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Nutrition: Eating Disorders - The Coach’s Role

By Teo McCormick, M.S., R.D.

In the past, eating disorders, in particular bulimia and anorexia nervosa, have gone both unnoticed and untreated. Within the past decade the number of athletes afflicted with the disorder has greatly increased. This, in part, is due to both increased pressure in society for thinness and increased emphasis placed on the relationship between body weight and athletic performance.

The role of the coach and trainer is that of support. You alone cannot diagnose or treat eating disorders. It is rather your role to watch for warning signs and to be accessible to athletes who may be searching for help. If an individual has demonstrated several of the warning signs and is believed to have a problem, you should tactfully approach the player in private to offer assistance in contacting a physician or an eating disorder specialist. The problem may need to be handled utilizing a physician, psychologist and registered dietitian. If the individual denies having a problem and it appears evident that he or she does have a problem, you should contact a physician or trained specialist for assistance in determining the next step.

Do's and Don'ts For Coaches

An estimated 5 percent of all teenagers suffer from a type of eating disorder. Approximately 10 percent of these individuals, consisting primarily of females, will die from one or more complications of the disorder. With these facts in mind, it should be obvious that eating disorders should be considered a serious health threat to many young individuals.

Eating disorders occur primarily in young females in early to middle adolescence. At this age increased growth and psychological changes play a critical role in the development of the disorder. The new growth experienced by the adolescent is viewed as being detrimental to performance, and the individual tries desperately to prevent it. This is accomplished either through self-starvation, known as anorexia nervosa, or bingeing and purging with or without laxative abuse, which is known as bulimia. It is not at all uncommon to see individuals who practice both types of behaviors.

It is believed that a feeling of low self worth and the need for a feeling of control result in extremely high personal expectations and the need to please others. Many times families of individuals with eating disorders can be characterized as over protective, placing little value on privacy and emphasizing excessive togetherness. Regardless of the origin of the disorder, the slow degenerative process must be reversed through psychological counseling, nutrition education and, if needed, family counseling.

Anorexia Nervosa and Bulimia Warning Signs

Although the below are all possible signs of an eating disorder, no one sign is a definitive indicator that an eating disorder is in fact present.

* Severe weight loss in a relatively short period of time.
* Repeated questions about being "overweight" or "too fat."
* Not eating with others around/will not eat at training table with other athletes.
* Pattern of disappearing immediately following meals.
* Bloodshot eyes after being alone or in the bathroom.
* Secretive eating or hiding of foods.
* Frequent complaints of constipation.
* Unusual irritability and/or mood swings.
* Excessive bloating and water retention.
* Loss of balance and/or lightheadedness.
* Excessive exercise beyond recommended training regimen.
* Avoiding situations when the athlete is able to be observed while eating.

The effects of eating disorders may not immediately be visible; however, performance will eventually be effected. Anorexia nervosa can even affect reproductive function and result in an absence of menstruation. Impaired brain function, irritability, depression and social withdrawal are just a few of the side effects of self-starvation and bingeing and purging. The practice of purging also exposes the throat and teeth to damage from gastric acid. All of these behaviors can result in dehydration, which when severe enough causes electrolyte imbalance resulting in irregular heartbeats and even cardiac arrest. Fortunately, if properly treated, most complications are reversible.

Complications of Anorexia Nervosa and Bulimia

* Loss of muscular strength and endurance
* Reduced blood volume
* Decreased oxygen utilization
* Decreased blood flow to major organs
* Decreased aerobic potential
* Severely decreased muscle glycogen
* Loss of coordination and balance
* Electrolyte imbalance and impaired heart function
* Impaired judgment
* Inability to regulate body temperature

Eating disorders are both psychological and physiological and need to be addressed on both levels. Trained health professionals are available to assist coaches and trainers in dealing with these problems. Remember, eating disorders are very treatable when handled by properly trained professionals.

Diagnostic Criteria For Anorexia Nervosa

1. Refusal to maintain body weight over a minimal normal weight for age and height, or weight loss leading to maintenance of body weight 15 percent below the weight expected using height and weight charts..

2. Intense fear of becoming obese, even when underweight.

3. The inability to accurately view one's own body's weight, size and shape.

4. In females, the absence of at least three consecutive menstrual cycles when otherwise expected to occur.

Diagnostic Criteria For Bulimia

1. Binge eating (hurried eating of large amounts of food in a short period of time).

2. Fear of not being able to stop eating during binge eating.

3. Regularly engaging in either self-induced vomiting, use of laxatives, of rigorous dieting or fasting in order to purge themselves of the food and calories consumed during binge eating.

4. At least two binge-eating sessions per week for at least three months.

Teo McCormick, M.S., R.D., is a former Exercise Science Specialist for the USTA.

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