Eating Disorders in Athletes

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Eating Disorders in Athletes

• Dave Sealy, MD, CAQSM
• Director, Sports Medicine, Residency Education
• Self Regional Hospital
• Family Medicine Residency Program
• Clinical Professor, MUSC
• Head Team Physician, Lander University (Div II)
• Greenwood, SC

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Eating Disorders in Athletes

• Goals
• Case finding, diagnosis and treatment review
• Application to the athletic arena
• How to assist and follow these athletes
• Special considerations

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Eating Disorders in Athletes

• How common is disordered eating?
• Unknown but the reported range is 1-64
• Elite female gymnasts may be as high as 80
• 4-20 of all collegiate women
• Prevalence among athletes estimated to be about
  twice the normal population
• Male/female ratio 5-201

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Eating Disorders in Athletes

• Which sports are the culprits?
• According to the ACSM there are five groups that
  place the athlete at highest risk for disordered
  eating

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Eating Disorders in Athletes

• 1. Sports with subjective scoring
• Dance
• Figure skating
• Gymnastics

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Eating Disorders in Athletes

• 2. Endurance sports favoring participants with
  low body weight
• Distance running
• Cycling
• Cross-country skiing

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Eating Disorders in Athletes

• 3. Sports in which contour revealing clothing is
  worn for competition
• Swimming
• Volleyball
• Diving
• Sprinting
• Luge?

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Eating Disorders in Athletes

• Sports using weight catagories for participation
• Wrestling
• Martial arts
• Horse racing
• Rowing sports

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Eating Disorders in Athletes

• 5. Sports in which prepubertal body habitus
  favors success (women)
• Gymnastics
• Figure Skating
• Diving

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Eating Disorders in Athletes

• Three Clinical Catagories
• 1. Anorexia Nervosa
• Less than 85 IBW
• Intense fear of gaining weight or becoming fat
  when already underweight
• Disordered body image
• Amenorrhea
• Denial of current low body weight

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Eating Disorders in Athletes

• 2. Bulemia Nervosa
• Recurrent episodes of binge eating
• Much larger amounts of food than normal
• Sense of lack of control over eating during the
  episode
• May consume 5-10,000 calories at a time
• Must occur at least two times per week for three
  months

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Eating Disorders in Athletes

• 2. Bulimia Nervosa
• Recurrent and inappropriate behavior to prevent
  weight gain-laxatives, diuretics, enemas,
  fasting, excessive exercise, vomiting,
  medications
• Self-evaluation is unduly influenced by body
  shape and weight

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Eating Disorders in Athletes

• EDNOS Eating Disorders Not Otherwise Specified
• Most athletes fall into this category
• Sometimes called anorexia athletica
• Often have normal weight
• Frequency of pathologic behavior less than
  2x/week
• They have normal menses
• Binge eating was reported in more than 25 of
  male and female athletes in the NCAA eating
  disorder project!

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Eating Disorders in Athletes

• Dont forget male dysmorphia reverse anorexia in
  males
• Sense of being small and weak
• 8.3 Male bodybuilders
• Negative impact on daily activities
• Highly associated with anabolic steroid abuse

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Eating Disorders in Athletes

• How can we identify these athletes?
• Clinical correlates
• Lanugo hair especially on the face
• Russells sign-abrasions or small lacerations and
  calluses on the dorsum of the hand
• Salivary gland hypertrophy
• Dental disease-caries and periodontal disease
• Menstrual history
• Exercise history
• Stress fractures-especially recurrent

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Eating Disorders in Athletes

• How can we identify these athletes?
• Clinical correlates (cont.)
• body fat (lt16 for women, lt7 men)
• Hypotension
• Bradycardia
• Anemia
• Acrocyanosis
• Waisthip ratio
• Older patient (gt16 yo female) with minimal
  secondary sexual changes

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Eating Disorders in Athletes

• Questions on the Preparticipation Physical
  assessing
• Satisfaction with current weight
• Menstrual history
• Dietary history
• Remember most of these athletes are very savvy
  and will answer the questions falsely

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Eating Disorders in Athletes

• HEADS assessment
• Home environment
• Education
• Activities
• Drugs and Depression Sx
• Sexual Activity, Suicidal ideation

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Eating Disorders in Athletes

• Eating disorder survey sensitively administered
  available through many web sites
• Eating Disorder Inventory (EDI)
• Eating Attitudes Test (EAT)
• Eating Disorder Examination (EDE)

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Eating Disorders in Athletes

• Management
• Identify and have a high index of suspicion
• Look for the Female Athlete Triad an eating
  disorder with (now osteopenia) osteoporosis and
  amenorrhea
• Create an environment of open feedback for team
  and teammates

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Eating Disorders in Athletes

• Management (cont.)
• Prevention, prevention, prevention
• Once identified, a team of therapist, coach,
  trainer, team physician, nutritionist needs to be
  assembled due to the complexity of the problem

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Eating Disorders in Athletes

• Management (cont)
• If suspected, the most sensitive diagnostic tool
  is a therapist skilled with eating disorders
• Every team physician and trainer should have such
  a person identified and available

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Eating Disorders in Athletes

• Management (cont)
• Be ready to manage, evaluate and identify the
  clinical complications
• Stress fractures
• Amenorrhea and its evaluation
• Electrolyte abnormalities
• Cardiovascular abnormalities
• Karen Carpenter and Christy Henrich died of
  multi-organ failure at 32 and 22 years old, this
  can be lethal

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Eating Disorders in Athletes

• Goals of Therapy
• Educate coaches who use body fat composition
  punitively
• Assess and restore bone density
• DEXA scanning
• 1-2.5 SD below is osteopenia
• gt2.5 SD below is osteoporosis
• May need to rescan if amenorrheic greater than
  six months after identification

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Eating Disorders in Athletes

• Goals of therapy
• Restore normal menses-consider workup to include
  TSH, preg test, PCOS evaluation
• Increase body weight to above 90 of IBW
• Continue sports activity and resistance training
  to increase bone density
• Provide psychosocial support for the athlete
  during treatment

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Eating Disorders in Athletes

• Athlete must be agree there is a problem and be
  willing to change
• Female nurse practitioner or therapist-cognitive
  therapy to change thinking
• Consideration of OCPs to restore menstrual
  function and bone density
• SSRIs to be considered if depressive sx are
  present or OCD
• AAP recommends 1500 mg Calcium Carbonate and
  400-800 IU Vit D per day

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Eating Disorders in Athletes

• How do you make the initial intervention?
• Springs from an environment of caring for the
  individual needs of the athletes
• Frequent education of all athletes done non
  judgmentally and with mutual accountability
• Suspected athletes should be approached gently
  and repeatedly

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Montana is nice but it may have some inherent
problems with sports