Being a college athlete requires a tremendous amount of personal commitment. There are unique pressures and demands placed on college athletes. Both you and others expect you to "always do your best." Your coach and teammates depend on you. Often hundreds of people are watching your performance at athletic competitions. Practices and sporting events take a great deal of time, yet you are also expected and required to successfully handle the same rigorous academic schedule as other Middlebury students. The intensity of the demand of this combination, of both academic and athletic performances, is very significant and stressful. Sometimes these demands can result in self doubt, a troubling sense of inadequacy and/or heightened anxiety and the decision to "do whatever it takes" to be successful. Too frequently, "whatever it takes" may include an unrealistic goal regarding weight control, weight loss, or achieving a percentage of body fat that is lower than what your body can realistically maintain. Sometimes this results in the development of an eating disorder. Bulimia and anorexia are two of the most common eating disorders among college women and women athletes. It is estimated that 90-95% of the eating disordered population in the U.S. are women. College age women have a particularly high incidence of eating disorders. Recently the media has highlighted the issue of eating disorders and women athletes. Eating disorders, such as anorexia and bulimia, have a detrimental and sometimes devastating effect on college athletes resulting in impaired athletic performance, possible serious long-term health consequences, and in some cases, premature death.
This information is provided to you in an effort to help you identify the signs and symptoms of an eating disorder, the short- term and long-term consequences on athletic performance and general health, what resources and treatment options are available, and how to access these resources. In addition, this information will focus on what to do if you are concerned about someone else, i.e., a friend and/or teammate. The information is practical and necessary for you to have. You are urged to read it in its entirety.
ATHLETES AND EATING DISORDERS
Dieting, conscientiously exercising, and maintaining a low percentage of body fat does not necessarily mean that a woman has an eating disorder. For most athletes, these are necessary components required to be fit, and keep one's body "tuned" for athletic competition. There is cause for concern if an athlete shows the following signs or behaviors:
1) Repeated disappearances immediately after meals, especially if a substantial amount of food was eaten. Often people who are bulimic will excuse themselves near the end of a meal and retreat to a bathroom in order to purge and rid themselves of what they consider to be an over consumption of food.
2) Agitation, irritability or nervousness if something or someone prevents the person from being alone shortly after eating. If a person coping with bulimia is prevented from purging after eating, they will often appear distracted and agitated.
3) Consumption of large amounts of food not consistent with an athlete's weight. The act of purging can reduce the amount of calories being absorbed by the body.
4) Bloodshot eyes after being in a bathroom or any other place where vomiting could have occurred. The act of forcing oneself to vomit creates pressure on the blood vessels in the face and eyes. This can result in the inflammation and rupture of blood vessels that is often most obvious in the sclera or whites of the eyes.
5) Vomitus or the odor of vomit in the bathroom, toilet, sink, or wastebasket.
6) Extreme fluctuations in weight over a relatively short period of time. For example, weight fluctuation of + or -10 pounds.
7) Continuing concerns about "being overweight" or "being fat" even when the person's weight is below average. People with eating disorders do not have an accurate perception of their body size and shape.
8) Expressions of concern about "becoming fat" or "being fat" that do not diminish as weight loss continues. People with eating disorders have a distorted body image.
9) Eating in secret, hoarding food or stealing food. Evidence suggesting this behavior may include, friends or teammates noticing that their "snack food" is disappearing, finding many candy wrappers or food containers that appear to have been "hidden" by a person.
10) Complaints of lightheadedness or disturbance of equilibrium not accounted for by other medical causes.
11) Purposeless, excessive physical activity that goes beyond the expected training regime.
12) Avoidance of social or "typical" eating situations. For example, constantly refusing to eat in the dining halls.
13) Heart irregularities, palpitation, or arrhythmia's.
14) Loss of one's regular menstrual cycle, i.e., missing three periods in a row.
Any of these behaviors is cause for concern. However, the diagnosis of an eating disorder is best left to a trained professional. If you are concerned about your own relationship with food or the behavior of a friend or teammate, you are encouraged to speak with a health or mental health professional.
