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Health & Exercise Forum

Common Eating Disorders In Athletes: Part 2

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May 7, 2009

Dr. Paul Mackarey(2nd of 3 Columns on Eating Disorders in Athletes)

Guest Columnist: Janet Caputo, PT, OCS

Eating disorders are becoming epidemic in athletes. This is the second of three columns addressing this topic. Eating disorders differ from dieting because of the preoccupation with body weight/shape, abnormal eating/exercise patterns, and emotional/medical problems. There are problems with self-image, mood, and interpersonal functioning. The three most common eating disorders in athletes (anorexia nervosa, bulimia nervosa, and compulsive exercise) have life threatening consequences.

Compulsive exercisers perform more exercise than needed for quality performance. Workouts purge calories. Compulsive exercise warning signs: exercising when tired/ill but not for fun or stress relief, exercising at extremely intense levels experiencing severe anxiety if a workout is missed for fear of gaining weight, absenteeism from family obligations/social events because they have to exercise to burn calories.

Anorexia Nervosa

Anorexia Nervosa is self starvation involving a relentless pursuit of thinness and an unwillingness to maintain a normal body weight. Despite emaciation, the fear of gaining weight does not subside.

Some health consequences:

  • Abnormally slow heart rate and low blood pressure increases risk for heart failure. Heart muscle becomes small/weak.
  • Permanent loss of bone mass; fractures; lifelong problems from brittle bones and fragile joints.
  • Muscle loss/severe dehydration results in kidney failure.
  • Growth of a downy layer of hair (lanugo) all over the face/body (body’s effort to keep warm).

Bulimia Nervosa

Bulimia Nervosa is consuming large quantities of food then purging to prevent weight gain. Despite vomiting, laxative abuse, and fasting, bulimics usually maintain a minimally normal body weight.

Some health consequences:

  • Electrolyte imbalances, caused by dehydration from purging, lead to irregular heartbeats, heart failure, cardiac arrest, and death.
  • Potential for gastric rupture during bingeing.
  • Possible esophageal rupture from vomiting.
  • Tooth decaying/staining from stomach acids released during vomiting.
  • Laxative abuse causes irregular bowel movements and constipation.

Other Medical Problems Associated with Eating Disorders

  • Delayed growth/permanently stunted growth from malnutrition.
  • Weakened immune system from intense exercise/over-training.
  • Seizures, sleep disruption, illogical choices, and irrational judgments because of chemical and physical changes in the brain associated with malnourishment.
  • Iron deficiency reduces athlete’s ability to train and compete because of: impaired immune function, diminished cognitive development, impaired temperature regulation, and decreased energy metabolism. Effects of iron deficiency can be magnified with intense training.
  • Increased injury/impaired tissue maintenance: Increased recovery time from muscle, tendon, and ligament injuries with inadequate dietary intake because the necessary constituents are not available for healing.

In 1993, the American College of Sports Medicine collectively termed amenorrhea, osteoporosis, and eating disorders as the female athlete triad. Intense training and insufficient caloric intake cause amenorrhea (absence of menstruation) or oligomenorrhea (irregular menstrual cycles with decreased frequency) indicating impaired ovarian function with insufficient estrogen to grow healthy bones. Since most bone development occurs during early childhood and late adolescence, female athletes need to acquire the greatest amount of bone mass during their first two decades to combat post menopausal osteoporosis. Estrogen also maintains bones. Bone damaged by daily wear and tear and intense athletic activity is repaired. However, with depleted estrogen stores, more bone is removed than replaced. The bones get thinner and break easier (Osteopenia; Osteoporosis). Estrogen’s third role is to direct calcium to bone to make bones hard. In amenorrhea, absorption of dietary calcium is impaired. The result is bone prone to fractures even during low impact activities (walking).
Low estrogen levels may also exist because estrogen storage lies within adipose tissues. Therefore, low body fat compositions could lead to decreased estrogen stores. Low body fat is a female athlete’s gauge for physical fitness.

Identify an Eating Disorder

Detection of eating disorders in athletes is critical. Knowledge of some of the signs/symptoms may help:

  • Restrictive dieting/significant weight loss with; preoccupation with weight, shape, food, muscles, body fat, appearance and/or calories.
  • Excessive exercise: exercising when tired, injured, or sick.
  • Withdrawal from teammates.
  • Chronic fatigue/inability to complete workouts.
  • Changes in mood/negative comments about body and self.
  • Fainting, light-headedness, stress fractures, and muscle injuries.

Visit next week to discuss treatment and prevention of eating disorders.

Visit your doctor regularly and listen to your body.
Keep moving, eat healthy foods, and exercise regularly

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email:

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an affiliated faculty member at the University of  Scranton, PT Dept.