by Paul Schienberg, Ph.D.
There was Refrigerator Perry, defensive tackle, for the football Chicago Bears. Why the nickname? He weighed well over three hundred pounds (almost the same size as a Frigidaire) and probably spent more time lifting food from shelves than lifting free-weights. He proudly boasted how many burgers and fries he ate in one sitting or standing. Then there was George Foreman, a boxer and spokesperson for a meat roaster. He became more famous for his relationship to food consumption and cooking than being the heavyweight champion of the world. Moe Vaughn is a first baseman for the New York Mets baseball organization. The team invested millions of dollars last year to get him from the Boston Red Sox. Never known as a slim fellow, he came into spring training significantly over weight, never regained his normal size and had a terrible year. Women athletes (gymnasts, skaters, divers, etc.) are often pressured by parents, peers, coaches and judges into making them lose weight to get better scores. These individual names are less known to the public. As much as the men tend to build themselves to get larger, women rip themselves up to get slimmer. Regardless of gender, poor weight management tendencies result in athletes performing at lower levels, having shorter sports careers, developing eating disorders and endangering their health. This article is intended to bring this important issue into our awareness and provide information to help athletes and educators identify and prevent the development of eating habits.
Prevalence
In order to assess the magnitude of eating disorder problems we need to share common definitions. Anorexia Nervosa can be identified by a refusal to maintain body weight over a minimal normal weight for age and height of the athlete; intense fear of gaining weight or becoming fat, even though underweight; in females, absence of at least three menstrual cycles when otherwise expected to occur; disturbance in the way in which one’s body weight, size, or shape is experienced. Bulimia nervosa is characterized by recurrent episodes of binge eating; feeling of being out of control over eating behavior during the eating binge; self-induced vomiting; use of laxatives or diuretics; strict dieting or fasting or vigorous, exercise in order to prevent weight gain; a minimum average of two binge-eating episodes a week for at least three months; and persistent over concern with body shape and weight.
The prevalence of either eating disorder is difficult to achieve due to the secretive nature of these problems. In sports the discovery could result in serious repercussions for the athlete including being cut from the team or program. Parents and roommates don’t become aware that there is a problem until something life threatening occurs and professional help is needed. In a recent prevalence survey, 695 male and female athletes reported 3% met criteria for anorexia nervosa, 21% met criteria for bulimia nervosa. Keep in mind that these numbers are lower than a real count because of the tendency to hide. It also found that there is a sport-specific prevalence for eating disorder conditions, but cautioned that no sport should be considered exempt from having individuals susceptible to eating disorders.
A second study assessed the frequency of eating behaviors that were just slightly below required criteria for eating disorders in female athletes. Thirty-two per cent practiced at least one pathogenic weight-control behavior – self-induced vomiting, use of laxatives, diet pills or diuretics. These behaviors were sport-related – 74% of gymnasts and 47% of distance runners. In addition, 83% of the athletes used pathogenic weight control behavior to improve their performance and 7% did so to improve appearance.
Predisposing Factors
Many aspects of various sports promote a focus on weight. This can be especially dangerous to a person who is predisposed to an eating disorder or weight-management problem.
The following sports have weight classifications that determine in which group an athlete competes: boxing, wrestling, weightlifting, judo, tae kwon do, and rowing. Some athletes desire to compete with lighter competition to improve their chances of success. Accomplishing this may require resorting to unusual and dangerous practices immediately before a weigh-in and competition: dehydration (sauna, sweat box, heat-restrictive clothing), use of laxatives, use of diuretics, fasting, crash-dieting, purging and fluid restriction. A lineman for the Minnesota Vikings died during a summer practice last year caused by dehydration. Often there is not enough time to re-hydrate before the actual competition. By and large it is not known that dehydrating in combination with significant weight loss for larger athletes can result in a health crisis.
Diving, figure skating, gymnastics and synchronized swimming are Olympic sports that use judges to determine performance outcome. Physical attractiveness is considered by participants to be a critical factor in a female athlete’s final score. It is known that there is open communication between judges, coaches and athletes about perceived body weight. There is no scientific information that supports a positive correlation between loss of body weight and improved performance. However, there is a strong relationship between athletic performance and muscle mass.
