Eating Disorders in Intercollegiate Athletes

Transcription

1 Eating Disorders in Intercollegiate Athletes

2 To sport or not to sport.that is NOT the question The benefits of participation in sports for people of all ages are clear. Builds self esteem Encourages physical conditioning Sets a foundation for lifelong physical activity Teaches the value of teamwork

3 Participation in sports do not cause eating disorders

4 Some athletes, like some people, come to the sport with risk factors that make them more vulnerable than others to developing eating problems.

5 Athletes are exposed to the regular pressures about body size, shape, weight and then are exposed to special pressures associated with being an athlete.

6 Numerous studies have shown that athletes are more prone to developing eating disorders than non-athletes.

7 The goal is to encourage participation in sports while also recognizing the reality that athletes are more at risk and learn about how to best take care of them.

8 Prevalence of Eating Disorders in Athletes *Athletes more prone to developing eating disorders than non athletes. *Female athletes more prone to develop eating disorders than males. *Disordered eating is seen in athletes of all sports.

9 Does the type of sport make a difference? Some studies show that particular sports do make a difference. Aesthetic sports, or sports that emphasize appearance, dieting, and weight such as body building, gymnastics, swimming/diving, or weight class sports (wrestling, rowing, horse racing) 62% of women and 33% of men have disordered eating.

10 Diagnosis: a continuum Considerable overlap among the disorders. Diagnoses are not stable. They change with age and duration of the disorder. 50%-64% of patients with Anorexia develop symptoms of Bulimia.

11 Types of Eating Disorders Anorexia Nervosa * Persistent restriction of energy intake leading to significantly low body weight (in context of what is minimally expected for age, sex, developmental trajectory, and physical health). * Either an intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain (even though significantly low weight). * Disturbance in the way one s body weight or shape is experienced, undue influence of body shape and weight on self evaluation, or persistent lack of recognition of the seriousness of the current low body weight.

12 Bulimia Nervosa 1. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: *Eating, in a discrete period of time (within any 2 hour period), an amount of food that is definitely larger than most people would eat during a similar period of time under similar circumstances. *A sense of lack of control over eating during the episode. 2. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise.

13 Bulimia Nervosa, contd. 3. The binge eating and inappropriate compensatory behavior occur, on average, at least once a week for three months. 4. Self-evaluation is unduly influenced by body shape and weight. 5. The disturbance does not occur exclusively during episodes of anorexia nervosa.

14 Binge Eating Disorder 1. Recurrent episodes of Binge Eating. 2. The binge eating episodes are associated with the following: *eating much more rapidly than normal *eating until feeling uncomfortably full *eating large amounts of food when not feeling physically hungry *eating alone because of feeling embarrassed by how much one is eating * feeling disgusted with oneself, depressed or very guilty afterward 3. Marked distress regarding binge eating is present. 4. Binge eating occurs, on average, at least once a week for 3 months.

15 Etiology of eating disorders *Many theories. No clear answers. *We know there is not one cause. *Many factors come together in a particular way to result in the disorder. *Factors include: cultural, family, stressors, personality characteristics, emotional and biological.

16 Signs and Symptoms: what to look for PHYSICAL * Decreased concentration, energy, muscle function, coordination, speed * Increased fatigue and perceived exertion * Longer recovery time needed after workouts, games, races * More frequent muscle strains, sprains, and/or fractures * Slowed heart rate and low blood pressure * Reduced body temperature and being sensitive to cold * Complaints of light-headedness and dizziness * Loss of fat and muscle * Parotid gland enlargement and/or callouses on the hand * Brittle hair and nails * Constipation, bloating, stomach pain

17 Signs and symptoms, continued EMOTIONAL/MOOD * Poor interaction with coaches/teammates * Perfectionism * Increased impatience, irritability * Increased isolation * Excessive concern with body aesthetic (complaints about being fat

18 Signs and symptoms, continued BEHAVIORAL * Difficulty with days off and tapering * Avoidance of water or excessive water intake * Preoccupation with one s own food or other s food * Ritualistic eating (pushing food around on the plate and/or avoidance of certain foods * Prolonged or additional training above and beyond that required for sport (extra workouts)

19 Physiological impact of eating disorders on athletic performance Fatigue Malnutrition Dehydration Electrolyte imbalance Osteoporosis Loss of endurance Loss of coordination Loss of speed Muscle cramps Overheating Amenorrhea Gastrointestinal problems Every BODY is different

20 Term coined in 1993 by American College of Sports Medicine Refers to a syndrome commonly seen in female athletes Involves the interrelated symptoms of disordered eating, menstrual irregularity and low bone mass. Eat too few calories to support activity level, brain hormone levels change disrupting signals to the ovaries to produce estrogen, which builds and maintains bones.

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22 Prevalence of the triad is unknown, some studies report disordered eating in up to 62% and amenorrhea in up to 66% of female athletes. Stages on a continuum. From mild disordered eating, irregular periods and/or possible stress fractures to eating disorder, long standing amenorrhea and bone density in the osteoporosis range.

23 Disordered Eating Disordered Eating: not eating enough for physical output Can be unintentional Can be intentional (restricting intake for purpose of weight loss-dieting) Dieting is considered disordered eating because it is the primary precursor for eating disorders. Affects more athletes in sports that emphasize a thin size/shape or low weight. Can lead to amenorrhea which can lead to bone loss. Can also lead to bone loss due to poor nutrition (calcium and vitamin D).

24 Amenorrhea Higher prevalence for athletes vs. non athletes. Hypothalamus turns off the reproductive system due to energy drain (imbalance). Prolonged amenorrhea can lead to increased risk for loss of bone mass.

25 Osteoporosis Low bone mass and deterioration of bone tissue leads to bone fragility and increased risk of fracture. Caused by insufficient estrogen needed to build bone mass.

26 Screening and Diagnosis Screening for the Triad should occur at pre participation exam or annual health screening exam. Athletes with one component of the Triad should be assessed for the others. Patient history to include: energy intake dietary practices weight fluctuations eating and exercise behaviors Physical exam to include: height/weight and vital signs Laboratory Tests electrolytes chemistry profile complete blood count with differential urinalysis

27 What to do if concerned? Take seriously any component of the triad. Identification of one component indicates need to asses/treat the other two. Approach the athlete privately with concern about her health. Require that athlete have an evaluation with a health care specialist who is knowledgeable about eating disorders who can determine current status. Tell the athlete she is considered to be injured until evaluated and told otherwise. Punishment vs. standard policy for managing an injury.

28 Treatment of Eating Disorders Eating Disorders are complex psychological problems that don t get better without treatment. Require a multidimensional approach: psychological, nutritional and medical aspect. Earlier intervention is always better. Levels of care of eating disorders treatment depend on symptom severity and other factors (previous treatment, medical complications, motivation ) Common concern that time in treatment may take away from time from sport. Must be a priority, like academics must be. Other concerns- confidentiality- athletic team feels left out of the treatment. Must be in place.

29 Prevention Promote an emphasis on health vs. size. Discourage dieting. Observe the eating and exercise habits of athletes. Talk openly about athletes increased vulnerability to eating disorders and importance of overall health on performance. Teach athletes how to maximize their potential by how they think (self-talk, goal setting, relaxation training) vs. changing their bodies. Recognize individual differences in athletes. Be cautious about using profiles of elite athletes regarding recommended weight or body compositions. Understand your power in relation to your athlete.