Essentials for Best Practice: Treatment Approaches for Athletes With Eating Disorders

Abstract

Eating disorders (EDs) and disordered-eating behaviors (DEBs), pose a high risk of morbidity and mortality, threatening physical health, emotional health, and overall quality of life. Unfortunately, among athletes, prevalence rates continue to increase. This document summarizes the challenges of establishing and navigating the multidisciplinary care needed to effectively treat EDs and DEBs among athletes. The benefits of timely and frequent communication within the multidisciplinary treatment team (MDTT) are emphasized and discussed. Authors advise who should be selected as members of the MDTT and suggest that all personnel, including athletic coaches, athletic trainers, physical therapists, and certified fitness professionals be ED-informed and ED-sensitive. Vital components of care are noted including use of a variety of evidence-based psychotherapeutic modalities, interventions which target emotional regulation, and prioritize values based compassionate care. Authors caution that performance decrements and medical/physiological changes are not always easily observable in individuals with EDs and DEBs and therefore, attuned, consistent, and ongoing monitoring is needed. Consensus regarding previously established parameters for return to play and careful titration of physical activity throughout the ED recovery process are suggested as important for preserving health, preventing re-injury, or relapse and facilitating successful return to sport participation.

Disordered Eating Attitudes, Anxiety, Self-Esteem and Perfectionism in Young Athletes and Non-Athletes

“…Eating disorders (EDs) are common and potentially serious conditions that have devastating effects on physical/emotional health, sports performance, and overall quality of life, carrying an increased risk of morbidity and mortality [ 1 , 2 ]. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) categorizes EDs into several specific types, including: Anorexia Nervosa (AN), Bulimia Nervosa (BN), Binge Eating Disorder (BED) Pica, Rumination Disorder, Avoidant/Restrictive Food Intake Disorder (ARFID), Other Specified Feeding or Eating Disorder (OSFED), Other Specified Feeding or Eating Disorder (OSFED), and Unspecified Feeding or Eating Disorder (UFED) [ 3 ].…”

Factors associated with disordered eating and eating disorder symptoms in adolescent elite athletes

“…Our results highlight that athletes’ disordered eating behaviour can precursor eating disorder symptoms. Therefore we recommend that not only coaches but also athletes, parents, and relevant personnel (e.g., physicians, physiotherapists, teachers) should be made aware of the symptoms of disordered eating (i.e., regular use of unhealthy weight control methods) and that it is a warning sign that should not be taken lightly or ignored [25, 26]. 33% of participants use at least one weight control method regularly, and athletes use up to six weight control methods at the same time, which both can be described as disordered eating [5, 7, 8, 9, 18].…”

“…Consequently, particularly coaches should be aware of the potential consequences when making comments that suggest an association between leanness/thinness and performance (i.e., athletes use methods to lose weight fast). Instead, coaches should educate athletes about the negative short- and long-term psychological and physiological consequences of fast and unhealthy weight loss and give appropriate advice for healthy dieting or refer athletes to an expert [9, 25, 26]. Results also indicated that athletes’ attitudes and expectations regarding an ideal body are modeled by friends and team norms.…”

“…Short-term physiological effects such as weakness, injuries, or stress fractures impact performance. More alarming are the long-term psychophysiological consequences of an adolescent eating disorder, such as heart palpitations, dyspnea, depression, anxiety, or even suicidal thoughts, which can seriously impact an athlete’s well-being [9, 25, 26]. Therefore, and according to previous suggestions, we call for the timely screening of disordered eating and eating disorders in male and female athletes, for all types of sports, and particularly during athletes’ transition from early to late adolescence [5, 6, 17, 18, 28].…”

“Horrible—But Worth It”: Exploring Weight Cutting Practices, Eating Behaviors, and Experiences of Competitive Female Taekwon-Do Athletes. A Mixed Methods Study

“…Increasing knowledge of professionals with responsibilities for athletes in taekwon-do may also be important so that they can recognise those athletes at risk from eating disorders and provide the necessary skills to either support them or signpost them on to a mental health care provider. A coach or trainer who is eating disordered informed or certified is better able to detect and support the recovery of athletes with eating disorders (Conviser et al, 2018).…”