ANOREXIA, BULIMIA, AND OTHER EATING DISORDERS
Most health and mental health professionals agree that the following symptoms are the diagnostic criteria for anorexia and bulimia:
ANOREXIA NERVOSA
A. Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight less than 85% of that expected; or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected).
B. Intense fear of gaining weight or becoming fat, even though underweight.
C. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
D. In postmenarcheal females, amenorrhea, i.e., the absence of at least three consecutive menstrual cycles. (A woman is considered to have amenorrhea if her periods occur only following hormone, e.g., estrogen administration.)
BULIMIA NERVOSA
A. Recurrent episodes of binge eating. An episode of binge eating is characterized by the following:
1) eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances, and
2) a sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
B. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting, or excessive exercise.
C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months.
D. Self-evaluation is unduly influenced by body shape and weight.
E. The disturbance does not occur exclusively during episodes of anorexia nervosa.
Specific type:
Purging Type: during the current episode of bulimia nervosa, the person has regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics or enemas.
Non purging Type: during the current episode of bulimia nervosa, the person has used other inappropriate compensatory behaviors, such as fasting or excessive exercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics or enemas.
It is important to recognize that in regard to bulimia, a person does not have to induce vomiting or abuse laxatives in order to be bulimic. The "non-purge" type of bulimia means that the purging takes the form of fasting or excessive exercise rather than vomiting or laxative abuse.
In addition to anorexia and bulimia, there are other forms of eating disorders. The other common diagnostic criteria or symptom group that is also considered an eating disorder is as follows:
EATING DISORDER NOT OTHERWISE SPECIFIED
The Eating Disorder Not Otherwise Specified category is for disorders of eating that does not meet the criteria for any specific Eating Disorder such as Anorexia or Bulimia Examples of a Non-Specified Eating Disorder include:
1) For females, all of the criteria for anorexia nervosa are met except that the individual has regular menses.
2) All of the criteria for anorexia nervosa are met except that, despite significant weight loss, the individual's current weight is in the normal range.
3) All of the criteria for bulimia nervosa are met except binge eating and inappropriate compensatory mechanisms occur at a frequency of less than twice a week or for a duration of less than 3 months.
4) The regular use of inappropriate compensatory behavior by an individual of normal body weight after eating small amounts of food (e.g., self-induced vomiting after the consumption of two cookies.)
5) Repeatedly chewing and spitting out, but not swallowing large amounts of foods.
If in reading these criteria, you identify your own behavior, you are encouraged to talk to a health or mental health professional. Having an eating disorder is serious and requires professional evaluation and input. Athletes can and do recover from eating disorders. The sooner you speak to a professional and begin the recovery process, the faster your recovery will be.
COMPLICATIONS OF ANOREXIA AND BULIMIA
Anorexia and bulimia are detrimental to your health and to your athletic performance. Because a young adult athlete's body is youthful and therefore somewhat forgiving, an athlete with anorexia or bulimia may continue to perform athletically quite well for longer periods of time than one might initially expect. However, it is just a matter of time before depriving the body of the needed energy supply and the needed nutrients will have an impact. Eating disorders, such as bulimia, have medical complications that effect virtually every organ system in the body to some degree.
If you are engaging in bulimic or anorexic behavior, you are depleting or depriving your body of calcium that can result in the weakening of the bones and the development of osteoporosis. This increases the likelihood of suffering bone fractures and can lead to osteoporosis, a very serious crippling bone disease later in life.
If you are purging through the use of laxatives, diuretics or vomiting, you are depleting your body of potassium, which can result in heart arrhythmia's, which can be fatal. You are also risking internal bleeding and dehydration. Purging through vomiting also exposes the teeth and esophagus to stomach acid that deteriorates tooth enamel and scars esophageal tissue, sometimes resulting in precancerous changes in the tissues.
