Lisa Diers, RDN, LD, E-RYT

Director of Nutrition & Yoga The Emily Program

Eating Disorders & Athletes When “Healthy” Goes Too Far

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Objectives

• Participants will be able to:

– Successfully identify helpful & unhelpful messages about eating & activity

– Gain knowledge in how to identify potentially dangerous & disordered eating & movement behaviors in athletes

– Learn key strategies in supporting & treating athletes struggling with eating disorders

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Defining An Eating Disorder

• What is an Eating Disorder?

• Who Gets an Eating Disorder?

• Is it a choice?

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Eating Disorders are NOT a choice

Recovery IS Possible

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What is an Eating Disorder?

• WHAT: Eating Disorders Such as Anorexia, Bulimia and Binge Eating Disorder- include extreme emotions, attitudes and behaviors surrounding weight and food. Eating Disorders are a serious emotional and physical problems that can have life threatening consequences.

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Types of Eating DisordersDSM V

• Anorexia Nervosa

• Bulimia Nervosa

• Binge Eating Disorder

• Avoidant/Restrictive Food Intake Disorder

• FEC-NEC – Atypical AN

– Sub BN

– Sub BED

– Purging Disorder

– NES

▪ Not Official ED, but commonly referred to: Diabulimia, Orthorexia

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• Eating disorders affect a person physically, behaviorally, emotionally, and

psychologically; including:

• Dramatic weight gain or loss; or no noticeable change in wt.

• Verbal preoccupation with food, weight, and shape

• Rapid or persistent decline or increase in food intake

• Excessive or compulsive exercise patterns

• Purging; restricting; bingeing; compulsive eating; abusing diet pills,

laxatives, diuretics, emetics

• Denial of food and eating problems, despite the concerns of others

• Eating in secret, hiding food, disrupting meals, feeling out of control with

food

• Medical complications, such as menstrual irregularity, dizziness, fainting,

bruising, dry skin, leg cramps, hair loss, brittle hair, osteoporosis, diarrhea,

constipation, dental problems, morbid obesity, diabetes, chest pain, heart

disease, heartburn, shortness of breath, organ failure, and other symptoms

Why do people get eating disorders? Bio-Psychosocial Model of Eating Disorders

Food restrictionGenetics

Physical changesPuberty/Menopause

neurotransmitters

StressorsIdentity/self-imagePersonality factors

PerfectionismDepression

Coping

Cultural factors

Pressure to “fit in”

Normalization of dieting

Media

biology psychology

social/environment

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concerns Healthy ➜ ➜ ➜ ➜ Problematic

Weight controlPractices:

Healthy eating behaviors

Dieting Unhealthy weightcontrol

Anorexia or BulimiaNervosa

Physical activitybehaviors:

Moderate physicalactivity

Minimalor excessiveactivity

Lack of, orobsessive, physicalactivity

“Anorexia athletica”

Body image: Body acceptance

Mild bodydissatisfaction

Moderate bodydissatisfaction

Severe bodydissatisfaction

Eating behaviors: Regular eating patterns

Erratic eatingbehaviors

Binge eating Binge eatingdisorder

Weight status: Healthy bodyweight

Mildly overweightor underweight

Overweight orunderweight

Severe overweightor underweight

Neumark-Sztainer D, “I’m, Like, SO Fat!”: Helping Your Teen Make Healthy Choices about Eating and Exercise in a Weight Obsessed World. New York: The Guilford Press; 2005.

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Who gets an ED • WHO: Eating Disorders are not discriminatory of body size, age, sex,

orientation, race or economic status.

Athletes• Sports that emphasize appearance, muscularity, or weight

requirements (cheerleading, diving, bodybuilding, or wrestling)• Individual-focused sports such as gymnastics, running, figure skating,

dance, or diving rather than a team sport like basketball, volleyball, or soccer

• Endurance sports, such as track and field, running, and swimming• Training for a sport since childhood or being an athlete of elite-status• An overvalued belief that lower body weight will improve

performance• An unhealthy focus on success and performance supported by those

invested in the athlete's performance• Unhealthy focus/messages: LEANER, BIGGER, STRONGER, LOOK

BETTER; PERFECTION

Continued…

• Study of elite female runners had 16% with a classifiable eating disorder at the start of the study

• Girls high school varsity sports- 18.2% disordered eating

• Ohio State University-subclinical eating problems affected 19% of female athletes & 12% of males

Weight Classed Sports

• Menstrual disturbance in approximately 30% of females

• 85% of females attempted to lose weight

• 93% of male athletes attempted to lose weight

• Most common compensatory behaviour reported by athletes was dehydration (e.g., sauna, exercise in sweat suites).

