Lecture Note
Eating Disorders Among Athletes
-
University:
California State University, Northridge -
Course:
FCS 481 | Sports Nutrition Academic year:
2009
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Views:
96
Pages:
33
Author:
Allioniy9p
Severe
alterations in eating patterns
linked to physiological changes.
Alterations associated with food
restriction, binge eating, purging, and
fluctuations in weight. Also involves
emotional and cognitive changes that
effect the way a person perceives and
experiences his/her body
1
Diagnosis Criteria:
◦ Under 85% expected weight (age,
height)
◦ Fear of gaining weight
◦ Disturbance in body image
◦ Amenorrhea
Two
types
1. Restricting type: not engaged in
binge-eating/purging behavior
2. Binge-eating/purging type: regularly
engaged in binge-eating/urging
Vomiting, laxatives, diuretics, enemas
2
Diagnosis Criteria:
◦ Recurrent Binge eating
Eating a large portion of food (2 hr period)
Lack of control
◦ Recurrent compensating behavior
Vomiting, laxatives, diuretics, enemas, other
medication, fasting, exercise
◦ 2x a week for at least 3 months
2
types
1. Purging Type: self-induced vomiting,
laxatives, diuretics, enemas
2. Nonpurging Type: fasting or excessive
exercise
3 Must meet all 5
◦ 1. Fear of weight gain
◦ 2. Calorie Restriction
◦ 3. Weight loss
◦ 4. No medical disorder to explain wt. loss
◦ 5. Gastrointestinal complaints
Must
meet 1 other criteria of AN or
BN
Does not meet all criteria
Females- have regular menses
AN- Normal weight range
BN- less than 2x a week
Compensatory behavior after normal
consumption of food
Chewing/spitting out food
4
Binge eating episodes without use of
compensatory behaviors
◦ Vomiting, laxatives etc.
Preoccupation with food and weight
Repeatedly expressed concerns about
being fat
Increasing criticism of one's body
Frequent eating alone
Use of laxatives
Trips to the bathroom during or after
meals
Continuous drinking of diet soda or
water
Compulsive, excessive exercise
Always being cold
5 7-10
million
1 million
1 in 200
2-3 in 100
ED
highest mortality over any
other mental illness
Mortality rates of ED are 12x
higher than rate of ALL other
causes of death among
females 15-24 yrs old
6 Slow heart rate
Low blood pressure
Risk of heart failure
Osteoporosis
Muscle loss/weakness
Dehydration
◦ Kidney Failure
Fainting, fatigue
Dry hair and skin, and hair loss
Lanugo
62%
All sports
◦ Gymnastics, figure skating, dancing
7 Body Image
All Sports
Low body fat
for
Make specific
competition/ weight class
aesthetics
Figure Skating
Dance
Gymnastics
Row
Martial Arts
Improved
performance
Running
Track and field
8 Irregular/absent
menstrual cycles
Tired
/ fatigued
Problems sleeping
Frequent/recurring injuries
◦ Stress fractures
Striving
to be thin
Decreased caloric intake to improve
performance or physical appearance
Cold hands and feet
• Males can sustain dramatically lower body fat
than females without profound medical
consequences
• Still less prevalent than in females, however…
•
– More cases are appearing
– Younger ages of onset
– Disordered eating behaviors and anabolic steroid
abuse
Few studies have been completed…
– Single source samples
– Non-specific weight control behaviors
9 •
•
•
Athletes may choose a sport (consciously or
unconsciously) as a way to sustain his disorder
Sometimes the sport itself promotes eating
disordered behavior
– Weight limits
– Pressures from coaches and teammates
– Judging criteria and performance demands
Athletes may be at a higher risk than nonathletes
– Drive to win
– Financial success
Make
weight for
competition
Wrestlers
Horse Racing
Jockeys
Low body fat
advantageou
s for
competition/
aesthetics
Figure Skating
Dance
Gymnastics
Desire to
bulk up
Football
Baseball
Body sculpt
Body Building
10 The athlete becomes preoccupied with
increasing muscle mass, excluding everything
else in their lives.
