Background

Individuals with an eating disorder can spend an unhealthy amount of time thinking about their weight or trying to lose weight in unhealthy ways. They often have an unrealistic or distorted view about their appearance, body weight, and food. Behaviors that severely limit eating or abnormally increase exercise can result in nutritional deficits and make an individual at high risk for serious injury or illness. Unhealthy behaviors can include eating very little food, making oneself vomit after eating, taking diet pills or exercising too much.

There are two main types of eating disorders: anorexia nervosa and bulimia nervosa. In anorexia nervosa, individuals are often very thin and fear gaining weight. They will often limit the amount of food they eat by eating small portions or skipping meals. Individuals with bulimia nervosa often feel that they eat too much and use “purging” behaviors such as making themselves vomit, exercising excessively or abusing laxatives.

Symptoms

Anyone can develop an eating disorder, but they are most common in younger females. People with depression or anxiety may be more likely to develop an eating disorder. Individuals who participate in competitive athletics, particularly in artistic sports (such as gymnastics or dance), endurance sports (such as running or cycling) and sports with weight classifications (such as wrestling or rowing) are at higher risk for an eating disorder.

• Sudden weight loss or fluctuation
• Feeling tired or dizzy
• Stomach pains, diarrhea or constipation
• Irregular or slow heartbeat
• Difficulty concentrating
• Thin bones or stress fractures
• Irregular or missed periods

Sports Medicine Evaluation and Treatment

The first step to treating an eating disorder is recognizing the problem. Treatment helps change how someone thinks about food, their body weight and exercise. Doctors, counselors, and nutritionists can work together by using counseling, support groups, and/or medications to help individuals struggling with an eating disorder.

Injury Prevention

Educating athletes, parents, and coaches about healthy eating and safe training is the mainstay of prevention. Emphasis should be placed on adequate nutrition and optimal health for performance rather than body weight. Recognition of unhealthy behaviors by parents, coaches, and teammates can lead to earlier treatment for athletes.

Return to Play

A decision about continuing or returning to exercise or competitive athletics should be made with a doctor. Athletes with eating disorders can have large energy and nutritional deficits, which must be restored before returning to exercise. A decision to return to play should consider the athlete’s current medical and mental health, along with as the risks associated with the particular sport and competition level.

AMSSM Member Authors
Vicki Nelson, MD, PhD & Andrew W. Albano, Jr., DO

References
Joy E, et al. 2014 female athlete triad coalition consensus statement on treatment and return to play of the female athlete triad. Curr Sports Med Rep. 2014; 13(4):219-32.
Joy E, Kussman A, Nattiv A. 2016 update on eating disorders in athletes: A comprehensive narrative review with a focus on clinical assessment and management. Br J Sports Med. 2016; 50(3):154-62.
Mountjoy M, et al. The IOC consensus statement: beyond the female athlete triad – relative energy deficiency in sport (RED-S). Br J Sports Med. 2014; 48: 491-97.