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Eating disorders – a coach’s guide

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The following information has been posted after gaining the authoring organisation Beat’s permission.

This blog post is taken from an information sheet produced by Beat - the UK’s leading charity supporting anyone affected by eating disorders or difficulties with food, weight and shape - in conjunction with UK Athletics, and has been reviewed with input from the National Centre for Eating Disorders in Sport at Loughborough University and Dr Alan Currie MB ChB, MPhil, FRCPsych.

Eating disorders - a coach's guide

Food and diet are an important part of any athlete's training and competitive programme. For an athlete in any sport to perform well, they must get an optimum balance of nutrients and energy to maintain their health and then to support the amount of exercise they do.

Experimenting with diet is common in sport. Searching for a diet to improve performance is perfectly normal.

However, some athletes develop eating habits which will not only put their sports performance at risk, but can also endanger their health. As a coach, you may be aware that eating disorders exist in your sport, but may not know how to spot the warning signs and the best way to approach an athlete you suspect has problems with their eating.

Some of my athletes want to diet. Should I let them?

Only if the athlete is significantly overweight. Any diet should be compiled and monitored very carefully, ideally by an accredited sports dietician. The method of weight loss, the rate of loss and the intended target weight all need careful thought.

A diet that results in more than 1 - 2 lbs weight loss per week will cause loss of muscle mass. In order to maintain performance and health, weight loss should be monitored carefully.

Can an athlete really be too thin?

Yes. Ultimately, training and competing at a very low body weight with insufficient energy and nutrient intake can be dangerous and even fatal.

At the very least, the long-term effects of under-eating may cause a drop in performance and an increased risk of stress fractures. Ultimately it could mean that an athlete has to stop running or competing altogether.

Are eating disorders common in athletes?

Yes. Recent research shows that eating disorders are more common among athletes than non - athletes, and especially in endurance sports like distance running, sports where the body shape is scrutinised and weight category sports. The causes are seldom straightforward and differ with every case. In some cases athletes may develop an eating disorder because they see weight loss as a means to better performance (e.g. running faster); in others, people with an eating disorder become athletes because they see it as a means to faster weight loss. But not every athlete who diets will develop an eating disorder, just as thin athletes are not necessarily anorexic. It is important to be aware that the problem exists and that it is best to take action early.

Are there obvious signs I can look for?

An athlete may not be aware (or willing to accept) that their eating behaviours could be harmful.

Those that are aware may try to keep their condition secret. However there are physical, emotional and behavioural signs to look out for:

Anorexia

Physical signs

  • Severe weight loss
  • Periods stop or are irregular
  • Difficulty sleeping
  • Frequent dizzy spells
  • Stomach pains, constipation or bloating
  • Growth of downy hair on face, legs and arms

Emotional signs

  • Insists they are fat when they are actually underweight
  • Irritable
  • Sets unreasonably high standards
  • Obsessed with training harder and longer
  • Wants to run alone
  • More aware of food and calories
  • Becomes socially withdrawn (e.g. from team mates)

Behavioural signs

  • Starts exercising excessively beyond the training plan
  • Suspect they are lying about eating meals and refuses to eat in company
  • Willingly supplys food for others

Bulimia

Physical signs

  • Suffers frequent dehydration even when isn’t training or competing
  • Dental and gum problems
  • Extreme weight fluctuations
  • Menstrual irregularities
  • Muscle cramps and weakness
  • Swollen salivary glands at the side of face
  • Abrasions on back of knuckles from induced vomiting

Emotional signs

  • Depression
  • Increasingly self-critical, especially about their body and performance
  • Noticeable mood swings
  • Becomes socially withdrawn (e.g. from team mates)

Behavioural signs

  • Eats large quantities of food and is sick after meals
  • Starts diets which are unnecessary for appearance, health or performance
  • Visits the toilet or ‘disappears’ after eating
  • Takes laxatives or diuretics
  • Steals food and laxatives
  • Becomes secretive and lies about eating

I think they may have an eating disorder

Even if you're sure that an athlete has an eating disorder, they may not be willing to acknowledge it at first. Accept that they may deny a problem whichever approach you take. But don't let this deter you if you feel your suspicions are right. The best action is to raise the problem early, directly, supportively and confidentially.

