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
Written by MEDA High School Intern, Siri Kazilionis
I’ve found it very hard to find documentaries that honestly comment on the struggles of body image and weight in a way that also promotes health at every size and body acceptance. But I am more than happy to say that I have finally discovered a documentary whose message encourages body positivity whilst also challenging the ways in which popular media depicts bodies. This documentary is Embrace, and it is so powerful that it has truly makes an impact on how one views their self.
The protagonist and director of the documentary, Taryn Brumfitt, struggled with her body image. After she had multiple children, she became obsessed with obtaining a ‘perfect’ post-pregnancy body as efficiently as possible. Even though Brumfitt spent years manipulating her body and weight in order to participate in a bodybuilding swimsuit competition, she eventually came to a life-changing realization after reaching “goal”. “In my ‘perfect’ body, I’m not happy”.
After coming to peace with her own body, Brumfitt decided to travel around the world to help her gain diverse perspectives as she seeks the answer to her guiding question: “Why do so many people hate their bodies?” Brumfitt has the goal of “do[ing] something about it”, or otherwise shedding light on the standards that the media holds young girls and women today, regardless of where they are from.
The documentary focuses on health at any body size (a body size actually healthy for each individual- not a body that is reached through plastic surgery or through struggling towards the ‘perfect’ body narrowly defined by the media). Brumfitt calls out many of the body-shamers that sent her negative message about her body over social media. Brumfitt was even accused of being “lazy” after not losing weight after having multiple children and instead embracing her body. Brumfitt then shows images as she engages in more intuitive exercise that makes her feel empowered and more connected to her body, and asks the listener- “can a lazy person do this?” Brumfitt is far from shy in calling out body-shamers, and makes it known that their negative comments do not impact how she sees herself or how she feels about her body.
Brumfitt interviews young women around the world about how they feel about their bodies. I was almost brought to tears at the sight of the women interviewed on the street, asked simply to give a few words to describe how they felt about their bodies. An overwhelming number of replied, “disgusted” or “sometimes I just want to cry”. I’ve never seen a film where that many women have honestly admitted their struggles with self image. It was both tear-jerking and enlightening.
Throughout the film many of Brumfitt’s interviewees provide viewers with special insight into the world of social media, fashion, and/or have experience with struggles around body image. Some of those interviewed include former editor of Cosmopolitan Mia Freedman, actress Nora Tschiner, photographer Jade Beall, actress and trans rights advocate Lea Nayeli, and many more. The documentary focuses on a very diverse group of women: diverse in race, body type, culture, language, religion, and in way of life. So often when a documentary is made about body image, it is filled with a very familiar image of a young white woman sharing her opinions and story. Although hearing many stories is wonderful- it is crucial that we hear from a variety of voices, as otherwise people feel insecure or invalidated in the stories of themselves if they don’t fit in the small group of women that often share their struggle. Through the varied group of women interviewed, the viewer can actually feel as if they are not alone and their feelings about their body are validated, regardless of who they are. Given that the overall ideal of the movement is to accept and love your body no matter who you are, it is SO important to reinforce that this is really for whoever you are- not just for a small group of women.
It is important to recognize how the material in this documentary is raw and can sometimes be triggering to those struggling with their body image. It includes images of individuals that are struggling with their body weight, uncut videos of plastic surgery, and media productions and advertisements of the ‘perfect’ body. Although it is a very raw and uncut documentary, it is a eye-opening resource for individuals who want to learn more about the media’s standards, how to have a more positive outlook on body image, or to simply feel less alone about their own struggles. I strongly recommend Embrace. To learn more about the film, you can go to the website for Embrace, https://bodyimagemovement.com/embrace-the-documentary/ , and the documentary itself is available on Netflix or to order on amazon.
Image source: https://bodyimagemovement.com/embrace-the-documentary/
Written by Stacey Koller of New Haven Residential Treatment Center
Each June, New Haven sends several father-daughter pairs to Alaska. These attendees escape Utah’s early summer heat to enjoy the lush greenery and expansive nature of Alaska. Their return from the 2017 trip last week brought up reflection on the role that fathers play in their daughter’s life.
Numerous research studies have shown the positive impact an engaged father has on his children. At New Haven, it comes as no surprise that the health of an overall family system positively correlates with the mental health of each parent and child. Our own internal outcome measuring tools have confirmed this fact. We regularly assess and test the closeness our students have with each parent. As families progress through treatment towards transition, these relationships become stronger and healthier.
The father-daughter relationship directly impacts how a daughter perceives herself. Her identity, appearance and overall positive perception are impacted by how close she is to her father. This dynamic is particularly stark for our New Haven students who have struggled with eating disorders or body dysmorphia. For these students, the father-daughter relationship can play a large role in her recovery and long-term health. Research has shown that a daughter who has a distant father is more likely to struggle with food and weight.
