Disordered Eating and Exercise Patterns in Athletes (PDF)

Disordered Eating and Exercise Patterns in Athletes Denelle Cosier, APD 1 1...

Disordered Eating and Exercise Patterns in Athletes Denelle Cosier, APD 1 1 About me Accredited Practising Dietitian (Bachelor of Nutrition and Dietetics, UOW) PhD Candidate – gut health Eating Disorder Dietitian in community setting past few years. 2 2 ©2019 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 1  Lecture Objectives By the end of this lecture, you should be able to: LO 12.1 Outline changes in eating and exercising patterns over time that may put athletes at risk for disordered eating and eating disorders. LO 12.2 Describe the concepts of normal eating, disordered eating, and eating disorders. Compare and contrast anorexia nervosa, bulimia nervosa and binge eating disorder LO 12.3 State the prevalence of disordered eating and eating disorders in male and female athletes and explain the distinctions between athletes with eating disorders and those who are training intensely but do not have a disordered eating pattern. 3 3 Icebreaker: Disordered eating and eating disorders are deviations from normal eating habits and practices. To identify potential deviations, an individual must have a working definition for “normal eating.” What is your definition of “normal eating”? How has the current culture influenced this definition? 4 4 ©2019 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 2  Introduction to eating disorders Dunford/Doyle, Nutrition for Sport and Exercise, 5th Edition. © 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 5 5 “Normal” Eating An eating pattern that: Is flexible and not obsessive Is moderate and balanced Is based on internal hunger and fullness cues Involves some constraint, but not reckless abandon or overly strict discipline Consists of consuming foods that are nutrient rich as well as eating some foods that might have a low nutrient content 6 6 ©2019 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 3  “Normal eating is being able to eat when you are hungry and continue eating until you are satisfied. It is being able to choose food you like and eat it and truly get enough of it – not just stop eating because you think you should. Normal eating is being able to use some moderate constraint in your food selection to get the right food, but not so restrictive that you miss out on pleasurable foods. Normal eating takes up some of your time and attention, but it keeps its place as only one important area of your life. Normal eating is flexible” Satter, 1987. 7 7 Normal eating in athletes Athlete’s diets often require careful plan ØEnsure adequate intake of macronutrients ØMinimize excessive caloric intake that may result in weight gain Diets may become more rigid at particular times ie competition season Normal eating amongst athletes is characterized by discipline, not obsession and inflexibility. 8 8 ©2019 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 4  Eating Disorders Eating disorders are defined as serious, complex and potentially life-threating mental illnesses characterised by disturbances in behaviours, thoughts and feelings towards body weight/shape and/or food and eating. Eating disorders represent a substantial deviation from normal eating. There are different types of eating disorders that someone can be diagnosed with, according to the DSM-5 (classification and assessment tool for mental disorders). 9 9 Anorexia Nervosa Caloric restriction that results in a significantly low body weight for age. Intense fear of gaining weight Extremely distorted body image Behaviors to prevent weight gain even at a significantly low weight Restricting type Binge-eating/purging type 10 10 ©2019 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 5  Bulimia Nervosa Recurring binge eating episodes coupled with compensatory behaviours in attempt to prevent weight gain Self-induced vomiting Laxatives Diuretics and/or enemas Fasting Excessive exercise Prevalence is difficult to estimate due to lack of treatment and detection 11 11 Binge Eating Disorder (BED) Eating a large amount of food in a short period of time (Binge) Accompanied with a loss of control over their eating behaviours Associated by having three or more of the following: More rapid eating than normal Eating until uncomfortably full Eating large amounts when not physically hungry Eating alone because of feeling embarrassed Feeling disgusted with oneself, depressed, or guilty afterward 12 12 ©2019 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 6  OSFED/USFED Not all of the criteria for diagnosis of the previous eating disorders have been met Symptoms are still clinically significant and problematic for daily functioning and health All these discussed eating disorders are characterized by poor body image, distortion of one’s own body, and fear of weight gain. 13 13 Exercise Dependence Exercise addiction or compulsive exercise Continue to exercise despite work or family commitments, or health contraindications. Adverse impacts on quality-of-life and health. Ie acute injuries, over-training. Often found in conjunction with eating disorders and disordered eating. Mechanism to control weight. Ways to assess 14 14 ©2019 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 7  Disordered eating Disordered eating behaviours are those that are not considered to be normal or optimal, and have some characteristics of eating disorders but not enough to be a diagnosed eating disorder. Include yo-yo dieting, restrictive eating patterns, removing whole food groups, fasting and then feasting patterns, rigid eating patterns, compulsive or dependent exercise. These behaviours are connected to attempts to lose weight or change body shape. 