Are Athletes At Risk?

There is data suggesting that athletes are at greater risk of developing an eating disorder (ED) than non-athletes.  There is also data that suggests the opposite.  Experts in the field have concluded that the dual pressure some athletes experience to obtain and maintain a particular body type does place them at higher risk - espeically in particular sports. Dual Pressures Both males and females experience the pressure to look a certain way based on societal/cultural expectations.  In addition to this pressure, those who are athletes may also experience the pressure to look a certain way in order to theoretically increase their chances for a better performance.  Trying to fit these expectations can be challenging at best and can often lead to performance and health problems.  Male Athletes  The societal pressure for males to have a certain body type seems to be increasing.  The general expectation for males is often referred to as the "muscular ideal."  The muscular ideal demands a chiseled, ripped physique with very little body fat.  Increasing lean muscle mass generally is not frowed upon; however, the image that is portrayed as being ideal in the media is virtually impossible for most males.  Just as most females cannot and should not strive for the "thin ideal" (see below) most males cannot and should not strive for the muscular ideal - it is simply not realistic for most males to achieve.  Trying to achieve this ideal can lead some males to engage in extreme and sometime dangerous eating and exercise practices. As noted above, developing lean muscle mass is generally a good thing to work on, and in the context of sport can help male athletes perform more effectively.  The incidence of eating disorders among males (regardless of whether or not they are an athlete) has been increasing.  One of the proposed reasons for this is that as women and girls have been increasingly exposed to the "thin ideal" men and boys have been increasingly exposed to the "muscular ideal."  Both of these "ideals" are impossible standards for 99% of the population.  For some male athletes this pressure to be muscular without body fat can translate into an Eating Disorder.  They may enter into an uncontrollable cycle of binging and purging or an uncontrollable effort at restricting intake.  Another way that males may try to attain this impossible standard is by engaging in excessive use of weights (which may or may not be accompanied by the "traditional" eating disorder behaviors).  This obsession with the development of muscle has been labeled "bigorexia."  This is not something that an individual can be diagnosed with; however, it is a term used to describe the uncontrollable determination to build muscle mass - often at any cost.  This obsession can lead to myriad serious psychological as well as medical consequences and should be taken seriously.  Female Athletes  Females experience pressure to conform to what is known as the "thin ideal."  The thin ideal demands that girls and women fit a very narrowly defined body type: tall, thin, small waist, etc.  Many females will go to great extremes to achieve this ideal which can include engaging in dangerous eating behaviors.  For some girls and women the eating patterns they develop to try to be thin can quickly develop into an eating disorder which is no longer under their control. In the quest to get thin females can lose lean muscle mass which is important for peak athletic performance.  Many athletes and coaches operate under the false assumption that thinner = faster, more agile, more flexible.  Over time, however, depriving one's body of enough fuel (i.e., food) and the ideal kind of fuel (i.e., balanced and varied food intake) will result in poorer performance. In addition to a decline in performance female athletes can be susceptible to the female athlete triad (see below for more information).  The female athlete triad is not a diagnosis, but a way of understanding how insufficient food intake can result in potentially permanent health issues.  The triad consistes of 1) low energy availability, 2) menstrual abnormalities, and 3) compromised bone density.  Female athletes who do not consume enough food for the amount of energy they are expending may notice that their menstrual cycle does not begin (if they are a young adolescent) or may become infrequent or stop altogether.  Unfortunately in some sports, the cessation of menstruation is thought to be a sign that the athlete is "training really hard."  What this means for their body, however, is that they hormone levels have been negatively affected.  When this occurs, bone remodeling cannot occur effectively and a loss of bone density can develop. Female athletes who are involved in sports/activities that emphasize thinness (e.g., distance running, gymnastics), aesthetics (e.g., dancing, equitation), have revealing uniforms (e.g., swimming, track & field, volley ball) or that have a judging component to them (e.g., diving, gymnastics) may be at greater risk for developing an eating disorder or related concern.  Regardless of the sport/activity in which you compete, in order to remain healthy as your participate it will be important for you to ensure that you are taking in enough fuel so that you can perform at your best.  It is a myth that "thinner is better" when it comes to improving performance.  While it is true that for some sports/activities a higher weight may decrease performance it is not the case that if losing weight will increase performance to a point, then losing even more weight will improve your performance even more.  At a certain point your body will be unable to function as it needs to due to lack of energy and necessary nutrients.  And your performance will begin to decline.  I routinely hear from competitive and non-competitive athletes who have lost an excess amount of weight that they miss their sport.  They tell me they can no longer do their sport because they literally do not have the energy it takes.  Some have said that they believe (or have been told) that season-ending injuries were a result of consequences of their eating disordered behavior (e.g., fractures due to loss of bone density).  I have yet to hear from an athlete who can no longer participate in their sport that they are glad they can't.  Thus far, all have said that they want it back.  Most recognize that they can't get it back until they are healthy again.

The Female Athlete Triad

Female Athlete Triad The Female Athlete Triad was proposed to help athletes, coaches, physicians, parents recognize when a female athletes may be at risk for serious psychological and/or medical problems.  The Triad consists of: Menstrual Irregularity Primary Amenorrhea - has not begun menstruating by the age of 16 Secondary Amenorrhea - stops menstruating for a minimum of 3 consecutive months Oligomenorrhea - infrequent menstruation Problematic Eating Behaviors Clinical Eating Disorder (i.e., Anorexia Nervosa or Bulimia Nervosa) Sub-Clinical Eating Disorder - this can be just as medically and psychologically serious as the above Loss of Bone Density Osteoporosis - severe loss of bone density; bones will easily fracture Osteopenia - mild thinning of bone mass It is important to realize that the presence of even one of the elements of the Triad means that the athlete should be assessed for the other two.  For example, if an athlete has stopped menstruating regularly or at all then she should be assessed for the other two elements of the Triad.  Getting Help It is inappropriate for anyone other than a licensed medical or mental health professional to diagnose an Eating Disorder or related condition.  If you suspect that an athlete is experiencing any of the above, they should be evaluated ideally by both a  medical and mental health professional.  Ideally, these professionals should not only be competent to work with Eating Disorders and related concerns, but they should also be familiar with working with athletes and their myriad supports (e.g., parents, coaches, trainers, etc.).