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How Many Female Athletes Have Eating Disorders

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Body Image Dieting And Social Media

USC Volleyball Star Talks Eating Disorders and Mental Health in Female Athletes
  • Body image has been listed in the top four concerns for young Australians from 2009-2018 with 30% concerned about body image .
  • Research shows that up to 80% of young teenage girls report a fear of becoming fat .
  • Nearly 23% of Australian women report a self over evaluation of weight and shape meaning they think they are larger than they are according to BMI .
  • It has been reported that more than 55% of Australian girls and 57% boys aged 8 to 9 years are dissatisfied with their body t .
  • Nearly half of Australian women and one third of Australian men are dissatisfied with their body .
  • Weight related teasing in children is associated with disordered eating, weight gain, binge eating, and extreme weight control measures .
  • Social media use has been linked to self-objectification, and using social media for merely 30 minutes, a day can change the way you view your own body .
  • A study of teen girls reported that social media users were significantly more likely than non-social media users to have internalized a drive for thinness and to engage in body surveillance .
  • Weight-loss dieting is a risk factor for the development of an eating disorders and. Dieting frequently precedes the onset of an eating disorder .
  • Dietary restraint influences binge-eating behaviour .
  • High frequency dieting and early onset of dieting are associated with poorer physical and mental health, more disordered eating, extreme body dissatisfaction, and more frequent general health problems .

Eating Disorders And Lgbtiqa+ Communities

  • People who are LGBTIQA+ are at a greater risk for disordered eating behaviours .
  • Gay, lesbian and bisexual teens may be at higher risk of binge eating than their heterosexual peers .
  • A review from the United States found that lifetime prevalence for eating disorders is higher among sexual minority adults compared with cisgender heterosexual adults however, more detailed research is required .

Lgbtq+ Eating Disorder Statistics

  • Gay men are seven times more likely to report binge-eating and twelve times more likely to report purging than heterosexual men.6
  • Gay and bisexual boys are significantly more likely to fast, vomit, or take laxatives or diet pills to control their weight.6
  • Transgender college students report experiencing disordered eating at approximately four times the rate of their cisgender classmates.7
  • 32% of transgender people report using their eating disorder to modify their body without hormones.8
  • 56% of transgender people with eating disorders believe their disorder is not related to their physical body.8
  • Gender dysphoria and body dissatisfaction in transgender people is often cited as a key link to eating disorders.7
  • Non-binary people may restrict their eating to appear thin, consistent with the common stereotype of androgynous people in popular culture.7

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An Illusion Of Virtue

Emphasis on thinness and demands for self-discipline invite the female athlete to believe that she is being good when she restricts food. She also believes that if she is good for a long enough period of time, she will improve her performance, win more often, and achieve more glory. She equates weight loss with becoming quicker, faster, and stronger. Research indicates just the opposite, but she will not believe that dieting could make her weak and slow. Unfortunately, some coaches encourage the thinner-is-better delusion.

Body Dissatisfaction Driven By Surroundings

Athletes and Eating Disorders: An Infograph

So how can we explain some of these trends? We know that athletes often compare their own bodies to that of their competitor, and that this might be one of the triggering factors for body dissatisfaction. And research shows that female athletes judge their bodies more negatively when they compare themselves to their competitors rather than the general population. So body perception is not stable but depends on a persons surroundings. For example, an at-risk athlete with 15% body fat surrounded by competitors with 10% body fat, could slip into bad eating habits and body dissatisfaction, even though 15% body fat is relatively low, especially for women.

At the same time, low self-esteem, high body ideals, performance anxiety, and pressure of meeting expectations of trainers and friends, are all clearly linked to restrictive and disordered eating. But despite the wealth of research to document the phenomenon of eating disorders among elite athletes, we still lack initiatives to prevent and reduce the problem.

