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Eating Disorders -- Part II

Part 2 in a series on the issue of sports-related eating disorders
Prepared by the U.S. Olympic Committee Sports Medicine Council, the International Center for Sports Nutrition

the source The United States Olympic Committee is the sole agency in the United States with the authority for the selection and participation of U.S. teams in the Games. The Olympic Training Centers serve more than 20,000 athletes each year, from the 41 sports on the Olympic or Pan Am programs. The International Center for Sports Nutrition, a division of The Center for Human Nutrition, is a key resource for all athletes and active people striving to enhance performance through improved nutrition. For further information, call (402) 559-5505 or write to ICSN at 502 South 44th Street, Room 3007, Omaha, NE 68105-1065.

How to Identify an Athlete with Anorexia Nervosa or Bulimia
Being "skinny" does not necessarily mean one has anorexia nervosa, just as being ideal weight does not necessarily mean one is healthy. An athlete with anorexia nervosa or bulimia may continue to perform well for a longer-than-expected time due to sheer determination combined with the body's remarkable ability to adapt to adverse circumstances.

Dieting, weight loss, and pre-event diet rituals do not mean an athlete has anorexia nervosa or bulimia. However, if the following signs or behaviors appear, there is need to pay attention.

• Repeated comments about being or feeling fat and questions such as "Do you think I'm fat?" when weight is below average.
  
• Weight loss below the ideal competitive weight set for that athlete and which continues even during the off-season.
  
• Secretive eating, perhaps noted by food wrappers in room or locker, or sneaking food from training table.
  
• Repeatedly disappearing immediately after eating, especially if a substantial amount of food was eaten.
  
• Apparent nervousness or agitation if something prevents ability to
  be alone shortly after eating.
  
• Bloodshot eyes, especially after being in the bathroom or any other place where vomiting could have occurred.
  
• Vomitus or odor of vomit in toilet, sink, shower, or wastebasket.
  
• Extreme weight fluctuations.
  
• Complaints or evidence of bloating or water retention not explained by premenstrual edema (in females) or other known medical conditions.
  
• Frequent complaints of constipation.
  
• Lightheadedness, disequilibrium (loss of balance), mood swings not accounted for by other known medical causes.
  
• Avoiding situations where the athlete would be observed eating. For example, scheduling other activities at mealtimes, refusing to eat at training table or with teammates on road trips. This may be disguised by an extreme interest in the eating habits of others.
  
• Purposeless, excessive physical activity that is not part of the
  training regimen.

Are Coaches to Blame?
An eating disorder is a symptom of underlying emotional distress. It is first a coping mechanism and then becomes an additional problem. The athlete who has an eating disorder will also have a history of low self-esteem and difficulty with problem-solving and handling stress. "Do coaches cause anorexia nervosa or bulimia?" The answer is no.