Prevent Eating Disorders in Female Athletes
By Terry Zeigler EdD, ATC
Eating disorders and disordered eating are seen in both males and females in the general population. However, females are ten times more likely than males to have an eating disorder. Of females with either eating disorders or disordered eating, a certain percentage gravitates towards athletics for several reasons.
First, the personality traits of individuals with eating disorders and of athletes are similar. Second, individuals may move towards athletics because certain behaviors of athletes can disguise behaviors of someone with an eating disorder (i.e., excessive exercise, focus on body shape and size, diet restrictions). Last, although sports do not cause eating disorders or disordered eating, there are a number of risk factors involved in sports which may lead someone who may be at risk for eating disorders towards disordered eating behaviors.
Understanding the risk factors that may trigger eating disorders in female athletes is an important component in preventing disordered eating in young women. Once the risk factors are understood, coaches and those working with young women can take proactive steps in preventing eating disorders in their athletes.
What places female athletes at risk for eating disorders?
There are a number of risk factors both in society in general and in sports that may place an athlete more at risk for an eating disorder. Some risk factors can be changed. Others cannot. Knowing the difference can help those who work with female athletes become aware of how to alter their own behavior, policies, and language to not increase existing risks.
Unfortunately, in western society, there is sociocultural pressure for women to be thin in order to be accepted (Beals, K., 2004). Girls are exposed at a very young age to the pressures of being thin via pictures and advertizing in the media as well as through television shows and movies. Happy, well-adjusted, and popular characters are portrayed as thin and fit.
Extremely lean female models are still used in the fashion industry and on the runways to market fashion trends. This message alone is a dangerous one as it sets the precedent that clothes can only look good on really thin body frames.
Added to the pressure that western society already places on girls and women to be thin is the additional pressure in “thin-build” sports. These are sports in which the athletes are either judged by their appearance or whose performance is enhanced with leaner bodies. These sports include dance (specifically ballet), gymnastics, distance running, triathlon, diving, figure skating, and cheerleading (Beals, K., 2004).
Individuals who coach these sports need to recognize the inherent risks of these athletes towards eating disorders just by the nature of the sport itself. More than other sports, these coaches need to be cognizant of comments and/or procedures that they follow that may add additional pressure to already at-risk athletes.
Finally, it is important for coaches to recognize that it is the female athlete’s perception of her body that is the important factor to focus on rather than the athlete’s actual body weight, size, or shape. Many females (athletes or not) have misperceptions about their body size or shape.
If an athlete perceives that her body size and shape is not good enough for her sport (regardless of whether it is or not), it is this perception that may cause disordered eating in the athlete.
The ability for an individual to be coping effectively with life’s stressors is an important psychosocial development that healthy young people develop. Knowing how to deal with adversity and cope effectively with problems may be one key to preventing the development of an eating disorder.
According to Beals (2004), individuals with eating disorders are often those who are raised in dysfunctional families in which there may be overbearing or over controlling parents or physical or sexual abuse. It is the loss of control that the individual feels and the loss of self-esteem that she is trying to gain control of through managing her food intake. Food is the one substance that the individual can completely control.
Second, effective coping mechanisms teach an individual how to handle stressful situations by facing them directly, thinking through possible options, and then acting on the option that best fits the scenario. Healthy coping mechanisms tend to include the ability to talk openly and freely about emotions and fears with family or close friends. A network of close family and friends are one of the most important coping mechanisms that an athlete can have.
Individuals who face adversity on a regular basis without an emotional outlet may learn unhealthy coping mechanisms including shutting down, withdrawing, and hiding their emotions. Although this may be a defense mechanism that a young girl may learn and need to survive while growing up in a dysfunctional family, it can lead to a myriad of problems coping as an adult.
While some people learn to overcome these factors, others may be at risk for eating disorders. While emotional experiences play a role in the background of predisposing an individual towards being at risk for an eating disorder, other personal characteristic are involved. Personality characteristics commonly seen in athletes with eating disorders include the following (Beals, K., 2004):
• Tolerant of pain and discomfort
• High self-expectations
• Low self-esteem
An individual who possesses these personality characteristics and who has a history of being raised in a dysfunctional family has a higher risk for eating disorders. What is really interesting is that the personality characteristics listed above are also many of the same ones found in good athletes. It is not a surprise that sports may draw in females who are at risk for eating disorders.