One exception is Norway where athletes representing Norway now have to have health certificates. If the athlete is deemed to be in a nutrition deficit condition or have an eating disorder, they do not get the certificate and get restrictions on their training. Whether the Norwegian approach is the right one to reduce incidences of eating disorders, especially among female elite athletes, is yet to be determined.

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Body Image Issues Lead To Eating Disorders In Women Athletes

Playing sports is a great way to boost your self-esteem, stay healthy and learn the value of teamwork. However, not all sport stressors are positive. The immense pressure to win and maintain your body shape can lead to a toxic lifestyle. Athletic competition can also be a factor contributing to severe psychological and physical stress. In many sports where body weight is associated with performance or aesthetics, the pressure of low body weight overshadows other health factors.

In a study of Division 1 NCAA athletes, over one-third of female athletes reported attitudes and symptoms placing them at risk for anorexia nervosa. Moreover, the research collectively showed that more than 40 percent of women engaged in aesthetic sports to a professional level, like dance and gymnastics, show signs of an eating disorder.

What are eating disorders?

An eating disorder is a mental illness. It is characterized as an illness in which the people suffering experience severe disturbances in their eating behaviours and related thoughts and emotions. People with eating disorders typically become pre-occupied with food and their body weight. It is often accompanied by a loss of control of eating habits, leading to overeating and fluctuating body weight.

Bipoc* Eating Disorder Statistics

* BIPOC refers to Black, Indigenous, and People of Color

  • BIPOC are significantly less likely than white people to have been asked by a doctor about eating disorder symptoms.3
  • BIPOC with eating disorders are half as likely to be diagnosed or to receive treatment.2
  • Black people are less likely to be diagnosed with anorexia than white people but may experience the condition for a longer period of time.4
  • Black teenagers are 50% more likely than white teenagers to exhibit bulimic behavior, such as binge-eating and purging.3
  • Hispanic people are significantly more likely to suffer from bulimia nervosa than their non-Hispanic peers.3
  • Asian American college students report higher rates of restriction compared with their white peers and higher rates of purging, muscle building, and cognitive restraint than their white or non-Asian, BIPOC peers.5
  • Asian American college students report higher levels of body dissatisfaction and negative attitudes toward obesity than their non-Asian, BIPOC peers.5

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The Conversation Needs To Start Early And Everywhere

Conversations, social media awareness and education are all positive steps in the efforts to help diminish the prevalence of eating disorders. So too is bringing awareness to the risk factors, especially to coaches, parents and health-care providers, who often unwittingly contribute to the issue. All three of us who founded Lane 9 experienced gaps in our health-care experience when it came to finding help, says Caplan. Too often, health-care providers just dont know what to do.

Atkins points to physicians who use BMI in adolescents over the age of 18 in determining likelihood of a disorder. A healthy BMI does not mean someone has escaped an eating disorder, she says. A disorder can affect your life long before you show deterioration.

Too often, health-care providers just dont know what to do.

Jody Whipple, RD, a dietitian who often works with athletes at Penn State, says that while disordered eating is different in every case, there are risk factors worth noting. Family influence is huge, especially in adolescence, she says.

Part and parcel to this is parental modeling of healthy body image and taking a no dieting approach. Family meals are an important place to exhibit this and communicate it, says Whipple. If there is any history of disorder, it is especially important to put those glasses on and use them for prevention.

Editor’s note: If you’re looking for help, please call the National Eating Disorder Association help line at .

What Types Of Prevention And Intervention Strategies Could Be Implemented To Help

What I know now – recovering from the female athlete triad & eating disorders

First, we need to better understand the existing types of resources and prevention/intervention programs present at institutions. From here, we can address the gaps in resources and ensure that all athletes are provided equitable access to services and prevention and intervention programs for disordered eating and body image disturbance. Pre-season physical exams, which are mandatory for all student athletes, could be an important time to screen for disordered eating and the physical health effects that often come with it, including menstrual disturbance.

