This is a registered dietitian with additional training in the area of providing nutritional guidance to athletes. Not only can they understand the goals of athletes and support them nutritionally, they can be on the look-out for how an athlete with an eating disorder might abuse or avoid nutrition in the context of sport.

A sport psychologist is a critical part of treatment for an athlete and provides support and encouragement while challenging the eating disorder thoughts and behaviors. With specialized training for the psychological aspects of sport, a sport psychologist understands the pressures of competition, will explore multifaceted issues that can influence athletic performance, and encourage a balanced approach to training and competition.

At The Victory Program athletes have several separate groups from the general population. These groups get to the core of the athletic experience and equip athletes with the skills, knowledge and group interaction needed to pursue recovery.

Victory groups include topics such as: body image, mental preparation for sport, challenges related to being injured, returning to competition and reintegrating training, all from the perspective of an athlete. This unique setting helps athletes feel understood and allows them to address issues that would otherwise be overlooked in typical eating disorder therapy groups.

The other body image they carry internally is connected to their sport. Or a gymnast may value her strong thigh muscles when tumbling during the floor routine but be highly uncomfortable wearing a pair of jeans to class. Groups specific to athletes allow individuals to explore these issues and feel understood by other athletes and treatment providers.

A unique aspect of treating athletes with eating disorders is the inclusion of a strength and conditioning coach on the treatment team. Many athletes may push themselves far beyond optimal training in time, intensity and frequency. In doing so the athlete may lose touch with both physical and emotional cues and experience injuries and emotional exhaustion.

A strength and conditioning coach who is trained to work with eating disorders can assist the athlete in better understanding what proper training feels like and correct the tendency to over train. When an athlete is medically stable, is nutritionally compliant, reaching treatment targets, and is mentally prepared, a strength and conditioning coach can assist in returning to a balanced training regimen.

This includes preparing workouts and exposure to the sport in an incremental way along with processing of triggers and body cues. Amanda Tierney with The Victory Program describes her role with athletes this way,. During the healing process, my hope is to create a compassionate and non-judgmental space to restore confidence and rediscover passion, in sport and life.

Addressing family and relational dynamics in the context of treatment is a common and important part of treating an eating disorder. When an athlete is performing at a high level and the sport contributes significantly to their identity and community, treatment providers need to work with sport personnel by listening, educating, and communicating with them.

ANAD is the leading nonprofit in the U. that provides free, peer support services to anyone struggling with an eating disorder, regardless of age, race, gender identity, sexual orientation, or background. Our free, Eating Disorders Helpline is available for treatment referrals, support and encouragement, and general questions about eating disorders.

Our Helpline is available Monday-Friday, 9am-9pm CST. We will return messages left outside of these hours. All content © National Association of Anorexia Nervosa and Associated Disorders. All Rights Reserved. This will include periodization of training, guiding optimal biomechanical technique, encouraging adequate rest and recovery, and creating safe and supportive training environments.

The ED-informed and ED-certified fitness professionals will thoughtfully anticipate physical and emotional challenges that could arise and assist the athlete in preparing to meet those challenges.

Athletic excellence typically requires an athlete to challenge their physical and psychological limits in order to meet the demands of a sport. Consistently performing at a high level requires dedication, a strong work ethic, perseverance, and coachability. DEBs and EDs and the associated chronic malnutrition impede improvement of strength, flexibility and aerobic conditioning.

Overtraining, especially given the presence of or history of DEBs and EDs, diminished athletic performance, increased frustration, decreased confidence, and increases risk of exacerbated ED symptoms and behavior.

While resuming physical training during or following treatment for a DEB or ED indicates significant progress, this phase of recovery is not without challenge especially given its frequent, gradual and tenuous nature. Athletes accustomed to extraordinary training loads may find that gradual and intentional training regimens at low levels of intensity feel relatively insufficient.

The athlete may doubt their ED recovery capability and their ability to re-establish successful training and competition. Negative self-talk, fear and anxiety concerning their athletic future may ensue.

Guilt specific to disappointing themselves and others may also emerge. Since EDs may be a way of coping with intense emotion, urges to use ED behaviors may thereby be aggravated see Figure 4. All potential ED complications may therefore further intensify especially given a history of trauma, loss, anxiety or mood disorders.

Decisions regarding changes in frequency and intensity of sport activity and training must cautiously consider factors such as meal plan compliance and weight restoration status, vital signs, laboratory results, ED symptom status, emotion regulation capability, and compliance with all MDTT recommendations.

Prescriptions for exercise and physical activity must be carefully adjusted throughout the process of treatment and recovery and must take into consideration all of the aforementioned factors.

The MDTT educates and supports athletes in optimal physical and mental training to improve performance and secure best overall health. Each member of MDTT should work within their scope of practice and relevant credentials and operate in close communication with each other. In an effort to best coordinate care and facilitate communication, MDTT members must provide their name, address, telephone, dates of service, type of service provided, relevant observations and recommendations for care for all other MDTT members.

