Home Eating Disorders in Sports: Anorexia Athletica

Eating Disorders in Sports: Anorexia Athletica

#Eating tendencies
Athletic Anorexia

Wednesday 7/08/2024

PHOTO: Leah Hetteberg.

TEXT: María Sabaté and Lina Camacho

 

In light of the 2024 Olympic Games currently taking place in Paris, we found it pertinent to dedicate the following blog entry to raising awareness about the high prevalence of Eating Disorders (EDs) in high-performance athletes. According to research, elite athletes are particularly at risk of developing an ED due to the physical and aesthetic demands of their discipline.

We are likely already socially familiar with the fact that there are higher rates of eating disorders in sports such as ballet, figure skating, and athletics. However, recent studies show that athletes participating in all types of sports are at a greater risk of developing an eating disorder than non-athletes.

Despite being a more vulnerable population, high-performance athletes are less likely to be diagnosed than their non-athlete counterparts. This is because the harmful behaviors of the disorder (such as excessive exercise, restrictive diets, or obsession with weight) are often normalized and celebrated in sports circles. In some cases, harmful eating or exercise behaviors may even be prescribed as part of a training program.

How to Identify an ED in the Athletes?

One common but little-known disorder in this population is Anorexia Athletica (AA), characterized by an obsessive pursuit of thinness accompanied by severe calorie restriction to improve athletic performance.

The diagnosis of AA is not formally recognized in current classification systems, such as the DSM-5 or ICD-11, partly because there is no general agreement that the diagnosis is sufficiently different from other restrictive eating disorders to justify a separate diagnosis. The syndrome was coined by the American College of Sports Medicine, considering the characteristics unique to this population compared to others.

How is Anorexia Athletica Different from Anorexia Nervosa?

  • A person with anorexia may eat a very small amount of food, and while those with Anorexia Athletica may do the same, for athletes this means eating less food than their body needs to maintain their level of physical activity. In other words, someone with Anorexia Athletica may eat what appears to be a normal amount but still fall far short of meeting their energy needs given the intensity of their training or exercise.
  • Another key difference between anorexia nervosa and AA is that AA occurs exclusively in the context of sports, and eating behaviors are often driven by a desire to improve performance or maintain optimal physical condition, as opposed to a fear of gaining weight or distress over body image.

ED in sports: How to Identify Anorexia Athletica?

  • Exercising more than necessary or healthy (more than peers in the same sport, using sports as an excuse to overexercise).
  • Training constantly beyond what a coach prescribes.
  • Exercising despite injury, illness, or bad weather.
  • Prioritizing exercise over other aspects of life, including work, school, relationships, and daily responsibilities.
  • Hiding exercise.
  • Restricting food intake.
  • Using exercise to compensate for food.

These criteria, along with structured clinical instruments, can be useful in identifying athletes at risk and monitoring the effectiveness of therapeutic interventions.

Risk factors for eating disorders in sport

Risk factors for developing AA can be divided into psychosocial and physiological factors.

Psychosocial risk factors for anorexia in sport

When discussing psychosocial factors, it is important to consider that low body weight is often seen as an important quality in many sports disciplines, providing advantages in direct competition with other athletes. Specifically, research shows that female athletes face greater demands on their weight than men due to two types of pressure:

  • The general sociocultural demand for women to maintain a slim body.
  • The specific pressure of certain sports where thinness is a prerequisite for better professional performance.

In sports such as long-distance running, sprinting, and swimming, low body weight is perceived as a competitive advantage, while for gymnasts, figure skaters, and dancers, a low BMI is not only a performance enhancer but also a factor evaluated by judges. These pressures can come from coaches, teammates, and society at large. Thus, given this combination of factors, it is common for female athletes to be especially exposed to negative emotional experiences such as anxiety and stress about winning, along with high external pressure, which can easily trigger an ED.

Additionally, on an individual level, a perfectionist personality and excessive concern about sports performance can increase vulnerability to these disorders. Frequently, athletes may also silently struggle with low self-esteem, trying to hide it behind their athletic achievements.

Risk factors and physiological symptoms

It is important to note that AA can persist and even worsen due to the physical symptoms it involves.  Anorexia Athletica (AA) is a multifactorial disorder where physical symptoms play a crucial role, especially the effects of calorie restriction and excessive exercise, significantly impacting the athlete’s health with alterations such as:

  • Hormonal imbalances: low levels of leptin and altered responses to ghrelin, affecting hunger regulation.
  • In women, low calorie intake reduces estrogen levels, causing amenorrhea and decreasing bone density, while in men, it can reduce testosterone levels.
  • The altered hormonal system and low bone density increase the risk of early osteoporosis and injuries.
  • Dysfunction of the HPA axis and chronic stress raise cortisol levels, contributing to muscle loss and immune problems. Malnutrition negatively impacts metabolism, cardiovascular function, and mental health (high anxiety, mood swings, irritability).
  • Excessive physical activity and severe calorie restriction also significantly decrease BMI, aggravating menstrual disturbances and delaying bone maturation.

Therapeutic approaches in athletes with eating disorders

The treatment of AA should be comprehensive and multidisciplinary, involving doctors, nutritionists, psychologists, and coaches. Interventions should focus on restoring weight and physical health, improving the athlete’s relationship with food and exercise, and addressing underlying psychological factors such as low self-esteem and perfectionism. It is crucial that the treatment is personalized, taking into account the specific needs of each athlete and the type of sport they practice.

ED and sport: prevention strategies

Prevention is essential to reduce the incidence of EDs in sports. Prevention programs should focus on educating about the risks associated with EDs, promoting a healthy body image, and encouraging balanced eating habits. Additionally, it is important to create a sports environment that values the overall well-being of the athlete over performance and for coaches and support staff to be trained to recognize and address early signs of EDs.

AA is a serious problem that affects many athletes, putting their health and sports careers at risk. However, with adequate support and a comprehensive therapeutic and preventive approach, it is possible to overcome this disorder and improve the quality of life for athletes. It is crucial that health professionals, coaches, and the general public are informed and sensitized about this issue to provide the necessary support and foster a healthier and more balanced sports environment.

 

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