Be prepared to listen and give time. Let them know that you are there if they want to talk to you. Your athlete will need support. They will want to feel accepted not just for their performance in sport, but for their existence as a person. Low self esteem is a common characteristic of eating disorder sufferers.

Should I seek professional help for him or her?

Only with their agreement. However, an athlete with an eating disorder will need to get professional help and support. It may be that by listening and being supportive, you can help them take the first step and encourage them as they recover. Some services may allow you to discuss your worries with them, keeping the confidentiality of the athlete, whilst also providing you with advice.

How do I support them as they get better?

The best way to help is to develop trust and friendship by being open, honest and supportive. However, recovering from an eating disorder can be painful and frightening. It will be difficult for them to hear comments from training partners like: "You are looking better", or "Good, you are putting on weight". Their reaction is likely to be, "Oh no, I am getting fat I will never be a good runner again - help - if I don't lose weight quickly I will get fat and slow."

Can I prevent eating disorders in my group of athletes?

Although sport is not to blame for causing an eating disorder, there are some ways in which the environment may increase the risk for the development of an eating disorder in a predisposed athlete. As a coach, you should be aware of the following factors:

  • Weight is largely determined by genetics, and bodyweight is only one of many components of overall fitness. Do not place too much emphasis on weight, especially publicly. For example, group 'weigh- ins' should be avoided.
  • Percentage body fat varies between individuals, but there is no ideal weight or percentage body fat for any event. The top performer in an event may happen to be one of the thinnest, but this is not necessarily the reason for their success.
  • Careful thought should be given to the value of measuring body fat in endurance athletes. It is not necessarily a reliable or valid measure on its own and it could be unhelpful in focussing unnecessary attention on weight.
  • Athletes are naturally very competitive. Avoid extending this competitiveness to include bodyweight or body fat percentages.
  • Eating disorders can 'spread' among the members of a training group. If one athlete loses weight, another may attempt to copy them; or if a naturally thin athlete is performing well, the others may think weight loss is the answer. Each athlete is different, so treat them individually.

The earlier the athlete seeks help, the sooner they can begin the road to recovery. As a result of recovering they can gain new confidence and begin to realise that there are other ways of coping.

This will also help to minimise the effect on their performance. They should never give up hope. Eating disorders can be beaten.

Download ‘Eating disorders – a coach’s guide’.

Next Steps

Beat is the UK’s leading charity supporting anyone affected by eating disorders or difficulties with food, weight and shape. To find out more about the organisation you can visit their website.

You might also find the 'Understanding Eating Disorders' blog post a useful read.

The UK Coaching (formerly sports coach UK) research team have also produced a research summary 'Strategies for Dealing with Eating Disorders Among Athletes and Players' 

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Comments (3)

   
David_T
I hope this is an area wee can really develop some fantastic coach education for in coming years- the pressure on everyone in terms of body image contuinues to grow. A researcher I know called Misia Gervis has done a lot of work in this area and has come horror stories about coaches asking for BMI numbers that are at hospitalisation numbers
09/10/15
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robertkmaaye
For anyone interested The Child Protection in Sport Unit has now produced a series of free webinars one of which is on Eating Disorders and Sport. It's available for free after sign up. More info here https://thecpsu.org.uk/news/2015/december/an-overview-of-eating-disorders-and-the-pertinent-issues-for-sport/
04/01/16
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williammte
A pity such a good article is full of poor grammar. There are many references to "an" athlete who becomes pluralised a few words later. e.g. The earlier the athlete seeks help, the sooner they can ...
03/03/16
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robertkmaaye
Glad you liked the article William! It was a straight copy and paste job from their pdf guide (with permission from Beat obviously) so I was merely transferring across their text. I shall pass on your grammatical observations and maybe they’ll update the guide
03/03/16
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