Disordered Eating

Eating disorders often begin or worsen during transition periods such as starting college.

Scenario

A friend of yours appears to have lost quite a bit of weight lately. You notice her eating habits are becoming more and more unusual. She is skipping meals and altering foods when she does eat (e.g., pulling cheese off pizza).

When approached, she is defensive, denying that anything is wrong. This has negatively impacted not only her performance but also your relationship with her. What do you do?

Questions

Have you personally ever struggled with eating issues?
Do you know anyone with disordered eating? What impact did that have on you and/or your relationship with the person?
What are some underlying reasons people develop disordered eating? Control issues, self-esteem, peer/societal pressure, Others? Does gender play a role? Can it be genetic?
Is this an athletic community issue? If yes, how so?
What role do the media play in this?

Considerations

Distinction

Disordered eating consists of the spectrum of unhealthy eating from dietary restraint to clinical eating disorders. All eating disorders are included in disordered eating but not all disordered eating meets criteria for an eating disorder.

A research project done by the NCAA looked at the number of student athletes who had experienced an eating disorder in the previous two years. 93% of the reported problems were in women’s sports. The sports that had the highest number of participants with eating disorders, in descending order, were women’s cross country, women’s gymnastics, women’s swimming, and women’s track and field events. The male sports with the highest number of participants with eating disorders were wrestling, cross country and track and field.

The three most common eating disorders:

Anorexia (Anorexia nervosa) (Self Starvation Syndrome)
Bulimia (Bulimia nervosa) (Binge/Purge Syndrome)
Binge Eating (Compulsive Overeating)

Triggers

Major life changes
Relationship problems
Depression
Desire to maintain control

Risk Factors

Societal, familial, psychological and genetic
Sport body stereotypes
Revealing uniforms
Competitive thinness
Pressures associated with sport life

Rationalizations

Athletics is sometimes used to “legitimize” an eating disorder by the persons explaining their symptoms (dieting, excessive exercise, etc.) as a way of becoming better athletes or to perform better. They sometimes get away with this because of the similarity between good athlete traits and eating disorder symptoms. There is the mistaken belief that a decrease in weight or body fat increases performance. But remember: disordered eating is usually only a symptom. It is important to try and found out what the real problem is.

Did you know…?

Dieting is the primary precursor for the development of an eating disorder.
The Female Athlete Triad is the combination of disordered eating, amenorrhea (loss of menses), and osteoporosis (loss of bone mineral density), where one leads to and interacts with the other. The presence of any Triad symptom indicates a need to assess for the others.
Disordered eating can lead to other problems: dehydration, depression, anxiety, malnourishment, decreased concentration, and decreased ability to make good decisions.

Warning Signs

Eating disorders often begin or worsen during transition periods such as starting college.
Usually the longer a person has the disorder, the more purposes and functions it serves. It can become the primary means of coping with life.
Dramatic weight loss in a relatively short period of time.
An intense and irrational fear of body fat and weight gain; hard for person to concentrate on anything besides weight.
A determination to become thinner and thinner.
A misperception of body weight and shape to the extent that the person feels fat even when underweight.
Basing self-worth on body weight and body image. Obsession with others’ weight and appearance.
Personality traits such as perfectionism, being obsessive, approval seeking, low self-esteem, withdrawal, irritability, and all or nothing thinking.
Frequent skipping of meals, with excuses for not eating; food restriction and self-starvation.
Eating only a few foods, especially those low in fat and calories. Secrecy around eating.
Unusual food rituals (e.g., moving food around plate, cutting portions into tiny pieces).
Frequent trips to the bathroom after meals.
Frequent weighing of self and focusing on tiny fluctuations in weight.
Excessive focus on an exercise regimen outside of normal practice and conditioning.
Using (or hiding use of) diet pills and/or laxatives.
Avoidance of social gatherings where food is involved, or isolating themselves.
Fatigue and overall weakness.
Eating very large quantities of food at one sitting but is normal weight or underweight.
No menstrual periods or irregular periods.

Action Steps

Talk to your friend. Keep the discussion informal and confidential, and focus on concerns about your friend’s health and your relationship with her/him, not on weight or appearance.
Encourage the individuals to be a part of social functions and reassure them that you (and hopefully others) will not pressure them to eat if they do not want to.
Let the individuals have as many options surrounding food as possible—for example let them choose the restaurant if you are going out to eat.
Find out what other things are going on in their lives.
Let them know that you will pass no judgments on them.
Ask them what you can do to help make dealing with food easier.
Be aware of how you talk about others’ bodies – Comments can sometimes slip out but can be unintentionally hurtful or confusing to others.
Promote the idea that good nutrition leads to good health and increased performance.
Discuss your concerns with a professional. Learn about eating disorders and available local resources.
Encourage the individual to seek professional help. Health care professionals are bound by confidentiality.

Remember:

You are not a professional and will not be able to fix the situation—however, you can offer resources and support.
You may be rejected. People with eating disorders often deny their problem because they are afraid to admit they have a problem. Don’t take the rejection personally, and try to end the conversation in a way that will allow you to come back to the subject at another time.

Resources

Handouts

Disordered Eating Continuum
Eating Disorders Brochure(National Institute of Mental Health)
Eating Disorders Toolkit for Educators(National Eating Disorders Association)
Reaching Out to Someone Who May Have an Eating Disorder: Some Do’s & Don’ts (Renfrew Center)
What Should I Say? Tips for Talking to a Friend(National Eating Disorders Association)
What the Stopwatch Doesn’t Tell – How Coaches Can Help
Tips for Coaches and Trainers

Local

National