February 26 to March 4 is National Eating Disorder Awareness Week. The purpose is to highlight the severity of eating disorders in society. The theme for NEDAW 2023 is C.A.R.E (Continue the Conversation. Act Early. Strengthen Recovery. End the Cycle).

Throughout the week, The Zone Medical Advisor Christie Brooks, a Functional Medicine Practitioner and Registered Dietitian, will be highlighting signs, causes and preventative skills around this very important topic.

Today, we focus on common types of eating disorders, as well as the long-term effects they pose on student-athletes.

Anorexia Nervosa in Athletes

Anorexia nervosa refers to behaviors of severely restricting food intake. Athletes in aesthetic sports, that is, those that emphasize body appearance, are often seen engaging in these behaviors.

This type tends to lean more towards a lower body weight.

Signs of disordered eating and exercising that may point to anorexia nervosa are:

· Fixation on body weight, shape or size.

· Calorie counting.

· Distorted body image.

· Declining/skipping meals.

· Food rules.

· Unusual food behaviors.

· Refusing to eat in front of others.

· Intense fear of gaining weight.

· Preoccupation on contents and nutritional aspects of food.

· Participation in an aesthetic sport (dance, gymnastics, figure skating, wrestling, equestrianism).

· Reported lethargy, difficulty with stamina.

· Impaired concentration.

· Reported feelings of depression or low self-worth.

Bulimia and Binging in Athletes

Bulimia nervosa involves individuals engaging in binge eating followed by compensatory behaviors such as purging, fasting, or excessive exercise (which is also called “Athletica Nervosa”). As noted above, this disorder is more common in athletes than anorexia nervosa as they require increased nourishment to fuel their activities yet may continue to struggle with appearance or weight due to sport requirements as well.

This type tends to lean toward an average to slightly larger body weight with extreme weight fluctuations.

The following may signify an athlete is engaging in bulimic behaviors:

· Binge eating behaviors after practice, interrupted or followed by trips to the bathroom for quick purging/vomiting.

· Eating in secret.

· Possessing/purchasing/overusing diuretics and/laxatives.

· Hiding food.

· Preoccupation with body weight/shape/size.

· Distorted body image.

· Eating beyond fullness with immediate feelings of shame or guilt.

· Scarring on the knuckles.

· Expressing shame or guilt around eating.

· Excessive coffee drinking/fluid consumption.

· Weight fluctuations.

· Nourishment in public is observed to be inappropriate with the amount of energy output.

· Reported feelings of depression or low self-worth.

Long-Term Effects of Eating Disorders on Athletes

The long-term impact of eating disorder behaviors on an athlete can be severe, as their energy output requires proper nourishment and optimal body functioning, both of which are impaired by an eating disorder.

The following consequences can occur long-term if an athlete is not treated for disordered eating behaviors:

· Metabolic imbalances.

· Increased risk of athletic injury.

· Poor sports performance.

· Inability to perform sports requirements resulting in quitting/retirement.

· Decreased training response.

· Impaired judgment.

· Decreased coordination.

· Impaired aerobic functioning.

· Damage to vital organs.

· Loss of menstrual cycle/infertility issues.

· Increased risk of heart failure and cardiovascular complications.

· Bone and muscle loss.

· Ulcers.

· Gastrointestinal complications.

· Tooth decay/gum disease/tooth loss.

· Increased depression/anxiety.

· Increased risk of substance abuse.

· Increased suicidal thoughts.

· Death.

Later this week we will explore ways that institutions can help athletes with eating disorders as well as preventative steps you can take to care for yourself.

References:

[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