Sport participation can be a very positive experience for an individual in that it can aid in developing self-esteem, a sense of competence, and physical conditioning, in addition to providing opportunities for healthy competition. At the same time, there are aspects of the sport environment that can increase a person’s risk for developing disordered eating. This concern, however, should not be misconstrued to mean that sport participation should be avoided. It is not sport or sport participation that needs to be avoided, but rather the risks often found in the environment.
Eating Disorders: What They Are and What They Are Not
Eating disorders are not simply “disorders of eating.” Also, they are not simply a misguided attempt to be thin; nor are they simply a sport participant’s means to reduce body weight or body fat in an effort to enhance sport performance. They are mental disorders that manifest themselves in a variety of eating and weight-related signs and symptoms. They are not caused by sports or coaches, although sports and coaches can increase the risk of developing such a disorder or exacerbate an existing disorder. Rather, they are potentially life-threatening disorders with multiple determinants and risk factors, including socio-cultural, familial, and personality factors, as well as genetics.
Identification difficulties.
Athletes are probably more at risk for developing eating disorders than non-athletes because they experience the same eating disorder risks as non-athletes but also face additional risk factors within the sport environment. Because treatment cannot occur until the athlete has been identified as symptomatic, a risk to athletes is that identification is more complicated in the sport environment. Several issues can make identification more difficult. One of these is the (mis)perception of eating disorder symptoms as “normal” or even desirable. For example, dieting, weight loss, and excessive exercise are eating disorder symptoms. However, in the sport world, where leanness and hard training are desirable traits rewarded by many coaches, such symptomatic behaviors, along with perfectionism, are apt to be viewed as traits of a good athlete. Even physiological symptoms such as amenorrhea may be viewed as “normal.” The aforementioned symptoms are even less likely to be viewed as symptoms when the athlete is performing well, because there is often a “presumption of health” with good sport performance.
Recommendations for Coaches
Coaches are in the ideal position to identify symptomatic athletes because they spend so much time with them. It is therefore important for coaches to be aware of the physical/medical and psychological/behavioral signs and symptoms of disordered eating. (See Table) Additionally, coaches have considerable influence with their athletes. Thus, their comments about weight are very powerful. As tempting as it may be to focus on loss of body weight or body fat to enhance sport performance, athletes and coaches need to be aware of issues regarding not only sport performance but also health. Sport performance is like most human behaviors in that it is determined by multiple factors. Leanness for some athletes is probably one of them, but it is one that is likely to increase the risk of disordered eating. Focusing on the other factors such as mental preparation, confidence, and physical factors such as endurance, strength, etc. is less likely to increase the risk. Other than genetics, the factor that probably plays the greatest role in sport performance is (good) health, and other than genetics probably the greatest contributor to good health is good nutrition. Additional information is available to coaches on managing disordered eating from the NCAA Coaches Handbook : Managing the Female Athlete Triad (NCAA, 2005). To download the manual, go here, then follow the link to Female Athlete Triad Prevention. Eating Disorders in Sport (Thompson & Sherman, 2010) provides a thorough discussion of the above topics.
Everybody Knows Somebody. Get involved in NEDAwareness Week 2012, February 26- March 3! Visit the NEDAwareness Week homepage under Programs & Events to register today and learn more about how you can do just one thing to help raise awareness about eating disorders and become part of the solution. Helpline: 800 931-2237
References
National Collegiate Athletic Association. (2005). NCAA coaches handbook: Managing the female athlete triad. Indianapolis: The National Collegiate Athletic Association.
Thompson, R.A., & Sherman, R. T. (2010). Eating disorders in sport. New York: Routledge.
Table. Disordered Eating: Signs and Symptoms
Caution: The fact that an athlete displays some of the characteristics below does not confirm that the athlete is engaging in disordered eating. However, the likelihood increases as more signs and symptoms are evident. Also note that this is not a complete list of symptoms, but rather includes the most common ones.
These tips are adapted from You’re Amazing! A No-Pressure Guide to Being Your Best Self
by Claire Mysko (Adams Media)
Girls today are told they can do anything. Unfortunately, the message they’re often getting is that they have to do everything–and please everyone while they’re at it. All this pressure is adding up to big time stress. According to The Supergirl Dilemma, a study conducted by Girls Incorporated, more than half of girls in middle school reported that they often feel stressed. By the time girls get into high school, that number jumps to 74%. One third of all girls in grades 3- 12 said they often feel sad and unhappy.
