Wednesday, February 3, 2016

Eating Disorders in Endurance Athletes

Psychology vs Nutrition - Kristen Martin

There is a spectrum that runs from "disordered eating" to "eating disorders".

Eating disorders are NOT about food, they are a manifestation of a deeper issue.

Psychological markers include: low self esteem, depression, anxiety, anger, loneliness, perceived lack of control, perceived inadequacy (NOTE - who doesn't feel like this from time to time? The seeds are in all of us.)

Society places an extremely high value on being thin - respect, attraction, value.

High achievers with low self esteem are at significant risk. NOTE - that would probably include nearly every age group female swimmer, at some stage of their development. NOTE - for this reason a critical role of a coach is to build the self-esteem of their athletes (young female, esp).

Family structure can be a trigger, it's not the style, it's the severity of the style.

Anorexia is typically about control. Bulimia is typically about release. NOTE - creating non-food pathways for venting and support is critical.

We start with food/weight obsession... then we use food to control/vent/avoid dealing with painful feelings... at first "it works", we feel very successful with the disorder mechanism... then the cognitive ability disappears, the senses are gone, reason is absent... then it takes over our lives and becomes powerful.

To successfully treat you need to: (a) change behavior; (b) restore cognitive function; then (c) work through the underlying emotional issues.

Some bulimics find that "it works" and therefore treatment is about providing other avenues to release/support/cope.

Most people value their disorder (protector, friend, comfortable, secure) but eventually they become miserable as it gains total control over them.

It is terrifying for them to leave the comfort of the disorder. They are losing their coping mechanism then find that they must deal with the feelings from the underlying issues.

Treatment can take up to five years. There is no fast-track recovery.

Perception of food must be "Food as fuel for performance"
Emotional health drives the issue, but often there is least resistance to commence treatment via a medical avenue.

Sports allow people to mask disordered eating and eating disorders. (NOTE - I know very few elites that don't exhibit many of the characteristics of disordered eating. The physician on the panel agreed with this observation. Therefore, it is safe to assume that every single female athlete that we coach will be at risk. Also, take a sport like running or cycling where the physical appearance of elites may be consistent with a person with an eating disorder).

Athletes will hide it, athletes are very good at hiding it.

Clinical Implications - Dr. Becky Morgan

Disordered eating - Restricting food intake, calorie counting, preoccupation with food/weight, skipping meals, fasting, rigid food patterns, elimination of certain food groups (esp. meat), not eating with others (NOTE - well, I meet a lot of these categories, I think nearly every athlete will qualify at some stage).

Eating disorders - Bulimia and anorexia - severe restrictions of intake, binge/purge, diuretics/laxatives, compulsive exercise (NOTE - which one of us doesn't meet the compulsive exercise point at some stage).

So what moves people along the continuum of DE to ED? The main thing is perception of self.

Obsessive / Compulsive - The physician noted that this isn't necessarily a bad thing and joked that every single person at her medical school fit this profile.

What to do? Educate about the consequences of EDs. Love.

Signs: If energy balance is negative for an extended period then the body will breakdown resulting in fatigue, chronic injury, slower times. Another marker is swimmers that get running injuries (they get shin splints or stress fractures from secret run training).

Anorexic Physical Markers: Cold all the time, dizzy, losing fat then muscle, dark circles under eyes, fine hair appearing on face and body, baggy clothes used to hide disappearing body, boney prominences.

Bulimic Physical Markers: Might not show weight loss, swollen cheeks, red eyes, cavities, dark teeth, calluses on knuckles, yellow nails.

Body Function Manifestations: Loss of period (tough for coach to spot, but Dr. should be able to find out), persistent fatigue, loss of concentration (declining grades), personality changes (loss of friendships), bone development suffers.

NEW - Recent research indicates that there is nothing that we can do to promote bone growth opportunities that have been "lost" due to amenorrhea. Many chronic female athletes are looking at hip replacement at 45-50 years old (!).

Invisible but dangerous: (a) massive fluid shifts, (b) electrolyte imbalances; (c) heart rhythm disturbances leading to sudden death; (d) starvation causing breakdown of vital organs.