15 15 The Eating Continuum -Moderate restraint -Mild-moderate psychological -Significant psychological -Eating when hungry; pathology pathology stopping when full -Eating and hunger not aligned -Social isolation -Flexible eating pattern -Restrained and rigid eating -Body image distortion -No psychological -Food is restricted and perceived -Self-esteem associated with pathology negatively weight -Eating and weight normal -Compensatory behaviours -Extreme control or lack of emphasis in life -Weight and food control overemphasized -Rigid and inflexible eating - Diet extremely overemphasized compared to other areas of life 16 16 ©2019 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 8  Prevalence of eating disorders In the general population, throughout their lifetime , ~8.4% women and 2.2% of men will experience an eating disorder. In athletes, this prevalence is much higher: modest estimate of 14-16% of athletes will experience an eating disorder in their lifetime. Estimates of disordered eating amongst athletes range from 6-45% in females and as high as 19% in males 17 17 Reference: Butterfly Foundation 18 18 ©2019 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 9  Risk Factors for Eating Disorders Genetics (psychiatric) Family environment – family history of eating disorders/disordered eating, dieting, obsessive food talk, children not modelled healthy food behaviours Personality – perfectionistic, obsessive, poor self-esteem, need to maintain control. Trauma/Complex PTSD Cultural influences – “thin ideal” Major life events, changes or loss. Athletics/sports with thin bodies and weight requirements. 19 19 Engaging in dieting (food restriction to intentionally lose weight) is the single biggest predictor for the onset of an eating disorder. 20 20 ©2019 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 10  Health consequences of eating disorders Low energy availability (starvation) à menstrual and endocrine disturbances, low bone mineral density, impaired immune function, intense fatigue Nutritional deficiencies à commonly iron-deficient anaemia. Electrolyte imbalances and dehydration – impaired cardiac function, low blood pressure Gastrointestinal problems – bloating, constipation, diarrhoea, impaired intestinal function Dental problems if purging Impaired mood, cognitive and psychological functioning due to lack of nutrition à impaired decision making and emotional regulation. 21 21 Disordered Eating and Eating Disorders in Athletes 22 22 ©2019 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 11  Complexities Eating disorders are complex and dangerous no matter the population. Difficulties in determining the presence of an eating disorder in athlete vs non- athlete populations due to disciplined eating and high-volume exercise required by athletes 23 23 Question: What sports do you think would have the highest prevalence of eating disorders? 24 24 ©2019 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 12  Sports and Activities Considered Higher Risk Disordered eating can occur in any athlete, in any sport, at any time, crossing boundaries of gender, age, body size, culture, socio-economic background, athletic calibre and ability. 25 25 Knowledge Check 2 Which statement is incorrect? a) Female athletes are more likely than male athletes to exhibit either disordered eating and eating disorders. b) Sports requiring a certified weight before competition do not have a higher prevalence of disordered eating. c) Estimates of disordered eating in female athletes range from 6–45 percent. d) Determining the prevalence of eating disorders and disordered eating in athletes is difficult. 26 26 ©2019 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 13  Knowledge Check 2: Answers Which statement is incorrect? Sports requiring a certified weight before competition do not have a higher prevalence of disordered eating. 