“The benefits of sport are well recognized: organized
athletics builds self-esteem, promotes physical conditioning, enhances skills, teaches the value of teamwork, and sets a foundation for lifelong physical activity. Athletic competition, however, can also cause severe psychological and physical stress. When the pressures of sport competition are added to cultural ideals that emphasize thinness or a certain body type, the risks increase for athletes to develop disordered eating (irregularities in eating patterns and behaviors that may or may not develop into an eating disorder).” – The National Eating Disorder Association
Last night, I attended the Colorado High School Coaches Association Multi-Sport Clinic as part of my volunteer work with The Eating Disorder Foundation. As a therapist who specializes in working with eating disorders and disordered eating – and who is especially interested in working with athletes who struggle with these issues – I was excited about the opportunity to discuss this subject with Colorado coaches. I am also a collegiate cross country coach, so this topic is important to me on many levels. Yesterday also marked the beginning of the Summer Olympic Games – and while this topic is always relevant and important – the Olympics have re-ignited the conversation about eating disorders and athletics in the media.
Coaches play an important role in the lives of their athletes and are in a position to notice signs and symptoms of eating disorders and disordered eating and respond in an influential and healthy way. As a coach, an athlete, or someone who is concerned about an athlete – what should you look for if you think you or someone you know is struggling with an eating disorder or disordered eating?
The National Eating Disorder Association (NEDA) is a great place to get information about the prevention and treatment of eating disorders. They have many free resources, including toolkits geared towards specific populations. NEDA’s toolkit for coaches and athletic trainers is a great resource for anyone concerned about an athlete and I want to share some of the information here with you. To access the entire toolkit for coaches and athletic trainers click here (they also have toolkits for parents and educators).
Early detection of signs and symptoms of an eating disorder or disordered eating is one of the best predictors of a full recovery. Here is a list of the signs and symptoms of an eating disorder or disordered eating NEDA recommends looking for in athletes:
- Decreased concentration, energy, muscle function, coordination, speed
- Increased fatigue and perceived exertion
- Longer recovery time needed after workouts, games, races
- More frequent muscle strains, sprains, and/or fractures
- Slowed heart rate and low blood pressure
- Reduced body temperature and being sensitive to cold—cold hands and feet
- Complaints of light-headedness and dizziness, abdominal pain
- Poorer interaction with coaches/teammates
- Increased impatience, crankiness
- Increased isolation
- Difficulty with days off and tapering
- Avoidance of water or excessive water intake
- Preoccupation with one’s own food
- Preoccupation with other people’s food
- Ritualistic eating and/or avoidance of certain foods
- Excessive concern with body aesthetic
- Prolonged or additional training above and beyond that required for sport (e.g. extra sit-ups and laps, extra workouts)
- Athletes on the team reporting concern about an individual
So, what do you do if you notice these signs and symptoms or if you are worried that an athlete may have an eating disorder or disordered eating? How you approach the conversation with an athlete you are concerned about is very important. You shouldn’t try to diagnose or treat an eating disorder but, if you suspect a problem, you need to refer the athlete to professionals who can help (i.e. therapist, nutritionist, psychologist, psychiatrist). NEDA provides the following recommendations to coaches and trainers when talking to an athlete about these issues and I think they are helpful to anyone having this conversation:
- Approach your athlete sensitively and in private, while being as direct and straightforward as possible; cite the evidence you see for disordered eating, the impact of his or her behaviors on both individual and team performance, while also expressing your concern for the athlete’s health and well-being.
- Do not judge or criticize your athlete. The goal is to help the athlete tell his or her parent/caregiver about the disordered eating, if he or she has not already done so.
- Seek help as soon as possible. Make a prompt and appropriate medical referral to a healthcare specialist familiar with treating eating disorders (e.g., physician, therapist, eating disorder specialist, or dietitian). Voice your concerns to a responsible family member or caregiver and to the school’s student assistance program or health services. Early detection increases the likelihood of successful treatment, as well as decreases the likelihood of serious or long-term medical and psychological consequences; left untreated a problem that begins as disordered eating may progress to an eating disorder.
- Encourage your athlete to seek treatment. Ideally, an athlete can stay involved in his or her sport while seeking treatment; however, when physical health is at risk, be prepared to encourage the athlete to abstain from participation until given a doctor’s permission to return to sport participation. Consider the whole person when making decisions about an athlete’s level of participation in sport: physical and emotional/
- If your athlete is non-compliant with treatment recommendations, consult with the treatment team about suspending participation until the athlete is willing to comply. This course of action may seem harsh. Tell the athlete that the suspension may feel like a punishment but is actually a protective action to guard against possible physical and psychological harm. It is a communication that says that health is more important than sport. Even though this communication is a positive one, it still should be approached cautiously. Reassure the athlete that his position on the team will not be jeopardized by seeking treatment.
- Be open and cooperative with the treatment team. The most effective treatment for an eating disorder is to utilize a collaborative treatment approach consisting of a team of health professionals (e.g., physician, therapist, dietician, etc.). As a coach, your support of, trust in, and cooperation with, the team’s treatment plan will be critical to your athlete’s successful recovery.
- As a coach, your involvement and positive communications are very important for your athletes. Be a source of support. Try to maintain open lines of communication with athletes dealing with eating issues and support them in their recovery. Ask what they need, what might be helpful in their recovery. Be as sensitive and understanding as you can. With adolescent athletes, be alert to changes in self- esteem that can make their recovery effort more difficult. (http://www.nationaleatingdisorders.org)
It can be difficult to know what to say or do if you worried that someone you know has an eating disorder or disordered eating. Athletes are particularly at-risk for developing these disorders because the same personality characteristics that drive athletes also fuel eating disorders (i.e. perfectionism, the desire to achieve, fear of failure, the need to please). According to NEDA, “In a study of Division 1 NCAA athletes, over one-third of female athletes reported attitudes and symptoms placing them at risk for anorexia nervosa. Though most athletes with eating disorders are female, male athletes are also at risk — especially those competing in sports that tend to place an emphasis on the athlete’s diet, appearance, size, and weight requirements.” If you are worried about an athlete, it is important to express concern in a private, caring, and non-shaming manner and be ready to listen and provide resources and support if the athlete is willing to talk and seek help.
Are you currently looking for a therapist? To schedule an appointment, contact me today at catherine@embracestrengthcounseling or visit my website for more information about my services.
For more information about local resources for eating disorders visit www.eatingdisorderfoundation.org. If you are interested in learning more about the National Eating Disorder Association please visit www.nationaleatingdisorders.org.