Eating Disorder and Athletes

Hafiz Nafees Ul Hassan Awan

 What is Eating Disorders
• Eating disorders are complex mental health conditions characterized by
abnormal eating behaviors, distorted body image and obsessive thoughts
about food, weight and shape
• There are several types of eating disorders, each with its own unique
features and diagnostic criteria. The main types of eating disorders include
Anorexia Nervosa
Bulimia Nervosa
Binge-Eating
Other Specified Feeding or Eating Disorders
 Anorexia Nervosa
• Anorexia nervosa is characterized by an extreme fear of gaining weight
and a distorted perception of body weight and shape
• Individuals with anorexia often restrict their food intake severely
leading to significant weight loss and malnutrition
• Other symptoms may include excessive exercise, obsessive calorie
counting and a preoccupation with food and body image
 Bulimia Nervosa
• Bulimia nervosa involves recurrent episodes of binge eating followed
by compensatory behaviors to prevent weight gain, such as self-induced
vomiting, laxative or diuretic abuse, fasting or excessive exercise
• Individuals with bulimia may experience feelings of guilt, shame and
loss of control during binge-eating episodes followed by relief or
satisfaction after purging
 Binge-Eating Disorder (BED)
• Binge-eating disorder is characterized by recurrent episodes of
binge eating without the use of compensatory behaviors
• Individuals with BED may consume large amounts of food in a
short period often feeling a loss of control during binge-eating
episodes
• Binge eating may be triggered by emotional distress, boredom or
negative body image
• Unlike bulimia, individuals with BED do not engage in regular
purging behaviors
Other Specified Feeding or Eating Disorders
• OSFED, formerly known as Eating Disorder Not Otherwise Specified
(EDNOS), encompasses a range of eating disorder symptoms that do
not meet the full criteria for anorexia nervosa, bulimia nervosa or
binge-eating disorder
• Examples of OSFED include atypical anorexia nervosa (where
individuals meet all criteria for anorexia nervosa except for low body
weight) and night eating syndrome (consuming a large portion of daily
food intake during nighttime hours)
 Avoidant/Restrictive Food Intake Disorder
(ARFID)
• ARFID is characterized by a persistent avoidance or restriction of food
intake, leading to inadequate nutrition and weight loss or failure to gain
weight in children
• Unlike anorexia nervosa, individuals with ARFID do not necessarily
have body image concerns or a desire for weight
• ARFID may be associated with sensory sensitivities, fear of choking,
vomiting or other psychological factors that impair eating
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• These are the main types of eating disorders recognized in the Diagnostic
and Statistical Manual of Mental Disorders (DSM-5)
• It's important to note that eating disorders can have serious physical and
psychological consequences and require professional evaluation and
treatment by mental health professionals, including therapists, psychiatrists
and registered dietitians to address both the underlying psychological
factors and the physical health implications of the disorder
• Early intervention and Comprehensive multidisciplinary care are essential
for supporting individuals with eating disorders on their journey to
recovery
 Types (Sports Related)
 Anorexia Athletica (Excessive Exercise Bulimia)
• Anorexia athletica, also known as excessive exercise bulimia,
involves an obsessive focus on exercise and physical activity often
coupled with restrictive eating habits
• Athletes with anorexia athletica may engage in compulsive
exercise routines, excessive training and calorie restriction to
achieve or maintain a low body weight or specific body
composition for their sports
 Muscle Dysmorphia (Bigorexia)
• Muscle Dysmorphia, sometimes referred MD as bigorexia or reverse
anorexia is a subtype of body dysmorphic disorder characterized by an
obsession with muscularity and a distorted perception of one's body
size and shape
• Athletes, particularly those involved in sports emphasizing strength and
physique such as bodybuilding, weightlifting and certain combat sports
may develop muscle dysmorphia and engage in excessive exercise and
dietary practices to increase muscle mass and achieve an idealized
muscular physique
 Weight-Cutting Practices
• In sports with weight classes or aesthetic ideals, such as wrestling,
boxing, martial arts, gymnastics and bodybuilding. Athletes may
engage in extreme weight-cutting practices to meet weight
requirements or achieve a desired appearance for competition
• These practices may include rapid weight loss through dehydration,
starvation, excessive exercise or the use of diuretics and laxatives
which can have detrimental effects on both physical and mental
health
 Disordered Eating in Endurance Sports
• Athletes participating in endurance sports, such as running, cycling,
swimming and triathlon (3) may be at increased risk of developing
disordered eating patterns due to the high energy demands of training
and competition
• Endurance athletes may experience pressure to achieve a lean
physique or optimize performance by restricting food intake,
manipulating macronutrient ratios or engaging in purging behaviors
