Why are sports people so susceptible to eating disorders?

With Eating Disorder Awareness Week in full swing, Loughborough academic and international athlete Dr Carolyn Plateau has shared her thoughts on why athletes are more susceptible to eating disorders than the rest of the population, and what we can do to reduce and prevent them.

“In athletes there is an increased prevalence of eating problems in comparison to the general population. In the general population we probably see around 1% incidence whereas in an athlete population you’re looking at one in five for female athletes and one in twelve for male athletes.

“Females on the whole are more vulnerable to eating disorders and that seems to translate to the athlete population as well. The incidence of a male in the non-athlete population suffering from an eating disorder is very low but it’s actually about 16 times higher in the athlete population. So where we wouldn’t traditionally associate eating problems with males, actually in athletes we do see that they are a significant issue.”

Eating disorders are characterised by distorted attitudes and behaviours around food and generally speaking lie on a spectrum with a change to eating habits at one end and very severe psychiatric conditions at the other.

We all know that there is a link between weight and performance and in the short term if athletes lose a little bit of weight it is often associated with an increased performance. For example in endurance sports such as long distance running or cycling the power:weight ratio will change as a result of a negative energy balance and that can result in a short term elevation in performance. The problem with that approach is that it’s very rarely a sustained increase in performance and whilst it might work for a short amount of time the likelihood is that that continued weight loss will result in a drop off in performance over time and severe health risks. You can’t sustain weight loss indefinitely.

Plateau adds:

“In other sports like figure skating or gymnastics there’s a subjective element to how those sports are assessed, so appearance, weight and shape are often an important element of an overall score; there’s definitely pressure on those athletes to adhere to some of those body-sport stereotypes and to try and meet some of those characteristics and weight and shape goals, which can put additional pressure on them to manipulate their weight and energy intake.

“Under fuelling, whether it’s caused by deliberate under eating or disordered eating, can lead to quite negative consequences both for an athlete’s performance and also for their health. Traditionally this area has been associated with female athletes and particularly around the impact on bone health and their menstrual function, which is known as the female athlete triad. There is definitely a link between low energy intake and the negative consequences on both of those systems, with an end point being amenorrhea (the absence of the menstrual cycle) or osteoporosis.”

What recent research has revealed it that the impact of under fuelling is much wider than just the impact on those two systems. Undereating can impact on an athlete’s ability to concentrate, their overall psychological wellbeing, but also their vulnerability to illness and injury. Simply, under fuelling can have a detrimental day to day impact on how an athlete feels, on their level of fatigue and their ability to train at a full capacity. An athlete who is under fuelling is more likely to pick up infections, illnesses and frequent niggles, which won’t resolve themselves as easily as if they were fuelling sufficiently for their exercise. Most importantly of all though, disordered eating will impact athletes wider health.

So what can you do then if you think that an athlete is suffering?

“Some of the initial warning signs can be quite subtle – the individual might make some changes to their diet perhaps in an effort to lose weight, or in an effort to eat more healthily, which in themselves are not necessarily characteristics of an eating disorder. However if those behaviours become slightly more severe, where an individual perhaps starts cutting out major food groups or abstaining from eating for long periods of time, or you notice that they might be skipping meals, making themselves sick or engaging in excessive exercise – these might be warning signs that it has elevated to a clinical or severe eating disorder.”

“It’s really important that we talk about eating disorders and try to raise awareness, because one of the key things that we know about eating disorders is that they’re very treatable if we can try and catch them in the early stages. If you can signpost someone into treatment and support then the chances of a full and quick recovery are much more likely than if those behaviours start to become engrained and the individual continues to suffer.”

Over the last couple of months Loughborough University student and Great Britain international athlete Bobby Clay has spoken out about her struggles over the past year, having suffered the long term effects of under-fuelling and over-training in her teenage years.

“I was probably training too much and at the same time I wasn’t eating enough to balance out the training I was doing, so a combination of over training and under fuelling depleted my body of all the resources I had. Because I was training so hard and under fuelling it meant that hormonally I was out of balance and I wasn’t having a menstrual cycle like I should have been. The absence of these hormones meant that my bone health had decreased to the level that I was diagnosed with osteoporosis and my bones were just breaking.

“I was just doing what I thought was right for my body and what was right for my sport and I never thought I’d become ‘that girl’. I always thought ‘it won’t happen to me’ and I was warned about the perils of overtraining and under eating but I was getting quicker and quicker so I didn’t think it would ever happen to me. But in the end I became that girl.”

Her advice to other young athletes:

“Enjoy being at school, being younger and having fun with your friends. Of course do your sport and be dedicated, those are great attributes to have, but at the same time you’re trying to balance school work and home life and friends, so be the child that you are as you have time to be a professional athlete. If you get it right you’re going to have a long career – if you get it wrong you’re going to have to deal with the consequences.”

For further information on Eating Disorders visit BEAT’s website by clicking here

Notes for editors

Press release reference number: PR 18/33

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