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Eating Disorders In Athletes - Anorexia Nervosa Athletica And Bulimia Nervosa In Sport

Liam Hallam is a sports science graduate. He is also a keen cyclist as well as being a lover of the Derbyshire Dales and Peak District.

Cycling- A high risk sport for eating disorders

In sports such as cycling, running and triathlon eating disorder incidence can be high due to a need to be lean for performance

In sports such as cycling, running and triathlon eating disorder incidence can be high due to a need to be lean for performance

Many athletes pay attention to their diet and nutritional needs

Many athletes are very careful about what they eat and often look at alternative dietary programmes in order to gain advantages in their endurance, strength, power and recovery from sporting performance however there is a very close relationship between attention to detail and obsession over diet, weight and body image.

Eating disorders such as anorexia nervosa (anorexia nervosa athletica it's sporting version) and bulimia nervosa represent extremes in eating behaviours.

Definition of an eating disorder

An eating disorder is defined as[1]

"A distorted pattern of thinking and behaviour about food"

Clinical eating disorders such as anorexia nervosa and bulimia nervosa have clearly defined official specific behaviour criteria for definition which involve cycles of food restriction.

It has to be noted that many people can still have disordered eating despite not falling into these categories. Many people have a fear of becoming fat and obese despite a normal healthy body weight. Many people look in the mirror and see a person that appears larger than they actually are and subsequently put restrictive calorie measures in place.

High risk sports for eating disorders include aesthetic sports such as gymnastics, figure skating, bodybuilding

The aesthetic nature of figure skating puts skaters at risk of developing eating disorders

The aesthetic nature of figure skating puts skaters at risk of developing eating disorders

Why are athletes likely to develop eating disorders?

Athletes have been shown to be vulnerable to eating disorders. In certain sports up to 60% of female athletes may suffer from disordered eating[1]

Eating disorders are more prominent within sports where a low body weight, slim physique or low body fat level is deemed to be an advantage to performance. Distance runners are at risk of developing eating disorders such as anorexia nervosa and bulimia[2] due to the close link between body weight and running performance.

Athletes at risk of eating disorder. Weight category sports risk

Muay Thai Boxing- fighters at risk due to eating disorders.

Muay Thai Boxing- fighters at risk due to eating disorders.

Weight category sports and eating disorders

Any sport which involves its athletes having the priority of specific weight categories will always be at risk of developing disordered eating. Examples include boxers needing to make specific weights for each fight.

Weight Category Sports include

Boxing

Muay Thai Boxing

Weightlifting

Lightweight Rowing

Judo

High risk sports for eating disorders include lean sports Such as cycling, running, horse racing

Jockey's needing to regularly 'make weight' are at risk of potential eating disorders.

Jockey's needing to regularly 'make weight' are at risk of potential eating disorders.

Checklist- Are you at risk of developing an eating disorder

While not intended as a full diagnostic method of eating disorder Bean 2004[3] considers that if you answer yes to six or more the below statements you could be at risk of developing an eating disorder and therefore may benefit from further help.

Factors that might indicate risk of eating disorder

  • Do you count the calories in everything you eat?
  • Do you think about food and eating a lot?
  • Do you worry about weight gain?
  • Do you consider that you diet excessively?
  • Do you feel guilty while eating?
  • Do you feel guilty after eating?
  • Do you dislike or worry about your body shape?
  • Do you exercise to compensate eating extra?
  • Do you consider yourself fat while family, friends and colleagues consider you to be slim?
  • Does your body weight fluctuate dramatically?
  • Do you every force yourself to vomit after eating?
  • Do you avoid certain foods despite liking eating them?
  • Do you feel guilty or stressed if you have interruptions to your regular diet or eating regime?
  • Do you incline invitations to meals out with friends and family in the event you may have to eat fattening foods?

And a factor to be considered in addition by the author

  • Do you feel inclined to weight yourself daily?

Can athletes exercise and train with an eating disorder?

Athletes are often creatures of habit and a combination of psychological drive and physiological factors mean that despite extremely low calorie intake many can often continue to train and compete despite disordered eating.

