21/10/2014

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
www.bodypositiveaustralia.com.au
@FionaBodyPosAus

Sport, Disordered Eating & Eating

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

Appropriate eating and exercise behaviours –

What is “disordered eating?” balanced and appropriate
Manageable
Often

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

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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
sustain
grief, personal disappointment, illness, sport-
specific training and dieting/restrictive eating

• Average length of illness varies from 4 - 7.5 years

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

Anorexia Nervosa
OSFED
(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

2

Binge Eating Disorder
• Approx 4% in population
• Most likely onset in adulthood
• Not always overweight, although more
likely
Why are athletes at risk?
• Shared personality traits
• Being a “good athlete”
• Training demands can mask disorder eg.
running, triathlon
• Acceptable/normalised eating patterns eg.
coffee/salads
• Open to suggestions for improved
performance
• Greater focus on body
Myth or fact?
Unless an athlete is losing a lot of weight, I
really don’t need to be concerned
MYTH
21/10/2014
Summary - what do most disordered
eating presentations have in
common?
• Using food (or lack of) to cope with difficulties
• Low self esteem, Poor body image
• Dieting, dietary manipulation
• 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
Myth or fact?
Anorexia nervosa is the main disorder I
should be looking out for…..
MYTH
Myth or fact?
Amongst athletes, particularly males, you are
much more likely to encounter behaviours
that are more similar to bulimia nervosa
FACT
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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…..
Body Image Dissatisfaction may present as:
• Exercise dependence
• Excessive use of food supplements
• Muscle dysmorphia
• The “ideal athlete” (lean and muscular)
(a.k.a. “red flags”)
• Physical symptoms such as headaches, fatigue,
bowel problems, dizziness, sleeping problems
• Desire to lose or gain weight or reduce body
fat, especially if unnecessary or unrealistically
relating directly to performance goal
• Perfectionistic attitudes towards food & eating
in a way that is unhelpful, unhealthy,
imbalanced or interrupting regular life

• An over-focus on eating/nutrition &

Diet & risk – know your limits
exercise
• 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

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The Female Athlete Triad The Female Athlete Triad:

British Journal of Sports
Medicine on the Female Athlete
Triad (BJSM, 2014. The 2014,
Feb:48(4),289)
• 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
• (3) low bone mineral density.

Energy Availability…….the driving

Each component of the Triad
force
• Difficult to estimate
Overt signs may include
• BMI <17.5kg/m2
• <85% IBW (adol)
• Lots of info re. dietary intake, any
restriction?
• Low RMR, low T3, RMR/predicted RMR
<0.9
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
and-performance/2014-female-athlete-triad-
consensus-statement-guidelines • Education

• Work collaboratively with other

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

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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

eating
• 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
coaches
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

Thankyou