When girls get caught up in the quest to be supergirls, they are less likely to feel confident in themselves and more likely to struggle with low self-esteem and poor body image. Here are five tips to help the girls in your life tackle The Supergirl Dilemma.
Does the pressure to do it all sound familiar? Supergirls and Superwomen hear the same voice, and it says “you’re not good enough.” Remember to give yourself a break and take time for healthy stress relief. If we want to break this damaging “super” cycle and set positive examples, we have to start with ourselves.
Teach girls to be savvy and critical media consumers. Resist the urge to simply lecture about what you think is inappropriate. Instead, ask them what they like about the movies and TV shows they watch and the magazines they read. What do they dislike? Talk about the difference between fantasy and reality by showing girls real examples of retouching. Point out how often retouching is used to make models and actors look artificially flawless.
Encourage girls to exercise their bragging rights. Girls are often hesitant to talk about what makes them amazing because they don’t want to be seen as conceited or they feel like they’re not perfect enough to be proud of themselves. Turn that thinking around by challenging girls to take pride in all of their amazing qualities, not just their achievements. Ask a girl what makes her amazing. If you get a sheepish shrug or an “I don’t know,” press on. You can spark the conversation by sharing a few of her qualities that you think are amazing, but don’t let her off the hook until she can say this sentence out loud: “I’m amazing because…”
Discuss the value of making mistakes and taking healthy risks. Many girls are so focused on being perfect and doing things “right” that they miss out on valuable opportunities because they are so afraid of failure. Share a mistake you made or a risk you took in life that helped you get where you are today.
When girls talk about the pressures they feel, the best thing you can do is listen. Don’t judge, interrupt, or get upset. Remember that what girls need most of all in their lives are supportive adults who take the time to hear what they’re saying.
Amazing Girl
Asks questions
Makes mistakes and learns from
Talks about her feelings, fears, hopes, and dreams
Tries new things
Supports other girls
Is proud of her accomplishments, no matter how big or small
Knows three trusted adults she could turn to if she had a problem
Knows how to set boundaries and say no
Takes care of her body, mind, and spirit
Super girl
Is afraid of not knowing the “right” answer
Makes mistakes and agonizes over them
Keeps it to herself when she’s stressed or sad
Doesn’t take on new challenges
Is jealous of other girls’ successes
Feels like no accomplishment is good enough or big enough
Wants adults to think she is happy, even if she doesn’t always feel happy
Sometimes does things she doesn’t want to do if she thinks people might like her more for doing them
Wishes she could be smarter, prettier, more popular, more athletic- -the list goes on
Everybody Knows Somebody. Get involved in NEDAwareness Week 2012, February 26- March 3! Visit the NEDAwareness Week homepage under Programs & Events to register today and learn more about how you can do just one thing to help raise awareness about eating disorders and become part of the solution. National Eating Disorders Helpline: 800 931-2237
If you have grown up in this culture, you probably associate quite a few things with fatness and quite a few of the opposite traits with thinness. Almost every audience comes up with the same lists:
Fat:
Lazy
Depressed
Sick
Out of control
Loser
Bad
Thin:
Productive
Confident
Healthy
Disciplined
Sexy
Good
Even though these associations are not something people from other cultures (or other times in history) believe, they are so strong and unquestioned in our own time that they form the basis of our weight stereotyping, bias, and stigma.
To test your own associations, go take the Weight version of the Implicit Attitudes Test. The test does not measure whether you inflict weight bias on people, but rather how strongly you have been taught to associate certain concepts with weight.
It might be surprising to know that weight stigma hurts both thin and fat people. In my work with people of all sizes who are struggling with disordered eating, it is clear that a huge factor in their misery is almost always the worry that they will be humiliated and rejected because of their weight – no matter what their weight is. I have had people sitting in my office who look like they walked straight out of a fashion magazine who are convinced they are not thin enough, not perfect enough, and not good enough (and some of them are absolutely accurate about the impossible standards of their world of ballet or modeling or a really bad relationship). Others have endured a lifetime of negative stereotyping and discrimination as fat children or adults, and can’t imagine loving the bodies they blame for the meanness of other people. Still others have witnessed the humiliation of a friend, a parent, a sibling– and are petrified about such a thing happening to them.
