Eating disorders

Eating disorders, including binge-eating disorder, anorexia nervosa, and bulimia nervosa, are serious mental health conditions that can affect both male and female athletes. These conditions are mentioned here to provide context, but strength and conditioning professionals should not attempt to diagnose them. Instead, coaches should be aware of warning signs and refer athletes to qualified medical or mental health professionals when concerns arise.

High-risk sports:

• Weight-class sports (e.g., wrestling, boxing)
• Endurance sports (e.g., long-distance running)
• Aesthetic sports (e.g., gymnastics, dance)

Common eating disorder symptoms:

• Restrictive eating
• Skipping meals
• Fasting
• Excessive exercise
• Laxative or diuretic use

Anorexia nervosa

Characterized by:

• Distorted body image
• Excessive fear of gaining weight
• Severe calorie restriction

Two subtypes:

• Restrictive type: No binge eating or purging.
• Binge-eating/purging type: Regular episodes of bingeing or purging.

Anorexia nervosa is a severe mental health disorder with the highest mortality rate among psychological conditions. Common symptoms include:

• Osteoporosis
• Brittle hair and nails
• Dry skin
• Muscle wasting and weakness
• Low blood pressure and slow heart rate
• Brain damage and multi-organ failure
• Severe fatigue and infertility

Coaches should recognize these warning signs and refer athletes to qualified medical or mental health professionals rather than attempting to manage the condition themselves.

Binge-eating disorder

Previously categorized as an unspecified eating disorder, binge-eating disorder (BED) is now recognized as a distinct condition in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

Key characteristics of binge-eating disorder:

• Recurrent episodes of binge eating at least once a week for three months.
• Uncontrolled eating of significantly larger amounts of food than normal in a short period.
• Binge episodes are associated with at least three of the following:
  • Eating much more rapidly than normal.
  • Eating until feeling uncomfortably full.
  • Eating large amounts of food when not physically hungry.
  • Eating alone due to embarrassment about food intake.
  • Feeling disgusted, depressed, or guilty afterward.

Unlike bulimia nervosa, binge-eating disorder does not involve purging. Importantly, it can occur at any body size, not only in individuals who are overweight or obese. Strength and conditioning professionals should focus on recognizing these behavioral patterns and refer athletes to qualified medical or mental health providers when concerns arise.

Bulimia nervosa

Bulimia nervosa is an eating disorder marked by:

• Episodes of binge eating, consuming excessive amounts of food in a short period (e.g., an entire pizza and a tub of ice cream).
• Compensatory behaviors to prevent weight gain, such as:
  • Self-induced vomiting
  • Excessive exercise
  • Laxative or diuretic use

To meet diagnostic criteria, binge-purge cycles must occur at least once a week for three months.

Prevalence and risk factors:

• More common in individuals with normal body weight than in those who are underweight.
• Onset typically occurs in late adolescence or early adulthood.
• Many individuals with bulimia do not receive treatment, highlighting the importance of awareness and referral.

Symptoms of bulimia nervosa:

• Chronically inflamed throat due to acid exposure.
• Swollen salivary glands in the neck and jaw.
• Tooth enamel erosion and cavities from stomach acid.
• Gastrointestinal problems (acid reflux, bloating).
• Severe dehydration due to purging.
• Electrolyte imbalances, which can lead to heart complications.

Avoidant/restrictive food intake disorder (ARFID)

ARFID is an eating or feeding disturbance characterized by:

• Apparent lack of interest in food or avoidance due to sensory sensitivity.
• Concerns over aversive consequences (e.g., choking, vomiting).
• Failure to meet energy needs, leading to:
  • Significant weight loss or failure to gain expected weight.
  • Nutritional deficiencies.
  • Dependence on enteral feeding (feeding tubes) or nutritional supplements.
  • Impaired psychosocial functioning.

ARFID differs from anorexia nervosa because it is not driven by body image concerns.

Pica

Pica is an eating disorder characterized by:

• Persistent consumption of non-nutritive substances for at least one month.
• Common substances consumed:
  • Clay
  • Laundry starch
  • Ice
  • Cigarette butts
  • Hair
  • Chalk

Pica can lead to electrolyte imbalances, gastrointestinal blockages, or poisoning. This condition is a medical red flag. Athletes should be referred for immediate medical evaluation, and training should be suspended until they are cleared to participate.

Rumination disorder

Rumination disorder involves chewing, reswallowing, or spitting up regurgitated food. Diagnosis requires that:

• The behavior occurs for at least one month.
• It is not due to a medical condition.
• It may occur alongside other eating disorders.

Managing eating disorders in athletes

Strength and conditioning professionals are not responsible for diagnosing or treating eating disorders, but they should be aware of the signs and refer athletes to appropriate professionals.

Key responsibilities:

• Recognize symptoms of eating disorders.
• Encourage proper diagnosis from qualified professionals.
• Refer athletes to trained healthcare providers when disordered eating is suspected.

Eating disorder resources:

• National Eating Disorders Association
• International Association of Eating Disorders Professionals
• The Renfrew Center Foundation
• National Association of Anorexia Nervosa and Associated Disorders