Eating Disorders in Sport
What are Eating Disorders?
Eating disorders are complex and serious psychiatric conditions that develop in both men and women, and both athletes and non-athletes. Eating disorders occur in all sports, however sports that have shown to carry the greatest risk for eating disorders include those referred to as ‘lean’ sports. Lean sports are sports that have weight class requirements or those where a low body weight or lean body is believed to give a competitive advantage. These include gymnastics, diving, long-distance running, cycling, and wrestling. Eating disorders also tend to develop more in athletes who compete in judged sports compared to refereed sports.
There are 3 main clinical eating disorders:
- Anorexia Nervosa – Anorexia is characterised by persistent caloric intake restriction, an intense fear of gaining weight, persistent behaviour impeding weight gain, and a disturbance in perceived weight or shape.
- Bulimia Nervosa – Bulimia is characterised by recurrent binge eating followed by inappropriate compensatory behaviours to prevent weight gain (self-induced vomiting and/or excessive exercise) and self-evaluation influenced by perceived weight or shape.
- Binge Eating Disorder – Binge eating disorder is characterised by recurrent episodes of binge eating without compensatory behaviours, but with marked distress with the binge eating.
Eating Disorder Symptoms
- An intense fear of gaining weight
- A negative or distorted body image
- Frequent checking in the mirror for perceived flaws
- Self-worth dependent upon body shape and weight
- Fear of eating in public or with others
- Preoccupation with food
- Obsessive interest in cooking shows or collecting recipes
- Only eating ‘safe’ or ‘healthy’ foods
- Making excuses for not eating
- Rigidity in behaviours and routines with extreme anxiety if these are interrupted
- Cooking meals for others but refusing to eat them themselves
- Eating strange combinations of foods
- Withdrawing from normal social activities
- Wearing baggy or layered clothing
- Flat mood or lack of emotion; alternatively, extreme mood swings
Health Risks of Eating Disorders
- Death (anorexia nervosa has the highest mortality rate of any mental illness)
- Heart failure caused by slow heart rate and low blood pressure
- Brain damage
- Brittle hair and nails
- Lanugo (develop a covering of soft hair)
- Swollen joints
- Reduced muscle mass
- Erosion of tooth enamel from the acid produced by vomiting
- Inflammation of the oesophagus
- Enlarged glands near the cheeks
- Damage to the stomach from frequent vomiting
- Irregular heart beat
- Heart failure
- Electrolyte imbalances that can lead to sudden death
- Peptic ulcers
- Long-term constipation
Binge Eating Disorder
- High blood pressure
- High cholesterol
- Joint pain
- Type II diabetes
- Gallbladder disease
- Heart disease
Eating Disorders in Athletes
The same competitive personality traits and perfectionistic tendencies that make elite athletes successful are also factors that contribute to eating disorders. These traits include having high self-expectations, perfectionism, competitiveness, hyperactivity and a preoccupation with one’s own body. Famous gymnasts Kathy Johnson, Nadia Comaneci and Cathy Rigby have all admitted to fighting eating disorders. Cathy Rigby, a 1972 Olympian, battled anorexia and bulimia for 12 years. She went into cardiac arrest on 2 occasions as a result. Christy Henrich, who missed the 1988 U.S. Olympic team by 0.118 of a point and placed fourth on the uneven parallel bars in the 1989 World Championships, was the first U.S. gymnast to die from an eating disorder. Christy was training nine hours per day and surviving on just one apple a day. During an interview she gave in 1993, she said, “My life is a horrifying nightmare. It feels like there’s a beast inside of me, like a monster. It feels evil.”