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Weight Classed Sports

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Weight Classed Sports

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What it Means to RDs

• Our profession needs to have a sensitivity to eating disorder treatment

• What are our own beliefs & biases on food, weight, shape, appearance, performance?

• So much praise for athletes; Extremism = success Can you tell if it’s healthy or disordered?

• Know when it’s time to refer – parents/coaches/MD• Consult with ED Dietitian specialists• Eating disorder treatment is HARD work• So are other major treatments

– It’s Hard work. It’s challenging. There are sacrifices.

• It works!

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Objectives

• Participants will be able to:

– Successfully identify helpful & unhelpful messages about eating & activity

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Helpful or Not?

• OK Team- see how Sally performed yesterday? Stellar. Sally – tell everyone what you’ve been doing. Especially how you changed your diet.

• Your body works for you. Not the other way around. You want to be on top, push harder-maintain control.

• You know your body. Eat what works best for you and helps you perform. Your body will tell you what to do.

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Helpful or Not?

• You don’t need to worry about how or what you eat! That’s the bonus of competing, you can eat whatever you want. You'll burn it off in practice!

• If you would cut some weight, you’d be faster. Only 5 pounds. You’d shave at least 3 seconds off your time.

• Whatever you're doing, keep it up!

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Helpful or Not?

• Wow. You look great!

• Excuses, don’t want to hear them. Complaints, Not Interested.

• There are many things that can be done to improve performance. What are your goals?

• Your Examples?

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Objective #2

• Gain knowledge in how to identify potentially dangerous & disordered eating & movement behaviors in athletes

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When Healthy Has Gone too FarSigns & Symptoms

• Avoidance of water or excessive water intake• Preoccupation with one’s own food• “Perfect” Eating- (orthorexia) • Preoccupation with other people’s food • Ritualistic eating and/or avoidance of certain foods • Excessive concern with body aesthetic• Decrease in performance, especially when combined

with other signs • Prolonged or additional training above and beyond

what is required for sport (e.g., extra sit-ups and laps, extra workouts)

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When Healthy Has Gone too FarSigns & Symptoms

• Athletes on the team reporting concern about an individual• Decreased concentration, energy, muscle function, coordination, speed • Increased fatigue and perceived exertion • Longer recovery time needed after workouts, events • Difficulty with days off and tapering• More frequent muscle strains, sprains, and/or fractures • Slowed heart rate and low blood pressure • Reduced body temperature and increased sensitivity to cold—cold hands and feet • Complaints of light-headedness and dizziness • Gastrointestinal complaints such as nausea, constipation, abdominal pain and fullness • Poorer interaction with coaches/teammates • Perfectionism • Increased impatience, crankiness • Increased isolation

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Objective #3

• Learn key strategies in supporting & treating athletes struggling with eating disorders

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Key Strategies

• In private setting communicate care and concern “I am concerned….”

• Be a listener. Let them know you are there whenever you need them

• Don’t pass judgment/Be a compassionately Curious

• Reinforce- weight doesn’t determine performance outcomes. Performance does.

• Athletes want to perform. Food= performance fuel

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Key Strategies

• Make tough calls. Sometimes it works to stay in the sport. Sometimes it doesn’t.

• Support your athlete- if your athlete had a broken leg- how would you handle it? Why is this different?

• Avoid body/food comments

• Support their Recovery Meal Plan

• Collaborate with ED RD

• Continue to follow-up/check-in

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Key Strategies

• Get an Assessment/ Refer

• College Campus Resources

• School Counseling Resources

• Involve parents

• Assess your clients/teams

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Team Activity: Food & Wt. Messages

• What Messages do you receive about Food?

• What messages do you receive about weight and Performance?

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Team Activity: Being a Change Agent

• How can you change the conversation?

• How can you promote a body positivity?

• How can you promote nutritionally positive messages?

• What can you do if feeling performance pressure to engage in extreme weight or food practices ?

• What can you do if you think someone you know has an eating disorder?

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Performance Stress & Anxiety and Pre/Post Fueling

• Wreaks havoc on the nervous system

• Can affect appetite pre and post competition

– Nausea

– Decreased appetite

– “Nervous” eating

– “Relief” eating (emotion eating)

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Performance Stress & AnxietyPre/Post Fueling

• Remind your Athlete that sticking to his/her pattern of eating is really important-restriction can exacerbate feelings of anxiety and nausea, it inhibits performance and for some it leads to over eating after the event

• So, what to do about the stress and anxiety…

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• Deep Breathing

• Journaling

• Eating with Someone

• Listening to Music

• Talking

• YOGA….

