Get Started
Get Started

Health & Exercise Forum

Treating and Preventing Eating Disorders in Athletes: Part 3

, , , , , , , , , , , ,
May 7, 2009

Dr. Paul Mackarey(3RD of 3 Columns on Eating Disorders in Athletes)
Guest Columnist: Janet Caputo, PT, OCS

Eating disorders among athletes is not uncommon, especially in the female athlete. This is the third of three columns on this topic.

Athletes with eating disorders need referral to a health care professional. This health care professional must be a part of a team: psychologists/psychiatrists, nutritionists/dieticians, and the primary care/team physician.

The physician coordinates the management of this condition. Psychologists address issues including anxiety and depression. A psychiatrist prescribes medications indicated for a specific disorder. Insight and support from trainers/coaches is crucial for success. Optimal treatment includes lifestyle changes to attain/maintain a goal weight. Education on / monitoring for adequate nutrition is provided by nutritionists/dieticians. Focus is optimal health and performance instead of weight. Exercise is decreased 10-20% and weight monitored for 2-3 months. Involvement and education of family members is critical for a complete resolution of the eating disorder.
Additional intervention may be required to treat the female athlete triad. Hormone Replacement Therapy (oral contraceptives/cyclic estrogen/progesterone) has been used to treat amenorrhea. Daily calcium/vitamin D supplementation may be recommended. All available treatment options (bisphosphonates/calcitonin) are considered for athletes with frank osteoporosis. The ultimate goal is return of regular menses through proper nutrition, revised training, and maintenance of reasonable body weight.

Preventing Eating Disorders

Coaches, athletic trainers, and teammates, can help prevent eating disorders:

  • Recognize/educate on the signs and symptoms of eating disorders.
  • De-emphasize impact of weight on athletic performance; educate on physical risks of low body weight.
  • Promote total and healthy nutrition.
  • Encourage positive self-image/esteem; eliminate public weigh-ins, body fat analyses, and ridiculing body shape/weight.
  • Recognize when healthy training regimens turn obsessive.
  • Provide a resource for emotional counseling.

Athletes can ensure proper nutrition and avoid eating disorders:

  • Keep track of menstrual cycles in a calendar. If the cycles cease, it will be evident.
  • Eat regularly. Athletes juggling the demands of school, practice, and competitions are tempted to skip meals to save time. Eating now will improve performance later. Eat at least five meals/day, starting with breakfast to maintain energy levels and supply protein for growth/recovery. Keep a food journal to determine daily caloric consumption. Compare this to recommended daily caloric intake for your age, weight, and activity level. (Find this at  HYPERLINK "" If caloric intake is below recommended levels, consult a dietitian/nutritionist to determine sufficient amount.
  • Monitor performance. If energy expenditure exceeds energy intake performance will decline (a red flag for an eating disorder).
  • Maintain good body image. If dissatisfied with body weight, but body composition is healthy, the problem is body image! Talk to a doctor!
  • Maintain proper body composition. The ACSM recommends 12%-14% body fat as the minimum safe percent for high school girls. Beware restricting meat/dairy to facilitate weight loss. Consuming too few calories, may cause deprivation of protein, calcium, and iron. To estimate caloric needs measure weight in pounds multiplied by a number based on activity level: Light (x13), 20 to 30 minutes of daily aerobic activity; moderate (x16), 45 to 60 minutes; heavy (x19), 75 to 90 minutes; exceptional (x22), > 2 hours/day. Daily Calories = Weight in lbs. x Activity Factor (AF).
  • Eat a balanced diet: 50 - 60% carbohydrates, 20 - 30% protein, and 20 - 30% fats. If total calories per day is 2,000, then protein = 500cal, fat = 400cal, and carbohydrates = 1100cal. Also useful is the 1-2-3 rule for each meal: 1 part from fats, 2 parts from protein, and 3 parts from carbohydrates. A multivitamin and four servings of calcium-fortified foods are recommended. Drink 8 to 10 glasses of water throughout the day to ensure fluid replacement lost during exercise. If thirsty, depletion already exists. Complex unprocessed carbohydrates, (grains, fruits, and vegetables) give a constant supply of energy until the next meal. Replenish your energy with post-exercise recovery meals.
  • Make wise food choices: Eat a variety. Eat foods that are low in saturated fats/cholesterol (avoid fried foods). Moderate sugar content. Moderate sodium content (avoid canned/processed foods).

Sports can have extreme positive effects on development and maturation of individuals. It promotes ability to work as a team member, teaches perseverance, and enhances goal attainment. With the right emphasis, coaches, athletic trainers, and teammates can promote emotional and physical health.

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