If you are taking inadequate amounts of food, your body cannot maintain adequate levels of glycogen. Glycogen is the basic fuel for the muscles and the brain. If you have an inadequate glycogen supply, this will affect your cognitive processes and impair your thinking process. In addition, an inadequate glycogen supply will lead to the rapid onset of muscle fatigue during strenuous exercise that adversely affects athletic performance. It also impairs the muscle tissues' ability to repair cells and heal minor injuries.
Bulimia and particularly anorexia can also lead to amenorrhea, the absence of a normal menstrual cycle. The long-term consequence of amenorrhea is now being studied.
Taking in an inadequate supply of vitamins can also have a negative impact on the body. For example, B complex vitamins help regulate important enzyme and metabolic functions. The heart, liver, thyroid, pancreas, skin, spleen, muscle tissue and kidneys can be affected by Vitamin B deficiencies. Vitamin A deficiency reduces the body's resistance to disease. Inadequate levels of Vitamin C in the body can contribute to anemia, reduced resistance to disease, and over-stimulation of the adrenal gland.
In 1987, the U.S. Olympic Committee Sports Medicine Council identified the following as complications that can arise from anorexia or bulimia:
- loss of muscular strength
- loss of endurance
- decreased oxygen utilization
- decreased aerobic power
- decreased speed
- loss of coordination
- impaired judgment
- reduced blood volume
- less blood flow to the kidneys
- loss of muscle glycogen
- reduced heart function
- increased heart rate
- electrolyte loss
- inability to regulate body temperature
The complications resulting from eating disorders are serious and can be life threatening.
FUELING YOUR BODY: FOOD AND THE ENERGY CYCLE
Normal eating is cyclical. The human body requires that food be consumed every 3-4 hours on a regular schedule. As fuel sources from food become too low, we experience hunger (a signal from our brain and endocrine system to eat) and we naturally satiate that sensation of hunger by eating. According to J.E. Wall in Food and the Energy Cycle, if at any point the cycle is broken, an abnormal cycle is created.
EVERY ATHLETE NEEDS ADEQUATE FUEL
It is important to get into a healthy cycle in regard to eating. It is also very important to consume enough food to adequately fuel your body. Too many female athletes try to maintain peak athletic performance when they are not consuming enough calories to adequately fuel their body's energy needs. Here is a formula to help you determine what your food and energy needs are. To calculate your daily caloric needs at your present body weight, refer to the following formula and list of training activities:
For athletes: (your body weight x 15) + exercise = calories needed per day
For example: A 125 pound basketball player practices one hour per day
(125 lbs. x 15) + 462 = 2462 calories needed per day to maintain
present body weight
The number of calories an athlete "burns" in one hour depends on the athlete's body weight, intensity of exercise and duration of the activity.
I DON'T HAVE AN EATING DISORDER, BUT I'M REALLY CONCERNED ABOUT MY TEAMMATE.....
If you are concerned about one of your teammates, you are encouraged to share your concerns with your coach. You may also speak with the person you are concerned about directly. If you do so, here are some things to consider:
(1) Discuss your concerns with a professional before you speak with your teammate. Either a coach, a member of the staff at the Office of Student Services or The Office for Counseling and can give you valuable information and help you evaluate the situation regarding what might be most helpful for your friend.
(2) Remember that many individuals with eating disorders have tried repeatedly to correct the problem on their own and have failed. Encourage them to get professional help.
(3) Talk to your teammate. Talk to her in a private setting and be respectful and compassionate. Be specific and concrete about what behaviors you have seen and are concerning to you. Focus on your concerns about your friend's health, not on weight or appearances. If your friend is able to acknowledge that there is a problem, suggest some resources.
(4) Realize your teammate may deny the problem. It is still important for her to hear your concerns.
(5) Don't try to control your teammate's eating by bringing her food, badgering her to eat, or ridiculing her. This will only damage your relationship.
(6) Remember that an eating disorder is a complex issue and requires professional help.
(7) Remind your teammate that athletes can and do recover from eating disorders. The sooner someone gets help, the sooner the recovery process can begin.