Because certain personality traits are well documented to place athletes at risk for eating disorders, coaches can help identify at risk athletes by getting to know their athletes on a personal level. Once communication is established between the coach and the athlete, the athlete may be able to open up about difficulties at home.
Becoming a safe mentor for a young female athlete may be one way to identify at risk athletes, provide an outlet for expressions of emotions in a safe environment, and provide further guidance or referral to a medical professional if necessary.
It is well known in those working with people with eating disorders that most eating disorders are developed in early adolescence during the teenage years.
Teenage years are difficult enough as hormones and bodies change. These alone can create tumultuous times for young people.
However, for those that do not have good coping skills and who already may have low self-esteem, the pressure of trying to fit in and be accepted can be the trigger towards experimenting with disordered eating behaviors.
Understanding how self-esteem can be impacted by changing body shapes and sizes in young females is a really important factor in helping to prevent disordered eating behaviors in young women.
It starts with teaching young girls that everybody has a unique body shape and size. Young girls need to be taught to accept their bodies and to focus on the good rather than the imperfections. Teaching a healthy body image needs to start in the elementary school age children and then be reinforced as these young girls move through puberty.
With the goal of improving self-esteem in young girls is a campaign launched in 2004 by DOVE to help girls and women accept their bodies regardless of their size and shape. DOVE launched the campaign called “Campaign for Real Beauty”. The goal is for girls and women to “Imagine a world where beauty is a source of confidence, not anxiety” www.dove.us.
It is a three phase campaign to reach women of all ages for the purpose of breaking down stereotypical perceptions of beauty by helping girls and women to each find and accept their unique beauty. Part of the campaign is a DOVE Self-Esteem Fund with part of the funds going towards a new program Uniquely ME! developed specifically for the Girl Scouts of America for the purpose of improving the self-esteem of young girls ages 8 – 17.
This type of program is a necessity for this age group because this is the age group in which disordered eating and eating disorders begin – adolescent females. Because low self-esteem is one of the character traits of an individual at risk for an eating disorder, programs like these are needed and are a valuable resource to programs working with young girls.
Coaches working with this age group need to be especially careful in their comments made to the girls about weight, size, and shape. Understanding that this age group is where disordered eating behaviors take root is critical to helping prevent disordered eating in this population.
Serotonin is a naturally found neurotransmitter in the brain that has a number of important functions including regulating sleep, body temperature, and mood. Low serotonin levels may create a number of side effects that would only compound problems seen in someone with an eating disorder.
There is some research that has shown that serotonin (a neurotransmitter) levels decreased in women who were on severely restricted diets (1,000kcal/day). What is interesting to note is that this neurotransmitter was shown to only decrease in women during three weeks of calorie restriction and not in men (Kaye, W.H. & Weltzin, T.E., 1991). This may be one explanation as to why women are more susceptible to eating disorders than men.
Sports Specific Risk Factors
While a number of societal factors may predispose an individual towards eating disorders, a number of sports-related factors may compound the problem. Awareness of these risk factors can help coaches adjust their approaches to sports (especially thin-build sports) to reduce the risk of eating disorders in their athletes.
In the early to mid eighties, a group of researchers (Epling, Pierce, & Stefan, 1983) theorized that extreme exercise might lead to anorexic behavior. Their theory proposed that extreme exercise decreased an athlete’s appetite thus the athlete ate less and began to lose weight. As the athlete’s weight dropped, the athlete’s performance increased which lead to an increase in motivation to exercise. The researchers hypothesized that this cycle led to exercise-induced anorexia.
Although this was a plausible scenario for some athletes, it did not explain the many individuals who are already suffered from eating disorders and then pursued sports as an excuse for extreme exercise. While it appears that exercise does play a role in eating disorders, it does not appear that research supports the hypothesis that exercise can cause an eating disorder.
