Starve Wars - eating disorders

Athletes need to be aware of the dark side of disordered eating.

"My girlfriend drives me crazy. I made her a birthday cake, and she didn't eat a bite."

"I'm worried about my son. He's refusing to eat any foods that have fat.

A few years ago, he'd devour chips and ice cream, but now he insists I buy only baked chips and fat-free frozen yogurt."

"I spend way too much time thinking about food. That's all I do ... and it's interfering with my life."

Eating disorders plague all types of casual exercisers and competitive athletes--male and female alike. Perhaps even you or one of your friends is currently experiencing this phenomenon. About 4 percent of female athletes struggle with anorexia, 39 percent with bulimia. Among male athletes, 1.5 percent struggle with anorexia, 14 percent with bulimia. These numbers, if anything, are underreported. That's because people who feel ashamed about their eating habits commonly give inaccurate self-reports. These numbers also exclude the large group of athletes with subclinical eating disorders who do not fit the diagnosis of anorexia (because they have a seemingly normal weight) but have an abnormal relationship with (and spend too much time thinking about) food and weight. They fritter away each day, trying to get thinner.

In-depth interviews of women with subclinical eating disorders delineate these characteristic behaviors:

* They restrict caloric intake in order to lose weight and follow a very repetitive diet, with little or no variety in the types and amounts of foods consumed.

* They follow strict dietary rules and experience guilt and anger if they break one of them.

* They limit their intake of "bad foods," and almost always choose low- or non-fat foods. (Manore, Int'l J Sports Nutr. 6-00.) Almost all of these women perceive themselves as being slightly to very overweight and are preoccupied with body image.

If any of this sounds familiar, keep reading!

A survey of 24 women (ages 18 to 36) who exercised about 10 hours per week and had subclinical eating disorders report they had 2.5 percent higher body fat than normal eaters who exercised only 6 hours per week. They also reported consuming less dietary fat than the normal eaters. These findings challenge two common beliefs:

1. the more you exercise, the thinner you'll be; and

2. avoiding dietary fat helps you lose body fat.

The women with eating disorders reported underconsuming calories to lose weight, but to no avail. The deficit did not contribute to weight loss. That is, the women theoretically deserved to eat 2,500 calories and reported eating only 2,000 calories. They seemingly adapted to the combination of high-calorie expenditure via exercise + restricted calorie intake. The big deficit caused the body to shut down and conserve energy (similar to hibernation). This is nature's survival technique to save women from getting too thin to reproduce.

This struggle to be "perfectly" thin creates health problems for casual exercisers and competitors alike. The restrictive consumption of food can greatly reduce the intake of vitamins, minerals and protein, placing athletes at risk for poor nutritional status. This restrictiveness can also lead to health problems such as chronic fatigue, compromised immune function, poor or delayed healing, anemia, electrolyte imbalance, menstrual dysfunction, reduced bone density and 300 percent higher risk of stress fractures.

At SportsMedicine Brookline, I counsel too many people with eating disorders. In fact, they fill the majority of my counseling hours. They come in believing, "If only I were thinner, I'd be a better athlete." I disagree. Their efforts to achieve their desired thinness reduces their energy and performance. These patients would be better athletes if they were better fueled.

Why Do Eating Disorders Happen?

Eating disorders commonly occur in athletes with low self-esteem. They believe thinness will make them a more perfect person. The truth is, by severely restricting food, they are losing muscle, strength and stamina. Smaller bodies does not make them better. There is simply less of them to love. They are the same person, just obsessed, withdrawn and tired.

The risk for developing an eating disorder increases dramatically when an athlete with low self-esteem is physically beautiful plus has traits of perfectionism and an underlying tendency to be hypercritical and anxious. Add to the scenario a mother who may have had (or still has) food and weight issues, and the daughter becomes a prime target for developing a full-blown eating disorder.

Athletes with eating disorders are less available to their friends. When a person is constantly counting calories (eaten at meals, burned during exercise, saved by skipping lunch, about to be eaten at dinner, etc.), grams of fat or dozens of sit-ups, his or her brain has little energy left to manage bigger issues like problems and relationships. The eating disorder creates a smoke screen that masks the underlying issues.