WEIGHT LOSS AND THE COLLEGIATE ATHLETE
If you are considering trying to lose weight, it is strongly recommended that you do so only after consultation with, and under the supervision of, a health professional or trainer. A personal consultation with an appropriate professional can help you set realistic weight loss goals and is your best assurance of designing a weight loss plan which is appropriate for you and which will be safe and effective.
Athletes need to remember that every athlete's caloric needs are different. If an athlete is 10 pounds overweight, this excess weight can have either a negative or a positive affect on their athletic performance.
For example, a marathon runner carrying an extra 10 pounds of body fat has little chance of winning the Boston Marathon. On the other hand, a professional football player 10 pounds overweight may still compete at top performance and win the Super Bowl. No matter what sport the athlete participates in, if they feel they need to lose weight or they simply want to maintain their present body weight, they should refer to the following 10 healthy weight loss tips:
- DO NOT DIET; DIETS DON'T WORK! - Diets deprive the athlete of needed calories and essential nutrients. These calories and nutrients (vitamins & minerals) fuel the brain and muscles during exercise. Many diets also deprive the person of their favorite foods and beverages.
- The athlete should never consume less than 1200 to 1500 calories per day. A lack of caloric intake (energy) may result in poor athletic performance. Starving the body of calories will only have a negative effect on a weight management program.
- Weight loss should be gradual and should not exceed 1 to 2 pounds per week. A slow weight loss will result in permanent weight loss.
- The athlete must not become obsessed with total body weight. When a person exercises (weight lifting, etc.) while trying to lose weight, they gain lean body weight (muscle) and lose body fat but their overall body weight may remain the same. The athlete should measure their weight loss success by their percentage (%) of body fat.
- Not everyone can be trim and lean like a ballerina or a body builder. A person needs to accept the "genes" their parents dealt them. All the dieting in the world won't change a person's genetic make-up.
- Set realistic and attainable long-term weight management goals.
- Diet pills, frozen entrees, and liquid diets ARE NOT the answer to safe and effective permanent weight loss. Rather, NUTRITION EDUCATION, CHANGES IN LIFESTYLE, and INCREASED ACTIVITY LEVEL will result in permanent weight loss and improved health.
- BE AWARE OF THE FOUR W's:
(1) WHAT you eat (select nutrient dense high carbohydrate, low-fat foods instead of "empty calorie" and high fat foods.)
(2) WHEN you eat (eat 3-5 small meals throughout the day and ALWAYS eat breakfast; avoid eating 3 hours before bedtime.)
(3) WHERE you eat (eat in a stress free and relaxed environment, this will allow a person to eat slowly and enjoy the meal.)
(4) WHY you eat (eat because you are hungry not because you are bored, stressed, or lonely.)
An athlete should know their "maintenance" number, the total number of calories a person needs each day in order to maintain their present body weight. To calculate an athlete's "maintenance" number, multiply his or her body weight by 13 if they are inactive (studying, reading, typing, and watching TV,) and 15 if they are active (walking, climbing stairs, light housework, etc.) Next, add the number of calories the athlete burns-off during a typical training session.
For example, a 160 pound active swimmer who trains 2 hours per day needs approximately 3700 calories per day to maintain his or her present body weight of 160 pounds (160 lbs. x 15 = 2400 calories + 1300 calories needed for 2 hours of swimming = 3700 total calories.)
For an athlete to lose weight, he or she must reduce their caloric intake by 500 to 1000 calories per day from their "maintenance" number. If his or her "maintenance" number is less than 2500 calories, the caloric reduction should be no more than 500 to 600 calories per day. If their "maintenance" number is more than 2500 calories, the athlete may reduce his or her caloric intake by as many as 1000 calories per day. Since one pound of body fat = 3500 calories, reducing the caloric intake by 500 calories per day over 7 days should result in a 1 pound weight loss and reducing the diet by 1000 calories per day should result in a 2 pound weight loss per week.
For example: 2300 calorie "maintenance" number - 500 calorie reduction = 1800 calories needed per day to promote a one pound weight loss per week (500 cal. x 7 days = 3500 calories)
BE PATIENT! You don't gain excess body fat overnight so don't expect to lose it all in one week.
