Anorexia and Female Athletes

Most sports are great for kids. There’s camaraderie, discipline, and commitment to physical conditioning that can last a lifetime. But sometimes they can become an obsession leading to anorexia nervosa.

According to ANRED , “eating disorders are significant problems in the worlds of ballet and other dance, figure skating, gymnastics, running, swimming, rowing, horse racing, and riding.”ANRED cited an NCAA study indicating that 93 percent of sports-related eating disorders afflict women. According to the study, the sports with the highest proportion of victims, in descending order, are: women’s cross country, women’s gymnastics, women’s swimming, and women’s track and field. News Channel 9, WTVC in Chattanooga, Tennessee, reported that eating disorders affect an estimated 15 to 62 percent of all female athletes.

According to ANRED, female competitors are at heightened risk to develop eating disorders. Not only are they subject to cultural pressures to lose weight, the sports that they engage in often convey the message that you must be thin to win.

By contrast, ANRED noted that men are usually encouraged to be large and powerful. In addition, there are important biological differences between the sexes. According to ANRED, women tend to put on weight more easily than men and have a harder time losing it.

ANRED noted that it is very easy for an anorexic athlete to hide her disorder. The organization’s website stated that “she may even receive praise and admiration for her self-control and denial of appetite.” According to ANRED, some coaches and others foster the notion that thinness improves performance, but research indicates that excessive dieting makes the athlete “weak and slow”.

As in all cases of anorexia nervosa, said ANRED, control is a paramount issue. The anorexic feels out of control. Weight is one thing she can control, and in the case of the athlete, she can control her performance. Thus the drive to excel and win praise.

ANRED emphasized the need for coaches to be actively involved in the treatment of eating disordered athletes. The coach should be informed of food, weight requirements, and restrictions on physical activity while the athlete is in treatment. Otherwise, he or she may sabotage progress.

In high school and college competitive sports, goals create many pressures: scholarships, championships, and, at the more advanced levels, a chance of making it to the “pros”. In extreme cases, medical treatment can require the athlete to stop training for an extended period. In this regard, it is crucial, ANRED observed, that the coach and medical providers work as a team.

A key danger, according to ANRED, is that many athletes who have trained since early childhood have so equated participation in their sport with self-identity that they are devastated when they are told they have to stop, even if temporarily. Such a situation can lead to extreme emotional distress.

There is much controversy over whether a person can become physically addicted to exercise. Vigorous workouts produce endorphins, opiate-like substances which produce a natural “high”.

Psychological addiction is another matter. ANRED noted that it is simple to tell if someone is emotionally addicted to exercise: she doesn’t enjoy it; that’s all she talks about; and she refuses to rest when injured. According to ANRED, despite their athletic achievements, these folks suffer from low self- esteem, repressed anger, and depression.

In order to maintain cardiovascular health, ANRED recommended aerobic exercise (e.g., brisk walking, dancing, jogging) for 30 minutes a day, six days a week, or milder activity (e.g., gardening) for an hour a day, five days per week. Beyond that, according to ANRED, health benefits decrease and the chance of injury increases.

ANRED cited U.S. Olympic Committee data indicating the healthy range of body fat for young women is 20-22 percent. ANRED observed that while most women need at least 17 percent to menstruate, many female athletes and their coaches push for 10-14 percent— or less.

Gymnastics

According to the Vanderbilt University Psychology Department, female gymnasts are under extraordinary pressures to maintain small, girlish figures. Growing hips and breasts may inhibit performance.

Moreover, Vanderbilt noted the subjectivity of the judging system. In contrast to sports like running or swimming, where a time is an objective measure of performance, gymnasts’ scores can be influenced by an athlete’s appearance. The Vanderbilt site recounted the tragic story of Olympic hopeful Christy Henrich. At a meet in Budapest, an American judge told her that she’d have to lose weight to make the U.S. Olympic team. She later died of multiple organ failure brought about by anorexia and bulimia.

Vanderbilt recounted important information from “Dying to Win,” a 1994 Sports Illustrated article. According to the article, in addition to instructing them on vaults and dismounts, a large proportion of coaches direct their impressionable, young female athletes on “how to count calories, how to act, what to wear [and] what to say in public.”

Vanderbilt noted a 1992 NCAA survey which found that 51 percent of responding gymnastics programs reported eating disorders.

In an interview with InteliHealth, Angela Guarda, M.D., assistant professor of psychiatry and director of the Eating Disorders Program at Johns Hopkins Medical Institutions, noted the practice of some coaches to “measure body fat as a team activity and publicly announce what each person’s measurement is.” This, according to Guarda, pressures athletes to lose weight and increases their risk of developing anorexia.

A disturbing trend noted by Vanderbilt is that svelte, female Olympic gymnasts are getting thinner. According to the site, the average size of the American team declined from 5′ 3″, 105 pounds in 1976 to 4′ 9″, 88 pounds in 1992. When 16 year-old Shannon Miller won the 1996 world championships, observed Vanderbilt, she was only 4’10” tall and weighed 79 pounds.

Dr. Guarda said that even Mary Lou Retton, who was husky compared to her teammates, “was still a low weight for her height.” The doctor characterized most gymnasts as “markedly underweight.”

In addition, Guarda noted that top athletes often have personality traits that predispose them to anorexia. “Typically, they are perfectionist over-achievers who like to please others.”

The Female Athlete Triad

Another topic Dr. Guarda discussed was the prevalence of the “Female Athlete Triad.” This syndrome consists of disordered eating, amenorrhea, and osteoporosis.

Verle Valentine, M.D., in a January 6, 1998 article for the Warthog Society, a worldwide association of sportsmedicine doctors, explained that the term “Female Athlete Triad” was coined by the American College of Sports Medicine (ACSM) in 1992. Dr. Valentine added that in 1997 ACSM published a position paper saying that the Triad is not only found in elite athletes but “also in physically active girls and women participating in a wide range of activities.” She added that “the Triad is often denied, not recognized, and under reported.”

Dr. Guarda observed that “when an individual falls enough underweight to lose her period, she becomes at risk for osteoporosis, even if she is an athlete. Bone loss starts within six months to two years of the loss of menses and it’s irreversible. The only way to truly stop it that we know of is to gain weight, return to at least low normal, and start menstruating again.”

According to Guarda, anorexics have seven times more risk of fractures than non-anorexics, and underweight athletes frequently get stress fractures.

Pregnancy

As a former competitive swimmer, I feel compelled to repeat that, if not overdone, there are many lifelong benefits to participating in sports, among them: better health, social interaction, and enjoyment. For teenage girls, there may be an extra bonus: fewer unwanted pregnancies. The Milwaukee Journal Sentinel cited a Women’s Sports Foundation study of girls in grades nine through twelve which found that female athletes were less than half as likely to get pregnant than non-athletes, and that more athletes than non-athletes were virgins (54 percent versus 41 percent).

While teenage pregnancy is usually something to be strenuously avoided, most older women want to have children. Lehigh University sports medicine and nutrition consultant Jennifer Becker noted that in order to bear children, women need approximately 7 percent more body fat than men. According to Becker, amenorrhea in pre-menopausal females leads to osteoporosis and barrenness. She noted that while amenorrhea affects two percent of the female population, it affects 40 percent of women athletes.

“Fewer periods mean bone weakening is worse,” Becker said. She recommended that athletes monitor their nutrition and menstrual cycles, and report changes to their physicians. To help reverse the Triad, Becker suggested decreasing physical activity by 10 to 20 percent and increasing daily calcium intake to 1,500 milligrams.

For an extensive selection of links to articles on anorexia and athletics, visit Caringonline.