The Silent Enemy, Eating Disorders in Sport: Part 2

Nutrition expert Joel Enoch offers answers to the question ‘what to do next?’ posed by the ‘The Silent Enemy’ feature, about eating disorders in sport, from issue 282

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‘From a coaching point of view, that’s our biggest challenge.’ explains our anonymous coach. ‘If you suspect one of your athletes has an eating problem, how do you tackle it without either offending them, scaring them off or causing them upset?’” Quoted from 'The Silent Enemy', issue 282. 

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In this short article we will look to answer this question with some simple, research-led advice for both coaches, families and friends of athletes struggling with eating-related issues and for the athletes themselves.

For coaches, families and friends

Know the signs Learn to recognise the signs and symptoms of EDs, which, as of May 2013, also include binge eating disorder. The following is a guide (for more information: b-eat):

ED definitions

• Anorexia: Low body weight, altered body image, inability to consume the energy needed for normal physical function over a period of several months and a halted or irregular menstrual cycle.

Bulimia: regular feelings of a loss of control, coupled to recurring episodes of binge eating and compensatory behaviour of some kind (including – but not limited to, vomiting, the use of laxatives or intense exercise).

• EDNOS: Some, but not all of the criteria for AN or BN, or meet all the criteria but not over a long enough period.

• Binge eating: Characterised by recurring episodes of binge eating accompanied by a lack of control. 

The definitions above are to be used only as a guide. They are however based on guidelines from academic research and credible ED support groups.

Avoid criticism EDs sufferers may need your help to ‘outshout’ the voice in their head with positive food, health and body image messages.

De-emphasise weight focus instead on other variables of performance such as S&C, type/frequency/volume (etc) of training, as well as the mental and emotional components of performance.

Think about what you say Weight loss is a sensitive issue for many and ANY comments – no matter how slight – about reductions in weight need to be delivered very sensitively. Talk about ‘conditioning’ rather than weight.

Know the basics Bulimia sufferers often know they are ill, and so may be ready to seek treatment. Anorexia suffers often do not realise or acknowledge the severity of their condition and so might need help to recognise unhealthy eating patterns. Coaches can utilise objective measures of performance, or squad-wide dietary analysis and advice.    

Seek help Expert support is key, help the sufferer to find this.

Observe training patterns Exercise addiction may be an issue too so if you're a coach, plan carefully and make sure your athlete sticks to the programme. If the athlete has no coach, and/or you have experience of planning training, offer to lend a hand in planning appropriate sessions.

Reflect Think about your own perceptions and opinions regarding weight, dieting, and body image, and how these attitudes may inadvertently affect others.

Take warning signs seriously Anorexia has the highest mortality rate of any psychiatric disorder and bulimia can be associated with severe medical complications.

Remember that men are at risk too Unpublished data observing the prevalence of EDs in UK triathletes showed 20% of men suffer from EDs, only 2.2% lower than women and that this was more likely to be linked to exercise dependence.

For sufferers

Rely on and trust the people around you who best seem to understand you and you situation. Although your experience is deeply personal, it is possible for others to appreciate some of what you feel so share your feelings and even trust them to make decisions regarding food when you feel that you cannot.

Feelings are real, but they don’t always reflect the truth They are subjective, chop and change and sometimes a situation looks very different when we step back from it, or take time for our feelings to change. Do this, make decisions objective. Is food bad? You might feel it is, but know that if it’s balanced and healthy, then it isn’t. Act on the truth, not the feeling. 

Take time to consider when and why you started to have issues with eating, maybe write it down for you and others to read. Can you do anything to address these issues specifically? 

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Continue to play a part of your club If participating in training and competition, make sure this is appropriate and doesn’t fuel an unhelpful mindset. If experts advise a brief period off training, then this could be the time to do some volunteering or coaching. Volunteering is known to increase feelings of self-worth so it could well help you and your club and you to move forward.