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Eating Disorders Among Athletes

February 28, 2019

Kimberly Tucker, MD, an orthopedic surgeon at Atlantic Sports Health at Bridgewater, answers questions about eating disorders and athletes:

Q: Regarding the reasons for eating disorders in female athletes, do competitive pressures figure in?

Competitive pressures definitely can contribute to reasons for developing an eating disorder. We know that athletes in sports that require subjective judging (figure skating, cheerleading, gymnastics), sports that have weight class components (lightweight rowing, wrestling), and sports that emphasize low body mass or leanness (middle and long distance running, dance) are at higher risk for developing female athlete triad (characterized by low energy availability with or without a diagnosed eating disorder, menstrual dysfunction, and low bone mineral density). Low energy availability leads to the other triad components of menstrual dysfunction (can cause loss of fertility) and low bone mineral density (can lead to osteoporosis), which can be irreversible depending on how long the triad remains untreated.

Sometimes the development of triad components is unintentional. The rigors of intense training and competition without adequate caloric and nutritional intake can result in low energy availability and other sequelae of the triad.

Q: What are some strategies for athletes struggling with an eating disorder or those who fear they may be headed that way?

Athletes who have been diagnosed with an eating disorder definitely need the support of a multidisciplinary team. The primary care physician or sports medicine physician should coordinate all the specialty care. An orthopedic surgeon may be involved in diagnosing and treating musculoskeletal injuries. A psychologist or psychiatrist is essential for evaluating and treating the eating disorder. They can also help provide coping strategies to the athlete for the changes they may need to make in their diet and training. A sports nutritionist can help with identifying areas of improvement in diet. An athletic trainer and/or physical therapist can assist with treating injuries and creating and managing a modified training program. Finally, the support of family, coaches, and teammates is invaluable to promote healthy behaviors and encourage the athlete to make the needed changes.

Q: What are some tips for parents/coaches of young athletes who may be facing this issue?

Education is key. In the cases of unintentional caloric or nutrient restriction, athlete/family/coach education often helps remedy this by learning the importance of optimal nutrition. Most athletes who fall into this category don’t realize the detrimental effects lack of adequate calories/nutrients can have on their fertility, bone health, mental health, as well as cardiovascular, gastrointestinal, and other major body systems. For example, 90% of peak bone mass is reached by age 18 in females with the maximum rate of bone formation occurring between ages 10 and 14 years. Deficits in bone formation in adolescence may never normalize and persist into adulthood.

Studies have proven that parents and coaches have an enormous amount of influence on young athletes. One study of gymnasts found that 75% who were told by their coaches that they were overweight resorted to pathogenic weight-control techniques (purging, extreme dietary restrictions, etc.). Another study found up to 17% of adolescent volleyball players felt pressured by their coaches or parents to achieve or maintain a particular body weight. Parents and coaches should focus on constructive feedback on performance instead of superficial appearance.

About Kimberly Tucker, MD

Dr. Tucker's concentration includes adult sports medicine and pediatric and adolescent sports medicine. Her special interests include knee, shoulder, elbow, hip, and ankle injuries, upper and lower extremity fracture care, as well as sports injuries and conditions in athletes of all ages and skill levels, including female, pediatric and adolescent athletes.