Athletes and eating disorders

Athletes and eating disorders - Too thin to win: why athletes who lose weight to enhance performance are dangerously misguided

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'Too thin to win' was the attention-grabbing headline used recently for an article in one of our broadsheet newspapers. This alarming article about eating disorders in athletes brought into the public domain an issue that is usually hidden within the sporting sub-culture: the fact that many athletes habitually starve themselves in a bid to achieve optimum performance.

Leading figures from sports governing bodies, psychologists and experts in eating disorders are concerned that a whole generation of athletes may be exposing themselves to a range of healt 23323m1224x h problems associated with inadequate dietary intake. Such behaviour is thought to stem from an obsessive will to win, coupled with pressure from coaches and society's overwhelming obsession with body image.

The article mentioned above highlights the fact that in sports like distance running, a high percentage of female athletes are excessively thin. Charlotte Dale, a 19-year-old European junior cross-country championship winner, is presented as a classic example of an élite-level athlete whose performance has been affected by an eating disorder. When she was 16, Charlotte's weight dropped to just four stone as part of her long battle with anorexia ⁽¹⁾.

In the general population, social and cultural values are seen as key causes of eating disorders. In western society, there is a powerful underlying belief that thinness leads to success, power, beauty and happiness. In the drive for this Nirvana, many people succumb to disorders associated with restricted eating habits. The long-term implications of this behaviour are well documented and can be very serious. The health risks associated with excessive thinness include a whole range of conditions from mild to life-threatening. Menstrual dysfunction, suppressed oestrogen levels and osteoporosis are all associated with low body weight ⁽²⁾.

From the outside, it is tempting to believe that athletes would never be at risk of such problems. After all, athletes tend to have better physiques than their sedentary counterparts. And the assumption is that their concerns for health and performance would outweigh mere vanity. But the truth is that athletes face the same cultural and social pressures to conform to a perceived ideal body image as everyone else. In addition, they often experience added pressure from within their own sport to attain and maintain a certain body weight or shape ⁽³⁾.

Within the sporting community, each athlete is intensely aware of what other athletes are doing in training and competition. In such extremely competitive circumstances, there is a great deal of pressure on athletes to manipulate their diets in order to achieve or maintain optimum performance. The fact that so much in the sporting world is about image, with many top athletes used to promote relevant merchandise, can only serve to increase the pressure on athletes lower down the ladder to conform to some perceived ideal.

But the drive to thinness comes from inside as well as outside. Athletes at all levels tend to be extremely single-minded, highly competitive individuals with one ultimate goal - to excel in their chosen sport. Far too often, such individuals are willing to go to any lengths to achieve this aim, heading down a route that leads first to disordered eating and eventually to a full-blown eating disorder.

Although eating disorders are most prevalent among women, men are also at risk, particularly in sports that are seen to require low body fat levels, such as distance running, gymnastics and lightweight rowing ⁽⁴⁾.

As a former competitive athlete, I know how easy it is to fall into the trap of thinking that weight loss is the key to improved performance. Being a distance runner, my perception was that excess weight could have a negative impact on my performance. As I progressed through the ranks, eventually reaching national standard, my weight came down at a steady rate in line with my improvements in performance. And this is where the problems started: each time weight was lost and performance improved, I would set a new weight target in the hope that it would help me to a new PB. Weight became the main focus, with weight loss rather than training the key to improved performance. Many of the athletes I trained with were also engaged in trying to lose weight to boost performance, and talked openly about it.

A false sense of security

But, while it is true that in some cases small amounts of weight loss may lead to improved performance, there is a line beyond which further weight reductions will impair the body's ability to perform. The initial improvement to performance may lead the athlete into a false sense of security, tempting him or her to overstep the mark. In the short term only performance is affected, but in the longer term restrictive eating rebounds on health.

In my own case, my weight reached 9 stone 13lb, which is ludicrously inadequate for someone 5ft 10in tall. At the time, though, I didn't realise I had a problem, and I failed to make the link between my restrictive dietary intake and my eventual losses in performance. Of course, such behaviour is paradoxical when you consider that the one thing athletes need to ensure they are at their best during competition is the one thing they are prepared to restrict. As an athlete, I would never dream of missing a training session - yet I wouldn't think twice about missing a meal if I had gained the odd pound!

Truly accurate data relating to the prevalence of eating disorders within the population as a whole is not easy to come by because of the reluctance of sufferers to come forward and admit they may have a problem. But research suggests that about 1.15 million people in the UK have some form of eating disorder, and that 10% of those are male ⁽⁵⁾.

