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The Pressure to Perform and the Risk of Eating Disorders in Student-Athletes



National Eating Disorder Awareness Week (NEDAwareness Week) is an annual event that takes place during the last week of February. The purpose of this week is to raise awareness and understanding of eating disorders, provide support for those affected by them, and to promote early intervention and treatment.


Throughout this week, we will be focusing on various topics and touch points of eating disorders amongst student-athletes, including signs, types, causes, risks, long-term effects, prevention and tips.


Concerns about Eating Disorders


Eating disorders are a serious mental health issue that can have devastating effects on college athletes. Athletes are vulnerable to disordered exercise, eating and behaviors due to the relationship their athletic performance may have with their training schedule and nutritional intake. Eating disorders can lead to physical and psychological problems, including depression, loss of energy and anxiety. College athletes are particularly vulnerable to developing eating disorders due to the intense pressure they face to perform at a high level.


Providing athletes with preventative support, coaching, and education of risks is key. This can help to reduce the likelihood of eating disorder development as well as increase the likelihood of early intervention and, therefore, long-term recovery.


Athletes with Eating Disorders Statistics


The National Collegiate Athletic Association (NCAA) estimates that up to 30 percent of college athletes suffer from an eating disorder. This is a staggering statistic, especially considering the fact that only 1 percent of the general population suffers from an eating disorder.


  • High school athletes are higher than non-athletes, with 7.3% of athletes affected and 2.3% of non-athletes impacted.

  • College Athletes: 35% of female athletes and 10% male athletes struggle with anorexia nervosa.

  • College Athletes: 58% of female, and 38% of male, athletes will struggle with bulimia nervosa

  • In a study of Division 1 NCAA athletes, over 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 place an emphasis on the athlete’s diet, appearance, size, and weight requirements, such as wrestling, bodybuilding, crew, and running.

  • In a study of Division II NCAA female athletes, 25% had disordered eating, 26% reported menstrual dysfunction, 10% had low bone mineral density, 3% had all three symptoms


Causes of Eating Disorders


  • Multifactorial: biological, psychological, and social factors contribute to their development.

  • Requirements of their sport and the pressure to perform.

  • Sports in which appearance is emphasized (ex. gymnastics, dancing, figure skating, wrestling, equestrianism, and body-building).

  • The culture of sports alone (ex. “endurance, weight category…the revealing nature of much sports clothing, the intense competitiveness of sports participants which can extend to ‘competitive thinness’, specializing in one sport at an early age and sudden increases in training volume.”


What are the Signs and Risks of Eating Disorders?


The warning signs of eating disorder behaviors in athletes are difficult to distinguish. Traits such as fueling the body with “healthy” foods but with obsession or training long and arduous hours outside of practice are all celebrated but are just a few signs that an athlete might be heading towards an eating disorder.


Eating disorders cause dangerous consequences for all individuals, however, this may present slightly different in athletes. For example, athletes struggling with disordered eating are at higher risk for RED-S, “Relative Energy Deficiency in Sport,” which “occurs when energy expenditure exceeds energy intake, creating an energy deficiency and a resulting compromise in health systems evidenced in one or more of the following: metabolism, menstrual function, bone health, immunity, protein synthesis, cardiovascular health and psychological health [3].”


Risk Factors

  • Sports that emphasize appearance, weight requirements, or muscularity (gymnastics, diving, bodybuilding, or wrestling).

  • Sports that focus on the individual rather than the entire team (gymnastics, running, figure skating, dance or diving, versus teams sports such as basketball or soccer).

  • Endurance sports such as track and field, running, swimming.

  • Overvalued belief that lower body weight will improve performance.

  • Training for a sport since childhood or being an elite athlete.

  • Low self-esteem; family dysfunction (including parents who live through thesuccess of their child in sport); families with eating disorders; chronic dieting; history of physical or sexual abuse; peer, family and cultural pressures to be thin, and other traumatic life experiences.

  • Coaches who focus primarily on success and performance rather than on the athlete as a whole person.

  • Three risk factors are thought to particularly contribute to a female athlete’s vulnerability to developing an eating disorder: social influences emphasizing thinness, performance anxiety, and negative self-appraisal of athletic achievement. A fourth factor is identity solely based on participation in athletics.


The most common eating disorder among college athletes is anorexia nervosa, which is characterized by extreme weight loss and an obsession with food and body image. Other common eating disorders include bulimia nervosa and binge-eating disorder.


This week we go in depth on these types of eating disorders as well as long-term effects and impact eating disorder behaviors can have on an athlete.


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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