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Health & Exercise Forum

Why Athletes are Susceptible to Eating Disorders: Part 1

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May 7, 2009

Dr. Paul Mackarey(1st of 3 Columns on Eating Disorders in Athletes)
Guest Columnist: Janet Caputo, PT, OCS

Over the past several years I have worked with many young female athletes that have suffered from injuries often associated with low body fat and poor bone density such as repeated stress fractures. In certain sports such as running and gymnastics this can be devastating. One thought that comes to mind is whether or not the young female athlete may also have an eating disorder. This prompts a discussion with the parents and family physician. This is the first of three columns dedicated to this topic as requested by several parents of local athletes.

According to the American College of Sports Medicine (ACSM), some athletes are at greater risk for developing eating disorders:

  • Sports in which performance is subjectively scored (dance, figure skating, gymnastics)
  • Endurance sports favoring participants with low body weight (distance running, cycling, and cross-country skiing)
  • Sports requiring contour-revealing clothing for competition (volleyball, swimming, diving, and running)
  • Sports using weight categories for participation (wrestling, horse racing, martial arts, and rowing)
  • Sports in which prepubertal body habitus favors success (figure skating, gymnastics, and diving)

Attributes of successful athletes predispose them to eating disorders. Athletes’ have A-type personalities: perfectionists and over-achievers, who are highly competitive, committed, compulsive, dedicated, and driven. These traits that provide success, when focused on the body, can have devastating consequences. These qualities are often found in eating disorder patients, although perhaps with a different label.

Coaches and teammates have a significant amount of influence over athletes. Coaches can be preoccupied with controlling body weight/shape to enhance athletic performance. Weekly public weigh-ins and body fat analyses which reveal personal information to the entire team/staff, causes embarrassment and fosters competition to obtain the lowest weight through dangerous dieting methods.

Judges in sports where athletes are evaluated on technical and artistic forms have admitted considering thinness an important factor in deciding excellence and have told athletes they should lose weight to achieve their athletic goals. When their bodies are being constantly assessed personally and by coaches, judges, and spectators, it is understandable why athletes develop disordered eating.

Athletes who compete at the highest levels of their sports are training and playing virtually year round. Unfortunately, for most young women increasing muscle mass means their bodies depart from the culturally desirable body frame. This increases body dissatisfaction and the pursuit of unhealthy weight control practices.

Athletics may be used to “legitimize” an eating disorder because of emphasis on low body fat and thinness. Coupled with the dedication and discipline required to comply, the athlete receives praise and admiration for self-control.

Emphasis on thinness and demands for self-discipline invite the female athlete to believe that food restriction will improve performance, enhance winning and achievement of more glory. Although research indicates the opposite, weight loss is equated with becoming quicker, faster, and stronger.

Since a serious athlete can never work too hard or too much, “no pain, no gain” is sought as a marker for achievement. This compulsive exerciser will use workouts to purge calories.

Athletes may use performance to define part of their identity. Their role as athletes may be the only part of their lives where they feel at least minimally competent and effective.

Some athletes insist that eating during the day will make them feel heavy and cause them to be slow at workouts, practices, and competitions. Other athletes vomit before competition to reduce high anxiety and then binge to ease depression after defeat.

There are huge demands placed on young athletes today. They are expected to specialize in a sport at a very young age. However, their mature, but larger body may be better suited for another sport in which they were never given the chance to excel because they specialized so young. This may cause them to set an unrealistic goal weight.

Athletes are expected to perform at a high level at a very young age. It is not good enough to be their best. They must be the best. They know they are not being judged on the effort of their performance, but on the outcome of their performance. Female athletes may eliminate meat and dairy from their diets to reduce calories and fat to achieve or maintain low body weight. By doing so, they are under nourishing themselves and risk developing protein, iron, and zinc deficiencies.

With a basic understanding of an athlete’s susceptibility to eating disorders, next week we will be able to discuss common eating disorders in athletes and their consequences.

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

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.

Sources: Otis CL, Drinkwater B, Johnson M, et al. ACSM position stand: the female athlete triad. Med Sci Sports Exerc 1997;29(5):i-ix.