2016 update on eating disorders in athletes: A comprehensive narrative review with a focus on clinical assessment and management

Abstract

Eating disorders, such as anorexia nervosa and bulimia nervosa, can have devastating effects on both the health and performance of athletes. Compared to non-athletes, both female and male athletes are at higher risk of developing an eating disorder. This is especially true for athletes participating in sports where low body weight or leanness confers a competitive advantage. Screening for disordered eating behaviours, eating disorders and for related health consequences should be a standard component of preparticipation examinations, and team physicians should be knowledgeable of the updated diagnostic criteria for eating disorders in the Diagnostic and Statistical Manual-V. Athletes with eating disorders should undergo thorough evaluation and treatment by an experienced multidisciplinary team. Team physicians play a critical role in decision-making on clearance for participation and return to play. Using evidence-based guidelines for clearance and return to play encourages transparency and accountability between the sports medicine care team and the athlete. Efforts to prevent eating disorders should be aimed at athletes, coaches, parents and athletic administrators, and focused on expanding knowledge of healthy nutrition in support of sport performance and health.

Gastrointestinal considerations related to youth sports and the young athlete

“…Other organ systems including the cardiorespiratory, endocrine, dermatological, musculoskeletal, neurological, and genitourinary systems can be involved in individuals with eating disorders (35). Additionally, female athletes with disordered eating have a 2-4 times the risk of developing a sport-related injury (38).…”

“…Manifestations of eating disorders can often be very subtle and therefore careful vigilance must be maintained to diagnose the entity. Additionally, the American Medical Society for Sports Medicine (AMSMM) and the American College of Sports Medicine (ACSM) have collaborated to develop the Preparticipation Physical Examination monograph which is endorsed by the American Academy of Pediatrics to screen for an eating disorder (35). The Female Athlete Triad Coalition has also published an 11-question screening tool (39).…”

“…Both female and male athletes are at a higher risk of developing an eating disorder such as anorexia nervosa or bulimia nervosa compared to non-athletes (35). Athletes competing in sports with endurance, aesthetic, and weight class components as well as emphasizing low body mass such as wrestling, gymnastics, dance, figure skating, long and middle distance running, and rowing are at the highest risk (36).…”

“…However, in 2007, this definition was changed to include low energy availability (with or without disorder eating), menstrual dysfunction, and/or low bone mineral density (37). Male athletes have a lower prevalence of eating disorders than female athletes, but a higher prevalence than male non-athletes (35). There has been data describing male athletes with low energy availability and disordered eating suffering from hormonal changes such as hypogonadotropic hypogonadism and low bone mineral density (36).…”

Female athletes and health

“…Brought to you by | MIT Libraries Authenticated Download Date | 5/10/18 11:59 AM Furthermore, it is worth noting that despite many years of studies concerning the female athlete triad, and clear procedures to prevent its adverse effects, recent data indicates that a similar phenomenon can be observed in male sportsmen who are engaged in disciplines that emphasise a lean body composition, accompanied by the well-known adverse effects including false dietary habits, hypogondotrophic hypogonadism and a low bone mineral density [24,57]. Thus, both coaches and sport medicine health professionals need to be especially concerned about the dietary habits of athletes to protect them from adverse health effects and a decrease in their performance.…”