What to do? Intervene early, get help early before it goes chronic, keep an eye on your athletes that have disordered eating (NOTE - that's pretty much every one if they are high performance), address with experts, give pathways to support networks, seek to reverse when minor, don't tolerate behaviors that lead to risk.

Pay particular attention to kids with fatigue, declining times, unexplained changes and/or chronic injuries.

NOTE - It's not you "fault". Many coaches and parents are in denial because they think that there is something wrong with them. Deal with the situation to help your athlete get well.

Early warning signs - Constant weighing, extra exercise, super low fat diets, constant calorie counting, eating alone, panics if can't train. (NOTE - I've shown ALL of these at one time or another. I think that the assumption should be that every female endurance athlete is at risk.)

How do we help?

  • Educate self and explore current language. Know that your ladies DO NOT hear things the way you think you are saying.
  • Examine your attitudes on weight versus performance (NOTE - I think swimming is lucky in a sense because I don't believe that weight makes ANY difference in the water, it's the ability to crank with good technique that matters.)
  • Talk openly and directly to your athlete when you have a concern
  • Provide links to athlete help resources
  • Discuss with parents
  • Provide support

"Food is fuel for performance". If you want to perform then you HAVE to have fuel.

Coping as a coach - know that:

  • Logic doesn't work, love does
  • Progress will be slow and frustrating
  • Support the athlete but get expert help
  • Coach needs an avenue to vent - talk to other coaches that have dealt with it
  • We can't fix it - male coaches must realize that they will never "fix" this problem
  • Ask the athlete how you can help
  • now that these things ARE happening, right now

Challenges to Coaches

  • Learn and modify attitudes
  • Create a caring and accepting environment
  • Base performance on strength not weight
  • Have your athletes fuel their bodies
  • Balance the human side your elites are real people

When an athlete comes to you:

  • "Thank you for coming to me."
  • Get facts, encourage communication
  • Encourage to see a doctor as the first step. Health issues are less embarrassing, easier to deal with. If an issue with seeing doc then direct to a sports nutritionist. Most these girls will have a physical complaint that can be used to get them in to see a doctor.
  • See if there is a local taskforce (more and more common in USA)

+++++

Thoughts and Other Points
DE/ED education should be a primary focus for Level One certification in every sport.

This is the number one health risk facing young women and most people are scared to talk about it!

NOTE - I don't think we can simply abdicate responsibility for this and try to pass the buck to experts. I think coaches have an obligation to get informed and share this information with their athletes.

USA Swimming will have brochures out this fall.

In the short term, ED can be performance enhancing but it will bite them in the end.

Focus praise on actions and efforts NOT appearance and visual.

Action and effort - not lean, not fit, not good looking

One coach asked if we are ready to say that vegetarianism for female athletes is sub-optimal. He coaches in North California and his community is rife with this issue. NOTE - I agree but I could see and feel the mood of the room change - not PC! Puberty brings food elimination in females. They have all kids of excuses for this. Personally, I believe this is sub-optimal for performance.

EDs can manifest as chronic fatigue, overtraining or overreaching.

They strongly recommend NO public weigh-ins, NO body fat testing, NO skin folds, NO public scorn for being overweight.

NOTE - For triathlon and running, for all but a select genetic few, I believe that there is an unresolvable conflict between female health and elite female athletic performance at the highest level. I think that many elite females in these sports have to constantly walk a physical and psychological tightrope. I discussed this with the physician and she said that there is an element of Darwinian selection at work with the ladies - so many fall by the wayside. Are we willing to pay this cost with our daughters, wives, girlfriends to have them simply run/climb at elite levels?

NOTE - I think we need to constantly talk about eating right and educate people what this means. They recommend that we also explain the health issues. So with adult ladies, "eat right", explain the risks, love them as best you can, be vigilant for the warning signs and say a prayer!

Jack Daniels was in the house. His points:

  • People first, athletes second.
  • Pregnancy as a performance enhancing tool - not hormones. It's rest and good nutrition for close to a year!

We can't change society but we can change our behaviour.

Educate - Love - Support

gordo

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