Pathologic Weight Control in Athletes: Eating Disorders

It is unclear whether athletes in general are at greater risk of developing eating disorders than are the nonathlete population. In a study of both athletes and non-athletes it was found that the risk for developing eating disorders was not related to whether or not the subjects were athletes.^2. A similar finding was observed in ethnically diverse urban female adolescent athletes and nonathletes; the athletes were not at higher risk for disordered eating.³ This study also found that Hispanic and Caucasian urban adolescent females were at higher risk for eating disorders than were African-American urban adolescent females. However, athletes involved in sports that emphasize appearance or that have a weight requirement are clearly at a higher risk of developing an eating disorder, and the risk is higher in female athletes than in male athletes.¹¹

There are clear differences in pubertal development in male and female artistic gymnasts, differences that are associated with adequacy of energy intake. Although female gymnasts display delayed menarche and delayed pubertal development, the male gymnasts'developmental patterns appear normal.¹² But there are exceptions to the occurrence of developmental delays in female athletes. A study of British female synchronized swimmers (a subjectively scored sport where appearance is important) found that this group is relatively free of menstrual disturbances associated with eating disorders. None of the 23 national-team members who were assessed had amenorrhea, and only 3 of the 23 had oligomenorrhea.¹³

The traditional view of eating disorders (see figure 12.3) is that a combination of genetic, social, and psychological factors create the basis for their development. In athletes, however, there may be yet another important factor in the development of eating disorders involving a desire to perform well athletically. Because attainment of an ideal weight and body composition is critical for high-level sports performance, many athletes are predisposed to placing themselves on restrictive intakes. Restrictive intakes in athletes, particularly female athletes, are common. In a study of male and female collegiate athletes, 23 percent of the males and 62 percent of the females had inadequate energy intakes because they wanted to lose weight.¹⁴ However, because restrictive intakes lower the metabolic mass, this makes it more difficult for athletes to eat normally without gaining weight, so they are forced into lower and lower caloric intakes that, ultimately, cause them to develop eating disorders.

Figure 12.3 The various causes traditionally believed to contribute to an eating disorder.

The most common eating disorders among these athletes are anorexia nervosa, bulimia, and anorexia athletica; in female athletes, these conditions often manifest themselves with low bone density and amenorrhea, referred to as the female athlete triad. Athletes and coaches should be sensitive to the warning signs of eating disorders, which include the following:¹⁵

• Preoccupation with food
• Preoccupation with weight
• Frequently stated concerns about being fat
• Frequent criticism about the eating patterns of teammates
• Going to the bathroom during or after meals
• Complaints about feeling cold
• Use of laxatives
• Frequently eating alone
• Additional exercise outside the normal training regimen

Anorexia Nervosa and Anorexia Athletica

Bulimia Nervosa

Eating Disorders and Sports Performance