Any treatment contracts regarding safety, return to play parameters, guidelines for traveling with a team, medication compliance, etc. Since ED recovery occurs over a lengthy period of time and considering the signs of recovery are not always outwardly tangible, the athlete will depend on the MDTT and family members for patience and encouragement in order to remain compliant and hopeful.

When collaborating within a MDTT, each MDTT member should assert their expert advice, even when it may not be supported by other members of the treatment team.

Expectations for academic, professional, and athletic participation, training load, and competition should be specified. The athlete and sport personnel must be familiar with early warning signs of potential lapse and understand the specific medical, psychological, and ED specific markers that warrant a higher level of care.

Lapse or relapse may be common occurrences along a recovery path but are not indications of failure or inability to recover. As such, avoid any shaming or blaming an athlete who exhibits signs of a lapse or relapse.

The MDTT can facilitate learning from lapses, sustain positive recovery and decrease the likelihood of a relapse by providing needed support. Physical, nutrition, sport performance, and emotional recovery must co-occur in synchrony. Action plans and treatment parameters should be agreed upon by all MDTT members, communicated to the athlete, and consistently upheld by all parties.

The clinical signs and risks of relapse should be identified and made familiar to the athlete and all care providers prior to returning to athletics or transitioning to a lower level of care. Athletes should avoid rushing or abbreviating treatment as a premature return to training or competition during the ED recovery process as doing so has been shown to further increase the likelihood of a relapse De Souza et al.

Additionally, it is beneficial to draft pre-established and agreed upon plans for resumption of more intensive care. The athlete should be informed about what is entailed in intensive levels of care including the type and length of the treatments, location, treatment objectives, cost of treatment, and insurance coverage.

All treatment providers should recognize when more intensive care see Table 1 is needed and respond swiftly to access additional support according to the treatment plan. Athletes will benefit from greater proficiency in accessing both internal resources e. and external sources of support e. Athletes may feel accustomed to managing emotional matters on their own and may avoid ED support because of related stigma and bias.

Successful athletes in recovery will benefit from improved understanding of the value of utilizing all available sources of support i. The complexity and severity of EDs are underestimated, especially when the athlete is performing well, creating a false sense of health and wellness.

In addition, athletes will characteristically work hard to meet the demands of the sport and mask any emerging performance deficiencies. In fact, athletic performance can temporarily improve after the emergence of ED symptoms, which can motivate additional changes in weight or diet, and subsequently reinforce unhealthy and dangerous behaviors.

The human body is resilient and able to function well for a finite period of time; however, ED complications resulting from prolonged states of energy deficiency and physical demands will eventually manifest with far-reaching implications for health and safety.

The aforementioned recommendations on the role of each MDTT member and considerations to support safe, appropriate treatment and training parameters, align with fostering an environment where the athlete is better able to navigate recovery and more consistently demonstrate an ability to adhere to treatment targets.

Unfortunately, the ED treatment and recovery process may be longer, more expensive, more time consuming, more trying and more convoluted than imagined or desired. There are many reasons to be frustrated and unsatisfied with change and growth that may appear relatively minor and intangible in the early phases of recovery.

The ability to remain patient, hopeful, and persistent can be challenging, but all are vital to recovery. Identify agreed upon parameters for treatment and return to play and avoid rushing to complete treatment or re-establish full training and competition.

Confidence in the MDTT and in ED recovery are essential components of a successful recovery process. Athletes excel when teachers, coaches, sport personnel, family and friends believe in their ability to make progress, are not alarmed or angered by lapse or slowed progress and remain hopeful.

Sport teams, athletic systems, health care providers, as well as families who leverage resources, awareness programming, policies and funding may collectively reduce risk of illness, relieve suffering, foster recovery and facilitate successful, safe and fulfilling return to sport participation.

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Given the pressures to perform and achieve success in sport, compounded by subjective evaluation or presenting bodies in revealing uniforms, many female athletes may resort to disordered eating to compensate for these pressures.

This article will help inform athletes, coaches and parents about factors leading to eating disorders and their consequences. Three young female college student-athletes affected by eating disorders were interviewed. They were given aliases of Jocelyn, Sophie and Jane. Their personal accounts along with some research evidence should be informative to everyone in the aesthetic sport community.

An eating disorder is an emotional and physical condition associated with an obsession with food, body weight or body shape. According to the National Eating Disorder Association NEDA , eating disorders are more common among females than males with as many as 10 million girls and women, and 1 million boys and men afflicted.

Eating disorders such as anorexia and bulimia primarily affect people in their teens and twenties, making the majority of adolescent athletes vulnerable. Because of its secretive nature, not many athletes are known by their athlete community to have eating disorders and the incidence is higher than you would think.

