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Athletes Are More Vulnerable to Anorexia than Non- Athletes

Liz Applegate

Liz Applegate is a contributor to Runner's World magazine.

Source Database: At Issue: Anorexia Table of Contents: Further Readings | Source Citation

Athletes are believed to be more vulnerable to anorexia and other eating disorders than nonathletes. In particular, anorexia tends to strike most often among athletes competing in sports, such as gymnastics, running, and wrestling, that require lean body types. Researchers believe that because of the highly competitive nature of sports, equally competitive participants become obsessed with maximizing their performance. The character traits found in many anorexics, such as perfectionism and obsessive behavior, are usually traits that can be observed in highly competitive athletes. Experts think that competitive sports can trigger an eating disorder in an athlete with an obsessive and competitive personality. Three female college students entered my office one afternoon desperate for advice that might help their roommate. "All Elise does is run," one of them told me. "She hardly eats anything, and she still thinks she needs to lose weight!" "We're just so worried about her," another said. "Elise is so skinny, but she denies anything is wrong. We want to confront her about it, but we don't know how." The third asked, "Do you think running started this whole thing?"

As you might guess, their description of Elise fit the classic profile of a person with the eating disorder anorexia nervosa. If left untreated, Elise's drive for thinness could land her in serious trouble, such as irreversible bone disease or even death. And these young women were right to be concerned that Elise's excessive running might be at the root of her eating and weight troubles. In fact, several studies have shown that compared with nonathletes, athletic men and women--especially those in sports in which body weight and shape are an issue, such as running, wrestling and gymnastics--have a greater

incidence of abnormal eating behaviors and the full-blown clinical eating disorders anorexia and bulimia.

So, for good reason, many runners question their own eating and exercise patterns. Many of us use running as a weight-control tool. And why not? Running burns calories, and it's good for you to boot. But sometimes we may find ourselves "running off" occasional indulgences--that is, using exercise to "make up" for our not-so-healthy eating habits. When this "eat-and-run" behavior becomes a compulsion, it may signal the onset of an eating disorder.

The quest for thinness Though they occur mostly in young women, anorexia and bulimia can strike anyone. Anorexia consists of a cluster of behaviors and symptoms, including self-induced starvation, an intense fear of becoming fat, body weight that's 15 percent or more below the normal range for one's height, and, in women, amenorrhea (the loss of a regular menstrual cycle).

Despite their frail appearance, anorexics view themselves as fat. Their distorted body image drives them to lose more and more weight, primarily through severe calorie- cutting and excessive exercise, which gives them a feeling of control. Usually perfectionists and highly motivated people, anorexics are typically college educated, single and from middle-to upper-class families. But they have low self-esteem, believed to stem from an upbringing by overly protective or controlling parents.

Bulimia affects many more individuals than anorexia. By some reports, anywhere from 15 to 62 percent of all female college athletes suffer from this eating disorder. And, like anorexia, bulimia strikes most often among athletes in sports in which a lean physique is crucial to performance.

Bulimics indulge in frequent episodes of binge eating, during which they often feel a sense of helplessness and a lack of self-control. Afterward, their feelings of extreme guilt and self-disgust prompt purging of the unwanted calories (usually by vomiting or the use of laxatives and diuretics) to prevent weight gain. Some may use excessive exercise such as running or stair-climbing for hours as a means of purging. But because bulimics are usually normal in body weight and appearance, family and friends may be unaware of their battle with food.

Anorexia and bulimia don't develop overnight; many athletes may be suffering from what's called a subclinical eating disorder, a possible precursor to a clinical problem. According to leading researchers, athletes may take up abnormal eating behaviors such as skipping meals, 24-hour fasts, calorie restriction and occasional purging (maybe once a week instead of the two or more times per week seen in bulimia) as a means to lose weight. They may also be obsessed with their weight and very fearful of becoming fat. The number of athletes with a subclinical eating disorder is unknown, but the problem is

believed to be rampant in such sports as gymnastics, crew, wrestling, volleyball and running.

Runners at risk? With all this glum news about exercise and eating disorders, it's only fair to ask if running--or any exercise, for that matter--may trigger these abnormal habits. Some researchers theorize that commitment to an exercise program such as training for a marathon could lead to eating disorders for some personality types or may aggravate an existing problem. For example, psychological traits such as high achievement orientation and perfectionism are common both in people with eating disorders and in athletes. Such traits are usually essential for successful competition.

What this may mean is that, given the right conditions, some people with certain personality types may be predisposed to develop eating disorders. Dr. Jorunn Sundgot- Borgen of the Norwegian University of Sport and Physical Education in Oslo studies the factors that may trigger or exacerbate eating disorders in female athletes. In one study, she evaluated middle- and long-distance runners who were identified as "at risk" for eating disorders based on their scores on a specially designed questionnaire.

Dr. Sundgot-Borgen found that anorexia, bulimia and a subclinical eating disorder called anorexia athletica were likely to take hold when an athlete began dieting or experienced frequent weight fluctuations. Also, those athletes who started dieting at a younger age were more likely to develop a serious eating problem. A traumatic event such as an injury also appeared to set off eating disorders, perhaps because of forced inactivity, which in turn may have led to unwanted weight gain.

Another potential trigger noted by Dr. Sundgot-Borgen was an abrupt increase in training volume that coincided with a sudden loss of weight, most likely due to the extra exertion. In any case, athletes weren't eating enough, and this lack of calories may have created a psychological and biological "climate" that prompted an eating disorder to develop.

Other researchers have noted that eating disorders in athletes may be connected to our genetic makeup. In fact, substance-abuse problems and clinical depression, both inheritable conditions, are common in bulimics and anorexics.

Triple trouble Eating disorders bring with them a myriad of health problems. Low calorie intake or sporadic eating, for example, results in poor performance and endurance. When we cheat the body of food, our low intake of protein and key vitamins and minerals can weaken the immune system and lead to chronic illnesses and fatigue. Also, skimpy nutrition makes injuries more likely and slows recovery.

But more threatening to an athlete's long-term health is a condition known as the female athlete triad: an eating disorder in combination with amenorrhea and osteoporosis (the debilitating bone disease seen most often in elderly women). Researchers and health professionals have identified this serious complex of problems in many female athletes of all ability levels and ages.

While it's not clear which comes first, eating disorders and menstrual irregularities are connected. Many women athletes--including an estimated 25 to 40 percent of female endurance athletes--experience amenorrhea or missed periods. But among women with diagnosed eating disorders and even those with subclinical problems, amenorrhea is much more common. Though some women athletes may welcome this condition as "less hassle," the consequences are severe.

Depressed levels of the female hormone estrogen accompany amenorrhea, and with this deficiency comes bone-mineral loss, or premature osteoporosis. In fact, even in young women, calcium loss from the bones can cause stress fractures and even fractures of the vertebrae similar to those seen in 80-year-olds.

Treatment of the female athlete triad requires the help of physicians, dietitians and mental-health professionals. In extreme situations, especially in women with prolonged cases, hospitalization may be needed. And, as with other serious diseases, prevention is key. This requires vigilance on the part of parents, coaches and friends watching for signs of abnormal eating and exercise behaviors.

Like Elise's roommates, if you see a friend or loved one seemingly wasting away before your eyes, don't be afraid to get involved. Ask him or her to seek professional guidance and treatment and offer your help in finding that guidance. And if your friends and family are sounding the alarm by constantly saying you look gaunt and unhealthy, consider the possibility that they may be right. Talk to a counselor. Eating disorders are no trivial matter; they can be deadly.