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Who Gets Female Athlete Triad

Female athletes, especially those who play sports that look for thinness such as dancing, gymnastics, cheerleading, figure skating, distance running, and rowing are more likely to have the triad. Other things that make someone more likely to have the triad include:

  • focusing on one sport at a young age
  • training too much
  • dieting, losing weight, or feeling pressure to lose weight
  • family problems

Research Shows That Eating Disorders Often Occur In Sports Where Body Aesthetic Plays A Significant Role Such Sports Are Gymnastics Weight

The Female Athlete Triad

The Female Athlete Triad includes disordered eating, amenorrhea, and osteoporosis. The lack of nutrition resulting from disordered eating can cause the loss of several or more consecutive periods. This, in turn, leads to calcium and bone loss, putting the athlete at risk for fractures of the bones. Each of these conditions is a medical concern. Together they create serious health risks that may be life-threatening.

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Professional Athletes More At Risk Than Amateur Athletes

An Australian study from 2002 investigated 263 elite athletes and compared them to 263 non-athletes matched on gender and age. They showed that the top athletes experienced pressure to be slim and reported more eating disorder symptoms compared to non-athletes.

This was true, 15 percent of elite female athletes met the criteria for anorexia and bulimia. Whereas the other 16 percent showed signs of having an eating disorder. Among the non-athletes, the numbers were much lower. None of the male non-athletes suffered from eating disorders, compared with six percent of elite male athletes.

Factors That Cause Eating Disorders

Women in sports comparing their bodies with their competitors might be one of the triggering factors of the eating disorder. Research shows that women athletes view their bodies more negatively than the general population.

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Community Discussion Share Your Thoughts Here

What characteristics or behaviors do you see in young athletes? Do you feel thinness and lean body types enhance performance in athletes?

About the Author: Libby Lyons, MSW, LCSW, CEDS is a specialist in the eating disorder field. Libby has been treating eating disorders for 10 years within the St. Louis area, and enjoys working with individuals of all ages.

References:

The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on January 3, 2017. Published on EatingDisorderHope.com

Helping Athletes With Eating Disorders

Charisa Wernick: Eating Disorders and Athletes

Treating athletes with eating disorders is not very different from treating non-athletes. In fact, the evidence-based treatments recommended such as Cognitive Behavioral Therapy , Dialectical Behavior Therapy and Family Based Treatment are still advised for athletes.

The most important aspect in supporting athletes struggling with disordered eating and exercise behaviors is to prioritize the athlete over the sport. Treatment takes time and commitment to be effective and an athlete cannot commit both to their sport and their recovery at the same time.

It will likely be necessary for the athlete to take some time off to solely focus on treatment and eating disorder recovery. While this can be difficult for the athlete, doing this increases their likelihood of being able to safely return to the sport they are passionate about.

Prioritize your athlete over the game, competition, or event by encouraging them to play the long game for their health, body, and future.

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Unique Vulnerabilities = Unique Treatment

Athletes who perform at a high level possess many qualities which also make them vulnerable to the development of an eating disorder. Consider the following list:

Good Athlete

Excessive Exercise

Perfectionism

These are just a few examples of how athletes share traits with many anorexic patients. Because of these similarities, athletes need help understanding how their competitive life can overlap with their eating disorder. An athlete does not necessarily need to quit his or her sport to recover. In fact, many individuals upon considering leaving the sport world will experience depression, identity confusion and lack of motivation. The opportunity to return to competition often is the greatest motivator available to an athlete. Other athletes may feel relieved with the opportunity to retire from sport. These are some of the many factors that treatment providers need to understand when working with athletes who, when properly motivated, often achieve strong and lasting recovery.

