Eating Disorders & Athletes When Healthy Goes Too Far Lisa - - PowerPoint PPT Presentation

Lisa Diers, RDN, LD, E-RYT Director of Nutrition & Yoga The Emily Program

Eating Disorders & Athletes When “Healthy” Goes Too Far

emilyprogram.com

Objectives

• Participants will be able to:

– Successfully identify helpful & unhelpful messages about eating & activity – Gain knowledge in how to identify potentially dangerous & disordered eating & movement behaviors in athletes – Learn key strategies in supporting & treating athletes struggling with eating disorders

emilyprogram.com

Defining An Eating Disorder

• What is an Eating Disorder?
• Who Gets an Eating Disorder?
• Is it a choice?

emilyprogram.com

Eating Disorders are NOT a choice

Recovery IS Possible

emilyprogram.com

What is an Eating Disorder?

• WHAT: Eating Disorders Such as Anorexia,

Bulimia and Binge Eating Disorder- include extreme emotions, attitudes and behaviors surrounding weight and food. Eating Disorders are a serious emotional and physical problems that can have life threatening consequences.

emilyprogram.com

Types of Eating Disorders

DSM V

• Anorexia Nervosa
• Bulimia Nervosa
• Binge Eating Disorder
• Avoidant/Restrictive Food

Intake Disorder

• FEC-NEC

– Atypical AN – Sub BN – Sub BED – Purging Disorder – NES ▪ Not Official ED, but commonly referred to: Diabulimia, Orthorexia

emilyprogram.com

• Eating disorders affect a person physically, behaviorally, emotionally, and

psychologically; including:

• Dramatic weight gain or loss; or no noticeable change in wt.
• Verbal preoccupation with food, weight, and shape
• Rapid or persistent decline or increase in food intake
• Excessive or compulsive exercise patterns
• Purging; restricting; bingeing; compulsive eating; abusing diet pills,

laxatives, diuretics, emetics

• Denial of food and eating problems, despite the concerns of others
• Eating in secret, hiding food, disrupting meals, feeling out of control with

food

• Medical complications, such as menstrual irregularity, dizziness, fainting,

bruising, dry skin, leg cramps, hair loss, brittle hair, osteoporosis, diarrhea, constipation, dental problems, morbid obesity, diabetes, chest pain, heart disease, heartburn, shortness of breath, organ failure, and other symptoms

Why do people get eating disorders?

Bio-Psychosocial Model of Eating Disorders

Food restriction Genetics Physical changes Puberty/Menopause neurotransmitters

Stressors Identity/self-image Personality factors Perfectionism Depression Coping Cultural factors Pressure to “fit in” Normalization of dieting Media biology

psychology

social/environment

emilyprogram.com

concerns

Healthy ➜ ➜ ➜ ➜ Problematic Weight control Practices: Healthy eating behaviors Dieting Unhealthy weight control Anorexia or Bulimia Nervosa Physical activity behaviors: Moderate physical activity Minimal

• r excessive

activity Lack of, or

• bsessive,

physical activity “Anorexia athletica” Body image: Body acceptance Mild body dissatisfaction Moderate body dissatisfaction Severe body dissatisfaction Eating behaviors: Regular eating patterns Erratic eating behaviors Binge eating Binge eating disorder Weight status: Healthy body weight Mildly

• verweight
• r underweight

Overweight or underweight Severe

• verweight
• r underweight

Neumark-Sztainer D, “I’m, Like, SO Fat!”: Helping Your Teen Make Healthy Choices about Eating and Exercise in a Weight Obsessed World. New York: The Guilford Press; 2005.

emilyprogram.com

Who gets an ED

• WHO: Eating Disorders are not discriminatory of body size, age, sex,
• rientation, race or economic status.

Athletes

• Sports that emphasize appearance, muscularity, or weight

requirements (cheerleading, diving, bodybuilding, or wrestling)

• Individual-focused sports such as gymnastics, running, figure skating,

dance, or diving rather than a team sport like basketball, volleyball, or soccer

• Endurance sports, such as track and field, running, and swimming
• Training for a sport since childhood or being an athlete of elite-status
• An overvalued belief that lower body weight will improve

performance

• An unhealthy focus on success and performance supported by those

invested in the athlete's performance

• Unhealthy focus/messages: LEANER, BIGGER, STRONGER, LOOK

BETTER; PERFECTION

Continued…

• Study of elite female

runners had 16% with a classifiable eating disorder at the start of the study

• Girls high school varsity

sports- 18.2% disordered eating

• Ohio State University-

subclinical eating problems affected 19% of female athletes & 12% of males

Weight Classed Sports

• Menstrual disturbance in

approximately 30% of females

• 85% of females attempted to

lose weight

• 93% of male athletes

attempted to lose weight

• Most common compensatory

behaviour reported by athletes was dehydration (e.g., sauna, exercise in sweat suites).