So some of them have had actual experiences of weight stigma, some of them give themselves the experience of stigma within their own minds, and some are convinced that it is only a matter of time before the axe falls unless they perfect their bodies to some mythical state. No one feels safe, because everyone has times when we feel something from the “fat” column.
When I work with clients, we have to figure out a way to handle both the real and the self-inflicted experiences of weight stigma , so that s/he can get unstuck and recover. Part of this work is to change one’s own mind about what fat and thin means. Part of it is to change other people’s minds.
And so today in the spirit of changing other peoples’ minds, I ask that we stop for a moment and question this weight stigma stuff, and why we keep it around.
It seems obvious that the diet (i.e., the weight cycling) industry wants to keep it around because how else would you sell a program that never works, over and over again, and not worry about the consumer getting hip to the fact that it is useless? But even though it is a big honking industry (most recently estimated at over $60 billion), most of us are not making money from it and would be fine if it suddenly went out of business. In fact, most of us would be much better off economically with our $500- 1000/year safe in our own pockets rather than the weight cycling industry.
So what about the rest of us who aren’t profiting off this industry? Why would we perpetuate weight stigma? When you look at the lists of traits associated with “fat” and “thin,” what strikes me is that they are such normal human states and traits. Is there a week that goes by when you don’t feel like some of Column A and some of Column B? But the “fat” traits are painful to experience – they are the things we feel when we miss the deadline, can’t get motivated, find ourselves rejected, or are diagnosed with a health problem. We would prefer not to feel them at all, and when we are promised that just by losing weight, we will become a Whole New Person (free of all the “fat” traits!), we think that would be a pretty great deal. That promise sucks us in. We cave to the illusion that life does not have to sometimes feel bad, and we perpetuate the myth that by changing our bodies, we can avoid ever feeling bad. In fact, if you feel bad, it must be your own fault.
The truth is, few people live only in the “Thin” column. And actually, when you think about it, doing so might make you pretty insufferable. It may be the reason some people can be so immensely clueless about the weight stigma they are inflicting on others – being cut off from your own human vulnerability makes it more possible to justify “punishing” other people. Only someone who refuses to identify with the person across from her who is suffering, would add to that suffering.
There are people who understand that weight stigma is causing suffering but feel like it is somehow going to make people care about their health. Like a person will start exercising to lose weight, but not to become more healthy, so we have to keep trying to stigmatize higher weight and promote weight loss.
It is true that people are social animals, and are very punished by being stigmatized. But punishment is famously unpredictable as a motivator. The things people do to leave the stigmatized group are often not at all conducive to their health. Injecting poison into your skin, slicing up healthy body organs, starving yourself, taking drugs, and even repetitive weight loss attempts, are things that make people sicker. Even though I don’t think people would go through half of what they do in the name of weight loss just to have lower blood pressure or better triglycerides or a lower risk of a stroke, I would argue that the net effect of the attempt to leave the stigmatized group is actually less health. Weight loss is not like trying to quit smoking. Weight cycling makes you sicker and fatter. And if your weight loss takes the form of an eating disorder you have a one of the deadliest psychiatric illnesses to battle.
And what about the health burden of weight stigma itself? Historical studies of cultures where higher weight is not stigmatized show that people at higher weights were just as, or even more, healthy than the thinner members of the community. And perhaps the most robust finding in all of epidemiology is that social support is the holy grail of health. How can removing social support – and making people sicker – be a path to making people healthier? How can the US government telling people that we are trying to eliminate them in a generation make them healthier?
The truth is, there is no reason to demonize people of certain weights. The far more effective message is that people can find things to do that support their health at whatever size they are. After all, the same practices and environments support health for thin or fat people. If the same cafeteria feeds the thin kids and the fat kids, why can’t we talk about what is on the menu that supports the health of all the kids? Why do we have to argue that the food has to change so we can have no fat kids? Why can’t we argue that the food should be healthy for the kids–period? We can work to create environments that support people in their efforts to thrive and make lasting efforts to take care of their bodies. Part of creating that environment is ridding it of the pollution of weight stigma.