Athletes with Eating Disorders Need Treatment

Without treatment, an athlete can become isolated and recovery from an eating disorder is unlikely. Over time, the physical and mental state of the athlete will deteriorate, negatively affecting their health and performance. Poor athletic performance will likely result in more eating disorder behaviors and will increase the risk of serious metabolic injuries, including:

  • fluid and electrolyte imbalances

Correlates And Risk Factors

Many eating disorder correlates and risk factors have been suggested. However, to properly classify these factors, a causal relationship needs to be established. Otherwise, the factors can only be viewed as correlates.

Cross-sectional studies only quantify the relationship between a given exposure and an outcome, allowing researchers to identify correlations, generate hypotheses, and describe prevalence. However, cross-sectional studies cannot distinguish between risk factors and prognostic factors and are thus susceptible to the phenomenon of reverse causality, the famous chickenegg dilemma. The inability to distinguish between classes of correlated factors precludes causal interpretation of the results from cross-sectional studies.

First, we present only cross-sectional and case-control studies about this issue. The correlates established in these studies are multifactorial. It is deeply relevant to know the nature of the correlates because if we can recognize them early, we will be able to treat these individuals as soon as possible, thus possibly enhancing our chances to prevent the onset of a clinical eating disorder.

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How Common Is Red

Prevalence rates of RED-S are not well-established. RED-S is a new syndromeonly defined in 2014so research is limited. Additionally, many athletes may be unwilling to report a problem or might be unaware of a problem given the focus on performance and thinness in many sports where dieting and restricting are encouraged.

The rates of eating disorders in athletes have been somewhat better investigated. Most studies to date have studied female athletes. Compared to non-athlete peers, female athletes report eating disorders at a higher rate: 18% to 20% compared to 5% to 9%. Prevalence rates of the entire spectrum of eating disorders and subclinical disordered eating vary from 0 to 19% in male athletes and from 6 to 45% in female athletes. The prevalence varies significantly among different sports.

What Else Should I Know

Recovering from an Eating Disorder as an Athlete

Exercise is part of healthy lifestyle. Girls and young women who exercise regularly feel better about themselves, do better in school, have better bone health, and are more like to keep a healthy weight.

Here are some tips for female athletes:

  • Keep track of your periods. It’s common for girls to miss periods once in a while. But talk to your doctor if:
  • You miss periods often.
  • You had regular periods and now are missing periods.
  • You are 15 or older and have never had a period.
  • Don’t skip meals or snacks. Athletes need more fuel, not less. Schedule 3 meals and 12 healthy snacks a day.
  • Meet with a sports nutritionist who works with teen athletes. A sports nutritionist can help you find out if you’re getting enough calories to match your activity level. They also can see if youre getting the right amount of key nutrients like calcium, vitamin D, and protein. Good nutrition can help improve your sports performance.
  • Take a break. To help prevent injury and burnout, take time off from your main sport. Experts recommend taking off at least 1 day a week, plus at least 1 month 3 times a year. You can still do other sports and physical activities during the time off, but keep it fun.
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    Factors Influencing Eating Disorder Development

    When looking at the healthy weight and nutritional intake for an athlete, they typically will fall between the 25th and 75th percentiles for weight and high for age, as recommended by the National center for Health Statistics. Some athletes will weigh outside this range due to increased muscle mass, and muscle weighing more than fat. Body Mass Index measurement is not recommended and has been unfounded recently to provide no relevant information in a persons health .

    Many sports emphasize the need for thinness and its link to higher performance within sport. Most typically this is seen in gymnastics, figure skating, running, and swimming . In a study conducted by the National Collegiate Athletic Association, athletes reported that 33% of female athletes have symptoms and attitudes that are at high risk for eating disorders .

    Behaviors include preoccupation with food, excessive fasting, binging, purging, fear of being overweight or fat, compulsive exercise , and continuing to train when injured . At the college level there are more fail safes for athletes struggling with an eating disorder.

    Athletes have athletic trainers, physicians, physicals, and coaches that are more focused on health issues due to many students being on athletic scholarships. At the high school level, it is more difficult to identify due to the fact that most schools have a nurse, and a coach.

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