27 27 Changes to eating and exercise behaviors are often gradual. Do you think you would be able to recognize early signs of an eating disorder in yourself or an athlete you are working with? Why or why not? 28 28 ©2019 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 14  Distinguishing “Normal” and Abnormal Eating and Exercise Patterns (1 of 2) Features of athletes with “normal” eating Features of athletes who may have and exercise patterns disordered eating and exercise patterns Performance Performance is improved, or a high level of Performance declines performance is maintained Training Purposeful training; no overtraining Excessive exercise or activity; self-imposed overtraining or exercise dependence; anxious if not able to train; continues to train with injury against medical advice Energy intake Caloric intake is monitored; athlete is disciplined Caloric intake is controlled; energy availability but not obsessive about the amount of food is low; athlete is disciplined and obsessive; consumed; adequate energy availability amount of calories consumed is recorded or mentally counted; consumption of caloric intake over self-imposed limit causes anxiety Perspective on food Food is needed to fuel training; eating is enjoyed Food needs to be restricted; eating is not intake and viewed positively enjoyable and viewed negatively 29 29 Distinguishing “Normal” and Abnormal Eating and Exercise Patterns (1 of 2) Features of athletes with “normal” eating Features of athletes who may have and exercise patterns disordered eating and exercise patterns Performance Performance is improved, or a high level of Performance declines performance is maintained Training Purposeful training; no overtraining Excessive exercise or activity; self-imposed overtraining or exercise dependence; anxious if not able to train; continues to train with injury against medical advice Energy intake Caloric intake is monitored; athlete is disciplined Caloric intake is controlled; energy availability but not obsessive about the amount of food is low; athlete is disciplined and obsessive; consumed; adequate energy availability amount of calories consumed is recorded or mentally counted; consumption of caloric intake over self-imposed limit causes anxiety Perspective on food Food is needed to fuel training; eating is enjoyed Food needs to be restricted; eating is not intake and viewed positively enjoyable and viewed negatively 30 30 ©2019 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 15  Distinguishing “Normal” and Abnormal Eating and Exercise Patterns (2 of 2) Dietary intake Consumption of “healthy foods” and adequate kilocalories; no Consumption of “healthy foods” but concern about occasionally eating low-nutrient-dense foods inadequate kilocalories; concern about or refusal to occasionally eat low-nutrient-dense foods Dietary Routinely follows a well-planned diet but is flexible as Ritualistic and inflexible pattern of eating flexibility needed Body image Accurate and positive body image Inaccurate and negative body image Body Realistic weight and body composition goals that improve or Unrealistic weight and body composition composition maintain performance; goals are attainable without goals that do not improve or maintain compromising health performance; goals are not attainable without compromising health Muscle mass Increased or maintained muscle mass with resistance training Decreased or inability to increase muscle mass with resistance training 31 31 Psychological distinctions between normal vs ED behaviours: Anxiety around body size, weight and appearance Anxiety, guilt and shame when unable to adhere to diet plan. Distress when unable to adhere to exercise plan. General social isolation, withdrawal or depression. 32 32 ©2019 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 16  A very fine line separates rigorous training and eating plans that enhance performance and contribute to wellbeing, from disordered eating and exercise behaviors that undermine performance and negatively impact wellbeing. This line may be crossed intentionally or unintentionally. 33 33 Signs and symptoms of EDs in athletes: Repeated injuries ie stress fractures or muscle injuries (may have continued to exercise despite initial pain or indicates low energy availability). Slow recovery from illness or injury, frequent illnesses. Gastrointestinal problems – constipation, diarrhoea. Rapid/unexplained weight gain or loss Iron deficiency anaemia Irregular or absence menstruation Sudden changes in food rules or patterns of eating. Bathroom visits after meals Avoiding eating with others and general social isolation, weary baggy and layered clothing. Relentless, excessive exercise. 34 34 ©2019 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 17  Case Study: Disordered Eating and Eating Disorders An athlete can move from a normal eating pattern to disordered eating and then to an eating disorder Inappropriate eating Dieting behaviors Training demands Psychological stresses 35 35 Case study: Allie Ostrander’s story: https://www.youtube.com/watch?v=W1eGSayIxyE&t=421s What changes occurred in Allie’s eating behaviors? What was the motivation for these changes? What influenced Allie’s diet restriction and onset of the eating disorder? 36 36 ©2019 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 18  What to do if an ED is suspected in athletes: Refer to the team Doctor or their GP for eating disorder screening If ED confirmed, community or hospital inpatient treatment will be recommended. Community treatment involves a GP, psychologist and dietitian (all suitably trained in eating disorder treatment) to address medical, nutritional and psychological pathologies. 37 37 ©2019 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 19