Eating Disorders and Athletes

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Curtis McKenzie
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1 Eating Disorders and Athletes When Health Gets Unhealthy Sara Gould, PhD June 4, 2016 The Children's Mercy Hospital, 2016

2 Outline Who gets eating disorders? Core symptoms of EDs Complications and Consequences Role of Coaches and Trainers Prevention, Identification, and Treatment 2

3 Who gets EDs? About 10% of the population (higher in young women) All socioeconomic and ethnic groups All BMI categories All ages 3

4 Who gets EDs? Males: 1 in 3-4 individuals with EDs Focus may be on muscularity rather than thinness At higher risk of growth retardation and osteoporosis during puberty 4

5 Who gets EDs? Athletes Females: 0.5%-3.7% AN; 1.1%-4.2% BN Males: Unclear Some subpopulations as high as 62% 5

6 Core Symptoms of EDs Disordered eating Caloric restriction Chaotic eating Rigid/rule-bound eating 6

7 Core Symptoms of EDs Body Image Fear of weight gain or drive for weight loss Overvaluation of weight/shape/size Disturbance vs. distortion 7

8 Core Symptoms of EDs Behaviors intended to manage weight Energy deficit Excessive exercise Compensatory(vomit, laxatives, pills, compensatory exercise, etc.) 8

9 Female Athlete Triad Energy imbalance Low bone density Loss of menstrual cycle Difference between F.A.T. and Anorexia Educate and recommend improved nutrition 9

10 Protective Factors in Athletics Improved body satisfaction Improved self-esteem Improved social relationships Improved teamwork Positive identity Face performance fears 10

11 Risk Factors in Athletics Energy demand Weight requirements or emphasis Revealing uniforms Individuals can view as weight management strategy 11

12 Risk Factors in Athletics Early sport-specific training Failure to focus on energy and fluid requirements Individual vs. team sport (or coaching) False belief that weight = performance 12

13 EDs and College Athletes 0oDxOQ 13

14 Physical Complications High risk of fractures Diminished muscle mass Cardiac compromise Low heart rate (under 60bpm) 14

15 Psychological Complications Preoccupation with food/weight/calories Social isolation Self-criticism (increased perfectionism) Difficulty adapting or with failure Emotional dysregulation 15

16 Role of Coaches and Trainers Unique position Time together Performance and body changes over time Respected authority figure 16

17 Role in Prevention Focus on skill development rather than performance Disconnect weight from performance Give balanced nutritional advice Discourage team dieting 17

18 Role in Identification Fluid/food restriction Not eating with team Isolation Decrease in stamina, speed, or strength Trouble with memory or plays Weight loss Discomfort with uniform or changing Increased emotionality Increased competitiveness Training beyond recommendations Difficulty with rest days 18

19 Acute Signs of Malnutrition Dizziness Fainting Dehydration Racing heartbeat Confusion 19

20 Role in Treatment Starting the Conversation Recommending Care Supporting athletes in ED treatment 20

21 Starting the Conversation I am concerned about you. Observations of behaviors: I have noticed you are getting tired faster. I have noticed you aren t eating with the team. 21

22 Starting the Conversation Educate Overuse injuries Impact of malnutrition on performance Need to communicate with parents of kids/teens 22

23 Recommending Care Recommend evaluation Don t need to say eating disorder Communicate health/performance compromise or impact of mental health on performance 23

24 Recommending Care Avoid blaming language Ex: We ve talked about the importance of rest days, but you don t take them. Help me understand that. Ex: Your son does not seem able to meet his nutritional needs. Let s figure this out. 24

25 Recommending Care Common barriers Athlete or family Misunderstands nutrition/health/eating disorders Athlete fears losing sport, scholarship, stigma Lack of resources 25

26 Recommending Care Red shirt EDs are metabolic injuries Protects place on team Sets expectation that return to sport will be a process 26

27 Supporting Athletes in ED Treatment Treatment involves Team Approach Medical, mental health, nutrition Ask to communicate with providers Be creative how athlete can be part of team if on activity restriction 27

28 Concerns with Exercise in Treatment Medical compromise and risk of injury Complicates restoring energy balance Particularly for growing athletes Coping skills development 28

29 Value of Exercise in Treatment Medically safe adults Improved body satisfaction and self-esteem Improved mood Learn to balance energy in and out Typically involved strength-building first 29

30 Supporting Athletes in ED Treatment Trust treatment team Individualized recommendations Stepwise approach based on success Be patient 30

Resources Children s Mercy http://www.childrensmercy.

31 Resources Children s Mercy tments/eating_disorders_center/eating_disorders_center/ Missouri Eating Disorders Association McCallum Victory Program 31

32 One more video _CIs 32

Eating Disorders in Athletes: Women and Men

Eating Disorders in Athletes: Women and Men Eating Disorders in : Women and Men Barbara J Long MD MPH Associate Clinical Professor Division of Adolescent Medicine University of California, San Francisco Why discuss eating disorders and the athlete?