emilyprogram.com

Weight Classed Sports

emilyprogram.com

Weight Classed Sports

emilyprogram.com

What it Means to RDs

• Our profession needs to have a sensitivity to eating

disorder treatment

• What are our own beliefs & biases on food, weight, shape,

appearance, performance?

• So much praise for athletes; Extremism = success Can you

tell if it’s healthy or disordered?

• Know when it’s time to refer – parents/coaches/MD
• Consult with ED Dietitian specialists
• Eating disorder treatment is HARD work
• So are other major treatments

– It’s Hard work. It’s challenging. There are sacrifices.

• It works!

emilyprogram.com

Objectives

• Participants will be able to:

– Successfully identify helpful & unhelpful messages about eating & activity

emilyprogram.com

Helpful or Not?

• OK Team- see how Sally performed yesterday?
• Stellar. Sally – tell everyone what you’ve been
• doing. Especially how you changed your diet.
• Your body works for you. Not the other way
• around. You want to be on top, push harder-

maintain control.

• You know your body. Eat what works best for

you and helps you perform. Your body will tell you what to do.

emilyprogram.com

Helpful or Not?

• You don’t need to worry about how or what

you eat! That’s the bonus of competing, you can eat whatever you want. You'll burn it off in practice!

• If you would cut some weight, you’d be faster.

Only 5 pounds. You’d shave at least 3 seconds

• ff your time.
• Whatever you're doing, keep it up!

emilyprogram.com

Helpful or Not?

• Wow. You look great!
• Excuses, don’t want to hear them. Complaints,

Not Interested.

• There are many things that can be done to

improve performance. What are your goals?

• Your Examples?

emilyprogram.com

Objective #2

• Gain knowledge in how to identify potentially

dangerous & disordered eating & movement behaviors in athletes

emilyprogram.com

When Healthy Has Gone too Far Signs & Symptoms

• Avoidance of water or excessive water intake
• Preoccupation with one’s own food
• “Perfect” Eating- (orthorexia)
• Preoccupation with other people’s food
• Ritualistic eating and/or avoidance of certain foods
• Excessive concern with body aesthetic
• Decrease in performance, especially when combined

with other signs

• Prolonged or additional training above and beyond

what is required for sport (e.g., extra sit-ups and laps, extra workouts)

emilyprogram.com

When Healthy Has Gone too Far Signs & Symptoms

• Athletes on the team reporting concern about an individual
• Decreased concentration, energy, muscle function, coordination, speed
• Increased fatigue and perceived exertion
• Longer recovery time needed after workouts, events
• Difficulty with days off and tapering
• More frequent muscle strains, sprains, and/or fractures
• Slowed heart rate and low blood pressure
• Reduced body temperature and increased sensitivity to cold—cold hands

and feet

• Complaints of light-headedness and dizziness
• Gastrointestinal complaints such as nausea, constipation, abdominal pain

and fullness

• Poorer interaction with coaches/teammates
• Perfectionism
• Increased impatience, crankiness
• Increased isolation

emilyprogram.com

Objective #3

• Learn key strategies in supporting & treating

athletes struggling with eating disorders

emilyprogram.com

Key Strategies

• In private setting communicate care and

concern “I am concerned….”

• Be a listener. Let them know you are there

whenever you need them

• Don’t pass judgment/Be a compassionately

Curious

• Reinforce- weight doesn’t determine

performance outcomes. Performance does.

• Athletes want to perform. Food= performance

fuel

emilyprogram.com

Key Strategies

• Make tough calls. Sometimes it works to stay

in the sport. Sometimes it doesn’t.

• Support your athlete- if your athlete had a

broken leg- how would you handle it? Why is this different?

• Avoid body/food comments
• Support their Recovery Meal Plan
• Collaborate with ED RD
• Continue to follow-up/check-in

emilyprogram.com

Key Strategies

• Get an Assessment/ Refer
• College Campus Resources
• School Counseling Resources
• Involve parents
• Assess your clients/teams

emilyprogram.com

Team Activity: Food & Wt. Messages

• What Messages do you

receive about Food?