A WORD ABOUT OSTEOPOROSIS
Osteoporosis decreases bone density in a person's skeletal system, making the bones weaker and more brittle which increases risk of broken bones. Osteoporosis is common among elderly people - in particular, elderly women. A lack of production of estrogen also increases a person's risk of osteoporosis as does calcium deficiency. Studies have suggested that low body weight, amenorrhea, eating disorders and excessive exercise also contribute to osteoporosis.
Healthy Levels of Calcium Intake
Consuming enough calcium can help to reduce your chances of developing weak and brittle bones. Recommended intake levels of calcium and common food sources of calcium are listed on the next page:
FOOD SOURCES OF CALCIUM
The RDA for calcium for young adults, up to the age of 24, has been set at 1,200 milligrams a day. This breaks down to four cups of milk a day. The following is a list of calcium sources:
MILLIGRAMS FOOD SOURCES OF CALCIUM
|
MILLIGRAMS OF CALCIUM |
FOOD SOURCES OF CALCIUM |
|
300 - 350 |
White or chocolate milk, l cup |
|
200 - 275 |
Calcium fortified orange juice, 6 oz |
|
150 - 175 |
Instant oatmeal, 1 pkt |
|
100 - 125 |
Broccoli, 1/2 cup cooked |
|
50 - 75 |
Gingerbread cake, 1 piece |
|
Below 50 |
Soy milk, 1 cup |
Source: Food Values of Portions Commonly Used. J. Pennington, J.B. Lippincott Co., Phila., 1989
It is very important that you have adequate calcium in your daily diet. If you need help in assessing whether or not you are getting an adequate supply of calcium, you are encouraged to speak with the Director of Recreation and Wellness.
A Word about Amenorrhea
Some female athletes experience amenorrhea, an absence of a normal menstrual cycle. Once dismissed as harmless, amenorrhea is coming under increased scrutiny. In most cases, treatment is simple, but questions remain about the long-term effects of amenorrhea.
It appears that amenorrhea can result from a variety of factors, including hormonal imbalances, low body weight, low percentage of body fat, etc. Eating disorders, such as bulimia and anorexia, can also cause amenorrhea.
Some of the factors which contribute to amenorrhea are under your control:
- Nutrition - some athletes are undernourished. Chronically consuming too few calories and, specifically, insufficient protein are risk factors.
- Weight - excessive thinness can add to your risk of amenorrhea.
- Sport - obviously there are many benefits associated with regular exercise and physical conditioning. However, excessive exercise and going to extremes in physical conditioning can cause problems.
What are the long-term consequences of amenorrhea? There is no current conclusive evidence regarding the long-term impact of amenorrhea caused by an eating disorder. However, some concerns have been raised in the following key areas:
Fertility, Stress Fractures and Osteoporosis
It is recommended that you not dismiss the absence of your period as a simple by-product of training. If you have amenorrhea check with your physician.
CONCLUSION
Eating disorders are serious and can affect the health and well-being of female athletes as well as their athletic performance. It is important for those who are dealing with an eating disorder to seek professional help. There are confidential services available to you at Upper Iowa University . You are urged to take advantage of these services. Remember people CAN and DO recover from eating disorders. YOU CAN TOO!
Resource Sheet for Students with Eating Issues, and Students Who Have Concerns About Body Image
1. Center for Counseling
Garbee Hall, Ext. 5786
Evaluation and individual counseling is available to all students free of cost.
2. Office of Recreation and Wellness Education, Garbee Hall, Ext. 5209
The College Health Educator is available to provide individual educational sessions regarding the topics of compulsive eating, eating disorders, etc. The Health Educator is also available to provide educational programs to groups on campus and training sessions for other professionals on campus.
3. Private Practitioners - For those interested in working with a private counselor, psychotherapist, mental health counselor, psychologist, social worker or psychiatrist, several options exist in the Middlebury area. Call Ext. 5209 for more information and/or a referral. Fees for private practitioners vary.