Scientific research has increased coaches’ awareness of physical attributes and levels of sports performance. There is a significant relationship between low percentage body fat and high performance levels in swimming, speed-skating, long distance running, cross country skiing. The problems here arise when this information is applied to every athlete without consideration of individual differences in body structures. There is no evidence that proves that for every athlete the leaner the body the better the performance.
A coach often pressures an athlete to lose weight by having frequent team weigh ins (6 times per month) and individual weigh ins (14 times per month). Also, if an athlete is referred to a therapist for an eating disorder, the coach expresses concern that the athlete will be encouraged to abandon the sport or reduce a competitive drive.
The close and shared experiences of people who train, compete and travel together increase the possibility of peer modeling of destructive weight-loss techniques. This is more true in a sports environment than in any other area of life. The major reasons given in self-reports for weight loss are performance excellence, aesthetic ideals of beauty, remarks of athletic staff about need to lose weight, and a desire to meet a lower weight category.
Recognizing Eating Disorders in Athletes
Again, these problems are not always obvious. It is important to keep in mind that early detection and early intervention improves likelihood of recovery.
There are assessment tools (Diagnostic Survey for Eating Disorders, Eating Disorders Inventory, Eating Attitudes Test) that should be used in the initial training stages. They should be administered by a licensed psychologist and followed up in a clinical interview.
Behavioral observations by coaches and teammates are critical. Some signs of a problem include weight loss, eating alone, preoccupation with food, mood changes and body distortion statements. Anorexics are often very involved with the preparation of food, but only eat their portions after everyone has finished. Bulimics eat alone so they can purge after the meal; they make frequent trips to the bathroom, have bloodshot eyes, and much talk about composition of food and caloric content. Depression, irritability, and wide fluctuations in moods are associated with an eating disorder in athletes. Other noted personality characteristics are highlighted by dissatisfaction with one’s body, feelings of ineffectiveness, interpersonal distrust and perfectionism.
A thorough medical assessment is required to detect an eating problem. The following physical symptoms might point to an easting disorder: anemia, leucopenia, osteopenia, renal and liver problems, peripheral edema, electrolyte imbalance, cardiac problems, dental problems and gastrointestinal problems. Fatigue and increased susceptibility to infections should trigger a concern for an eating disorder problem. A body image that is quite different from objective viewpoint is cause for serious focus.
Perfectionism can create a desire to hide valuable information in the assessment of eating disorders and resistance to referrals for professional help. These athletes want to please others. Therefore, they are concerned about disappointing fellow players, coaches and parents. Another cause of resistance to detection and treatment is loss of a spot on the team or suffering reduced playing time. A referral discussion should be targeted to feelings, not the eating behaviors. Eating is often experienced by the athlete as the only part of her life she has control over.
Preventing Eating Disorders
Communicating knowledge about eating, weight, health and sports performance to athletes is vital. A prevention program should target the junior and senior high school populations because adolescents are more at risk than any other group.
In an athletic training program, there should be an emphasis on fitness over body weight. An ideal weight range must be developed individually through the assistance of an exercise physiologist and the coach. Nutritional education and counseling should be mandated. Coaches and athletes would benefit greatly by a sports nutrition and weight control workshop. As part of the program, coaches should curtail team weigh-ins, setting arbitrary weight or body composition goals, punishments for not making weight, insensitive remarks about weight issues, associating weight with enhanced performance, and minimize the detrimental effects of rapid weight loss or gain.
Summary
Eating disorders and their manifestations exist all too frequently in the sports’ world. In-service training programs should play a vital role in reducing the frequency and detrimental effects of pathological weight management with amateur and professional athletes. Our children’, teammates, and friend’s lives are on the line. Early detection and referral is necessary if we hope to achieve a more successful recovery. As with any compulsive behavior where shame or hiding is a key component, significant others in an athlete’s life need to be sensitive to the signs of eating disorders. Then, they need to step forward. A clear plan of action with a relevant team of professionals should be in position to provide immediate and on-going assistance.