Pope et al
Some athletes will…
Sit in heated cars or saunas
wearing rubber suits
Skipped meals
Self-induced vomiting
Laxatives
11 Estimates of the prevalence are highly variable
•Female athlete: 1% - 62%
•Male athlete: 0% - 57 %
Due to
•definition of eating disorders applied
- DSM (Diagnostic and Statistical Manual of Mental
Disorder)
criteria
•the athletic populations studied
- female athletes
- Lean sport athletes
•assessment measures
Popular measures
EAT (Eating Attitudes Test)
EDI (Eating Disorder Inventory)
-EDI-BD (Body Dissatisfaction)
-EDI-DFT (Driving For Thinness)
New measures – Q-EDD
(Questionnaire for Eating Disorder
Diagnosis)
12 Purpose:
1. Identify at-risk athletes as part of a
screening process designed for eating
disorder prevention
2. Refine the assessment of disorder eating
in athletes
1.
2.
3.
4.
Subjects:
For two consecutive years
2001: 773 athletes, 46% women
2002: 882 athletes, 43% women
Both lean & nonlean sport athletes
13 Measures:
Q-EDD
1. A fifty item self-report questionnaire on DSM
2. Clinical & subclinical & asymptomatic
individuals
Diagnosis of Muscle Dysmorphia
1. 8 questions added in 2002 data
2. Target men’s eating issues
Result
Prevalence Rates
14
Result
Type of Sport
2001 – 18.8% lean & 12.1% non-lean
2002 – 17.5% lean & 9.2% non-lean
Muscle Dysmorphia
1 % male athletes & 0% female athletes
Petrie, T.A., Greenleaf, C., Reel, J., &
Carter, J. (2009). The Journal of Treatment
and Prevention, 17, 302-321.
15
What personality traits and psychological
factors are predictors of disordered
eating among female collegiate athletes
Asymptomatic athletes will exhibit
◦ Positive well-being
◦ Exercise for “positive” reasons
◦ Perfectionism???
16 204
Female collegiate athletes
3 Division I universities
Mean age of 20 years
17 sports
BMI avg. 23.1 kg/m2
10 Previously Diagnosed with Eating
Disorder
Web-based
surveys
On campus computer lab
Researchers available
No coaches resent
$5 compensation
17
Demographic information and Weight
◦ Self-reported
Disordered Eating
◦ Questionnaire for eating disorder diagnosis
(Q-EDD)
◦ Classified as
Eating Disorder
Symptomatic
Asymptomatic
Perfectionism
◦ Multidimensional Perfectionism Scale (MPS)
Measured 6 dimensions
Psychological well-being
◦ Life orientation test-revised (LOT-R)
Positive vs. negative outcome
◦ Rosenburg Self-Esteem scale (RSE)
18
Reasons for exercise
◦ Reasons for exercise inventory (REI)
Motivation for exercise
Appearance Orientation
◦ Appearance orientation subscale from multidimensional body-self relations (MBSRQ-AO)
Investment in look, time spent in grooming
148 Asymptomatic
56 Disordered Eating
◦ 52 Symptomatic
◦ 4 Eating Disordered
Demographic
◦ N= 50 minority ethnicities
◦ No difference in sport
19
Perfectionism
◦ No significant difference among 2 groups
Psychological Well-being
◦ Asymptomatic higher self-worth
Reasons or exercise
◦ Similar on Health/Fitness
◦ Disordered Eating more likely to
Exercise to feel better
More attractive
Appearance Orientation
◦ Symptomatic
More time and energy for grooming
20 QEDD status used as outcome
Psychological and personality variables as
predictors
Classified
◦ 79.4% all athletes
◦ 90.5% Asymptomatic
◦ 50% Symptomatic
Significant Predictors of disordered eating
◦ Appearance Orientation
◦ Exercising to improve appearance
◦ Lower levels of self-esteem
21 QEDD classification
Not related to
◦ Age
◦ Year in school
◦ Sport
Related to
◦ Ethnicity
Caucasian/nonminority more likely to develop
disordered eating
•
•
Subjects: 74 volunteers
– 22 men with Bulimia Nervosa
– 27 competitive male body builders
– 25 recreational male body builders
22 man clinical sample had sought treatment from
eating disorder clinics, symptomatic at time of
testing.
