Eating Disorders Awareness Week 2022

National Eating Disorders Awareness Week is an annual campaign to provide education about the realities of eating disorders and to provide hope, support, and visibility to individuals and families affected by eating disorders. National Eating Disorders Awareness Week 2022 is taking place from February 28 – March 6, 2022.

Dr Anita Biswas, Senior Sports Physician and Co-Lead for Female Athlete Health at the English Institute of Sport (EIS), shared some useful information in relation to eating disorders in elite athletes, including where to find help and support.

What does ‘eating disorder’ typically refer to?

‘Eating disorder’ is a broad term and can refer to any of a range of psychological disorders characterized by abnormal or disturbed eating habits such as anorexia nervosa or bulimia nervosa.

What tends to cause eating disorders in athletes?

Eating disorders can and do occur in athletes (one paper has suggested that 13.5% of athletes struggle with an eating disorder, although this may be higher in some sports than others). What may be more common is ‘disordered eating’, which may not be due to psychological issues but due to athletes not fully understanding the nutritional needs that their training requires. This could lead to them eating too little or too few of the right foods.

A common mistake that is made is avoiding certain groups of food such as carbohydrate due to popular diets that they might have seen in the media. However, these tend to be designed for an overweight general population and not for those training at the elite level.

Athletes transitioning from a junior to a senior programme can be particularly at risk (especially if they are not used to preparing their own food) as they can underestimate how much more food they need due to the increase in their training.

In the elite athlete population, the causes are often very complex, with a number of contributing factors that could include:

– Moving away to training sites away from their support network
– Having friends who are also their competitors
– Feeling lonely or stressed; eating disorders can result from a need to have control over an element of their lives
– The belief that lighter is better, which may come from having a particularly good result when they were lighter, but then not recognising that even lighter isn’t even better
– Seeing their ‘hero’ being very lean and not recognising that they have a different body type.

Trying to become lighter can get out of control. Sometimes comments by those around them suggesting that weight loss may help them to be better athletes can stick in the mind of a young athlete. Again, the weight loss can get out of control and become an eating disorder.

What are the associated health risks? (Both physical and mental)

Under-fuelling in athletes, whether due to an eating disorder, accidental under-eating or poor eating habits, can affect every system in the body.

Before any health issues are noticed, concentration, decision-making and sleep can be affected. An athlete may experience low mood and irritability and this can increase underlying mental health issues related to eating disorders.

Initially they may find that they can run faster or feel better. If an athlete continues to not eat enough, they may continue to lose weight, but this has been shown to be muscle loss, rather than fat loss, or their weight may become static which can be frustrating if weight is their main focus. Loss of muscle can affect the strength and endurance of the athlete, so far from making the athlete better, gradually performances can drop off. These athletes are more at risk of illness and injuries including stress fractures, muscle injuries and tendon injuries. These injuries can be slower to heal.

Longer term, the body responds to ‘starvation’ by switching off non-essential functions such as reproduction, so we often see periods stopping in female athletes. But there can also be impacts on other organs such as hair loss, damage to the heart blood vessels, damage to the teeth and gut (especially if purging is part of the illness), as well as in severe cases of depression and anxiety; suicidal thoughts and self-harming. These can have long lasting health consequences.

Do eating disorders affect both male and female athletes?

Eating disorders are two to three times more common in female than male athletes, but male athletes are certainly also at risk of developing eating disorders. In males it may be less obvious because traditionally loss of periods has been used as a red flag, but male athletes won’t get that warning. However, they will experience other symptoms such as low mood, loss of concentration or poor sleep, injuries and illness, all of which could be warning signs.

What support is available for athletes in the high performance system?

Education of athletes is an important part of what we are doing at the EIS with the Female Athlete Health and Performance Programme, helping athletes to understand the health risks and performance impacts of under fuelling.

In all cases, preventing issues is better than treating them, which is why we aim to support in the following areas:

– Nutritionists supporting sports are able to provide education about the amount and types of foods required for different sports, food preparation for those who haven’t lived away from home, and share recipes

– Psychologists offer support for those athletes that are experiencing loneliness, stress and anxiety

– Athletes are advised to speak to their EIS or sport doctor if their periods stop or they are experiencing mental health issues

– Athletes have access to specialist support for eating disorders through a referral by their sport’s doctor via the Athlete Medical Scheme. The EIS Mental Health Expert Panel are also available to provide advice and guidance to sports on eating disorders and disordered eating and they can be contacted via mentalheath@uksportsinstitute.co.uk.