Researchers have noticed more Disordered Eating Behaviors (DEBs) and Feeding and Eating Disorders (FEDs) among younger athletes, males, minority populations, and marginalized people (Miller & Bravender, 2018). This trend continues to pose a risk to both sport performance and health, especially given escalating rates of co-occurring psychiatric disorders, substance use disorders and serious chronic somatic conditions (Udo & Grilo, 2018). Furthermore, individuals who have been diagnosed with an FED in their lifetime have a significantly increased risk of suicide attempt (Smith et.al., 2018). This is particularly concerning given a 30% increase in rates of suicide overall in the United States from 1999 to 2016 (Udo, Bitley & Grilo, 2019).
Members of the Association for Applied Sport Psychology’s Eating Disorders Special Interest Group (SIG) spoke at the recent 2019 conference on a panel called Making Weight: Risks and Rewards, chaired by Jenny H. Conviser, the SIG coordinator. Fellow AASP members joined the discussion to highlight communication strategies professionals can use when working with athletes, coaches, and parents involved in sports that have aesthetic and weight requirements. Awareness of related DEB and FED risks and the importance of seeking opportunities to reduce harmful physical and psychological risks associated with these sports were encouraged.
Rates of FEDs are higher among adolescent elite athletes than non-athletes (7% and 2.3%) and are higher among female than male athletes (14% and 3.2%; Martinsen & Sundgot-Borgen, 2013). According to Chatterton and Petrie (2013), the highest FED rates are also found in sports with weight classes such as wrestling, rowing, and boxing compared with athletes participating in sports without weight classes such as endurance or ball sports. Athletes in sports with weight classes were found to be highly FED symptomatic and frequently engaged in pathogenic eating and weight control behaviors (Sungot-Borgen & Garthe, 2011).
Similarly, FEDs were identified among athletes who participate in sports requiring body-related aesthetic such as diving, gymnastics, and skating (42% females); among athletes who participate in sports where body weight may impact anti-gravity forces (22% males); and in endurance sports (9% males and 24% females; Sundgot-Borgen & Torstveit, 2004). A lower but substantial risk (5% males and 16% females) appears among those participating in ball sports (Sundgot-Borgen & Torstveit, 2004).
Another risk involves injury and premature death. Females who have DEBs (41.5 %) and participate in aesthetic sports are eight times more likely to suffer one or more injuries (Jankowski, 2012). Mortality rates for males with FEDs are higher than mortality rates for females (Raevuoni, 2014).
Some people encourage athletes to “get over it” and retire from the sports associated with the risk of DEBs and FEDs. However, evidence indicates that DEBs and FEDs do not remit after retirement from sport and can continue into later adolescence and adulthood (Neumark-Sztainer, 2011), posing ongoing health risks and a decreased health-related quality of life (Styer & Conviser, 2014).
Our expert panel provided information to better understand DEB and FED risk and proposed strategies for combating these growing trends.
Jenny H. Conviser, PsyD, CEDS, CMPC,Northwestern University & Ascend Consultation in Health Care, Chicago
I was impressed with the many in attendance at this panel presentation and to witness such enthusiasm for the topic. Discussion covered a wide variety of topics and sports from children and adults to boxing, wrestling, crew, and more! Thank you to all those who participated. We are working together to improve safe training and competition environments.
It continues to inspire me in the work that I do, to hear both concerns from the psychological community treating eating disorders as well as folks from athletic communities expressing shared concerns about the higher risk of eating disorders for competitive athletes. I was pleased with the growing body of knowledge and experience expressed in this panel toward helping our at-risk populations both prevent and treat disorders more expediently.
Michele Kerulis, EdD, LCPC, CMPC,The Family Institute at Northwestern University
It was a pleasure to participate on this panel with my esteemed colleagues. We are all passionate about helping athletes achieve success in healthy and productive ways. I discussed the pressures athletes face as they are continuously exposed to social media and expectations to have specific body types. I also talked about professional ethics as they relate to our field and media interactions. I was energized by the inquisitive audience and their commitment to continue educating athletes, parents, and coaches about this important topic.