Athletes often have a strong psychological drive to exercise and be able to motivate them to push to exhaustion. Sufferers of anorexia are often strong willed too and have a high desire to achieve their goals.

It is also noted that the body adjusts to a reduced calorific intake by slowing the resting metabolism to compensate. In a way the body becomes more energy efficient to maintain an energy balance despite fasting.

Many anorexics and bulimics have been known to abuse caffeine drinks such a coffee and diet cola to increase energy levels. However long term glycogen stores become exhausted and ultimately affect performance through decreasing VO2 Max and chronic fatigue may also set in as well as increased infection susceptibility.

Below are characteristics of anorexia nervosa and bulimia nervosa to look for.

Anorexia nervosa characteristics to be aware of

Visible (physical) signs of anorexia nervosa Psychological signs of anorexia nervosa Behavioural signs of anorexia nervosa 

Extreme severe weight loss 

 Obsession regarding food and dieting

Eating very little/ nothing

Emancipated appearance

Obsession regarding thinness

Obsession with food calories

Significantly below normal body weight

Claiming to be fat when normal/ underweight

anxiety and arguments about food

Irregular Menstrual Cycle

Fear of weight gain

Refusal to eat in public

Amenorrhoea

Low self image/ self esteem

Lying about eating habits

Regularly feel cold

Depression

Obsession with weighing scales

Bluish extremities

Anxiety

Eating rituals

Restlessness, disturbed sleep pattern 

Perfectionist attitude 

 

Dry/ yellowish skin 

High need for social approval 

 

Characteristics of bulimia nervosa

Visible (physical signs of bulimia nervosa Psychological signs of bulimia nervosa Behavioural signs of bulimia nervosa 

Salivary glands swollen leading to puffy face 

Low self esteem 

Uncontrolled binge eating

Excessive tooth decay

Impulsive personality

Eating for comfort/ numbness

Normal weight or extreme weight fluctuations

Depression

Guilt and shame after bingeing

Damaged knuckles from self induced vomiting

Anxiety

Purging

Menstrual pattern irregularities

Anger issues

Laxative abuse

Regular muscle cramps 

Body image dissatisfaction 

Disappearing after meals to vomit up food 

Frequent dehydration 

Preoccupation with food, body image, appearance and body weight 

Secretive eating patterns 

Useful Links

Boxing Weight Categories from BBC Sport

It's uphill all the way and extra weight slows a cyclist down

Lean sports like cycling can lead to potential eating disorders in athletes

Lean sports like cycling can lead to potential eating disorders in athletes

Support for Eating Disorders

References

1. Sundgot-Borgen J. Eating disorders in female athletes. Sports Med. 1994 Mar;17(3):176-88.

2. Katz J L., Long-distance running, anorexia nervosa, and bulimia: A report of two cases. Comprehensive Psychiatry Volume 27, Issue 1, January-February 1986,74-78

3. Bean A, The complete guide to sports nutrition (4th Ed). London. A & C Black 2004.

Comments

Liam Hallam (author) from Nottingham UK on December 16, 2011:

Thanks for taking the time to coment Woman. However eating disorders such as anorexia nervosa athletica and bulimia nervosa are not simply women's problems. They do seem to be covered more in terms of the female population however coverage of the problem in men is much less documented.

Woman on December 15, 2011:

Men it is a woman disese

Liam Hallam (author) from Nottingham UK on October 19, 2011:

Thanks NotSoPerfect- sometimes it takes a shock toi get someone's attention. Thank you so much for your feedback. CF

NotSoPerfect from United States on October 18, 2011:

Yikes, a little scary, something to think about. I know a few of my female friends who should read this. Good hub. Voting up, useful and interesting.

Liam Hallam (author) from Nottingham UK on September 01, 2011:

Thanks INFJay for your feedback. Cool Tshirt- I want one!! CF

Jay Manriquez from Santa Rosa, California on September 01, 2011:

thought provoking article! Thanks.

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