Involvement in sport can promote a healthy lifestyle, create positive outlooks on self-image, and instil motivational attitudes in individuals. However, athletes have been identified as an at-risk population for the development of body image concerns and disordered eating because of the unique pressures they face within the sport environment. These “sport specific” pressures can include specific judging criteria, sport weight limits, coach/teammate expectations, and revealing their figure in athletic uniforms. While historically such pressures have been more present for female athletes, male athletes also report experiencing them.
Disordered eating in athletes is characterised by a wide spectrum of maladaptive eating and weight control behaviours and attitudes. Although the extent of disordered eating in athletes is unclear, prevalence estimates have ranged as high as 62% among female athletes and 33% among male athletes (Bonci et al., 2008).
Maladaptive behaviours may begin as an attempt to enhance performance by losing weight, or perhaps by failing to maintain adequate energy availability during high intensity or high volume sport training, not necessarily from psychopathology. Determining when athlete behaviours and attitudes specific to diet and exercise are consistent with eating disorders is challenging due to the performance expectations, training demands, and energy requirements. Furthermore, many athletes demonstrate psychological traits commonly associated with clinical eating disorders (Sundgot-Borgen & Torstveit, 2010) which can also be important determinants in the drive for success in sport, such as high achievement orientation, self-motivation, rigid self-discipline, and perfectionism. Awareness of behavioural and psychological indicators of athletes with eating disorders may be helpful in determining when to intervene.
Unfortunately, many athletes are particularly sensitive to, and fearful of, psychological evaluation and treatment. Possible explanations include reluctance to admit personal weakness, desire to maintain autonomy, receipt of social support from teammates, and fear of derogation. In addition, it has been reported that some athletes look at their disordered eating behaviour as a natural part of their sport and reflect dedication rather than psychopathology (Martinsen & Sundgot-Borgen, 2013). Consequently, athletes who present for therapy show a continuum of readiness; some will be determined to change, while others will be reluctant or even hostile. In an athletic population, resistance to consultation or treatment is a challenging problem and may necessitate restricting training and competition until compliance is established.
It is important for health professionals to recognise that athletes are not immune to engaging in eating disordered behaviours. Because certain behaviours (e.g. over-exercising, rigid eating) may be valued in the sport environment, athletes’ disturbances may not be readily identifiable. For that reason, athletic trainers, medical professionals and coaches need to be educated about possible indicators that athletes may be engaging in unhealthy behaviours and steps taken to intervene once any problems have been identified.
Athletes require information that destigmatizes disordered eating through open, factual discussions. Fear associated with talking about the behaviours must be allayed, as well as the social stigma, shame and guilt that prevent athletes from seeking help. Accomplishing this goal requires increasing awareness of disordered eating and clinical eating disorders, and available and effective treatment options.
Coaches are in a unique position to denounce unhealthy attitudes and behaviours that may trigger disordered eating (Bonci et al., 2008). However, they also juggle a combination of role demands and conflicts that are not always consistent with making decisions in the best interests of their athletes’ health. The more enlightened coaches are about nutritional issues, the more they are able to follow nutritional guidelines, emphasise healthy eating habits rather than weight standards, and have a better understanding of why weight is such a personal and sensitive issue for athletes.
Moreover this information could be used in the prevention of eating disorders. Programs that educate athletes about the physical health consequences of disordered eating, specifically related to impaired athletic performance and risk of being sidelined by injury may be particularly effective to deter maladaptive eating and exercise behaviours.
The sport environment is dependent on increased openness regarding psychological challenges that athletes face, making it easier for an affected athlete to come forward and seek treatment rather than evading detection to avoid embarrassment or removal from training and competition.
Bonci, C. M., Bond, L. J., Granger, L. R., Johnson, C. L., Malina, R. M., Milne, L. W., et al. (2008). National athletic trainers' association position statement: Preventing, detecting, and managing disordered eating in athletes. Journal of Athletic Training, 43(1), 80-108.
Martinsen, M., & Sundgot-Borgen, J. (2013). Higher Prevalence of Eating Disorders Among Adolescent Elite Athletes than Controls. Medicine and Science in Sports and Exercise, 45(6), 1188-1197.
Sundgot-Borgen, J., & Torstveit, M. (2010). Aspects of disordered eating continuum in elite high-intensity sports. Scandinavian Journal of Medicine & Science in Sports, 20(Suppl 2), 112-121.
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