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Disordered Eating & Outline for today

Athletes • Body Image Dissatisfaction, Disordered
eating, eating disorders – facts & myths
• Risk factors & impact of disordered eating
Fiona Sutherland, in athletes
Sports Dietitian
• The female athlete Triad
Body Positive Australia

Sport, Disordered Eating & Eating

Body Image Dissatisfaction
• Society regards athletes as “fit and • Is a serious health concern
healthy” • Strongly correlated with low self esteem,
• Pressure to “look the part” disordered eating and other behaviours
• Risk factors with training that contribute to ill health
• Body monitoring • Females more likely to recognise (&
• Personality traits of high performance present) than males
athletes • Drives a desire to change the body to feel

Appropriate eating and exercise behaviours –

What is “disordered eating?” balanced and appropriate

Behaviours such as lowering energy intake

with the specific attempt to lose weight or
body fat
Using more extreme weight loss methods
such as short-term restrictive eating or
Requires health

intense, heavy exercise

team support

Chronic, repetitive dieting in attempts to

lose/control weight.

ED – extreme dieting, distorted body image,

weight fluctuations, highly abnormal eating
behaviours, performance suffers


What is an “Eating Disorder?” Prevalence

• Anorexia 0.5% in females
– AN is the third most common chronic illness for
adolescent girls in Australia

Bulimia 5% in females
10% of all ED’s are male
Epidemic numbers of people with EDNOS
High rate of mortality with AN and BN
20% after 20 years
EDFV statistics 2006

What causes an ED? Bulimia Nervosa

Caused by a complex combination of Restrict eating
• genetic predisposition for both AN and BN +/- exercise
• personality traits - hypervigilant, perfectionistic,
high achieving, obsessional, impulsive/chaotic,
feelings of personal ineffectiveness, guilt, distrust,
low self-esteem Unable to
• environmental triggers - life crisis, trauma, loss, Compensation
grief, personal disappointment, illness, sport-
specific training and dieting/restrictive eating

• Average length of illness varies from 4 - 7.5 years

• Frequent co-morbidities of anxiety, depression and OCD binge eat

Anorexia Nervosa
(Other specified feeding and
earing disorders)
• The most physically obvious of the EDs
• Gradual or rapid weight loss • Doesn’t fit “neatly” into
• More commonly seen in sports where low any other category
weight or leanness confers a performance • May have all symptoms of AN but not
advantage eg. running, triathlon underweight
• Potentially the most common diagnosis
but diagnostically represents the “residual”
of the other diagnoses


Summary - what do most disordered

Binge Eating Disorder eating presentations have in
• Approx 4% in population
• Using food (or lack of) to cope with difficulties
• Most likely onset in adulthood • Low self esteem, Poor body image
• Not always overweight, although more • Dieting, dietary manipulation
likely • Perception that things will be better if weight
or body shape improved
• Over-focus of food/body/weight in life over
other things that are actually more important
eg. social, education, training

Why are athletes at risk? Myth or fact?

• Shared personality traits Anorexia nervosa is the main disorder I
should be looking out for…..
• Being a “good athlete”
• Training demands can mask disorder eg.
running, triathlon
• Acceptable/normalised eating patterns eg.
coffee/salads MYTH
• Open to suggestions for improved
• Greater focus on body

Myth or fact? Myth or fact?

Unless an athlete is losing a lot of weight, I Amongst athletes, particularly males, you are
really don’t need to be concerned much more likely to encounter behaviours
that are more similar to bulimia nervosa



Myth or fact? Males and Body Image….

Taking an athletes skinfolds will lead to an • Research indicates that 40-50% of males
eating disorder report body image dissatisfaction
• Can present differently to females…
• Serious and growing concern
MYTH • Less likely to come forward
• Pressure of media, products

What you may see/hear/observe

For the male athlete….. (a.k.a. “red flags”)
Body Image Dissatisfaction may present as:
• Physical symptoms such as headaches, fatigue,
• Exercise dependence bowel problems, dizziness, sleeping problems
• Excessive use of food supplements • Desire to lose or gain weight or reduce body
• Muscle dysmorphia fat, especially if unnecessary or unrealistically
relating directly to performance goal
• Perfectionistic attitudes towards food & eating
• The “ideal athlete” (lean and muscular)
in a way that is unhelpful, unhealthy,
imbalanced or interrupting regular life

• An over-focus on eating/nutrition &

Diet & risk – know your limits
• Talking about food/diet ++ (eg. clean • Certain style of eating are NOT SUITABLE for
eating, paleo…) people at risk of engaging in disordered
• Weight or body comp loss/gain or eating (eg. paleo, or any style that
fluctuations encourages elimination of food groups)
• Reluctance to eat with the team, • Be very mindful about offering dietary
distancing behaviours advice – know your limit, refer on
• Mood swings • There is no one “right” diet for everyone
• Inconsistent attendance at training


The Female Athlete Triad The Female Athlete Triad:

• The Triad has been well established as a
medical condition often observed in
physically active girls and women, and
involves three components,
• (1) low energy availability with or without
disordered eating,
• (2) menstrual dysfunction, and
British Journal of Sports
Medicine on the Female Athlete • (3) low bone mineral density.
Triad (BJSM, 2014. The 2014,

Energy Availability…….the driving

Each component of the Triad
• Difficult to estimate
Overt signs may include
• BMI <17.5kg/m2
• <85% IBW (adol)
• Lots of info re. dietary intake, any
• Low RMR, low T3, RMR/predicted RMR
Female athlete triad (ACSM
position stand, 2007)

More Information here: Role of the EP

Triad Coalition (USA):
http://www.ncaa.org/health-and-safety/nutrition- • Support
consensus-statement-guidelines • Education

• Work collaboratively with other

AIS website:
http://www.ausport.gov.au/ais/nutrition/fac health team members


Goals of the recovery process What is helpful and unhelpful?

• Achieve healthy weight or support family in
• It is not about food and weight
achieving healthy weight (adolescents)
• Maintain normal growth in adolescents • Do not offer dietary advice
• Prevent long term complications - • Remember the person
osteoporosis, dental erosion, pregnancy
• Reduce shame
• Provide strategies for reducing and managing
ED behaviours • Keep your mind open

• Promote normal natural eating, intuitive • Flexible but firm

• Nutrition education - correct myths
• Address body image issues

Summary Resources and services…

***National Eating Disorders Collaboration***
• Body Image Dissatisfaction is the primary
driver of disordered eating behaviours http://www.nedc.com.au

Sports Dietitians Australia – online resource for

• Aim to create & maintain a culture where
athletes feel committed to health first over http://www.sportsdietitians.com.au/content/2583/EatingDisorders/
conforming to certain body shape
Eating Disorders Victoria (EDV)
• If concerned, act early www.eatingdisorders.org.au