Disordered Eating in Athletes & Anyone Who Moves Their Body
Image by Jon Chng (@jonchng) via Unsplash
Back-to-school means back to recreational, team, and collegiate sports. As someone who treats people who are healing from disordered eating and eating disorders, I have worked with many clients who have a complicated relationship with food and exercise. Underfueling for sports and activity is something that I frequently discuss in my practice.
I’m not alone in my concern. During the past few years, there has been greater awareness about disordered eating among athletes. One such example was The New York Times feature of elite runner Mary Cain. Disordered eating is a concern for athletes, parents, coaches, healthcare providers, gym-goers, occasional walkers, and anyone who moves their body!
Unfortunately, we live in a society that promotes “socially sanctioned” disordered eating (e.g., cutting out food groups, eating “clean”, the keto “lifestyle”, intermittent fasting, macro counting) as a way to improve health and athletic performance. This advice is much more likely to lead to negative health consequences from energy deficiency and eating disorders, than to sustained weight loss and improved athletic performance. In this post I will discuss:
The definition of disordered eating
Why underfueling is a disordered eating behavior
Who’s at risk for relative energy deficiency in sport (RED-S)
Signs of RED-S
Where to seek help for disordered eating & RED-S
Disordered Eating
Let’s start with disordered eating. Disordered eating is a phrase used to describe a person’s eating habits that are not “normal” (e.g., a healthy relationship to food, physical activity, and body image), yet do not describe eating behavior that would be diagnosed as an eating disorder.
Ubiquitous public “health” messages such as “eat less and move more” or “take in less calories than you burn and you’ll lose weight” are unhelpful, inaccurate, and potentially harmful. These messages encourage food deprivation and disconnection from your body’s internal cues. This is a recipe for disordered eating behaviors, not improved health and athletic performance.
There can be varying degrees of intensity to disordered eating, from “dabbling” with the newest fad diet, all the way to intrusive and obsessive thoughts about food and physical activity that get in the way of living life. Here are a few examples of disordered eating behaviors:
Rigid food rules (e.g., “I can’t eat anything past 7 pm” or “I won’t eat anything with added sugar”)
Basing what you plan to eat for the day on your morning “weigh in”
Feelings of shame when eating certain foods (e.g., bread, pasta, dessert)
Exercising for a certain number of minutes or at a particular intensity to “make up” for what you ate
Disordered eating can easily spiral into a full-blown eating disorder. Whether or not disordered eating progresses to an eating disorder, you deserve treatment from a team of knowledgeable professionals to help you heal from these unhealthy behavioral patterns.
Underfueling is Disordered Eating
Before we dive into underfueling, let’s define some important terms:
Metabolism- All of the processes within the body to maintain life and to perform activities of daily living (including physical work). Our caloric intake from food provides the cellular energy needed to maintain life and activities of daily living.
Energy balance- The balance between energy consumed (calories from food) and energy expended by the body to sustain life and perform activities of daily living. This is most often assessed by changes in body weight.
Low energy availability- This happens when insufficient food energy is consumed to support the body’s energy expenditure. Dieting is a form of low energy availability.
Energy deficit- The deficit of food energy consumption that our body naturally compensates for through adjustments in our physiological processes. For example, if we’re not eating enough calories, our body can break down our own muscle tissue to produce energy for our cells to function.
Underfueling, or not taking in enough energy (calories from food) to support the body’s energy expenditure can be an issue for anyone, at any age, and at any physical activity level. Underfueling is often an intentional method to control (or lose) body weight by eating a low or very low calorie diet, avoiding certain foods (e.g., gluten, dairy, sugar), and/or skipping meals.
Underfueling methods are disordered eating behaviors. Athletes and non-athletes alike may feel pressure to lose weight in order to improve their performance (e.g., to increase speed during a race) or to improve their health (e.g., increasing physical activity to try and lower their blood sugar level).
Low energy availability via underfueling can lead to negative health consequences in all of our body systems (more on that in a moment). For anyone who moves their body, the consequences from underfueling can have a significant impact on overall health, well-being, and athletic performance.
