Published: March 1, 2008
Determination—the ability to train hard, to push oneself to the max—is an admirable quality that helps propel competitive athletes to the top of their game. In encouraging girls to “go for the gold,” it is important to be aware of potential health risks. The pursuit of athletic perfection, in combination with a relentless drive for thinness, may open the door to the development of an eating disorder—anorexia nervosa or bulimia nervosa. These illnesses involve thoughts, emotions and behaviors and—unless treated—can result in serious problems such as abnormal heart rhythms, infertility or bone loss.
In the world of competitive sports, high performance standards, self-discipline and rigorous training are the norm. A modest percentage of intense exercisers live with body dissatisfaction, which can set the stage for the development of an eating disorder. If an athlete has negative thoughts about her size and shape and believes that having the “perfect” body will help make her a winner, she may resort to unhealthy weight control practices. Particularly prone to anorexia and bulimia are those who compete in activities that tie performance to thinness, such as ballet dancing, gymnastics or figure skating. Often, perfectionism and drive—qualities that enable athletes to achieve—are part of what puts them at risk for eating disorders.
The Warning SignsIndividuals with anorexia nervosa perceive themselves as heavy even when they are far from it. Intensely afraid of gaining weight, they strictly limit what they eat and may look markedly thin. The anorexia sufferer is unusually sensitive to the cold. Her menstrual periods stop or become irregular. She will often berate herself and her body with comments like “I'm such a pig” or “My thighs are huge.” Typically, she avoids eating in social settings, distancing herself from her friends. If the individual does join others at the table, she tends to push her food around on her plate or cut it into tiny pieces, ingesting little or nothing. She might, however, become eager to cook for others, encouraging them to enjoy what she has prepared while claiming that she “already ate” or “isn’t hungry.”
Like people with anorexia, those with bulimia nervosa are critical of their bodies and live in dire fear of gaining weight. But bulimia is particularly difficult to recognize because many with this condition are normal in weight and look healthy. The main features of the illness are binge eating and behaviors to prevent weight gain, such as self-induced vomiting or the misuse of laxatives or diuretics. Does food “disappear” from the refrigerator? Does the individual hurry to the bathroom after eating? If she induces vomiting, she might have scars on her hands. Are there laxative or diuretic containers in the house or food wrappers in her bedroom?
Because athletes lead such disciplined lifestyles, their eating disorders are very difficult to spot. Individuals who are struggling with eating problems are likely to arrive at the gym before the others in their group and to stay longer. Controlled by constant thoughts about food and weight, they derive very little, if any, enjoyment from life and are incredibly hard on themselves. Many are determined to be the best in their sport no matter what the cost and will not want to acknowledge that they have abnormal eating habits or confide in anyone. Some are afraid that their problems will disappoint important people in their lives. The many months—even years—of hard work that these individuals have poured into their athletic pursuits makes them all the more reluctant to admit they are engaging in dangerous weight control practices.
How to HelpProfessional care is most successful when it is provided early in the course of an eating disorder. But many individuals are hesitant to seek help. Some are unable to see that they have a problem, while others are ashamed of their eating behaviors and keep them secret. In order to reach out to those at risk for anorexia or bulimia, parents, coaches and athletes themselves need to know the warning signs.
The best way for family members, friends and coaches to help an at-risk athlete is to encourage her to accept treatment. But this isn't easy. Abnormal eating habits are often an attempt to cope with emotional turmoil, and the individual may initially refuse treatment. If she has experienced fainting episodes or other medical complications or if her food restriction is extreme, she needs to receive immediate help even if she is reluctant. Usually, however, there is time to build dialogue with the athlete about the prospects of entering treatment. Motivating her to accept help is a gradual process, so it is important to use an empathic, gentle approach aimed at keeping the lines of communication open.
Editor's Note
David B. Herzog, M.D., is the Director of the Harris Center for Education and Advocacy in Eating Disorders at Massachusetts General Hospital and the Endowed Professor of Psychiatry in the field of Eating Disorders at Harvard Medical School.
Debra L. Franko, Ph.D., is the Associate Director of the Harris Center at Massachusetts General Hospital, a Full Professor in the Department of Counseling and Applied Educational Psychology at Northeastern University, and a Visiting Scholar in Psychology at Wesleyan University.RESOURCESHerzog D.B., Franko, D.L., Cable, P. Unlocking the Mysteries of Eating Disorders: A Life-Saving Guide to Your Child's Treatment and Recovery, Harvard Medical School Guide. New York: McGraw-Hill (2007).
Harris Center for Education and Advocacy in Eating Disorders
Massachusetts General Hospital
2 Longfellow Place
Boston, MA 02114
617-726-8470
National Eating Disorders Association
603 Stewart Street, Suite 803
Seattle, WA 98101
Toll-free helpline: 800-931-2237
Eating Disorders Coalition for Research, Policy & Action
611 Pennsylvania Avenue SE #423
Washington, DC 20003-4303
202-543-9570