Eating Disorders: A Guide for coaches, parents and friends

These athletes think (or feel pressured by the athletic community to believe) that by restricting their food to lose weight, they will exercise better, look better and enhance their overall performance. Ironically, restricting food in an attempt to improve performance can actually result in really bad physical problems. Some athletes may manage to exercise well for a while without an obvious decline in performance. But injuries and lack of energy will eventually catch up with them.

For example, is the “triathlete” carbo-loading — or binge-eating only to purge by training exhaustively for hours? Is that skinny skater dieting to lose weight for a competition — or starving herself due to lack of self-esteem? If you suspect that someone has an eating problem but aren’t sure, look for these tell-tale behaviors and physical symptoms associated with anorexia:

significant weight loss (with no known medical cause)
loss of menstrual periods for more than three months
growth of fine body hair (noticeable on the arms and face)
hyperactivity and compulsive exercise beyond normal training
intense fear of becoming fat and comments about being fat despite obvious thinness
complaints of being cold all the time; wearing heavy sweaters even in the middle of summer
layers of baggy clothing to hide the thinness and provide warmth
avoidance of eating in public or nervousness at meal times
compulsiveness and rigidity in all aspects of daily living (working, studying)
In contrast to the obviously skinny athlete with anorexia, the athlete with bulimia may be normal weight, or even a little over-weight. Unusual behaviors and physical symptoms associated with bulimia include:

extreme concern with body weight, shape and physical appearance
anxiety that surrounds secretive eating and even petty stealing of food or money to buy food for binges
disappearance after eating, often to the bathroom to “take a shower”
the sound of water running in the bathroom after meals to hide the sound of vomiting
complaints of weakness or fatigue, often due to dehydration and electrolyte loss from vomiting
bloodshot eyes (from the force of vomiting), swollen glands and puffiness below the cheeks.
Eating disorders arise from a combination of family problems, longstanding emotional issues with family members, and other troubled relationships. Sometimes the anorexia started with an innocent reduction diet that began either before or after a major life event (such as physical maturation, sexual abuse, divorce, death of a loved one) and ended with a passion to control food and weight. The athlete commonly feels inadequate, depressed, lonely and anxious. These feelings, in addition to the beliefs the thinnest athlete is the best athlete and thinness is happiness can culminate in eating disorders.

If you think that your friend, training partner, child or teammate is struggling with food, address it; don’t wait until medical problems prove you right. Behind their seemingly happy facade is a very unhappy person. Remember that food is not the problem, but rather the symptom. Do not talk to the athlete about how thin he or she is or tell her to “just eat normally”, but do express your concern about his/her health and lack of happiness.

The best route for helping the athlete get help is to talk about what you see: light-headedness or chronic fatigue, loss of concentration, inability to complete workouts. These health changes are more likely to be the stepping stones for accepting help because the anorexic and bulimic cling to food and exercise for control and stability. After all, s/he takes pride in being perfectly thin and able to endure the rigorous training schedule.

When approached, some athletes burst into tears and want to share the “secret”. But more often, they will deny the problem and insist that everything is “perfectly fine”. In this case, continue to routinely express your concern. As a parent or coach, you can insist the athlete get a medical check-up from a sports physician or pediatrician skilled in handling eating disorders. As a friend, you can find local resources to handle the problem, such as eating disorder clinics, support groups, or counseling. Some national resources include: American Dietetic Association (800-877-1600; referral to a sports nutritionist in your area); American College of Sports Medicine (317-637-9200; brochure about eating disorders), American Anorexia/Bulimia Association (212-734-1114; referrals, written materials). Most importantly, be patient, and know that in the long run, you can make an important difference in that person’s life.