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Disordered Eating in Student-Athletes: Understanding the Basics and What We Can Do About It

What is Disordered Eating and How Often Does It Occur in Sport?

Disordered eating encompasses a wide range of problematic eating attitudes, behaviors and body image distortions that adversely impact physical and psychological health. Unfortunately, student-athletes are not exempt from the dangers of disordered eating symptoms, which have been reported to occur in approximately 25 percent of collegiate female athletes and 20 percent of male collegiate athletes competing in a diverse range of sports. The prevalence of disordered eating is highest among those competing in aesthetic sports in which student-athletes are judged on both technical skill and the artistic quality of their performance (e.g. gymnastics). However, student-athletes participating in any sport may show signs and symptoms of disordered eating, including excessive body and appearance-related concerns and unhealthy weight control behaviors (e.g., restrictive dieting, binge eating, over-exercise, self-induced vomiting, or abuse of laxatives, diet pills, and diuretics).

What Is the Role of Disordered Eating in the Female Athlete Triad?

Dietary energy (the energy that comes from food) not only supports athletic performance but also sustains life. After energy is expended through exercise, the remaining energy is used to support the body’s metabolic processes. Thus, when athletes have not adequately fueled, little energy is left to support the body’s critical functions after intensive sports training. Declines in reproductive health and bone density are primary areas that may be adversely affected and comprise the other two components of the triad.

For some student-athletes, low energy availability occurs in the absence of disordered eating. In these instances, low energy availability is an unintentional, but negative byproduct of not consuming enough calories to offset the energy expenditure of sport training. In contrast, other athletes purposefully engage in disordered eating often in an attempt to achieve greater athletic success and meet appearance standards for their sport, society or both.

How and Why Does Disordered Eating Occur in Athletes?

Disordered eating in student-athletes is a complex phenomenon and includes a range of genetic (e.g., heritable characteristics), environmental (e.g., peer and family modeling), psychological (e.g., body dissatisfaction, perfectionism, low self-esteem) and behavioral factors (e.g., dietary restraint). In sport, the role of weight management pressures has become a popular research topic. Sources of pressure to lose, gain or maintain weight in sport may include: (1) demands to meet technical aspects of performance such as speed and agility; (2) demands to meet appearance-based aspects of performance such as long lines and aesthetically pleasing routines; (3) conventions of sport such as requirements for form-fitting or revealing athletic attire; (4) expectations of others such as coaches, parents, judges, peers and teammates; (5) media images of elite or professional level athletes that emphasize stereotypically attractive bodies for sport (e.g., slender and tone); and (6) societal demands to achieve stereotypically attractive bodies (e.g., tall and thin). All are critical considerations in the prevention of disordered eating in athletes.

Weight Pressures in the Athletic Environment

Source of Weight Pressure

Example

Technical Demands of Sport

Achieving faster race times, higher flight patterns

Aesthetic Demands of Sport

Achieving grace, beauty, and long lines during performance

Rules or Conventions of Sport

Form-fitting or revealing athletic attire, team weigh-ins

Important Others

Critical comments from coaches, parents, judges, peers, or teammates about weight, shape, or body size

Media

Images of high level athletes that promote lean, tone, and stereotypically attractive bodies for sport

Societal Demands

Images of models that promote tall, thin, and stereotypically attractive bodies for society in general

Note. This table was adapted from Voelker, D. K. (2012). Weight pressures: What coaches need to know. Game Plans: Coaching Advancement Program Newsletter, VIII (5), 2-3.

How Can Disordered Eating in Athletes Be Prevented?

Stakeholders in the collegiate athletic community play key roles in the prevention of disordered eating in athletes. Athletics healthcare professionals, athletic administrators, coaches and student-athletes may consider the following reflective questions and prevention principles:

Awareness

Consider your influence on others in your athletic community. Are you a positive role model for healthy nutrition, exercise habits and body image? What messages do you send to student-athletes about weight? Practicing healthy habits of your own can set a good example for others around you and promote a body-enhancing versus body-disparaging athletic culture.