such as self-induced vomiting or excessive exercise
 Performance-Enhancing Substance Use
• In addition to disordered eating behaviors, some athletes may resort to
using performance-enhancing substances such as anabolic steroids,
stimulants or appetite suppressants to enhance athletic performance,
control weight or alter body composition
• Substance use can exacerbate the risk of developing eating disorders
and have serious health consequences
• It's important to recognize that eating disorders in sports are often
driven by a combination of factors, including societal pressures, sport-
specific demands, perfectionism and psychological stressors
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• Addressing eating disorders in athletes requires a comprehensive
approach that involves collaboration between sports medicine
professionals, coaches, sports psychologists and other members of the
athlete's support team
• Early identification, education, supportive interventions and access to
specialized treatment are essential for promoting the health and well-
being of athletes and preventing the onset or progression of eating
disorders in the sports population
 Addressing disorders
• Eating disorders are serious mental health conditions that can affect
athletes in various sports
• In sports psychology and sports physiotherapy, addressing eating
disorders requires a multidisciplinary approach involving collaboration
between mental health professionals, sports medicine practitioners,
coaches and other members of the athlete's support team
Here's how eating disorders are addressed in sports psychology
and sports physiotherapy
 Education and Awareness
• Sports physiotherapists and sports psychologists play a crucial role in raising
awareness about the prevalence, signs and consequences of eating disorders
among athletes
• Education sessions and workshops can help athletes, coaches and support staff
recognize the warning signs of disordered eating behaviors and understand the
importance of early intervention
 Screening and Assessment
• Sports physiotherapists may conduct screenings or assessments to identify
athletes at risk for or experiencing eating disorders
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• This may involve asking athletes about their eating habits, body image
concerns, weight fluctuations and history of disordered eating behaviors
• Referrals to mental health professionals or specialized eating disorder
treatment centers may be necessary for comprehensive assessment and
diagnosis
 Psychoeducation and Counseling
• Sports psychologists and mental health professionals can provide
psychoeducation to athletes about the psychological factors underlying
eating disorders such as body image dissatisfaction, perfectionism and
low self-esteem
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• Counseling sessions may focus on exploring the emotional triggers
and maintaining factors contributing to disordered eating behaviors,
as well as developing coping strategies and healthier ways of
managing stress and emotions
 Nutritional Counseling
• Registered dietitians or nutritionists may collaborate with sports
physiotherapists and sports psychologists to provide individualized
nutritional counseling to athletes with eating disorders
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• This may involve addressing myths and misconceptions about
nutrition, establishing balanced meal plans, and promoting intuitive
eating practices to restore a healthy relationship with food and
nourish the body for optimal performance and recovery
 Behavior Modification and Cognitive Restructuring
• Cognitive-behavioral techniques such as cognitive restructuring and
behavior modification may be used to challenge distorted thoughts
and beliefs about food, weight and body image
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• Sports psychologists can help athletes develop more adaptive coping
strategies, challenge negative self-talk and build self-esteem and resilience
to counteract the psychological effects of eating disorders
 Collaborative Care and Support
• Collaboration between sports physiotherapists, sports psychologists,
coaches, and other members of the athlete's support team is essential for
providing comprehensive care and support to athletes with eating disorders
• Regular communication and coordination of care ensure that athletes
receive holistic treatment addressing both the physical and psychological
aspects of their condition
 Long-Term Monitoring and Follow-Up
• Eating disorders recovery is Often a long-term process requiring ongoing monitoring,
support and follow-up care
• Sports physiotherapists and sports psychologists can work together to develop relapse
prevention strategies, monitor athletes' progress, and provide continued support as they
navigate their recovery journey and return to sport
• By addressing eating disorders in sports psychology and sports physiotherapy practitioners
can help athletes overcome their struggles with disordered eating, restore their physical
and psychological health and cultivate a positive and balanced relationship with food,
body and sport
• Early intervention, comprehensive assessment, and multidisciplinary collaboration are key
to supporting athletes' recovery and promoting their overall well- being