Many fathers take a step back when their daughters hit the teenage years. Several years ago New Haven started watching these relationships more closely. We were able to confirm that this was in fact true, but found that during treatment the father-daughter bond grew immensely. However, upon returning home, we found that dads tended to fall back into old patterns—at the expense of the now close and connected relationship. So, New Haven took this data to design elements into our program to strengthen the father-daughter bond and to better prepare the family for their transition.
In addition to added preparation and candid discussions around keeping fathers highly engaged following transition from New Haven, we implemented new elements into our program to strengthen the father-daughter bond, including our Father-Daughter Alaska Trip. This trip is designed to draw fathers and daughters close through focused therapy and recreational activities including fishing, trail hiking, and exploring the wilderness. In Alaska, amid the breathtaking scenery, fathers are able to spend time in reflective conversation with their daughters. Away from the normal distractions of home, work, and even New Haven’s normal routine, our fathers and their daughters share an experience and deepen the bonds that will connect them for life.
For more information on New Haven Residential Treatment Center, visit their website.
written by MEDA undergraduate intern, Alexa Riobueno-Naylor
I’m a huge Roxane Gay fan. Her writing is honest, elegant, and powerful. So naturally, I was extremely excited when I found out her new book, Hunger: A Memoir of (My) Body was coming out. In the book, she works to reclaim power over her body through telling its story. At the beginning of the book, she writes:
“This is my truth. This is a memoir of (my) body because, more often than not, stories of bodies like mine are ignored or dismissed or derided. People see bodies like mine and make their assumptions. They think they know the why of my body. They do not. This is not a story of triumph, but this is a story that demands to be told and deserves to be heard.” (p.5)
By the time I was done reading Hunger, my copy of the book was not the same. I had underlined countless paragraphs, phrases, and words, putting exclamation points next to them, smiley faces, hearts, and writing “WOW” in huge letters. I loved the book, even though at some points I was uncomfortable or in disagreement with some of the arguments that Gay made. However, I have no right to judge Gay’s views as right or wrong, because they are just that— her views. The opinions she expresses in the book were born out of her own experience, and are legitimate in their own right. With that in mind, I still think it is important to take into consideration a few points before reading her book:
There are many reasons to pick up this book, and I would definitely recommend it to those who think it is appropriate for them. Two of the most important reasons for reading this book include:
Written by Clinical Director of Clementine Miami Pinecrest, Bertha Tavarez, PsyD
The “Recovery ABC’s” is a framework used by the Clementine Miami Pinecrest team to help guide adolescents on their recovery journey.
As a clinical director of Clementine, my team and I guide adolescents in sculpting a recovered identity that will sustain them through the later stages of treatment and beyond. As you can imagine, helping carve out this identity presents with additional challenges because adolescents in general are just beginning to individuate from their families and develop a standalone “I am.” What follows this “I am” statement can set an individual on a path toward wellness or self-destruction.
The Recovery ABC’s is the undercurrent of living a recovered life. At Clementine, adolescents learn to self-define these terms, notice when they are in alignment or in conflict with them, and learn to communicate these terms to their loved ones. They are the foundation that will stabilize nutritional and clinical treatment gains.
When an adolescent faces a challenge with accountability, they usually find out through feedback that is difficult to internalize. Over time, it becomes such an intolerable value, that many clients cannot access it through feelings of shame, guilt, and victimization. What we teach clients is that accountability is not a bad word. Accountability does not mean blame. Accountability in its purest forms means taking part ownership over a situation so that it can serve as a stepping stone to self-efficacy in resolution.
Teaching an adolescent about the importance of boundaries goes in alignment with their drive toward individuation. Adolescents enter into a phase of noticing emotional proximity in relation to others and are guided in vocalizing their experiences with physical and emotional closeness within the family system and social settings. For example, normalizing the need for “space” and verbalizing, “no” in an effective manner are self-protective actions that can help clients hold relationships with integrity and safety.
When adolescents experiment with new value-systems, there is a period of time in which they will verbalize recovery-oriented statements, but not be able to carry them through to action. It is important that actions are held to the standard of values-congruency. Consistency is seen as an element of building trust with the self and others. When an adolescent is struggling with consistency, it is our job as providers to bring this to their awareness, challenge conflicting behaviors, and reinforce their mastery over consistency in all the areas of their recovery. Adolescents are also taught to differentiate consistency from perfection so that their motivation is not hindered by unattainable recovery goals.
To learn more about our newest location, Clementine Briarcliff Manor, please reach out to a Clementine Admissions Specialist at 855.900.2221.
Content originally posted on May 30, 2017 at http://clementineprograms.com/2017/05/30/the-recovery-abcs/