Who’s at Risk for Relative Energy Deficiency in Sport (RED-S)?
When there’s a deficit in consuming enough food energy it can lead to relative energy deficiency in sport (RED-S). RED-S is a syndrome (a group or set of associated symptoms) that impacts people of all ages, genders, and activity levels who have low energy availability (Mountjoy, et al. 2018).
RED-S can have a negative effect on overall health and athletic performance. People who move (and eat) at any age are at risk; however athletes in the following sport categories are at an especially high risk:
Aesthetic sports: gymnastics, ice skating, diving, dancing, cheerleading, artistic swimming (formerly known as synchronized swimming)
Gravitational sports: cycling, running, triathlons, climbing, skiing (cross-country), ski jumping, horse racing
Weight category sports: wrestling, boxing, mixed martial arts, weightlifting
All people who regularly exercise!
Signs of RED-S
RED-S affects up to 60% of all athletes (Mountjoy, et al., 2018), making it important for anyone involved directly or indirectly with exercise and athletics to be aware of the signs and symptoms of RED-S.
Here some signs & symptoms of RED-S by category:
Heart & blood vessels: slow heart rate, low blood pressure, dizziness upon standing, lack of blood flow to hands and feet
Immune system: low white blood cell count, recurrent illnesses (e.g., colds), slow wound healing
Bones: low bone mass, stress fractures
Menstrual issues: disruption in menstrual cycles or cessation of menstrual cycles
Digestion & gut issues: slowed digestion, early fullness, bloating, constipation, food intolerances
Blood: anemia, easy bruising
Hormones: low sex drive, low estrogen or testosterone, low Vitamin D levels, changes in appetite, changes in body composition, changes in menstrual cycle
Metabolism: fatigue, intolerance to cold temperatures, weight changes
Growth and development (kids & teens): arrested puberty, drop from centile on growth charts
Psychological: mood changes, personality changes, brain fog, fatigue, disrupted sleep
Athletic performance: changes to expectations for training load, impaired performance
Disordered eating behaviors or an eating disorder
RED-S can have a significant impact on athletic performance. RED-S decreases training response, endurance, muscle strength, concentration, coordination, and glycogen stores (for sustained energy). Moreover, RED-S affects mood (e.g., depression, irritability), can impair judgment, and increases the risk for injury.
Where to Seek Help for Disordered Eating & RED-S
If you read the criteria and believe that you or someone you know & care about might be experiencing RED-S it’s important to seek out help from a knowledgeable professional.
Bottom line, your nutritional intake must match or exceed your energy expenditure in order for your body to function optimally. Top priorities are to assess your symptoms and correct the nutritional deficiency.
1) Physical Exam: Make an appointment to see your primary health care provider for a physical exam and ask for a referral to a sports medicine physician.
2) Referral to a Nutrition Expert: Seek out a registered dietitian with expertise in sports nutrition and/or eating disorders. Click on this link to the Academy of Nutrition & Dietetics to find a nutrition expert in your area (you can filter your search to sports nutrition and/or eating disorders). A nutrition expert will help you determine your energy availability and align training (or movement) with adequate nutrition to meet your needs.
3) Referral to an Eating Disorders Expert: Seek out a knowledgeable professional with expertise in disordered eating and eating disorders. I wrote a blog post about this; click here for a full list of resources. You can also visit the National Eating Disorders Association (NEDA) website by clicking here.
4) Book Recommendations
These books can give you a general overview of why fueling your body is essential as a person (or athlete) who moves. You can purchase a copy of the recommended books by clicking on the links below. Disclaimer: As an Amazon Associate, I earn from qualifying purchases.
Reference:
Mountjoy, M., et al. (2018). International Olympic Committee (IOC) consensus statement on relative energy deficiency in sport (RED-S): 2018 update. British Journal of Sports Medicine, 52(11), 687-697. doi: 10.1136/bjsports-2018-099193