Pressures to Lose Weight
For athletes who incur eating disorders during sports participation, a primary risk factor appears to be the pressure to lose weight. Because dieting is the primary precursor to the development of an eating disorder (Thompson, R.A. & Trattner Sherman, R., 1993), the perception that an athlete needs to lose weight is all that may be needed to trigger disordered eating.
Whether real or perceived, the issue at the center of the problem is the perception of the athlete’s own body image. For athletes who may already have a poor self-image, a comment towards an athlete about her needing to lose weight is all that it needs to take to start and athlete towards disordered eating.
Adding to the above pressures of self and the coach, the athlete is at an even higher risk if she is involved in a “thin-build” sport in which the focus during competition is on the athlete’s body. Combine all three of these issues and it is not surprising that athletes develop disordered eating behaviors.
While good intentioned, some coaches make the mistake of setting weight limitations for their female athletes. Athletes are weighed at the end of a season and then are required to come back in to the sport for the following season at a specific weight. If the weight requirements are not feasible or guided by sports medical professionals, athletes may turn to pathological eating behaviors to drop weight.
Pressure to make a certain weight for a female athlete may be all the pressure that is needed for an athlete to start dieting, restricting calories, over exercising, or turning to other purging techniques to drop weight. With all that is known about the risk factors for disordered eating in female athletes, there is no place for mandatory weigh-ins or weight restrictions in female sports.
For more information on the pressure of body weight and performance, click the following link Ideal Body Weight and Athletic Performance.
Stress and Trauma
According to Katherine Beals (2004), author of Disordered Eating among Athletes, stress and/or trauma can lead to disordered eating in susceptible athletes. Types of stress might include injury, illness, change or loss of a coach, moving away from family or friends, academic challenges, and athletic performance changes.
The trait that all of these stressors are able to evoke is the feeling of being in or losing control over something that was important to the athlete. If the athlete feels out of control in some areas of her life, she may try to regain control through strict control of the food that she eats along with her energy expenditure.
Long term injuries can add a slightly different risk in that the athlete may not be able to exercise or compete with her team for long periods of time. If this is the case, she may try to control her weight through strict calorie restriction since she may be unable to burn up calories through her normal practices and competitions.
This is another factor that coaches and sports medicine professionals need to be cognizant of. Athletes who are identified as those with injuries, illness, or who are experiencing stressful situations need to be carefully monitored to ensure that they have the emotional support they need.
One important role of a good coach is to mentor their young athletes and to help them develop into responsible adults. As much fun as winning is, coaches can impact players for a lifetime if they can offer the emotional support and stability for their athletes during difficult times.
Daily personal contact is one way to provide much needed support for a struggling athlete. The challenge for the coach is to choose to take the time to invest in the athlete off of the field of play and not just on the field. Sending the message that the athlete is more than just a “performer” is a powerful message to athletes who may only perceive themselves as valuable because their athletic ability.
Understanding the risks that may place female athletes at risk for disordered eating/eating disorders is the first step to helping prevent these disorders. While some risk factors cannot be altered, others can be addressed by coaches and others working with female athletes to help minimize the impact and help prevent disordered eating.
- Beals, K.A. (2004). Disordered Eating Among Athletes: A Comprehensive Guide for Health Professionals. Human Kinetics: Champaign, IL.
- Epling W.P., Pierce, W.D. & Stefan, L. (1983). A theory of activity-based anorexia. International Journal of Eating Disorders, 3, 27-46.
- Kaye, W.H. & Weltzin, T.E. (1991). Serotonin activity in anorexia and bulimia nervosa: Relationship to the modulation of feeding and mood. Journal of Clinical Psychiatry 52: 41-18.
- Kettles, M., Cole, C.L., & Wright, B.S. (2006). Women’s Health and Fitness Guide. Human Kinetics: Champaign, IL.
- Thompson, R.A & Trattner Sherman, R. (1993). Helping Athletes with Eating Disorders. Human Kinetics: Champaign, IL.
- www.dove.us. Campaign for Real Beauty. Accessed on September 21, 2010.