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NEDA TOOLKIT for Educators Tips and information for coaches Disordered eating and full blown eating disorders are common among athletes. For example, a study of Division 1 NCAA athletes found that more than one-third of female athletes reported attitudes and symptoms placing them at risk for anorexia nervosa. Though most athletes with eating disorders are female, male athletes are also at risk — especially those competing in sports that tend to emphasize diet, appearance, size, and weight. The benefits of sport are well-recognized: building self-esteem, staying in good physical condition, and setting a foundation for lifelong physical activity. Athletic competition, however, can also cause severe psychological and physical stresses. When the pressures of athletic competition are added to societal norms that emphasize thinness or a certain body type, the risks increase for athletes to develop disordered eating. Listed below are some recognized risk factors for developing an eating disorder as an athlete. Although increased risk of eating disorders in specific sports like gymnastics, running, swimming, diving, dancing, rowing, bodybuilding, and wrestling that require athletes “make weight” or maintain a certain body size to stay competitive has been documented, the fact is that any athlete in any sport can develop an eating disorder. No one is immune. Personal factors that may create risk for an athlete • Inaccurate belief that lower body weight will improve performance. In fact, under-eating can lead the athlete to lose too much muscle, resulting in impaired performance. • Imbalance between energy input and output resulting in weight loss. This is especially a risk for athletes who burn high levels of energy in their sport, such as distance runners. • Family history of eating disorders, addiction, and other mental health disorders. • Personal history of anxiety and perfectionism. • Coaches who focus only on success and performance rather than on the athlete as a whole person. • Performance anxiety, fear of failure. Athletes who feel they are not performing at their peak capability may increase training and/or decrease food intake to bridge the gap. If no improvement in performance results, they may believe they didn’t lose enough weight or body fat they may step up their efforts even more. • Social influences, including family and peer pressure about athletic ability and performance. Concerns specific to female athletes The Female Athlete Triad (the Triad), a term coined in 1993 by the American College of Sports Medicine, refers to a syndrome commonly seen in athletic women. It involves the interrelated symptoms of disordered eating, menstrual irregularity and low bone mass. Although the exact prevalence of the Triad is unknown, studies have found that nearly three- quarters of female athletes have at least one sign of the Triad, according to a 2009 study in the Clinical Journal of Sports Medicine. How do you detect the Triad? The signs and symptoms of the Triad are very broad, and they involve all of its three components: eating and exercise habits, menstrual irregularity and poor bone health. • Disordered eating • Menstrual irregularity is not usually detectable by a coach, but it is important to let your athletes know that missing menstrual cycles is not normal and they should feel comfortable going to student health or a specialist to have this addressed. Missed cycles in athletes are not always an indication of the Triad, so it is important to have the athlete evaluated by a doctor for other medical problems that may cause amenorrhea (e.g., polycystic ovarian syndrome or a pituitary tumor). This evaluation involves various laboratory tests and sometimes imaging. Once other causes are ruled out, treatment can proceed with dietary and exercise adjustments. Female athletes taking oral contraceptive pills (OCP) may be unaware of menstrual irregularities or think the artificial period created by the pills will protect her from decreased bone density. More recent studies show that this is not the case. Only natural menstruation produces the right hormones at the right levels to build bone mass. Page  | 28