Anorexia and bulimia are well known eating disorders. People with anorexia have an intense fear of gaining weight or becoming fat even though they are underweight and they use weight as the only source of self-worth. Other symptoms of anorexia are denying the medical seriousness of low weight, and for women who have reached puberty, missing at least three menstrual cycles in a row.

People with bulimia nervosa engage in binge eating, feeling a lack of control over eating behaviors during eating binges. Purging occurs after these bouts of over-eating to eliminate calories from the body through self-induced vomiting, starving, vigorous exercise, laxatives, or other methods to prevent weight gain.

A minimum average of two binge-eating episodes a week for at least 3 months and persistent concern with body shape and weight help characterize bulimia. Eating disorders often begin with weight restrictive behaviors but can have several health consequences, some which are irreversible.

For example, anorexia and missing menstrual cycles are also associated with osteoporosis bone loss. Other common medical complications include: erosion of teeth and gums, constipation, acid reflux, slowness of thought, abnormal liver functioning, anemia, abnormal blood pressure and brain shrinkage.

People can die from eating disorders. What causes weight restriction behaviors that can lead to eating disorders? When asked about their personal experiences with eating disorders and their sport experiences three female athletes who have suffered from eating disorders had a lot to say.

Jocelyn, a year old college senior was 17 when her eating disorders started. She experienced both bulimia and anorexia. Researchers have categorized eating disorder risk factors into four categories that everyone in aesthetic sport communities should know about.

These are:. Factors from each of these categories can interact, further fueling disordered eating behaviors. With this information, various people in the athlete community can strive towards controlling their actions. More specifically, athletes can realize that some issues are not in their control and require positive ways of coping.

The most important aspect of sports such as dance, synchronized skating, and swimming is to move as one. Sticking out in any way can be a problem. If you make a mistake you are letting down all of your teammates. For athletes like Sophie, who competes in international events, representing her country is an additional stressor.

Although many athletes get used to competitive attire, wearing skimpy outfits is stressful for some. Involving athletes in the decision making process is also a healthy way to boost motivation and team cohesion. With the evolution of technical elements in many sports that now include jumping and lifting, being thin can be even more important than just for aesthetics.

Being thin is thought to make the rotation and the height of jumping easier. But if you think about it, one of the consequences of having an eating disorder is to reduce the amount of energy your body stores and needs to perform.

Environmental pressures generally involve people who interact with athletes including teammates, peers, coaches, parents, parents of other athletes, judges and the audience. In many aesthetic sports scores for artistry are tied to appearance.

Much of the appearance and weigh-related pressures aesthetic sport athletes experience are from coaches. Consistent with research on female athletes, those interviewed also reported coach practices such as weigh-ins, cutting athletes based on weight, and diet restriction warnings around the holidays as stressful.

Coaching is difficult because they are being paid a lot of money to develop a winning team and they make team selection decisions accordingly. During the season, it can be hard to focus on needs of individuals who comprise the team. It is important to point out that there are many coaches out there who realize the consequence of such negative statements and practices.

Sophie indicates that she has never had a coach make negative comments about needing to lose weight. Aesthetic sports are considered an early-entry sport where young girls often specialize in the sport as early as eight years of age.

This means that in many sports, girls grow up in front of the sport community where many are quick to point out changing bodies. A changing body is stressful, especially in the face of constant comparisons. Coaches or other adults who focus primarily on success and performance rather than the athlete as a whole person can do a lot of damage; even seemingly innocuous comments around weight or body shape can be harmful in certain environments.

Athletes are uniquely at risk of developing eating disorders, and some sports pose a higher risk than others. Aesthetically-judged sports, for example, like gymnastics, figure skating, ballet, and synchronized swimming invite more focus on the physical form.

And since these sports tend to be more popular with women, female athletes are affected at higher rates. This condition includes disordered eating or low energy , amenorrhea, and decreased bone density osteoporosis 3. Treatment of this triad is complex, often involving multiple specialty care providers.

Examples of these include wrestling, boxing, weight lifting, and rowing. Sports that focus on individual athletes rather than the performance of a team as a whole can also be considered higher risk, like cross country, sprinting, bodybuilding, or diving.

And if athletes are facing the pressure of competition in combination with past negative experiences — low self-esteem, family dysfunction, a history of abuse — these conditions leave them even more open to developing an eating disorder.

As a parent, you can help your young athlete deal with pressures and avoid eating disorders by modeling love and support, regardless of appearance or athletic performance! Let your children know that you value them for who they are, not what they can do or how they look.

Promote a positive body image and lead by example by enjoying a healthy lifestyle of fun physical movement and nutritious foods. Focus on and stress health, fitness, and energy over a number on the scale. Coaches and other adults who play leadership roles in sports organizations are important parts of keeping athletes mentally healthy.

Make sure young athletes are participating on teams that model a positive, supportive culture. The 'Experts in Sport' podcast is a regular series that brings together experts from across Loughborough University with external thought leaders to discuss the latest research and hot topics in sport and academia.

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