Alarmingly, research indicates a significantly higher prevalence of eating disorders among athletes. Concerns about long-term health implications have meant that most attention has been focused on women, particularly in sports like gymnastics and distance running, where women feel they need to be very thin to perform at their best. Restrictive eating habits put women at risk of developing such potentially serious problems as amenorrhoea (loss of menstrual cycle), reduced bone density and a consequently increased risk of stress fractures and osteoporosis. Collectively the combination of disordered eating, menstrual irregularities and reduced bone density has become known as the female athlete triad ⁽⁶⁾.

A whole range of studies have attempted to gather data on the prevalence of disordered eating patterns in those taking part in sport and physical activity, with estimates ranging from as low as 1% to as high as 60% ^(7,8,9,10). This very wide range is obviously attributable to differences in the design of the studies as well as differences in those taking part. Nevertheless the athletes who consistently demonstrate the highest prevalence of eating disorders are those taking part in 'aesthetic' sports, like gymnastics, and weight-dependent sports, like wrestling.

Clearly, then, restrictive eating habits are practised by a significant proportion of athletes. And I am sure most readers of Peak Performance would agree that it is the responsibility of all those who work with them to ensure that in focusing on performance they do not imperil their health. Coaches, in particular, have a huge responsibility to make sure that any derogatory comments they make, however throwaway, do not impact on their athletes' body image and self-esteem, leading to inappropriate weight concern and disordered eating patterns.

Such patterns can develop at any time in an athlete's career. But it is as athletes - particularly females - approach adolescence that they are most vulnerable. As their body composition begins to change with the natural process of growth and maturation, some girls find they are no longer able to compete at their accustomed level. A seeming inability to hold back these biological processes and prevent weight gain may lead them to restrict food intake in a misguided attempt to regain control. In such situations, coaches and parents need to tread very carefully. While everybody involved may be keen to help the athlete maintain his or her performance level, it is important to be aware of the bigger picture. Advising young athletes to try to maintain a set weight at this time could store up major problems for the future.

With the main focus on performance, it may be hard for the athlete - and even the coach - to recognise there is a problem. But everyone involved in supporting the athlete needs to take a step back at this point and look out for the following warning signs and types of behaviour that could indicate a real problem:

• Unexplained losses in performance;
• An obsession with body image, shape and weight;
• Constant use of weighing scales;
• Missing meals or avoiding certain foods;
• An obsession with the quantities or proportions of food in the diet;
• Rapid mood swings;
• Rapid and significant weight loss.

Athletes are no different from the rest of the population in terms of their need for a well- balanced diet. From a performance perspective, athletes need a diet that allows them to strike a balance between maintaining a particular body weight and safeguarding their health and wellbeing. The following tips are designed to help them achieve that balance:

• Don't be too selective, but choose a wide variety of different foods to ensure you get your full quota of essential nutrients;
• In sports with weight categories, like wrestling and boxing, athletes may need to reduce their weight as they approach competition. This process requires careful planning and should be supervised by a sports nutritionist or dietician. If you must lose weight, a reduction of 2lb per week should be seen as the absolute maximum. If performance levels start to fall, you should respond by increasing food intake with a view to slowing the rate of weight loss;
• If at any time you feel pressured to lose weight, seek independent advice (from a sports dietician, for example);
• Carbohydrates should form the basis of your diet, giving you the energy to support training and competition. Any reduction in energy intake should come from foods containing large amounts of saturated fat, such as meat;
• Following high-protein diets (like Zone or Atkins) is generally not a good idea as they don't provide the energy athletes need to support training;
• Small fluctuations in body weight, seen from day to day or from week to week, are most likely to be the result of either fluid retention/loss or changes in the body's carbohydrate stores and not of any changes in the body's fat stores;
• Always remember that sound nutrition is fundamental to optimum performance.

As someone who has experienced the problems associated with disordered eating at first hand, I think that we need two things to happen to improve the current situation:

1. A significant increase in the level of nutritional understanding of all those involved in sport and exercsie;
2. A shift in perception of ideal body shapes and weights, particularly in aesthetic sports like diving, figure skating, dance and gymnastics. Again, a slow change is taking place in some, if not all, of these sports. As a keen spectator of gymnastics I have noticed a slow but significant change in the degree of maturation of high-level competitors, particularly females.