I grew up during times of great social upheaval, and I have seen a lot of change when it comes to social stigma. Though the world is far from perfect, it is a very different place now than it used to be if you live together without being married, or get divorced, or have a baby as a single parent, or work as a female airline pilot, or get around in a wheelchair, or raise kids as gay parents, or love someone of a different race or religion. Stigma is a kind of fashion. We can change what is fashionable. We can make weight stigma incredibly uncool. Because it is.
So what are you going to do today to end weight stigma, in your mind, and in the world?
Deb Burgard, PhD is a psychologist specializing in eating, weight, and body image concerns. She practices in the San Francisco Bay area, blogs for ASDAH, and is the creator of Body Positive.com.
Everybody Knows Somebody. Get involved in NEDAwareness Week 2012, February 26-March 3! Visit the NEDAwareness Week homepage to register today and learn more about how you can do just one thing to help raise awareness about eating disorders and become part of the solution. NEDA’s Helpline number is: 800 931-2237
Certified Eating Disorder Specialists Available for Interview in Conjunction with 25th Annual National Eating Disorders Awareness Week, Feb 26th- March 3, 2012
According to statistics, more young women in the US die from anorexia nervosia than from any other cause. That’s why it’s so critical that we raise awareness of eating disorders in the United States.
February 26th- March 3, 2012, marks the 25th annual National Eating Disorders Awareness Week (NEDAwareness Week) in an effortto bring public attention to the critical need to raise awareness and funding to battle eating disorders in the U.S.
Who: Certified Eating Disorder Specialists from Doorways, LLC, the only organization in Phoenix that specializes in the outpatient treatment of teens and young adults with mental health issues.
What:National Eating Disorders Awareness Week, February 26- March 3rd, 2012
Story Ideas:
How do you know if someone has an eating disorder?
What do you do if you suspect someone has an eating disorder
How can you get help for someone has an eating disorders
For females between 15- and 24-years-old-old who suffer from anorexia nervosa, the mortality rate associated with the illness is 12 times higher than the death rate of all other causes of death
We live in a culture saturated with unrealistic body-image messages and almost all of us know somebody struggling with an eating disorder.
Eating disorders are serious illnesses, not lifestyle choices
As many as 10 million females and 1 million males in the U.S. battle anorexia or bulimia. And as many as 13 million more struggle with binge eating disorder. Millions practice disordered eating due to an obsession with dieting
Four out of 10 Americans either suffered or have known someone who has suffered from an eating disorder
40% of newly identified cases of anorexia are in girls 15-19 years old
There was a significant increase in incidence of anorexia from 1935 to 1989, especially among young women 15-24
There has been a rise in incidence of anorexia in young women 15-19 in each decade since 1930
Over one-half of teenage girls and nearly one-third of teenage boys use unhealthy weight control behaviors such as skipping meals, fasting, smoking cigarettes, vomiting and taking laxatives
Girls who diet frequently are 12 times as likely to binge as girls who don’t diet
42% of 1st-3rd grade girls want to be thinner
81% of 10 –year-olds are afraid of being fat
The average American woman is 5’4” tall and weighs 140 pounds. The average American model is 5’11” tall and weighs 117 pounds
Most fashion models are thinner than 98% of American women
46% of 9-11 year-olds are “sometimes” or “very often” on diets and 82% of their families are “sometimes” or “very often” on diets.
About Doorways LLC.
Doorways LLC. is a faith-based counseling organization in Phoenix, Arizona, that provides comprehensive outpatient treatment focused exclusively on adolescents, young adults and their families. Therapists at Doorways specialize in treatment for eating disorders, mood disorders, substance abuse, depression, ADD/ADHD, self-harm, suicide and more. For more information, visit http://www.doorwaysarizona.com, or call 602-997-2880.
March 15th-May 3rd, 2012. Enrollment is now open for a new adolescent DBT Group in Phoenix, Arizona. Join anytime during session. Read more below:
Who: This group is recommended for male and female adolescents ages 13-17 who are struggling with their emotions and want to learn how to take back control of their life. The group exercises are fun and interactive and through them kids learn how to handle stress, be more self confident, regulate mood swings, communicate their feelings and more.
