Eating Disorders & Athletes When Healthy Goes Too Far. Lisa Diers, RDN, LD, E-RYT Director of Nutrition & Yoga The Emily Program

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1 Eating Disorders & Athletes When Healthy Goes Too Far Lisa Diers, RDN, LD, E-RYT Director of Nutrition & Yoga The Emily Program

2 Objectives Participants will be able to: Successfully identify helpful & unhelpful messages about eating & activity Gain knowledge in how to identify potentially dangerous & disordered eating & movement behaviors in athletes Learn key strategies in supporting & treating athletes struggling with eating disorders

3 Defining An Eating Disorder What is an Eating Disorder? Who Gets an Eating Disorder? Is it a choice?

4 Eating Disorders are NOT a choice Recovery IS Possible

5 What is an Eating Disorder? WHAT: Eating Disorders Such as Anorexia, Bulimia and Binge Eating Disorder- include extreme emotions, attitudes and behaviors surrounding weight and food. Eating Disorders are a serious emotional and physical problems that can have life threatening consequences.

6 Types of Eating Disorders DSM V Anorexia Nervosa Bulimia Nervosa Binge Eating Disorder Avoidant/Restrictive Food Intake Disorder FEC-NEC Atypical AN Sub BN Sub BED Purging Disorder NES Not Official ED, but commonly referred to: Diabulimia, Orthorexia

7 Eating disorders affect a person physically, behaviorally, emotionally, and psychologically; including: Dramatic weight gain or loss; or no noticeable change in wt. Verbal preoccupation with food, weight, and shape Rapid or persistent decline or increase in food intake Excessive or compulsive exercise patterns Purging; restricting; bingeing; compulsive eating; abusing diet pills, laxatives, diuretics, emetics Denial of food and eating problems, despite the concerns of others Eating in secret, hiding food, disrupting meals, feeling out of control with food Medical complications, such as menstrual irregularity, dizziness, fainting, bruising, dry skin, leg cramps, hair loss, brittle hair, osteoporosis, diarrhea, constipation, dental problems, morbid obesity, diabetes, chest pain, heart disease, heartburn, shortness of breath, organ failure, and other symptoms

8 Why do people get eating disorders? Bio-Psychosocial Model of Eating Disorders biology Food restriction Genetics Physical changes Puberty/Menopause neurotransmitters social/environment Cultural factors Pressure to fit in Normalization of dieting Media psychology Stressors Identity/self-image Personality factors Perfectionism Depression Coping

9 Healthy concerns Problematic Weight control Practices: Healthy eating behaviors Dieting Unhealthy weight control Anorexia or Bulimia Nervosa Physical activity behaviors: Moderate physical activity Minimal or excessive activity Lack of, or obsessive, physical activity Anorexia athletica Body image: Body acceptance Mild body dissatisfaction Moderate body dissatisfaction Severe body dissatisfaction Eating behaviors: Regular eating patterns Erratic eating behaviors Binge eating Binge eating disorder Weight status: Healthy body weight Mildly overweight or underweight Overweight or underweight Severe overweight or underweight Neumark-Sztainer D, I m, Like, SO Fat! : Helping Your Teen Make Healthy Choices about Eating and Exercise in a Weight Obsessed World. New York: The Guilford Press; 2005.

10 Who gets an ED WHO: Eating Disorders are not discriminatory of body size, age, sex, orientation, race or economic status. Athletes Sports that emphasize appearance, muscularity, or weight requirements (cheerleading, diving, bodybuilding, or wrestling) Individual-focused sports such as gymnastics, running, figure skating, dance, or diving rather than a team sport like basketball, volleyball, or soccer Endurance sports, such as track and field, running, and swimming Training for a sport since childhood or being an athlete of elite-status An overvalued belief that lower body weight will improve performance An unhealthy focus on success and performance supported by those invested in the athlete's performance Unhealthy focus/messages: LEANER, BIGGER, STRONGER, LOOK BETTER; PERFECTION

11 Study of elite female runners had 16% with a classifiable eating disorder at the start of the study Girls high school varsity sports- 18.2% disordered eating Ohio State Universitysubclinical eating problems affected 19% of female athletes & 12% of males Continued

12 Weight Classed Sports Menstrual disturbance in approximately 30% of females 85% of females attempted to lose weight 93% of male athletes attempted to lose weight Most common compensatory behaviour reported by athletes was dehydration (e.g., sauna, exercise in sweat suites).

13 Weight Classed Sports

14 Weight Classed Sports

15 What it Means to RDs Our profession needs to have a sensitivity to eating disorder treatment What are our own beliefs & biases on food, weight, shape, appearance, performance? So much praise for athletes; Extremism = success Can you tell if it s healthy or disordered? Know when it s time to refer parents/coaches/md Consult with ED Dietitian specialists Eating disorder treatment is HARD work So are other major treatments It s Hard work. It s challenging. There are sacrifices. It works!

16 Objectives Participants will be able to: Successfully identify helpful & unhelpful messages about eating & activity

17 Helpful or Not? OK Team- see how Sally performed yesterday? Stellar. Sally tell everyone what you ve been doing. Especially how you changed your diet. Your body works for you. Not the other way around. You want to be on top, push hardermaintain control. You know your body. Eat what works best for you and helps you perform. Your body will tell you what to do.

18 Helpful or Not? You don t need to worry about how or what you eat! That s the bonus of competing, you can eat whatever you want. You'll burn it off in practice! If you would cut some weight, you d be faster. Only 5 pounds. You d shave at least 3 seconds off your time. Whatever you're doing, keep it up!

19 Helpful or Not? Wow. You look great! Excuses, don t want to hear them. Complaints, Not Interested. There are many things that can be done to improve performance. What are your goals? Your Examples?

