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| Anorexia Athletica |
| Criteria that must be met: Weight loss, gastrointestinal complaints, absence of medical illness or affective disorder explaining the weight reduction, excessive fear of becoming obese, restriction of calorie intake One or more of the following: Delayed puberty, menstrual dysfunction, disturbance in body image, use of purging methods, binge eating, compulsive exercising. Researchers from Arizona State University have claimed that these criteria are somewhat ill-defined and indiscriminate. They suggest that more research is needed to further delineate and define the unique characteristics of those with subclinical eating disorders such as anorexia athletica. They make their own suggested list of absolute and relative diagnostic criteria, with the caveat that the number of criteria needing to be met remains to be determined. Their list is summarised as follows: Absolute criteria: 1 Preoccupation with food, calories and body shape 2 Distorted body image 3 Intense fear of gaining weight or becoming fat even though moderately or extremely underweight 4 Over at least a one-year period, the athlete maintains a body weight below 'normal' (5-15%) for age and height, using one or a combination of the following: a) restricting energy intake b) severely limiting food choices or food groups c) excessive exercise (ie, more than necessary for success in sport or as compared to athletes of similar fitness levels). 5 Absence of medical illness or affective disorder explaining the weight loss or maintenance of low body weight Relative criteria: 6 Gastrointestinal complaints. 7 Menstrual dysfunction. 8 Frequent use of purging methods (self-induced vomiting, or use of laxatives or diuretics for at least one month) 9 Bingeing (at least eight episodes a month for at least 3 months). Causes? There has been considerable speculation about why athletes are at such increased risk for eating disorders (clinical and subclinical). It' s hard to pin down which comes first - is it a predisposing personality or life circumstances which lead both to athletic participation and an eating disorder, or does participation in certain sports cause the onset of the eating disorder? It seems likely that there will be some interaction. A comprehensive study of elite female athletes undertaken in Norway sought to identify risk factors for eating disorders, along with trigger factors responsible for precipitating their onset or exacerbation. An initial screening questionnaire was sent to all elite female athletes in Norway (defined as one who qualified for the national team at junior or senior levels, or was a member of a recruiting squad for these teams, aged between 12 and 35). The 522 athletes responding represented six groups of sports: technical, endurance, aesthetic, weight dependent, ball games, and power sports. The Eating Disorder Inventory was used to classify individuals at risk for eating disorders were thereby defined as at risk, and 103 of these agreed to being given a clinical interview to diagnose eating disorders. A comparison group was also interviewed, consisting of 30 athletes chosen at random from a pool not at risk (ie, they were found to have low scores on the initial Eating Disorders screening questionnaire). These control subjects were matched to the at-risk subjects for age, community of residence, and sport. Ninety-two of the at-risk athletes met criteria for anorexia nervosa, bulimia nervosa, or anorexia athletica. All of these athletes were asked if they had any suggestions as to why they had developed an eating disorder. 85 per cent of these gave reasons. Information collected during the interviews was then combined with the specific reasons given by the athletes to define possible trigger factors associated with the development of eating disorders. The results showed that athletes competing in the aesthetic and endurance sports were leaner and had a significantly higher training volume than athletes competing in the other sports. The prevalence of eating disorders was significantly higher among athletes in aesthetic and weight dependent sports than in the other sport groups. Risk factors for eating disorders in athletes Several risk factors were identified. Dieting at an early age appeared to be associated with the onset of an eating disorder. A significant number of athletes who began dieting to improve performance reported that their coach recommended they lose weight. For young and impressionable athletes, such a recommendation may be perceived as a requirement for improved performance. Other researchers have reported a similar syndrome - for example, finding that 75 per cent of female gymnasts who were told by coaches that they were too heavy used unhealthy weight control measures. The results of the Norwegian study also suggested that the risk for eating disorders is increased if dieting is unsupervised. Athletes with eating disorders may not