Disordered Eating and Eating disorders are not just about food, weight, vanity, or willpower, but are serious and potentially life-threatening mental disorders. A person with an eating disorder can be underweight, normal weight, or overweight. Most eating disorders occur when a person has distortions in thoughts and emotions related to body image, leading to marked changes in eating or exercise behaviors that interfere with the person’s life.

Why student-athletes are at risk

Prevalence.
Eating disorders occur in all sports, but not equally in all sports. As in society, eating disorders in sport occur more frequently in females than males. One area in which research findings are more definitive is for "lean" sports for which a thin/lean body or low weight is believed to provide a biomechanical advantage in performance or in the judging of performance. Women in these sports are considered to be at the highest risk.

Genetics.
Epidemiological and molecular genetics studies suggest a strong genetic predisposition to develop an eating disorder, and that these disorders aggregate in families in part due to genetics. Family and twin studies have found heritability estimates of 76 percent for anorexia nervosa and 83 percent for bulimia nervosa. Not all individuals with a genetic predisposition develop the disorder, as other factors are involved.

Sociocultural factors.
Before genetics-related findings, the primary explanation for the development of eating disorders involved sociocultural factors. Certainly, from a sociocultural perspective, most individuals are exposed to societal or cultural pressures regarding weight or appearance, but again, not all will develop an eating disorder. Most who do are female, and the disorder’s onset often occurs during adolescence.

A simple conceptualization is that genetics sets the stage for the disorder, but sociocultural pressures can precipitate it. Once the disorder begins, sociocultural pressures usually assist in maintaining the disorder. Also, from a sociocultural perspective, eating problems can begin or worsen during transition periods, which makes freshman student-athletes particularly vulnerable.

Additionally, student-athletes may experience more stress than non-athletes because they deal not only with the transition away from home and pressures related to academic demands of college but also the pressures associated with sport participation. Eating problems are often the way individuals deal with such stressors.

Sport-related factors.
Just as society and culture emphasize the "thin ideal," similar pressures exist in the sport environment regarding being thin/lean and its purported positive effect on sport performance.

This emphasis on reducing body weight/fat to enhance sport performance can result in weight pressures on the student-athlete from coaches (or even teammates) that increase the risk of restrictive dieting, as well as the use of pathogenic weight loss methods and disordered eating. Even the student-athlete’s perception that her coach thinks she needs to lose weight can heighten weight pressures and increase the risk of disordered eating.

For some student-athletes, revealing uniforms can increase body consciousness, body dissatisfaction, and the use of pathogenic weight loss methods. One study found that 45 percent of swimmers surveyed reported a revealing swimsuit as a stressor. Another study in volleyball found not only that revealing uniforms contributed to decreased body esteem but also distracted players and negatively affected sport performance.

The relationship between body image and body dissatisfaction in female student-athletes is more conflicted and confused than in the general population. Sportswomen have two body images – one within sport and one outside of sport, and disordered eating or an eating disorder can occur in either context or both. Additionally, some female student-athletes are conflicted about having a muscular body that facilitates sport performance but may not conform to the socially desired body type and may be perceived as being too muscular when compared to societal norms regarding femininity.

Coaches have considerable influence with their athletes, and it appears that their relationship with their student-athletes – and more specifically their motivational climate – can influence the risk of disordered eating. A relationship between coach and athlete characterized by high conflict and low support has been associated with increased eating pathology among athletes. Additionally, an ego/performance-centered motivational climate (vs. a skills-mastery climate) that some coaches use has been associated with an increased risk of disordered eating.

Another risk to student-athletes relates to aspects of the sport environment that make identification of disordered eating/eating disorders more difficult. In society and sport, athletes are often expected to display a particular body size or shape that becomes characteristic of a particular sport, such as distance runners being thin. Such "sport body stereotypes" can affect coaches’ perceptions of athletes, and athletes who fit the "thin" stereotype are less apt to be identified as having an eating problem. Identification by coaches is sometimes influenced by sport performance, and student-athletes are less likely to be identified if their sport performance is good.

Finally, eating disorder symptoms (such as dieting, weight loss and excessive training) may be misperceived as "normal" or even desirable in the sport environment, and personality characteristics/behaviors similar to those of eating disorder patients (such as perfectionism and excessive training) may be misperceived as "good athlete" traits.

Anorexia Nervosa

Anorexia Nervosa is an eating disorder characterized by an extremely low body weight, an intense fear of gaining weight and a distorted perception of weight. Those with anorexia often place a high value in controlling their own weight and intakes. 