– Binge eating weekly in the past 3 months
– Persistently over concerned with body shape/
weight
– Using at least one method of weight control within
the last 2 weeks
22 • Male body builders were recruited at a local
gym
◦ Criteria for competitive male body builders:
Actively training for a competition
or
Competed within the last year
• Criteria for recreational male body builders:
Engaged in traditional forms of weight training at
least twice weekly for the last 7 months
and
Had never competed in body building with no
plans to do so in the next year
Subjects completed an assessment
package:
◦
◦
◦
◦
Demographics questionnaire
Beck Depression Inventory
Eating Disorder Inventory
Body building questionnaire (too classify
between competitive and recreational)
◦ Anabolic Steroid Questionnaire
23 30% of competitive BB’s met the criteria for
Bulimia at some point in their lifetime. (A rate
8% higher than recreational BB’s)
The fact that Bulimic tendencies do exist even
in non-competitive BB’s
shows that more personal
reasons may contribute to
the overvaluing of weight and
shape.
24 Although male bulimics were more likely
to purge, there were no differences
between them and the body builders in
the lifetime prevalence of using vigorous
exercise, strict dieting, or diuretics.
The use of steroids in recreational BB’s
provides evidence that their practices are
for cosmetic, NOT competitive purposes
Too often, coaches
are unprepared to
respond to the
needs of an eating
disordered athlete.
A study found 78% of female
high school athletes perceived
that they never had a coach
speak to them about proper
weight loss and nutrition.
25 •
•
•
•
Coaches reported they deiced whether or
not their athletes needed to lose weight
based on their appearance (29%),
performance (24%), height and weight (12%),
body fat % (10%), and fitness/health (9%).
Most coaches place emphasis on body
weight but 37% reported taking no nutrition
coursework.
44% weighed their athletes.
30% suggested athletes lose weight by
restricting calories.
Designed to test coaches’ perceived knowledge about
nutrition and weight compared to their actual
knowledge.
26 •
•
•
•
42 coaches of female high school sports in four
different high schools.
53.7% male coaches, 46.3% female
46% coaching 1-5 years, 20% 6-10 years, 34% 10+
years
All coaches were volunteers
Procedure
All subjects completed the Coaches’ Nutrition and
Weight Survey and the Coaches’ Nutrition and
Weight Quiz. Both were administered by an onsite coordinator.
91% rated their knowledge as average even
though only 40% had ever taken classes.
Less than half were able to identify sources of
complex carbohydrates.
80% thought that muscle is gained by eating
protein.
These same coaches say they frequently spoke
to their teams about nutrition.
27 40% think decreased body weight would
improve their athlete’s performance.
33% communicated this to their whole
team, 28% spoke to individuals.
76% reported monitoring their athletes’
weight by visual inspection (37%), group
weigh-ins (17%), private weigh-ins (11%),
and measuring body fat (11%)
82% thought body image distortions
happened equally among male and female
adolescents.
68% thought they had an athlete with an
eating disorder.
60% say they need more education about
eating disorders.
28 Most frequently used method of
monitoring was visual inspection, sending
the message that appearance is the most
important goal for the athlete.
Most coaches who used weigh-ins used
group weigh-ins, sending a subliminal
message that you better lose weight
because everyone will know.