Caitlyn Hauff, PhD,University of South Alabama
It is always empowering to discuss topics you are passionate about with other experts in the field and share that knowledge with those who have a desire to enact change within this sport and exercise community. After the panel, I felt inspired to continue this conversation, as it is essential that we find ways to provide the best care for athletes’ physical and mental health. In light of the recent accusations made against Nike’s Oregon Project, it is evident now more than ever that we need to change the rhetoric surrounding weight and performance and provide evidence of the damage that these training practices are causing athletes. I hope that AASP continues to allow us to use our voices to discuss this matter, as we are in positions to enable change. We must strive to have an open dialect with coaches, parents, and athletes about the matters of disordered eating and eating disorders and encourage not only safe practices but create supportive, caring environments.
Christine Selby, PhD, CEDS,Husson University
I take an identity-related focus when working with athletes and non-athletes with EDs or DEBs. Many dealing with long-standing eating disorders struggle to visualize what life would be like for them without their ED and in many cases are terrified to relinquish their ED or DEB behaviors. Those who believe their ED and DEB help them achieve improved or peak performance coupled with a strong athletic identity can leave the athlete feeling like they cannot make any changes to their behaviors without risking their athlete status. Helping athletes explore their identity as fully as possible can help them recognize that while they can remain committed to their sport there is more to who they are than their status as an athlete and they are far more complex than their ED. This, in turn, can increase the possibility that they can see a life without their ED as well as high athletic performance without their ED.
Riley Nickols, PhD, CEDS,The Victory Program at McCallum Place, St. Louis, Missouri
It was energizing to be on a panel of incredibly knowledgeable presenters and to witness the commitment that attendees have to best care for athletes. Collectively, I am encouraged by the desire to continue educating the sport community about ED and DEB vulnerabilities that exist among athletes and the importance of timely and targeted treatment.
To learn more about how sport and exercise psychology experts work with people and organizations to provide education about eating disorders and related issues, please see the AASP Eating Disorder Special Interest Group resources.
Chatterton, J. M. & Petrie, T. A. (2013). Prevalence of disordered eating and pathogenic weight control behaviors among male collegiate athletes. Eating Disorders, 21 (4), 328-41.
Martinsen, M. & Sundgot-Borgen, J. (2013). Higher prevalence of eating disorders among adolescent elite athletes than controls. Medicine Science & Sports, 45 (6), 1188-1197.
Miller, C. & Bravender, T. (2018). Mental disorders and learning disabilities in children and adolescents: eating disorders. FP Essentials, Dec, 475, 23-29.
Neumark-Sztainer, D., Wall, M., Larson, N.I., Eisenberg, M.E, Loth, K., (2011). Dieting and disordered eating behaviors from adolescence to young adulthood: Findings from a 10-year longitudinal study. Journal of the American Dietetic Association, 111 (7),1004–101.
Raevuoni, A., Keski-Rahkonen, Hoek, H. (2014) A review of eating disorders in males. Current Opinions on Psychiatry, 27-6, 426-430
Smith, A. R., Velkoff, E. A., Ribeiro, J. D., Franklin, J. (2018). Are eating disorders and related symptoms risk factors for suicidal thoughts and behaviors? A meta-analysis. Suicide Life Threat Behavior, 49, (1), 221-239.
Styer, D.M., Conviser, J. H., Washburn, J. J., & Aldridge, D. (2014, March). Gender differences in quality of life and functional impairment associated with binge eating disorders: a clinical population study. Paper presented at the International Conference on Eating Disorders, New York, N.Y.
Sundgot-Borgen, J. & Garthe, I. (2011). Elite athletes in aesthetic and Olympic weight-class sports and the challenge of body weight and body composition.& Journal of Sports Science, 29, 101-114.
Sundgot-Borgen, J. & Torstveit, M. K. (2004). Prevalence of eating disorders in elite athletes is higher than in the general population. Clinical Journal of Sport Medicine, 14, (1), 25-32.
Udo, T, Bitley, S. & Grilo, C. M. (2019). Suicide attempts in US adults with lifetime DSM-5 eating disorders. BMC Medicine, 17, P. 120.
Udo, T, & Grilo, C. M. (2019). Psychiatric and medical correlates of DSM-5 eating disorders in a nationally representative sample of adults in the United States. International Journal of Eating Disorders, 52 (1), 42-50.