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Tips and information for coaches

What coaches, parents, and teammates need to know

Disordered eating and full blown eating disorders are common among athletes. For example, a study of Division 1 NCAA athletes, found that more than 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 emphasize diet, appearance, size, and weight.

The benefits of sports are well-recognized: building self-esteem, staying in good physical condition, and setting a foundation for lifelong physical activity. Athletic competition, however, can cause severe psychological and physical stresses. When the pressures of athletic competition are added to societal norms that emphasize thinness or a certain body type, the risks increase for athletes to develop disordered eating. Listed below are some recognized risk factors for developing an eating disorder as an athlete.

Specific sports that can create risk for developing an eating disorder

  • Gymnastics, swimming, diving, bodybuilding, wrestling because athletes must "make weight" or maintain a certain body size to stay competitive.
  • Gymnastics, track and field, figure skating, dance or diving sports because they focus on the individual rather than the entire team.
Personal factors that could create risk for an athlete
  • Inaccurate belief that lower body weight will improve performance.
  • Training for a sport since childhood or being an elite athlete.
  • Low self-esteem or self-appraisal, family dysfunction, family history of eating disorders, chronic dieting, history of physical or sexual abuse, peer, cultural pressures to be thin, other traumatic life experiences.
  • Coaches who focus only on success and performance rather than on the athlete as a whole person.
  • Performance anxiety
  • Social influences, including family and peer pressure about athletic ability and performance
Factors that protect athletes from developing eating disorders
  • Positive, person-oriented coaching style rather than negative, performance-oriented coaching style.
  • Social influence and support from teammates with healthy attitudes towards size and shape.
  • Coaches who emphasize factors that contribute to personal success such as motivation and enthusiasm rather than body weight or shape.
Concerns specific to female athletes

Female athletes may be at risk of a triad of harmful consequences:

  • disordered eating,
  • loss of menstrual periods, and
  • osteoporosis (loss of calcium resulting in weak bones).
The lack of adequate nutrition resulting from disordered eating can cause the loss of several or more consecutive periods. This in turn leads to calcium and bone loss, placing the athlete at greatly increased risk for stress fractures of the bones. These conditions are a medical concern and taken together, create serious, potentially life-threatening health risks. While any female athlete can develop this triad, adolescent girls are most at risk because of the active biological changes and growth spurts, peer and social pressures, and rapidly changing life circumstances that accompany the teenage years. Males may develop similar syndromes.

The University of Minnesota Tucker Center for research on girls and women in sports web site provides many links and a bibliography of papers related the impact of eating disorders on to women's health and athletic activity. http://cehd.umn.edu/tuckercenter/resources/bibliographies/disordered-eating.html

What coaches can and should do
Compiled for the National Eating Disorders Association by Karin Kratina, MA, RD

  1. Take warning signs and eating disordered behaviors seriously! Cardiac arrest and suicide are the leading causes of death for people with eating disorders.
  2. Pay attention to chronic dieting or slightly odd eating habits. Coaches should refer concerns to the school's student assistance program, responsible family member of the student, or a health professional with eating disorder expertise. Early detection increases the likelihood of successful treatment; left untreated a problem that begins as disordered eating may progress to an eating disorder.
  3. De-emphasize weight. Whenever possible, avoid weighing athletes. Eliminate comments about weight. Focus on areas that athletes can control to improve performance. For example, focus on strength and physical conditioning, and mental and emotional aspects of performance. Improving mental and emotional coping skills carries no risk.
  4. Don't assume that reducing body fat or weight will enhance performance. Weight loss or lower body fat can may improve performance, but studies show this does not apply to all athletes. Performance should not come at the expense of the athlete's health.
  5. Coaches and trainers should obtain basic education on recognizing signs and symptoms of eating disorders and understand the role they can play in preventing them—or helping athletes who have them. People with eating problems are often secretive about their eating habits. They develop coping skills to mask symptoms and to make believable excuses when their behavior is noticed or questioned. They are often ashamed, though they may be aware that the behavior is abnormal.
  6. Athletes need accurate information about healthy weight, weight loss, body composition, good nutrition, sports performance, and the impact of bad nutrition. Information should include the common myths about eating disorders and challenge unhealthy practices. Make use of local health professionals with expertise in eating disorders and athletics who can help educate athletes.
  7. Emphasize the health risks of low weight, especially for female athletes with menstrual irregularities or total cessation of menses. Refer athletes for medical assessments in these cases.
  8. Understand why weight is such a sensitive and personal issue for both male and female athletes. Eliminate derogatory comments or behaviors about weight—no matter how subtle, slight, or "in good fun" they seem.
  9. If an athlete has an eating disorder, don't automatically curtail his or her participation unless warranted by a medical condition that is documented by a physician. Consider the whole person: physical and emotional/mental health when making decisions about an athlete's level of participation in his/her sport.
  10. Coaches and trainers should explore their own values and attitudes regarding weight, dieting, and body image, and how their values and attitudes may inadvertently affect their athletes. They should understand their role in promoting a positive self-image and self-esteem in their athletes.

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Bulimia nervosa is an eating disorder in which a person engages in binge eating (eating a lot of food in a short time) followed by some type of behavior to prevent weight gain from the food that was eaten. This behavior can take two forms: self-induced vomiting, misuse of enemas, laxatives, diet pills (called purging) and excessive exercise, fasting, or diabetic omission of insulin (called non-purging). Some people with bulimia nervosa may also starve themselves for periods of time before binge eating again. Bulimia nervosa has important mental, emotional, and physical aspects that require consideration during treatment.

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