessive levels, and possible harm to physical and mental health, such as injuries, depression and damage to social relationships.
As exercise participants likely discuss many of these factors with their coaches and trainers, these professionals my be able to spot them — and initiate a conversation to explore whether their nutrition and eating are also impacted.
The Big Picture: How Exercise Science Can Help
The National Eating Disorders Collaboration notes that eating disorders and disordered eating can impact all parts of an athlete’s life, not just exercise performance. An eating disorder can cause problems with concentration, psychological well-being (e.g., negative moods and depression) and withdrawal from social life. And it can result in muscle loss, gain or cramps, bone loss, digestive problems, dizziness/fainting, headaches and sleep problems. So these, too, all count as potential warning signs.
Because fitness trainers and coaches spend so much time with athletes, they have the perfect vantage point from which to watch for signs of disorders in eating or exercise (or both). Admittedly, it can be challenging to understand the scope of practice of the fitness professional — and to tell whether a possible sign is a cause for concern. For example, is the exerciser sleeping poorly because of work problems — or an eating disorder? Is the keto diet a sign of orthorexia — or a well-conceived program that suits the athlete? When is it safe for an athlete to resume training during treatment or recovery from an eating disorder? How do you know if you, as a fitness professional, are unintentionally supporting disordered behavior?
These are just some of the questions answered by professionals with direct experience in the field in the 100 percent online Bachelor of Arts in Exercise Science program offered at Minnesota’s Concordia University, St. Paul. Courses, including applied nutrition, health psychology and exercise assessment, will provide a solid foundation from which informed decisions can be made with future clients or exercise participants. Students participating in the program also will gain a deep understanding of kinesiology concepts in human movement, exercise and management in preparation for careers in training, coaching, fitness, health and wellness, and rehabilitation sciences.
Look into the program today and plan how you can support your athletes in a program that is as healthful in reality as it seems at first glance.
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