In an interview with the NY Times in 1990, she said, “You hear people say, ‘She didn’t win the gold medal; she failed.’ I don’t mean just me. You hear it all the time. I still believe you can create great athletes without going that far. Let them have their own life… There’s so much denial in gymnastics. It’s a beautiful sport but the other part is numbing. You become machinelike. They’ll refute this, but I’ve been around it. I know.” Christy retired from gymnastics in 1991, but died 3 years later aged just 22. Christy’s fiancé, Bo Moreno, asked those present at her funeral to do what most people had always had trouble doing when she was alive… to think of her as more than just a gymnast; “She was a talented artist and an unbelievable cook. But I must admit, her favourite hobby was shopping, for herself and others.”
Gymnasts, however, are not the only sportspeople to suffer from eating disorders. Patti Catalano, the world’s number 2 marathon runner in 1980, suffered from bulimia and both Tiffany Cohen, the 1984 double gold medallist swimmer and Kim Rhodenbaugh, the 1984 Olympic breaststroker, were both hospitalised for eating disorders. But why might gymnasts be more vulnerable to eating disorders than other athletes? The subjectivity of the judging system can’t help, nor can the fact that to reach the top, gymnasts must sacrifice having ‘normal’ childhoods. Bo Moreno suggests that, “a large percentage of coaches tell the girls how to count calories, how to act, what to wear, what to say in public… It becomes a control issue for the girl. They feel the only thing they control is the food they put in their bodies.” Moreno and Christy’s parents, Sandy and Paul Henrich, agree that the blame for Christy’s obsession with weight should not fall only on her coach; “It’s the whole system. No matter what you do, it’s never, never enough. The whole system has got to change – parents, coaches, the federation.”
“I think Christy had a problem a long time before the obvious symptoms appeared” says Macy, who herself suffered from anorexia while competing for Georgia and now travels the country speaking about the dangers of eating disorders. “I just didn’t realise it. She was always working out, always doing extra stuff after practice. We’d finish, and she’d jump right on the exercise bike. Even my mother commented on it. She said, ‘That Christy Henrich looks like she puts 150,000 percent into everything.'” Moreno has also come to understand Christy’s eating disorder as a disease that strikes people with a perfectionistic attitude; “I can remember Christy telling me, ‘there’s only one first place. Second place sucks.’”
What Can Coaches Do?
Coaches can educate themselves on the signs to look for in an athlete who may be suffering from an eating disorder. It is important to be able to recognise when healthy training routines begin to turn into an obsession where the athlete turns to drastic measures, such as excessive exercise. Coaches can also educate athletes on healthy eating and the importance of eating enough, especially when engaging in periods of intense training. Coaches can also include parents within this education. It is also important to encourage athletes to develop themselves away from their sport; to see themselves as much more than an athlete. Additionally, creating an autonomy-supportive training environment for the athletes may deter the feelings of having little or no control over their body and their performances. If athletes are required to lose weight to meet weight requirements of their sport, support from a sports nutritionist should always be sought to ensure any weight loss is achieved safely.
If an athlete is suspected to have an eating disorder, it is important that they are referred to a specialist in order to seek help as early intervention has been shown to dramatically increase the likelihood of the athlete recovering well and returning to their sport. However, coaches, parents and the athlete themselves must acknowledge that the athlete’s physical and psychological states may not reflect that of their former healthy self before they developed the illness.
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FCN Academy Coach: Louise Capicotto BSc(Hons), MSc, MBPsS
Louise has been involved with coaching weightlifting and athletics (throws) for the past 5 years and was part of the National Coach Development Programme (NCDP) run by England Athletics. She volunteers at her local secondary school, running lunch time and after-school sessions. Alongside coaching, Louise is training towards being a BPS-accredited Sport Psychologist at Loughborough University, whilst also having a background in sports science. She has a particular interest in the treatment of eating disorders in athletes, as well as mental health in elite sport, the psychology of coaching, and resilience. Alongside coaching and sport psychology, Louise is an international powerlifter winning multiple national and international medals, as well as being the current British record holder for the under-53kg class squat. Louise is passionate about translating theory into practice and helping athletes to overcome obstacles and reach their full potential.