Written by Patty Atkinson, MEDA Undergraduate Intern
As a collegiate cross country runner, I have seen eating disorders affect both my teammates and myself, due to the psychological and physiological effects that sports environments can have on athletes’ eating patterns. The character trait of perfectionism that is seen in so many eating disorder patients displays itself in the athletes’ desire for competitive excellence. Combining the pressure to perform competitively with existing societal value for thin bodies makes athletes even more at risk for developing eating disorders.
Athletes most at risk for developing some type of disordered eating are those that participate in performance sports that emphasize an ideal body weight, shape, size or build. Some of these sports include gymnastics, dance, diving, wrestling or body building. In addition, prevalence of eating disorders is higher among many endurance sports including swimming, long distance running, and track.
In a survey which included data from 204 female athletes from three Division 1 schools, 54.4% of the female athletes reported being dissatisfied with their current weight. Of those women, 88.2% believed that they were overweight, reporting that they wanted to lose an average of 13.58lbs. In addition, 25% of the participants reported exercising at least 2 hours a day on top of their collegiate sports training to burn calories and control their weight (Greenleaf et al., 2009).
Disordered eating patterns create a dangerous energy deficiency in athletes who are expending more energy than they are taking in. Female athletes become vulnerable to menstrual abnormalities, known as amenorrhea, in which one may miss consecutive periods or lose their period all together due to low body fat and poor nutrition. Irregular periods may lead to osteoporosis, a weakening of the bones which results in an increased risk of fracture and break (Barrack et al., 2013).
The American College of Sports Medicine (ACSM) termed the three issues of disordered eating, amenorrhea and osteoporosis, the “Female Athlete Triad” in 1993. The distinct components of the Triad are interconnected, each contributing to one another. Female athletes in their teens and early 20s, when most are at peak competing age and when bones are still developing, are at the greatest risk for osteoporosis due to decreased level of estrogen in the body. All parts of the Triad can be harmful to an athlete’s performance as well extremely dangerous to their overall and long-term health.
Sport environments that focus on an ideal body weight or size as well as physical training may conceal disordered eating issues that athletes may be experiencing, making recognition of symptoms and signs particularly challenging for both coaches and teammates. The perceived notion that increased thinness can benefit athletic performance can make it hard to see weight loss or restrictive eating as dangerous behaviors.
Long distance running made it especially easy to hide my eating disorder. The training needed for cross country without even attempting to over exercise seems excessive to the average person. I mean who really wants to run for hours casually after work? It seems crazy, but it can be healthy if done with a proper and balanced training schedule, supervision, and a most importantly a nourishing and fueling diet. However, running this much can become extremely unhealthy when one of these isn’t met.
In high school, I quickly became a star athlete in track, breaking PR after PR, making all conference and to nationals on the 4×1 mile relay team. I was at my peak running performance right before I hit my lowest weight. I knew that the lower weight I could maintain the faster I would run. Luckily, I was able to regain healthy eating habits before anything more serious occurred. Unfortunately, for some of my teammates this was not the case. I have seen teammates on both my teams in high school and college go through all aspects of the Triad. I have seen girls go from star athletes, first on the team, to being constantly injured, stress fracture after stress fracture, who were eventually forced out of running and into the long process of physical therapy and cross training.
College health professionals are in ideal position to intervene, prevent and help detect when athletes may be struggling with disordered eating patterns. Coaches can help to prevent disordered eating from occurring in their athletes through emphasizing personal success through motivation and encouragement rather than body weight, shape or size. It is important for coaches to take the focus away from weight by not weighing athletes and making comments on weight. Rather, they should emphasize how the athlete is feeling.
Below, I’ve included some additional resources to help coaches, parents, athletes, and others better understand these issues and how to recognize them. Please explore them so you can help look for the signs of disordered eating in athletes, so we can all help prevent symptoms of the Triad in athletes.
From Managing the Female Athlete Triad: NCAA Coaches Handbook:
Disordered Eating (DE): Signs and Symptoms
Physical/Medical Signs and Symptoms
3. Gastrointestinal Problems
4. Hypothermia (cold intolerance)
5. Stress Fractures (and overuse injuries)
6. Significant Weight Loss
7. Muscle Cramps, Weakness or Fatigue
8. Dental and Gum Problems
Psychological/Behavioral Signs and Symptoms
1. Anxiety and/or Depression
2. Claims of “Feeling Fat” Despite Being Thin
3. Excessive Exercise
4. Excessive Use of Restroom
5. Unfocused, Difficulty Concentrating
6. Preoccupation with Weight and Eating
7. Avoidance of Eating and Eating Situations 8. Use of Laxatives, Diet Pills, etc.
Tips for Coaches: Preventing Eating Disorders: NEDA https://www.nationaleatingdisorders.org/tips-coaches-preventing-eating-disorders-athletes
How Coaches Can Help Prevent Eating Disorders in Athletes: Rosewood Center for Eating Disorders: https://www.rosewoodranch.com/blog/coaches-can-help-prevent-eating-disorders-athletes/
Managing the Female Athlete Triad: NCAA Coaches Handbook: http://www.femaleathletetriad.org/wp-content/uploads/2008/10/NCAA-Managing-the-Female-Athlete-Triad.pdf
Barrack, M. T., Ackerman, K. E., & Gibbs, J. C. (2013). Update on the female athlete triad. Current reviews in musculoskeletal medicine, 6(2), 195-204.
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), 489-496