Additionally, athletes often cite that their disordered eating behaviors began or were reinforced after belittling comments from a coach about their weight, shape or body size. Even a comment intended to be helpful (e.g., “Losing a bit of weight will help your presentation and improve your scores”) may be perceived as harmful (e.g., “Coach thinks that I’m fat and not good enough”). Help athletes to feel comfortable in their own skin and show them how to appreciate their body’s health and function above and beyond what it looks like.

Education

Consider your understanding of disordered eating in sport. How well educated are you on healthy eating and exercise behaviors for student-athletes? Where do you get your information? How well do you know the signs and symptoms of disordered eating and is there a referral protocol in place if disordered eating were detected? Research indicates that a minority of collegiate coaches have adequate knowledge on eating disorders. Seeking resources that will provide this education from credible sources (e.g., science versus popular media) such as the American College of Sports Medicine is important. Moreover, eating disorders are not a phase and must be treated by a team of licensed professionals (e.g., physician, psychologist, psychiatrist, and sports dietician). When those closest to student-athletes know the signs and symptoms of disordered eating, they are able to quickly recognize when help is needed and pursue the appropriate resources.

Culture

Consider the athletic culture you help to change and grow. Would you describe your athletic department as promoting a body-positive culture? Do you ascribe to a health-first focus and prohibit unhealthy weight control practices? Working together to promote a healthy culture can improve the developmental outcomes of student-athletes.  

Student-athletes are deserving of the benefits that their sport has to offer. Maximizing these benefits means using athletics as an opportunity to show athletes how to maintain proper eating and exercise habits as well as how to take pride in their bodies. Such efforts will both promote athletic performance and build healthy lifestyles.

Eating Disorders and Disordered Eating Resources

National Eating Disorders Association – Tool Kits

http://www.nationaleatingdisorders.org/toolkits

National Institute of Mental Health – Eating Disorders

http://www.nimh.nih.gov/health/publications/eating-disorders/index.shtml

The Victory Program at McCallum Place

http://www.thevictoryprogram.com/

References

De Souza, M. J., Nattiv, A., Joy, E., Misra, M., Williams, N. I., Mallinson, R. J., . . . Expert, P. (2014). 2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad: 1st International Conference held in San Francisco, California, May 2012 and 2nd International Conference held in Indianapolis, Indiana, May 2013. British Journal of Sports Medicine, 48(4), 289-289. doi: 10.1136/bjsports-2013-093218

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), 489-495.

Petrie, T. A., & Greenleaf, C. (2012). Eating disorders in sport. In S. Murphy (Ed.), Handbook of sport and performance psychology (1st ed.). New York, NY: Oxford University Press.

Petrie, T. A., Greenleaf, C., Reel, J. J., & Carter, J. (2008). Prevalence of eating disorders and disordered eating behaviors among male collegiate athletes. Psychology of Men & Masculinity, 9(4), 267-277. doi: 10.1037/a0013178

Reel, J. J., Petrie, T. A., SooHoo, S., & Anderson, C. M. (2013). Weight pressures in sport: Examining the factor structure and incremental validity of the weight pressures in sport – females. Eating Behaviors. doi: 10.1016/j.eatbeh.2013.01.003

Torres-McGehee, T., Pritchett, K. L., Zippel, D., Minton, D. M., Cellamare, A., & Sibilia, M. (2012). Sports nutrition knowledge among collegiate athletes, coaches, athletic trainers, and strength and conditioning specialists. Journal of Athletic Training, 47(2), 205-211.

About Dana K. Voelker, PhD, CC-AASP

Dr. Voelker is a Certified Consultant of the Association for Applied Sport Psychology (CC-AASP), and an Assistant Professor at The College at Brockport, State University of New York where she teaches and conducts research on positive youth development through sport from a life skills and health perspective. She is a certified performance enhancement consultant for athletes and teams from youth through elite levels out of DKV Performance Consulting. Dr. Voelker is a published scholar, contributing textbook author, and presenter at conferences and workshops. She is a former figure skater and past captain of the Penn State women’s ice hockey club.