What: This Dialectical Behavior Therapy (DBT) group is an interactive and educationally based group that explains the DBT coping skills to help young adults replace unhealthy and problematic behaviors.
When: Thursdays, March 15 – May 3, 2012, 6:30 – 8:00 p.m. Open enrollment, can join any time during 8 weeks.
Where: Doorways, 1825 E. Northern Ave, Suite 200, Phoenix, Arizona
Cost: $45 per session, $360 total. Pay only $300 if paid in full by March 16.How: To sign up or for more information call Trina at Doorways, 602-997-2880 or email her at trina@doorwaysarizona.com.
The pressure to be thin in order to fit in is more extreme for today’s teenagers than it was for their parents and grandparents, often resulting in the development of eating disorder and the need for teen counseling. The obsession with weight that so often contributes to the development of eating disorders like bulimia is starting younger and younger. The National Association of Anorexia Nervosa and Associated Disorders (ANAD) found that almost half of girls in 1st-3rd grade wish they were thinner and by age 10, 80% of those girls will be afraid of getting fat. By the time they reach college, more than 90% of them will have been on a diet at some point in their lives and 25% of them will be using the binge and purge cycle associated with bulimia as a way to manage their weight.
Statistics show that more than 80% of eating disorders start before age 20. As many as 4% of women will struggle with bulimic behaviors at some point in their lifetime and since people with bulimia can be any weight, this eating disorder can be harder to spot than others like anorexia. It is common, however, for people who are anorexic to also use bulimic behavior to control their weight.
What Bulimia Looks Like
People with bulimia can be any weight- from the kind of underweight associated with anorexia to obese. Like other eating disorders, those with bulimia are often afraid of being overweight, obsessed with weight management, and always trying to lose weight so that they will be happier with their body. However, the behaviors people with this disorder use to address those fears don’t generally result in weight loss by themselves. Bulimic behaviors follow a cycle that starts with the binge. During a binge, people will eat excessive amounts of high-calorie food in a short period of time and feel like they have no real control over their eating. After bingeing, the person feels ashamed, disgusted, afraid, or guilty for consuming so many calories and purging feels like a way to rewind the clock and undo the damage. Purging, which can occur through vomiting, abuse of laxatives, excessive exercise, or starvation, often relieves the anxiety and helps alleviate the negative emotions caused by bingeing.
The shame associated with bulimia often results in secretive behavior and people with the disorder may go to great lengths to hide their abnormal eating habits and purging behavior. There are however, some signs that can point to a problem with bulimia, if you know what to look for. People with this disorder are often preoccupied with food, may exercise compulsively for hours each day, frequently go to the bathroom directly after eating, and may take an excessive number of diet pills, diuretics, or laxatives. There are physical signs as well, but they can be more difficult to spot. They may have broken blood vessels in their eyes and swollen salivary glands at the corners of their mouths caused by vomiting, small calluses or cuts across their knuckles from inducing vomiting, and problems with their teeth like excessive decay, gingivitis, or loss of tooth enamel.
The Real Dangers of Being Bulimic
Like other eating disorders, bulimia can be dangerous and even life-threatening. People with bulimia may experience problems with constipation, dehydration, hemorrhoids, and even pancreatitis. Excessive vomiting can lead to serious damage to the esophagus including tearing and rupture in addition to permanent damage to teeth and gums. Overuse of laxatives or diuretics can result in electrolyte imbalance, and dehydration.
How You Can Help
People who have eating disorders need the support of those around them. If someone you know has an eating disorder, the best way to help is to educate yourself about the disorder and provide the support they need throughout their recovery.
It’s no secret that eating disorders are a real and pressing problem for today’s teenagers. According to the National Association of Anorexia Nervosa and Associated Disorders (ANAD), there are more than 24 million Americans with eating disorders and only 1 out of every 10 of those people will receive any treatment. ANAD indicates that more than 80% of eating disorders, including anorexia nervosa, begin in adolescence. Anorexia is the third most common chronic illness amongst adolescents and it carries a mortality rate twelve times that of any other cause of death for females between 15 and 35.