29 Purpose:
1. examine differences in ED exist between
women who are varsity athletes, club
athletes, independent exercisers and nonexercisers
2. determine whether sports anxiety moderate
any observed between-group effects.
Subjects: 274 female undergraduates
Measures:
1. EDI (Eating Disorder Inventory) with
subscales: DFT (drive for thinness), BUL
(bulimia), BD (body dissatisfaction
- eating-related behavior and attitude
2. RSE (Rosenberg Self Esteem Scale)
- higher scores indicate higher self-esteem
3. PASAS (The Physical Activity and Sport Anxiety
Scale)
- higher scores indicate a higher amount of
social anxiety
30 regular exercisers have higher rates of ED than
non-exercisers
2. non-exercisers have lowest DFT / BUL , also
have lower BD
3. female athletes competed in high level
competition and had high levels of sports
anxiety experienced the most ED symptoms.
1.
1. women may develop ED symptoms as a result
of participating in athletic events and
experiencing the associated pressure of
competition
2. coaches and athletic department of
competitive athletes need to know that
athletes may be at a higher risk for ED
31 Society
- pervasive attitudes to body weight
- athlete experience more societal pressure
Family
- overbearing or controlling parents
- parents have a history of alcoholism or
substance abuse
- victims of physical
Type of Sport
- specific aesthetic and performance demands
- thin- build sports or require a low body weight
or lean physique
eg. gymnastics, distance running, figure skating,
diving, cheerleading
Person:
- Personality- large tolerance of pain
32 Others
- excessive demands from coach
- discrepancy between one and the
perceived idea body weight or peer
- sudden traumatic event such as injury
•
•
•
•
•
•
•
•
•
Baum, A. (2006). Eating disorders in the male athlete. Sports Medicine, 36(1), 1-6.
Dunford, M. (2006). Sports nutrition a practice manual for professionals (4th edition). Chicago, Il:
American
Dietetic Association.
Goldfield, G.S., Blouin, A.G., Woodside, D.B. (2006). Body image, binge eating, and bulimia nervousa in male
bodybuilders. The Canadian Journal of Psychology, 51(3), 160-168.
Hobart, J.A., & Smucker, D.R. (2000). The Female athlete triad. The American Academy of Family Physicians, 61(11),
Retrieved from http://www.aafp.org/afp/20000601/3357.html
Hornak, N.J., Hornack, J.E. (1997). The role of the coach with eating disordered athletes: recognition, referral, and
recommendations. Physical Educator, 54(1), 35-39.
Jennifer, E. C., & Nancy, A. R. (2005). Disordered Eating Assessment for College Student-Athletes. Women in Sport
& Physical Activity Journal, 14(1), 62-71.
Jill, M. H.,Vasessa, S., Kathryn, H. G., Kimberly, A.V. O., & Thomas, E. J. (2009). Eating Disorder Symptoms among
Undergraduate Varsity Athlete, Club Athletes, Independent Exercisers, and Non-exercisers. International Journal of
Eating Disorders, 42(1), 47-53.
Overdorf,V.G., Silgailis, K.S. (2005). High school coaches’ perceptions of and actual knowledge about issues related
to nutrition and weight control. Women in Sport and Physical Activity Journal, 14(1), 79-85.
Petrie, T.A., Greenleaf, C., Reel, J., Carter, J. (2008). Prevalence of eating disorders and disordered behaviors among
male collegiate athletes. Psychology of Men and Masculinity, 9(4), 267-277.
Petrie, T.A., Greenleaf, C., Reel, J., & Carter, J. (2009). Personality and psychological factors as predictors of
disordered eating among female collegiate athletes. The Journal of Treatment and Prevention, 17, 302-321.
Wardlaw, G.M., Hampl, J.S., DiSilvestro, R.A. (2004). Perspectives in nutrition (6th edition). New York, NY: McGraw-Hill.
Williams, M.H. (2005). Nutrition for health, fitness, and sport. New York, NY: McGraw-Hill.
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