What Are Eating Disorders?
Eating disorders are characterized by the persistent disturbance of eating that impairs health or psychosocial functioning. The most common eating disorders that have the most damaging effects on the health and performance of athletes are anorexia nervosa and bulimia nervosa.
Anorexia nervosa is characterized as an emotional disorder where the individual exhibits an obsessive desire to lose weight by refusing to eat. The signs of anorexia nervosa are the restriction of energy intake that leads to low body weight, intense fear of gaining weight, and a distorted perception of body weight and shape. New criteria for anorexia nervosa states that patients no longer need to explicitly endorse a fear of weight gain, for it can be now inferred from patient behaviors. Complications due to anorexia nervosa include heart problems, lack of menstruation, excessive bone loss, stomach issues, and constipation.
Bulimia nervosa is characterized as an emotional disorder that involves bouts of extreme overeating, followed by depression and self-induced vomiting, purging, or fasting. The signs of bulimia nervosa include recurrent episodes of both binge eating (consumption of large quantities of food) and inappropriate compensatory behavior to prevent weight gain. Complications due to bulimia nervosa include dehydration, low potassium levels in the blood, menstrual irregularities, erosion of dental enamel, and heart problems.
Eating Disorders and Athletes
Disordered eating is more prevalent among athletes than non-athletes which illustrates the importance of this problem to the athletic community. The majority of studies investigate the prevalence of eating disorders in female athletes, however males can be affected as well. An increasing body of research has indicated that eating disorders and disordered eating are significant problems among male athletes. Generally, male athletes have a lower prevalence of eating disorders than female athletes, but have a higher prevalence than male non-athletes. Male athletes in lean sports are more likely to suffer form an eating disorder than those in other sorts.
Among female athletes the rates of eating disorders vary by sport and generally have been higher in sports with weight classes, aesthetic sports (gymnastics and figure skating), and sports where having a low body mass is seen as advantageous (cross country or cycling). In female athletes, the combination of low caloric intake, menstrual dysfunction and low bone density is called the “female athlete triad”. This dangerous triad can have lasting effects on development and the female reproductive system. The Triad is paralleled in males to include signs and symptoms of low energy availability, gonadal effects, and low bone mineral density. It is important to emphasize that for both male and female athletes low energy availability may be predisposed to stress fractures and bone stress injuries.
It is important to note that athletes tend to under-report disordered eating symptoms, and that the prevalence of disordered eating behaviors is higher among college-aged population. Individuals affected by eating disorders commonly suffer from other mental conditions including depression, anxiety, obsessive-compulsive disorder, and substance use disorder.
What Do We Do Now?
Physicians, trainers, parents, coaches, friends, and everyone in between need to be aware of the signs and symptoms of eating disorders, and of the devastating effects. Eating Disorders have wide-ranging health consequences, one of which is the highest mortality rate of any mental health condition. It is particularly worrisome that among individuals with an eating disorder, over-exercises is the disordered eating behavior most strongly associated with suicidal behavior. By intervening early and comprehensively, clinicians, family members, friends, and athletic professionals can decrease serious health and performance consequences for athletes.
If you think that either yourself or someone you care about is suffering from an eating disorder, contact your physician as soon as possible.
M. Jensen Horan ASU (Pre-Med)
David Carfagno, D.O., C.A.Q.S.M.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington, VA 2013.
- Joy, Elizabeth, Andrea Kussman, and Aurelia Nattiv. "2016 update on eating disorders in athletes: A comprehensive narrative review with a focus on clinical assessment and management." British journal of sports medicine50.3 (2016): 154-162.
- Warren, M. P., and N. E. Perlroth. "The effects of intense exercise on the female reproductive system." Journal of Endocrinology 170.1 (2001): 3-11.