How do we define eating disorder?

During adolescence, the bodies of boys and girls are changing rapidly and maturing.  According to Brown (2017), body image and self-esteem are very interrelated.  As their bodies continue to change through adolescence, reports state 60% of girls and 35% of boys have body dissatisfaction (Brown, 2017).  Weight-related issues for adolescents can lead to disorders, specifically disordered eating and potentially to a clinically diagnosed eating disorder. 

It’s important to note that disordered eating and eating disorders are not interchangeable terms.  Disordered eating “is the general term used to describe the spectrum of abnormal and harmful eating behaviors that are used in a misguided attempt to lose weight and/or maintain a lower than normal bodyweight” (Burke & Deakin, 2006, pp. 202).  An eating disorder, however is the term used to reference clinically diagnosed conditions such as anorexia nervosa, bulimia nervosa, or eating disorders not otherwise specified (EDNOS) (Burke & Deakin, 2006).  An individual must meet the DSM-V’s criteria to be clinically diagnosed with an eating disorder (Burke & Deakin, 2006).  

How are eating disorders in sport different?

Eating disorders in adolescent athletes are typically different when compared those individuals not involved in sports with eating disorders, since as athletes, they not only want to achieve thinness but also associate that thinness with improvements in their performance (Burke & Deakin, 2006). 

A sub-clinical term for athletes, adolescent and adult, who present with body weight concerns and eating pathology but who do not technically meet the DSM-V criteria for anorexia nervosa is called “anorexia athletica”.  Anorexia athletica presents with a fear of weight gain, (even though the individual is 5% below normal weight for age and height), weight loss due to food reduction, and/or excessive exercise (Burke & Deakin, 2006). 

Disordered eating and eating disorders in adolescents are more commonly seen in sports categorized as either aesthetic sports (gymnastics, synchronized swimming, figure skating, and diving), sports with weight categories (wrestling, weightlifting, lightweight rowing), or sports where low bodyweight and low body fat provide a biomechanical or physical advantage (road cycling, distance running, track & field, and triathlon) (Burke & Deakin, 2006).  

When a growing adolescent presents with either disordered eating or a diagnosed eating disorder, they not only can face health consequences but performance consequences as well if they are involved in sports.  Some health concerns for the adolescent athlete could include increased risk of infections, increased injuries, increased illness, vitamin and mineral deficiencies, anemia, and chronic fatigue.  In more severe circumstances of caloric restriction, they could experience decreased metabolic rate, depression, menstrual dysfunction, cardiovascular disorders, decreased bone density and gastrointestinal disorders (Burke & Deakin, 2006).  In terms of performance consequences, an interesting piece of research from Beals (2004) noted that in the early stages of an eating disorder, the individual may actually feel good and experience an initial improvement in performance.  This is said to be the result of an elevation in the individual’s adrenal fight-or-flight hormones, cortisol, norepinephrine and epinephrine that are able to initially mask feelings of fatigue by acting on the central nervous system and increase the feeling of euphoria (Beals, 2004).

How can eating disorders be remedied?

Treatment of clinically diagnosed eating disorders will vary depending on the severity.  For example, if an individual presents with life-threatening issues, they may be advised to enter into an inpatient program, whereas someone who is psychologically and medically stable take part in a partial-inpatient treatment with weekly visits (Brown, 2017).  The main components for treating an adolescent with an eating-disorder are achieving a normal bodyweight, treating medical issues, improving nutrition education, establishing normal eating behaviors, and providing emotional psychotherapy and family therapy (Brown, 2017).  

Because easy access to social media can make adolescents feel like they are constantly comparing themselves to one another, I think preventing eating disorders is key to creating a healthy mind and body for a growing child.  Prevention can be achieved by creating awareness and education on how the media can influence an adolescent’s appearance and view of themselves (Brown, 2017).  In addition, professional athletes speaking out about personal experiences with eating disorders and disordered eating and sharing their struggles can help to change the perception in some sports that thinner is better.

References:

1. Beals, KA. Disordered eating among athletes: A comprehensive guide for health professionals. Champaign, Ill: Human Kinetics, 2004.
2. Brown, J. (2017). Nutrition through the life cycle (6th ed.).  Boston, MA: Cengage Learning.
3. Burke, L., & Deakin, V. (2006). Clinical sports nutrition (3rd ed.). North Ryde NSW: McGraw-Hill Book Company Australia.