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How schools and universities can help student-athletes with eating disorders

As National Eating Disorder Awareness Week comes to a close, we round out our week-long journey exploring ways schools and universities can assist their student-athletes when it comes to eating disorders.


Treating athletes with eating disorders is not very different from treating non-athletes. In fact, the evidence-based treatments recommended such as Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT) and Family Based Treatment are still advised for athletes. Yoga has been in recent studies to show cognitive improvement towards eating disorder as well.


The most important aspect in supporting athletes struggling with disordered eating and exercise behaviors is to prioritize the athlete over the sport. Treatment takes time and commitment to be effective and an athlete cannot commit both to their sport and their recovery at the same time.


It will likely be necessary for the athlete to take some time off to solely focus on treatment and eating disorder recovery. While this can be difficult for the athlete, doing this increases their likelihood of being able to safely return to the sport they are passionate about.

Student-athletes often resist treatment for the same reasons as non-athletes but also for additional ones related to sport. Some resist because they assume they will gain so much weight that it will negatively affect sport performance. They may resist due to a concern that having a mental health problem will result in a loss of status or playing time. Some fear that being in treatment for a mental health problem will displease significant others (like family, coaches and teammates).


Also, student-athletes sometimes resist treatment because they fear their treating professional(s) will not value the importance of sport in their lives. Given these common reasons to resist treatment, motivation for treatment and recovery is particularly important.


Regarding treatment motivation, research investigating factors that facilitated student-athletes’ recovery from their eating disorder found the desire to be healthy enough to perform in sport to be most helpful.


Tips for coaches and school administration:

  • provide education around prevention and recognition of eating disorders particularly to staff and coaches

  • provide education around prevention and recognition of eating disorders to all athletes

  • make appropriate treatment recommendations for athletes who are suspected of having an illness

  • work with treatment team professionals to set clear expectations around necessary recovery parameters to resume or maintain athletic participation

  • foster a culture of safety around the athlete asking for help and expressing concerns about weight

  • allow for and enable a female athlete to express when a training schedule feels like too much or feels too intense

  • be part of the solution, rather than part of the problem (denial, shaming, etc.)

And most importantly: Prioritize your athlete over the game, competition, or event by encouraging them to play the long game for their health, body, and future.


Resources:

[1] Ghoch, M. E., et al. (2013). Eating disorders, physical fitness, and sport performance: a systematic review. Nutrients, 5:12. [2] Conviser, J. H., Schlitzer Tierney, A., Nickols, R. (2018). Essential for best practice: treatment approaches for athletes with eating disorders. Journal of Clinical Sports Psychology, 12. [3] Conviser, J. H., Schlitzer Tierney, A., Nickols, R. (2018). Assessment of Athletes with eating disorders: essentials for best practice. Journal of Clinical Sports Psychology, 12.

[4]The National Center on Addiction and Substance Abuse (CASA) at Columbia University. Food for Thought: Substance Abuse and Eating Disorders. The National Center on Addiction and Substance Abuse (CASA) Columbia University; New York: 2003.

[5] Sport Nutrition for Coaches by Leslie Bonci, MPH, RD, CSSD, 2009, Human Kinetics. Byrne et al. 2001; Sundot - Borgen & Torstviet 2004

[6] Jankowski, C. (2012). Associations Between Disordered Eating, Menstrual Dysfunction, and Musculoskeletal Injury Among High School Athletes. Yearbook of Sports Medicine, 2012, 394-395. doi:10.1016/j.yspm.2011.08.003

[7] Johnson, C. Powers, P.S., and Dick, R. Athletes and Eating Disorders: The National Collegiate Athletic Association Study, Int J Eat Disord 1999; 6:179.

[8] Greenleaf, C., Petrie, T. A., Carter, J., & Reel, J. J. (2009). Female Collegiate Athletes: Prevalence of Eating Disorders and Disordered Eating Behaviors. Journal of American College Health, 57(5), 489-496. doi:10.3200/jach.57.5.489-496

[9] Beals KA, Hill AK. The prevalence of disordered eating, menstrual dysfunction, and low bone mineral density among US collegiate

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