disordered eating in sport

DSM-V: anorexia nervosa criteria

a. restriction of energy intake leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health

b. intense fear of gaining weight or becoming fat, or persistent behaviour that interferes with weight gain, even though at a significantly low weight

c. disturbance in the way in which one’s body weight or shape is experiences, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight

d. removed because it was completely gendered response (stigma to men)

DSM-V: bulimia nervosa

a. recurrent episodes of binge eating. an episode is characterized by both of the following:

1. eating, in a discrete period of time, an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances

2. lack of control over eating during episode

b. recurrent inappropriate compensatory behaviour to prevent weight gain (excessive exercise, vomiting or laxative abuse)

c. binge eating and inappropriate compensatory behaviours both occur, on average, at least once a week for 3 months

d. self evaluation unduly influenced by body shape and weight

e. the disturbance does not occur exclusively during episodes of anorexia nervosa

problems with diagnostic criteria

existing criteria may still be too specific

“there is something amiss with the scheme for classifying eating disorders if the most common category is the ‘residual’ one” - (Fairbum + Bohn, 2005)

the disordered eating

“a spectrum of problematic eating practices, ranging from unhealthy weight control methods, to severe pathological attitudes and behaviours” (Shisslak, Crago + Estes, 1995)

central hypothesis: Athlete disordered eating

pressures to be lean for performance gains, and/or to conform to a particular athlete aesthetic, can lead to body dissatisfaction and disordered eating attitudes and behaviours, including clinically severe eating disorders

prevalence studies

questionnaires, give it out to two different demographic groups (eg. gymnasts vs. politics students)

tell us there is a problem but don’t explain why it happens

correlation studies

give an eating disorder inventory and questionnaire on perfectionism and see if there is any relationship

risk- factor studies

look at longitudinal data: pick relevant factors you might hypothesize are connected

qualitative studies

ask about their experiences, managing the ED, beliefs and perceptions

interventions

(takes a lot of money)

go in and work with people, based on a prevention basis as well

prevalence of ED in general pop

lifetime prevalence estimates for anorexia nervosa and bulimia nervosa:

• respectively 0.9% and 1.5% in women

• 0.3% and 0.5% in men

prevalence in ED in sport

prevalence studies show female athletes in ‘lean’ sports can be twice as likely to experience eating disorders than non-athletes

(Torstveit, Rosenvinge + Sundgot-Borgen, 2008)

increased prevalence in lean and aesthetic sports

Mancine et al (2020)

research on lean sports found athletes participating in lean sports and significantly higher rates of ED than non-lean sports in 6 out of 7 studies

• increased aesthetic and weight dependent sports as lead sports

lean inclusive of "“endurance”, “aesthetic”, and “weight-dependent sports”

prevalence research: methodological difficulties

1. fears over anonymity / confidentiality

2. breadth of eating disorder measures make results difficult to compare across studies (eg. EAT-26, EDI-2, EDI-3, the SCOFF)

3. studies employing same measure use different cut-off scores to signify positive cases of “disordered eating”

4. eating disorders can only be properly identified through clinical interview

gaps in research

not a major concern but is still present

ED is widely still considered a female issue

Papathomas + Lavallee (2014)

• female basketball players

• male footballers

• female tennis players

Smolak, Levine + Ruble (2000)

non-elite, power athletes report significantly less disordered eating than non-athletes

Souliard et al (2019)

athletes regularly report a more positive body image than non-athletes

Mongrain et al (2018)

non-elite endurance runners score low on disordered eating measures

a multi-causal phenomenon

most experts acknowledge eating disorders as multi-causal, a consequence of various combinations of “biopsychosocial” factors (Breuner, 2010)

strong social element in relationships + literature where it is strongly accepted that it is socially prescribed
met with vulnerable individual who might internalize those social expectations

individual risk factors

research shows several personal afflictions to be regularly associated with increased eating disorder risk

• increased levels of perfectionism (Hasse, 2011)

• high social physique anxiety (Bradturd, Parmer, Whitehead + Eklund, 2010)

• low self-esteem (Petrie, Greenleaf, Reel + Carter, 2009)

individual risk factors: subtext

it is the vulnerability of individuals, not the cultural environment that leads to eating disorders

• this idea takes the “pressure” off certain toxic coaching environments

sport + society

sporting pressures to be thin are in addition to the pressures that exist in wider society… eg. mass/social media

athletes can be torn between Western feminine body ideals and athletic body ideals

• athletes not immune to generic pressures

• research on women rugby players regularly stating “I have a positive body image (functional +important for sport) but when out with friends, I feel different)

the thin female ideal

“exposure to the thin ideal; internalization of the ideal; and experience of a discrepancy between self and ideal, which in turn leads to body dissatisfaction, dietary restraint, and restriction”

• what we would say Western society decides is / states is physically attractive for females

Striegel-Moore + Bulik, 2007

thin ideal: male perspective

there is evidence that an overarching cultural preference for thinness as a mark of beauty has growing relevance for men

• research says that there is also an element of thinness that is expected of men

critical coach comments

simplistic connection between weight and performance in a sport that is high skill drive - not especially a close relationship

speaking about a sport where you don’t need your regular brain to sit down because power, strength and explosive attributes

cultures of surveillance to self-surveillance

body composition surveillance (regular weigh-ins, skin-fold measurements, weight targets ext) breeds self-surveillance and preoccupation with weight

• weight targets typically without support on how they might be achieved

• weight is lowest dominator to consider + easy to suggest it without suggesting why it’s needed / how someone might achieve it

skinfold feedback (Cosh et al 2015)

how do exercise physiologists report skinfold measurement results to athletes?

• moralising of scores lower than previous tests…”keep it up”

• athlete satisfaction kept in check…

• what is low enough? (never defined / never considered)

caliper test

typically carried out by physiologists to measure athlete’s fat levels

during those tests, put a voice recorder in the middle of the meeting, pressed record, and got a naturalistic data of what goes on during a Caliper test

analyzed the types of messaged and say what was going on during that test - subconsciously weight loss / maintenance is good and any change is bad

broader “sport ethics” (Papathomas, 2018)

the sport ethic depicts the values of the archetypal athletic hero; the pursuit of excellence, personal sacrifice, and the tolerance of pain and risk. In a bid to uphold this dominant value system, athletes may go to extreme lengths to the point of engaging in risky and dangerous behaviours. From a disordered eating perspective, abstaining from bad foods and tolerating persistent hunger uphold the sport ethic

core signs versus the “good” athlete

discussing nutrition a lot —> “taking responsibility”

obsessing over calories in and out —> “single-mindedness”

regimented diet —> “self-sacrifice”

exercising beyond schedule —> “commitment”

weight loss —> “success”

prevention (Sundgot-Borgen + Torstveit, 2010)

advocate, de-emphasize, use, refer, dispel, make

intervention studies

• intervention studies have typically adopted a psychoeducational approach

• considered essential due to poor treatment outcomes (typically 50% success or lower)

• to date, programmes have invariable demonstrated negligible effects

• minimal long-term follow-up

what happens when athletes leave athletic culture?

participants judge retired bodies against former bodies (Greenleaf, 2002)

retired gymnasts reported persistent body dissatisfaction and disordered eating (Kerr et al 2006)

perceived weight gain, muscle loss, and pathogenic weight control behaviours (Stirling et al, 2012)

retirement perspectives of retired female swimmers / gymnasts

Papathomas et al 2018

four themes

1. a move towards the feminine ideal

2. feeling fat, flabby and ashamed

3. a continued commitment to a former self

4. conflicting ideals: the retired female athlete paradox