When you consider the life-long consequences and life threatening danger faced by people with anorexia nervosa, it is clear to see that early detection is critical. Whether you are a parent, a teacher, a coach, a best friend, or a boyfriend, it is more important than ever for everyone to know how to recognize the signs and symptoms of anorexia. Understanding what to look for and knowing what to do could help save the life of someone you love.
What Anorexia Nervosa Looks Like
Everyone has seen pictures of people with the tell-tale emaciation that can be caused by anorexia nervosa. But there are many other signs that someone in your life has this eating disorder that are less overt.
Food consumption and weight management become an obsession. This is not your teenage daughter complaining that she looks fat today. This is an all encompassing obsession with how much food they eat and how many calories and fat grams each bite of food they take contains that can take over their life.
Food consumption decreases to starvation levels. People with anorexia nervosa may stop eating around other people, start making plans that result in them missing regular mealtimes, and use extreme portion control to limit their caloric intake.
Irregular growth and loss of hair. While it may seem strange to have both excess growth and abnormal loss, both can be seen in someone with anorexia nervosa. Lack of nutrition can cause hair to become brittle and fall out while lack of body fat can signal the body to grow more hair in an attempt to regulate body hair. This abnormal growth appears as a fine layer of hair on the face and body.
Overuse and abuse of laxatives, diuretics, and diet pills.
Consistently low body weight paired with a refusal to maintain a normal weight. This is an important distinction as some people who do not have an eating disorder may be perpetually below their ideal body weight. But someone who has a body weight more than 15% below their ideal weight who also refuses to gain enough to maintain a normal weight may be anorexic.
The Real Dangers of Being Anorexic
Anorexia nervosa takes an immediate toll on the body that results in abnormal weight loss and nutritional deficiencies. But it also causes other problems that can take longer to be seen and may have life-long impacts. It creates a type of mental fog that makes it difficult to concentrate and regulate mood fluctuations. It causes irregularities in the cardiovascular system including slow, uneven pulse rates, low blood pressure, shortness of breath, and dizziness. It also impacts the musculoskeletal system and can lead to stunted growth rates, an increase in bone fractures, and osteoporosis. It can result in abnormalities in thyroid function that cause fatigue, hair loss, and low body temperature. It can lead to dependence on laxatives or other pharmaceuticals that result in life-threatening conditions like electrolyte imbalances and dehydration. Overall lack of specific nutrients like potassium can also be immediately life threatening.
How You Can Help
The best way to help someone with an eating disorder is to be there for them and provide the support they need to regain their health throughout the various stages of recovery. That starts with speaking up when you have concerns and following through until you are no longer concerned or the person in your life gets the help they need. We at Doorways have trained counselors to treat teens and adolescents struggling with eating disorders such as Anorexia.
It is a common misconception that it takes years to die from anorexia nervosa. If you are concerned about someone in your life, don’t wait; they may have less time than you think.
Doorways is available by contract to provide confidential, professional, onsite counseling (counceling) services to schools and universities, community organizations, associations and more. Onsite services offered include counseling for:
A dietitian is available to go to your site to provide nutritional advice for:
Athletes
Vegetarians
Internationals confused about American food
Allergy sufferers
Disordered eating or eating disorder awareness
Weight management, how to lose or gain weight
Diabetes, and other medical conditions
Workshops are also available on topics such as hydration, how to eat healthy in the cafeteria, snack ideas, how to avoid the freshman 15 and more.
Other counseling and nutritional services are offered off-site at Doorways, LLC for teens and young adults. Cost for offsite services vary. Please contact Doorways for more information about counseling for teens and young adults-ages 13-25. Additional services offered at Doorways include:
Psychiatric Evaluations
Family Counseling
DBT Support Groups
Medication Management
For more information about onsite counseling services for your school, university, business, or organization contact Doorways at 602-997-2880.
Now Hiring: Adolescent & Young Adult Psychiatric Nurse Practitioner or Psychiatrist PT, Independent Contractor
Doorways LLC. is a faith-based counseling organization in Phoenix, Arizona, that provides comprehensive outpatient treatment focused exclusively on adolescents, young adults and their families. Providers at Doorways