Signs and Symptoms:

• Excessive weight loss/low body weight
• Always thinking about food, calories, and weight
• Focus on Healthy Eating/Adopting a strict new diet
• Wearing layered clothing (to hide weight loss)
• Mood swings or depression
• Inappropriate use of laxatives, enemas, or diuretics in order to lose weight
• Avoiding activities that involve food
• Excessive working out

Health Complications from Anorexia in Athletes

Anorexia poses life-threatening complications for athletes, including:

• Heart complications 
• Anemia
• Increased bone loss therefore increasing fracture risk
• Loss of muscle
• Low Blood Pressure
• Dehydration
• Sleep Disturbances
• Increased risk of injury
• Kidney Problems and Failure

Bulimia Nervosa

People with bulimia nervosa binge and then purge to try to get rid of calories in an unhealthy way. 

Signs and Symptoms:

• Feeling a loss of control when binging (can't stop eating)
• Fear of gaining weight
• Fasting between eating sessions
• Preoccupation with food
• Loss of tooth enamel/yellowing from excessive purging

Binge Eating Disorder

Many people who have BED eat in secret. Once behind closed doors, they eat large amounts of food for a certain length of time. For example, they may eat large amounts of food for 2 hours. A binge is often followed by feelings of guilt, shame, and embarrassment. Despite not wanting to do it again, the compulsion to binge returns. It’s not unusual for people with BED to also have low self-esteem or the symptoms of depression.

Effects of Disordered Eating on Performance

• Decreased Oxygen Capacity
• Decreased Running Speed
• Low Energy and General Weakness
• Increased Risk of Energy
• Decreased Concentration

The Female Athlete Triad

The Female Athlete Triad includes disordered eating, amenorrhea, and osteoporosis. The lack of nutrition resulting from disordered eating can cause the loss of several or more consecutive periods. This in turn leads to calcium and bone loss, putting the athlete at greatly increased risk for stress fractures of the bones. Each of these conditions is a medical concern. Together they create serious health risks that may be life threatening. While any female athlete can develop the triad, adolescent girls are most at risk because of the active biological changes and growth spurts, peer and social pressures, and rapidly changing life circumstances that go along with the teenage years.

References:

Beals, K.A. (2004). Disordered Eating Among Athletes: A Comprehensive Guide for Health Professionals. Human Kinetics: Champaign, IL.

Chelsea Fielder-Jenks, M.A. | CFJCounseling.com, Bulimia In Athletes, Eating Disorder Hope

Hudson J.I., Hiripi E., Pope H.G., & Kessler R.C. (2007). The Prevalence and Correlates of Eating Disorders in the National Comorbidity Survey Replication. Biological Psychiatry, 61, 348-358.

Johnson, C., Powers, P.S., & Dick, R. (1999). Athletes and Eating Disorders: The National Collegiate Athletic Association Study, International Journal of Eating Disorders, 6, 179.

National Eating Disorders Association. (2014). Learn, Special Issues, Athletes and Eating Disorders. Retrieved from https://www.nationaleatingdisorders.org/athletes-and-eating- Disorders

Pietrangelo, Ann. Medically Reviewed by Timothy J. Legg, PhD, PMHNP-BC on Binge Eating Disorder: Signs and Symptoms, Healthline, January 22, 2016.

Quinn, Elizabeth, Athletes and Anorexia: Everything You Need to Know: Certain athletes are more prone to eating disorders. Sports Medicine, February 22, 2016.

Ray, R. & Wiese-Bjornstal, D.M. (1999). Counseling in Sports Medicine. Human Kinetics: Champaign, IL.

The Renfrew Center Foundation for Eating Disorders.

Thompson, R.A. & Trattner, S.R. (1993). Helping Athletes with Eating Disorders. Human Kinetics: Champaign, IL.

Vohs, K., Heatherton, T., & Herrin, M. (2001). Disordered eating and the transition to college: A longitudinal study. International Journal of Eating Disorders, 29, 280-288.

• Eating a lot of food, even if you’re not hungry
• Frequently eating until you feel overstuffed
• Eating a lot of food very quickly
• Bingeing in secret
• Lying about your food habits
• Stashing food for later
• Rearranging your life around binges
• Continuing a cycle of bingeing and trying to gain control over eating
• Bingeing when you feel stressed, anxious, or depressed
• Feeling out of control when it comes to eating
• Guilt, shame, and embarrassment after bingeing
• Weight gain followed by repeated attempts to diet, which is often called “yo-yo dieting”
• Powerful cravings, or irresistible urges to eat particular foods
• Decreased Oxygen Capacity
• Decreased Running Speed
• Low Energy and General Weakness
• Increased Risk of Energy
• Decreased Concentration