seek supervision for fear their disorder will be discovered. In addition, many athletes have little knowledge about proper weight loss methods and receive their information in haphazard ways, from friends, magazine crash diets, and so on.. Such diets are unlikely to account for the high energy requirements resulting from training, or the fact that maturing females have special nutritional requirements. Unsuitable crash diets may appeal to athletes if they feel that rapid weight loss is necessary to make the team or to remain competitive. Finally, the restrictive diets and fluctuations in body weight that accompany these efforts may also increase risk for eating disorders. Early start of sport-specific training was also associated with disordered eating. A higher percentage of athletic controls than of eating-disorder athletes participated in other sports before choosing their preferred sport. An individual' s natural body type usually steers the athlete to specific sports, and body type dictates in part whether the athlete will be successful. Beginning training for a specific sport before the body matures might have hindered these athletes from choosing a suitable sport for their adult body type. This could Provoke a conflict in which the athlete struggles to prevent or counter the natural physical changes precipitated by growth and maturity. Extreme exercise in itself has previously been cited as a potential causal factor in anorexia nervosa. In the Norwegian study, many of the athletes who did not give specific reasons for the onset of their eating disorder reported a large increase in training volume and a significant weight-loss associated with the increased activity. Athletes who increase their training volume may experience relative calorie deprivation, possibly because of not realising that they need to eat more to meet the increased energy demand, or perhaps due to reduced appetite produced by changes in endorphins. This calorie deprivation may create a biological or psychological climate in which eating disorders are more likely to develop. It has been observed previously that starvation itself can bring about symptoms of eating disorders - eg, obsession with food and hyperactivity('The psychology of eating and drinking', AW Logue, pub Freeman, NY, 1986,pl56) Finally, the loss of a coach occurred in some athletes with eating disorders. These athletes described their coaches as vital to their athletic careers. Other athletes reported that they developed eating disorders at the time of injury or illness, which left them unable to train at high levels. Thus, the loss of a coach, injury, or illness must be seen as traumatic events that become trigger events for the onset of eating disorders. Prevention Prevention is the key to addressing the problem of disordered eating, and education is a necessary first step. Athletes, parents, coaches, athletic administrators, training staff and doctors need to be educated about the risks (as detailed above) and warning signals of disordered eating. Mimi Johnson, in 'Disordered Eating in Active and Athletic Women' identifies the following checklist of warning signs: 1. A preoccupation with food, calories and weight 2. Repeated expressed concerns about being or feeling fat, even when weight is average, or below average 3. Increasing criticism of one's body 4. Secretly eating, or stealing food 4. Eating large meals, then disappearing, or making trips to the bathroom 5. Consumption of large amounts of food not consistent with the athlete' s weight 6. Bloodshot eyes, especially after trips to the bathroom 7. Swollen parotid glands at the angle of the jaw, giving a chipmunk-like appearance 8. Vomiting, or odour of vomiting in the bathroom 9. Wide fluctuations in weight over short periods 10.Periods of severe calorie restriction 12.Excessive laxative use 11.Compulsive, excessive exercise that is not part of the athlete' s training regimen 12. Unwillingness to eat in front of others (eg, teammates on road trips) 13. Expression of self-deprecating thoughts following eating 14. Wearing layered or baggy clothing 15. Mood swings 16. Appearing preoccupied with the eating behaviour of others 17. Continuous drinking of diet soda or water If you are concerned that someone you know may be suffering from an eating disorder, you need to go softly in approaching them about it. People who are truly anorexic or bulimic will often deny the problem, insisting that there' s nothing wrong. Share your concerns about physical symptoms such as light-headedness, chronic fatigue or lack of concentration. These health changes are more likely to be stepping stones for accepting help. Don't discuss weight or eating habits directly. Avoid mentioning starving/bingeing as the issue, and focus on life concerns. Offer a list of sources of professional help. Although the athlete may deny the problem to your face, they may secretly be desperate for help. |
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