Performance Stress & AnxietyPre/Post Fueling

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Experience it FirstUnderstand it later

BREATH-CENTRIC ASANA (yoga postures)

• “Notice what you notice” (Bring Awareness to Sensation. Emotion.)

• Contralateral Movement

• Hands to eyes

• Neck stretch

• Nyasa

• “Notice what you notice”

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Three Yoga Techniques Non food way to manage stress &

anxiety

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YOU can teach this!

• Try a technique prior to a meal

• Real life strategies

• Proven

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RCT Yoga & Meal Time Anxiety

• 1Carly R. Pacanowski, Lisa Diers, Ross D. Crosby & Dianne Neumark-Sztainer (2016): Yoga in the treatment of eating disorders within a residential program: A randomized controlled trial, Eating Disorders, DOI: 10.1080/10640266.2016.1237810

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RCT

• looked at the relationship between yoga and negative affect (a term used to describe experiencing unpleasant emotions) before mealtime, as it is known that meals are especially difficult for clients with eating disorders, and negative mood at mealtime is associated with poorer recovery outcomes. Results showed the group that participated in a yoga class designed to target eating disorder symptoms exhibited significantly lower negative affect before meals compared to a group that did not practice yoga (this effect did weaken somewhat throughout the meal). Participants who had practiced yoga also reported feeling calm and in tune with their internal drives.

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The Truth About Weight & Performance

When Do We Perform Well? • Physically Fit

• Mentally Fit

• Emotionally Fit

• Nutritionally Fit

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Summary

• No one “chooses” to have an eating disorder

• Can affect anyone, high prevalence in college athletes

• Weight does not determine performance outcomes

• Food is Fuel. Performance Eating.

• Stress reduction techniques like yoga can help

• YOU can make a difference/ Agent for change

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Resources/References

• www.emilyprogram.com• https://emilyprogram.com/blog/tag/yoga• https://emilyprogram.com/blog/tag/nutrition• Journal of Athletic Training; 2005; 40(1); 47-51• Clinical Journal of Sports Medicine; 2004; 2006• http://journals.lww.com/cjsportsmed/pages/default.aspx• College Campus Student Counseling Services • American college of sports medicine http://www.acsm.org/• http://www.scandpg.org/sports-nutrition/• http://www.sportsnutritionsociety.org• www.NCAA.com

http://www.emilyprogram.com/https://emilyprogram.com/blog/tag/yogahttps://emilyprogram.com/blog/tag/nutritionhttp://journals.lww.com/cjsportsmed/pages/default.aspxhttp://www.acsm.org/http://www.scandpg.org/sports-nutrition/http://www.sportsnutritionsociety.org/http://www.ncaa.com/

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Resources/References

https://www.nationaleatingdisorders.org/sites/default/files/Toolkits/CoachandTrainerToolkit.pdf

https://www.nationaleatingdisorders.org/athletes-and-eating-disorders

http://www.eating-disorders-research.com/content/athletes-and-eating-disorders-0

http://www.ncbi.nlm.nih.gov/pubmed/16461868/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3246101/

http://www.researchgate.net/profile/Monica_Torstveit/publication/234012834_Sundgot_Borgen_Torstveit_DE_HIS_2011/links/02bfe50e3ecdf04ca9000000.pdf

http://search.proquest.com/openview/0045dbeaea7fefa2226e17f09c7dae4a/1?pq-origsite=gscholar

http://tim.blog/2013/05/06/how-to-cut-weight-ufc/

https://www.nationaleatingdisorders.org/sites/default/files/Toolkits/CoachandTrainerToolkit.pdfhttps://www.nationaleatingdisorders.org/athletes-and-eating-disordershttp://www.eating-disorders-research.com/content/athletes-and-eating-disorders-0http://www.ncbi.nlm.nih.gov/pubmed/16461868/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3246101/http://www.researchgate.net/profile/Monica_Torstveit/publication/234012834_Sundgot_Borgen_Torstveit_DE_HIS_2011/links/02bfe50e3ecdf04ca9000000.pdfhttp://search.proquest.com/openview/0045dbeaea7fefa2226e17f09c7dae4a/1?pq-origsite=gscholarhttp://tim.blog/2013/05/06/how-to-cut-weight-ufc/

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THANK YOU!!• Lisa.Diers@emilyprogram.com

• www.emilyprogram.com

mailto:Lisa.Diers@emilyprogram.comhttp://www.emilyprogram.com/