Identifying an athlete with anorexia nervosa or bulimia can be difficult, and confrontation is uncomfortable for all concerned. Like all people with eating disorders, the impaired athlete denies anything is wrong and rationalizes what s/he cannot deny. Read on for background information and practical tips on how to proceed.
The athletic environment
Unfortunately the sports milieu defines as normal, and even praiseworthy, questionable behaviors that enable the eating disordered athlete to escape detection and avoid treatment.
- Excessive exercise is not just accepted in the sports world, it is praised and admired as a standard of "excellence."
- Even behaviors like fasting and vomiting are accepted in some sports and dance schools as part of the normal routine.
- Athletes are assumed to be superbly healthy because they can spectacularly outperform the average person.
- Over time, media images of tiny, childlike gymnasts and skinny runners have desensitized us. We no longer worry that these people are too thin. We accept them as normal, thus allowing the truly malnourished to go undetected.
These factors make it difficult to identify an athlete who is also eating disordered.
In addition, many coaches, trainers and players demand low body-fat percentage. Sometimes their demands are frankly unhealthy. For example, The U.S. Olympic Committee states that the average and healthy range of body fat for young women is 20-22%. Most women need at least 17% body fat to menstruate, a marker of female health. Nevertheless, many female athletes and dancers, and their coaches, strive for 10-14% body fat or even lower.
Some coaches and players insist athletic performance will be enhanced when weight and fat are lost. This is not necessarily true. In addition, if the person develops an eating disorder as a consequence of excessively disciplined dieting, any advantage conferred by lighter weight will be more than offset by the physical and emotional destruction caused by starving, stuffing and purging.
What to do: some suggestions
Approaching an athlete whom one suspects is in trouble with food and weight issues is challenging. It requires sensitivity, honesty and determination to do what is best for the person, not what s/he wants to do and not what other team members may want (e.g., letting the athlete continue to compete even when impaired and in medical danger).
- The coach or trainer who has the best rapport with the person should arrange a private meeting.
- Express support for the person and concern for her/his best interests. Stress that health and happiness transcend the athletic arena. Be empathic and caring.
- In an objective, nonpunitive way list what you have seen and what you have heard that have leads you to be concerned. Let the athlete respond fully. Expect denial and rationalization.
- Emphasize that the person's place on the team or in the program will not be endangered by an admission that s/he has an eating disorder. . .
- Unless the eating disorder has compromised the person's health or put her/him at risk for injury. If that is the case, consultation with a physician will help decide the wisest course of action.
- If the athlete admits having an eating disorder, try to determine if s/he can voluntarily abstain from the behaviors.
- If, in the face of compelling evidence, the athlete refuses to admit that a problem exists, or if it seems that the problem has either been long-standing or cannot be corrected readily, consult a clinician with expertise in treating eating disorders. If you work in a school athletic department, the school nurse, counselor or health center would be a good place to begin.
- Remember that many people with eating disorders have tried, and failed, to correct the problem on their own. Failure is especially demoralizing to athletes who are always oriented toward success.
- Let the person know that eating disorders are treatable, and people do recover from them. Almost always, though, professional help is necessary. Needing help should not be regarded as a sign of weakness or inadequacy or lack of effort.
- Depending on indivudual circumstances, the athlete's continued participation in the program may be made conditional on formal treatment, medical and/or psychological.
- Arrange for regular, private follow-up meetings apart from practice times. In these meetings check to make sure the athlete is still seeing a physician and mental health therapist on a regular basis if that was part of the overall plan.
- If the athlete is working with a physician or counselor, ask for a signed release so you can talk to to that resource person. Then when you have doubts about what may, or may not, be in the best interests of the athlete, you can consult with the expert.
- Remember that many athletes who develop eating disorders have been told that they need to lose weight. Realize that past or present coaches or trainers may have contributed to the eating disorder. Let the athlete know that you know that the demands of the sport may have played a role in the development of the problem.
- At this point, if the athlete still seems to be in trouble, do not continue by yourself. Enlist the help and support of your own resource people: appropriate school personnel, owners and managers of health clubs, perhaps an attorney, and so forth. The health and wellbeing of the athlete is no longer the only consideration. There may be liability exposure for the team, school or facility as well.
What not to do
Good-hearted and well-intentioned people can sometimes make matters worse. Such is the nature of eating disorders. Here are a few suggestions:
- Don't question teammates or talk to them about the athlete. Talk directly to her/him.
- If you have evidence that a problem exists, intervene. Don't hope it will go away if you ignore it. It won't.
- Don't tell the person that you know s/he has a problem without giving her/him your reasons and evidence. S/he will only become defensive.
- Don't tell the athlete to straighten up. Don't threaten to keep checking on her/him. S/he will experience increased stress which will only make matters worse.
- Never conclude that if the athlete really wanted to stop the behaviors, s/he would. Don't make the mistake of believing that failure to improve shows a lack of effort. Even the fastest of recoveries, facilitated by mental health professionals, take several months to many years to achieve.
- Don't refuse to admit that you, and the demands of the sport, may have contributed to the eating disorder.
- Don't try to keep the problem hidden by attempting to deal with it yourself when professional intervention and treatment are clearly appropriate.
- Don't nag, bribe, threaten, or manipulate. These tactics don't work; they only make matters worse.
- Don't try to rescue the athlete from the eating disorder single-handedly. Anorexia nervosa and bulimia are complex medical and psychological challenges. Unless you are a physician or mental health clinician, you do not have the training or skills to provide the treatment that is needed. Help the person connect with appropriate professionals.
(The above was taken in part from an article by Lionel Rosen, MD, that appeared in The Physician and Sports Medicine. We are grateful for permission to reprint for nonprofit educational purposes.)
Please Note: ANRED information is not a substitute for medical or psychological evaluation and treatment. For help with the physical and emotional problems associated with eating disorders, talk to your physician and a mental health professional.
Page updated April 28, 2008
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