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Eating Disorders in Athletes


Unknown but the reported range is 1%-64% Elite female gymnasts may be as high as 80 ... Cross-country skiing. Eating Disorders in Athletes ... – PowerPoint PPT presentation

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Title: Eating Disorders in Athletes

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

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

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

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 Disorders in Athletes
  • 1. Sports with subjective scoring
  • Dance
  • Figure skating
  • Gymnastics

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

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

Eating Disorders in Athletes
  • Sports using weight catagories for participation
  • Wrestling
  • Martial arts
  • Horse racing
  • Rowing sports

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

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

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
  • May consume 5-10,000 calories at a time
  • Must occur at least two times per week for three

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

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
  • They have normal menses
  • Binge eating was reported in more than 25 of
    male and female athletes in the NCAA eating
    disorder project!

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

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

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

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

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

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)

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
  • Create an environment of open feedback for team
    and teammates

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

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

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

Eating Disorders in Athletes
  • Goals of Therapy
  • Educate coaches who use body fat composition
  • 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

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

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

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