• What messages do you

receive about weight and Performance?

emilyprogram.com

Team Activity: Being a Change Agent

• How can you change the conversation?
• How can you promote a body positivity?
• How can you promote nutritionally positive

messages?

• What can you do if feeling performance

pressure to engage in extreme weight or food practices ?

• What can you do if you think someone you

know has an eating disorder?

emilyprogram.com

Performance Stress & Anxiety and Pre/Post Fueling

• Wreaks havoc on the nervous system
• Can affect appetite pre and post competition

– Nausea – Decreased appetite – “Nervous” eating – “Relief” eating (emotion eating)

emilyprogram.com

Performance Stress & Anxiety Pre/Post Fueling

• Remind your Athlete that sticking to his/her

pattern of eating is really important- restriction can exacerbate feelings of anxiety and nausea, it inhibits performance and for some it leads to over eating after the event

• So, what to do about the stress and anxiety…

emilyprogram.com

• Deep Breathing
• Journaling
• Eating with Someone
• Listening to Music
• Talking
• YOGA….

Performance Stress & Anxiety Pre/Post Fueling

emilyprogram.com

Experience it First Understand it later

BREATH-CENTRIC ASANA (yoga postures)

• “Notice what you notice” (Bring Awareness to
• Sensation. Emotion.)
• Contralateral Movement
• Hands to eyes
• Neck stretch
• Nyasa
• “Notice what you notice”

emilyprogram.com

Three Yoga Techniques Non food way to manage stress & anxiety

emilyprogram.com

YOU can teach this!

• Try a technique prior to a meal
• Real life strategies
• Proven

emilyprogram.com

RCT Yoga & Meal Time Anxiety

• 1Carly R. Pacanowski, Lisa Diers, Ross D.

Crosby & Dianne Neumark-Sztainer (2016): Yoga in the treatment of eating disorders within a residential program: A randomized controlled trial, Eating Disorders, DOI: 10.1080/10640266.2016.1237810

emilyprogram.com

RCT

• looked at the relationship between yoga and negative

affect (a term used to describe experiencing unpleasant emotions) before mealtime, as it is known that meals are especially difficult for clients with eating disorders, and negative mood at mealtime is associated with poorer recovery outcomes. Results showed the group that participated in a yoga class designed to target eating disorder symptoms exhibited significantly lower negative affect before meals compared to a group that did not practice yoga (this effect did weaken somewhat throughout the meal). Participants who had practiced yoga also reported feeling calm and in tune with their internal drives.

emilyprogram.com

The Truth About Weight & Performance When Do We Perform Well?

• Physically Fit
• Mentally Fit
• Emotionally Fit
• Nutritionally Fit

emilyprogram.com

Summary

• No one “chooses” to have an eating disorder
• Can affect anyone, high prevalence in college

athletes

• Weight does not determine performance
• utcomes
• Food is Fuel. Performance Eating.
• Stress reduction techniques like yoga can help
• YOU can make a difference/ Agent for change

emilyprogram.com

Resources/References

• www.emilyprogram.com
• https://emilyprogram.com/blog/tag/yoga
• https://emilyprogram.com/blog/tag/nutrition
• Journal of Athletic Training; 2005; 40(1); 47-51
• Clinical Journal of Sports Medicine; 2004; 2006
• http://journals.lww.com/cjsportsmed/pages/default.aspx
• College Campus Student Counseling Services
• American college of sports medicine http://www.acsm.org/
• http://www.scandpg.org/sports-nutrition/
• http://www.sportsnutritionsociety.org
• www.NCAA.com

emilyprogram.com

Resources/References

https://www.nationaleatingdisorders.org/sites/default/files/To

• lkits/CoachandTrainerToolkit.pdf

https://www.nationaleatingdisorders.org/athletes-and-eating- disorders http://www.eating-disorders-research.com/content/athletes- and-eating-disorders-0 http://www.ncbi.nlm.nih.gov/pubmed/16461868/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3246101/ http://www.researchgate.net/profile/Monica_Torstveit/public ation/234012834_Sundgot_Borgen_Torstveit_DE_HIS_2011 /links/02bfe50e3ecdf04ca9000000.pdf http://search.proquest.com/openview/0045dbeaea7fefa2226e 17f09c7dae4a/1?pq-origsite=gscholar http://tim.blog/2013/05/06/how-to-cut-weight-ufc/

emilyprogram.com

THANK YOU!!

• Lisa.Diers@emilyprogram.com
• www.emilyprogram.com