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NEDA TOOLKIT for Coaches and Trainers If an athlete insists they are fine, I should believe them. Problems with accurate self-awareness are one of the hallmarks of EDs, so an athlete may not currently have the self-awareness required to recognize a problem. Thus, someone may genuinely believe they are fine when they are acutely ill. Other people may deny the presence of an eating disorder even when they know they are ill because they are afraid of treatment. Regardless of the reason, it is important to insist on regular medical follow-up with a physician who is well- versed in eating disorders. Eating disorders occur only in females. Eating disorders can affect anyone, regardless of their gender or sex. Although eating disorders are believed to be more common in females, researchers and clinicians are becoming aware of a growing number of males who are seeking help for eating disorders. A 2007 study by the Centers for Disease Control and Prevention found that up to one-third of all eating disorder sufferers are male. It’s currently not clear whether eating disorders are actually increasing in males or if more males who are suffering are seeking treatment or being diagnosed. Because physicians don’t think of eating disorders as occurring in males, their disorders have generally become more severe and entrenched at the point of diagnosis. There may be subtle differences in eating disorder thoughts and behaviors in males, who are more likely to be focused on building muscle than weight loss. They are also more likely to purge via exercise and misuse steroids than females. Men who suffer from eating disorders tend to be gay. Although gay, bisexual, and transgender males are more likely to develop an eating disorder than straight males, the vast majority of male eating disorder sufferers are heterosexual. Subclinical eating disorders are not serious. Although a person may not fulfill the diagnostic criteria for an eating disorder, the consequences associated with disordered eating (e.g., frequent vomiting, excessive exercise, anxiety) can have long- term consequences and require intervention. Early intervention may also prevent progression to a full- blown clinical eating disorder. Eating disorder behaviors only focus on food. Individuals with eating disorders generally have an unhealthy focus on food and weight, but the symptoms of an eating disorder can extend far beyond food. Numerous scientific studies have shown links between eating disorders, perfectionism, and obsessionality, which can lead to a fixation on grades or sports performance. Although many sufferers report that eating disorder behaviors initially help them decrease depression and anxiety, as the disorder progresses, the malnutrition caused by eating disorder behaviors paradoxically increases depression and anxiety that can affect all aspects of life. Dieting is normal adolescent behavior. While fad dieting or body image concerns have become “normal” features of adolescent life in Western cultures, dieting can be a risk factor for developing an eating disorder. It is especially a risk factor for young people with family histories of eating disorders and depression, anxiety or obsessive-compulsive disorder. A focus on health, wellbeing and healthy body image and acceptance is preferable. Any dieting should be monitored. Anorexia is “dieting gone bad.” Anorexia is not an extreme diet. It is a life-threatening medical/psychiatric disorder. A person with anorexia never eats at all. Most anorexics do eat; however, they tend to eat smaller portions, low-calorie foods or strange food combinations. Some may eat candy bars in the morning and nothing else all day. Others may eat lettuce and mustard every two hours, or only condiments. The disordered eating behaviors are very individualized. Total cessation of all food intakes is rare and would result in death from malnutrition in a matter of weeks. Only people of high socioeconomic status get eating disorders. People of all socioeconomic levels have eating disorders. The disorders have been identified across all socioeconomic groups, age groups, races, ethnicities and genders. Page  | 12