20 Objective #2 Gain knowledge in how to identify potentially dangerous & disordered eating & movement behaviors in athletes

21 When Healthy Has Gone too Far Signs & Symptoms Avoidance of water or excessive water intake Preoccupation with one s own food Perfect Eating- (orthorexia) Preoccupation with other people s food Ritualistic eating and/or avoidance of certain foods Excessive concern with body aesthetic Decrease in performance, especially when combined with other signs Prolonged or additional training above and beyond what is required for sport (e.g., extra sit-ups and laps, extra workouts)

22 When Healthy Has Gone too Far Signs & Symptoms Athletes on the team reporting concern about an individual Decreased concentration, energy, muscle function, coordination, speed Increased fatigue and perceived exertion Longer recovery time needed after workouts, events Difficulty with days off and tapering More frequent muscle strains, sprains, and/or fractures Slowed heart rate and low blood pressure Reduced body temperature and increased sensitivity to cold cold hands and feet Complaints of light-headedness and dizziness Gastrointestinal complaints such as nausea, constipation, abdominal pain and fullness Poorer interaction with coaches/teammates Perfectionism Increased impatience, crankiness Increased isolation

23 Objective #3 Learn key strategies in supporting & treating athletes struggling with eating disorders

24 Key Strategies In private setting communicate care and concern I am concerned. Be a listener. Let them know you are there whenever you need them Don t pass judgment/be a compassionately Curious Reinforce- weight doesn t determine performance outcomes. Performance does. Athletes want to perform. Food= performance fuel

25 Key Strategies Make tough calls. Sometimes it works to stay in the sport. Sometimes it doesn t. Support your athlete- if your athlete had a broken leg- how would you handle it? Why is this different? Avoid body/food comments Support their Recovery Meal Plan Collaborate with ED RD Continue to follow-up/check-in

26 Key Strategies Get an Assessment/ Refer College Campus Resources School Counseling Resources Involve parents Assess your clients/teams

27 Team Activity: Food & Wt. Messages What Messages do you receive about Food? What messages do you receive about weight and Performance?

28 Team Activity: Being a Change Agent How can you change the conversation? How can you promote a body positivity? How can you promote nutritionally positive messages? What can you do if feeling performance pressure to engage in extreme weight or food practices? What can you do if you think someone you know has an eating disorder?

29 Performance Stress & Anxiety and Pre/Post Fueling Wreaks havoc on the nervous system Can affect appetite pre and post competition Nausea Decreased appetite Nervous eating Relief eating (emotion eating)

Performance Stress & Anxiety Pre/Post Fueling Remind your Athlete that sticking to his/her pattern of eating is really importantrestriction can

30 Performance Stress & Anxiety Pre/Post Fueling Remind your Athlete that sticking to his/her pattern of eating is really importantrestriction can exacerbate feelings of anxiety and nausea, it inhibits performance and for some it leads to over eating after the event So, what to do about the stress and anxiety

31 Performance Stress & Anxiety Pre/Post Fueling Deep Breathing Journaling Eating with Someone Listening to Music Talking YOGA.

32 Experience it First Understand it later BREATH-CENTRIC ASANA (yoga postures) Notice what you notice (Bring Awareness to Sensation. Emotion.) Contralateral Movement Hands to eyes Neck stretch Nyasa Notice what you notice

33 Three Yoga Techniques Non food way to manage stress & anxiety

34 YOU can teach this! Try a technique prior to a meal Real life strategies Proven

35 RCT Yoga & Meal Time Anxiety 1 Carly R. Pacanowski, Lisa Diers, Ross D. Crosby & Dianne Neumark-Sztainer (2016): Yoga in the treatment of eating disorders within a residential program: A randomized controlled trial, Eating Disorders, DOI: /

36 RCT looked at the relationship between yoga and negative affect (a term used to describe experiencing unpleasant emotions) before mealtime, as it is known that meals are especially difficult for clients with eating disorders, and negative mood at mealtime is associated with poorer recovery outcomes. Results showed the group that participated in a yoga class designed to target eating disorder symptoms exhibited significantly lower negative affect before meals compared to a group that did not practice yoga (this effect did weaken somewhat throughout the meal). Participants who had practiced yoga also reported feeling calm and in tune with their internal drives.

37 Physically Fit The Truth About Weight & Performance When Do We Perform Well? Mentally Fit Emotionally Fit Nutritionally Fit

38 Summary No one chooses to have an eating disorder Can affect anyone, high prevalence in college athletes Weight does not determine performance outcomes Food is Fuel. Performance Eating. Stress reduction techniques like yoga can help YOU can make a difference/ Agent for change

39 Resources/References www. Journal of Athletic Training; 2005; 40(1); Clinical Journal of Sports Medicine; 2004; College Campus Student Counseling Services American college of sports medicine

40 Resources/References olkits/coachandtrainertoolkit.pdf ation/ _sundgot_borgen_torstveit_de_his_2011 /links/02bfe50e3ecdf04ca pdf 17f09c7dae4a/1?pq-origsite=gscholar

41 THANK YOU!! www.

DSM-5: Binge Eating Disorder. DSM-5: Bulimia Nervosa. Comorbidities 4/17/2015. DSM-5: Feeding and Eating Conditions Not Elsewhere Classified

DSM-5: Binge Eating Disorder. DSM-5: Bulimia Nervosa. Comorbidities 4/17/2015. DSM-5: Feeding and Eating Conditions Not Elsewhere Classified Prevalence in Minnesota Estimated 202,357 Minnesotans struggle with an eating disorder MN Adult (18-65 yrs old) Specific Data: 2.8% of 1,645,270 males in MN; that s 46, 067menin MN 5.9% of 1,678,711 females