Rare gem: article on EDs and sports that gets it

A set of pieces in the Atlanta Journal-Constitution about high school athletes and eating disorders is 100% recommendable.

Instead of flogging one clinician's press release and illustrating it with one "heroic" fighter (see yesterday's blog post), these journalists have really explored the breadth of this topic and let the issues unfold. No parent-bashing, no patient-shaming, psychobabble-free.

I was completely clueless about youth sports before my daughter took up cross country. I didn't know that eating disordered thinking draws kids to these sports, and I didn't know that clear symptoms of illness are misunderstood, ignored, and sometimes even encouraged by coaches and trainers.

Newspapers have entire sections devoted to high school sports. How much print is spent on the casualties? So glad to see these issues really being explored. That's the first step.


  1. Great points Laura. Several studies around the world in the past ten years have shown a much higher rate of AN among athletes than within the general population. Although it is commonly believed this is because athletes want to "look good" in "appearance" in sports, an alternative hypothesis gaining ground in the scientific community is that certain sports that require lots of energy, including distance running, rowing, gymnastics, figure skating, and others, can lead to what's called "low energy availability." This means that when the person is burning lots of calories in physical activity, but is not consuming more calories to make up for the greater caloric requirements, the body can no longer sustain all its functions and shuts down the ones not needed for survival. Often the first to go in women is the reproductive cycle. If there is still not enough energy available, parts of the brain are shut down or altered to save energy. (It is amazing how much energy our brains need to operate normally.) While these adaptations may have helped our ancestors survive famine, it appears they may also be significant contributors to AN. In other words, the lack of energy availability (i.e. not enough calories) might actually cause the changes in the brain that lead to the disordered thinking characteristic of AN. So why are athletes particularly susceptible to AN? One possible explanation is that in some people the brain's hunger and satiety signals simply don't adequately signal them to eat more even though the amount of exercise they are doing increases. This has been observed in people and also in laboratory animals. This leads, inadvertently, to not eating enough, the resulting energy imbalance, and ultimately low energy availability. It's not that the person has an underlying psychopathology or bad parents. It's just that their body is not telling them to eat more when they exercise more. Once the biological changes caused by low energy availability take hold, however, the resulting patterns of thought and behavior become hard to break. It makes sense, then, if this is what's happening, that the best medicine would be food, and that Maudsley treatment would be effective.
    A good book on eating disorders in women's athletics, by the way, is Carol Otis's, The Athletic Woman's Survival Guide. Otis is a doctor at UCLA who works with many of the athletes there. Other sources of interesting reading include the Academy of Sports Medicine Position Stand on the Female Athlete Triad, www.acsm.org. A biologist at Ohio University, Anne Loucks, has done much of the leading work on energy availability in female athletes. Several of her papers are available on the web. Loucks has shown that athletes, including women, can do HUGE amounts of exercise without ill effects, as long as they eat enough to fuel their bodies and avoid energy unavailability.
    What all this means to me is that when a young person goes into athletics, it is imperative to keep a watchful eye on their eating habits. Losing weight should set off alarm bells immediately. Early intervention is needed to restore the person to full nutrition, before the bilogical changes have occurred. This is where I feel I made a mistake as a parent with my d. I assumed that as she began to run cross country and compete in rowing, she would naturally eat more to compensate for an increase in caloric requirments. But she didn't. I don't think it was because she was trying to starve herself; I think it was because she wasn't getting accurate hunger signals from her brain. Also, I think she was skipping meals, including breakfast (she was rushing out the door in the mornings to get to school on time) and lunch (runners who eat a big lunch find that running in the mid-afternoon on a full stomach is uncomfortable). Before we knew it, the energy unavailability had become AN.

  2. Hey,

    I was a high school athlete and am now a college athlete and really appreciate your post.

    The reason I started playing sports, is that I thought I would lose weight and look better. I DID lose weight, but I didn't feel much better about my physique. I still struggle with obsessing about my food intake and making weight for my competitions.

    I wish that this information was available to me and other students when I was active in high school, because I think it would have helped alot of people to understand why/what they were doing.

    I wasn't the only one who started sports because of weight and image issues instead of for the joy of playing.

    There is a great online community that I'm apart of at www.DailyStrength.org. It's a forum for people with eating disorders as well as for people that are trying to live healthier.

    I really think that they would benefit from your insight. If you want to check it out, you can go to..


    thanks so much! and keep blogging!

    Warmest Regards-
    Chantal P.

  3. I think that this is a very important topic and that needs addressing.
    I used to tell my daughter to just run for fun, not to compete, if she wanted to run. I'm not the competitive sort.
    The difficult part is the private place in the mind that can start taking them down the wrong track. I think my daughter's motivation was to have a group of friends and she went along.It turns out that she was the one with the legs for running and she was fast. It probably doesn't take long to see the physical "rewards" of running. I know a walk or hike makes me feel better than sitting around. Our body is designed to move.
    Still, in hindsight I can see back where cross country became my daughters first form of purging. The meets were lined with on-lookers and most teens are well aware that they are being observed. There's pressure right their to "look" good though you rarely see a smile.
    Sadly, we don't have to look far to see someone obsessed with being thin and willing to push themselves beyond the limits.
    For anyone in sports they first need an education on the fundamental needs of an athletes body, nourishment first. The pasta parties, the night before a meet, may have been a good start here in our town but awareness to the risks and better trained coaches is a must. It can't wait!

  4. Laura, great article. I ran college cross country and saw many of my team mates struggle with issues around what to eat and over training. That is a tough sport because as the article points out less weight means more speed. I also think there are other ways runners can attain a higher performance, especially when it comes to girls there are many cross country runners with more muscular and athletic body types. Bottom line--you need the nourishment to be the best you can be. I hope there is a way for coaches to address this issue.

  5. These are great ideas. I think it is also important for doctors to be better educated about the dangers of undernutrition in athletes. Our d was cleared by her primary care doctor for cross country and competitive rowing two years ago, then was so ill with anorexia she was hospitalized only about a month later. It's now clear there were lots of red flags, including a substantial loss of weight, that the doctor assured us were nothing to be too concerned about when he cleared her for sports. I don't mean to be critical, but it seems that many doctors don't learn all that much about anorexia in medical school, and those who went to med school many years ago didn't necessary get accurate information. A local group I'm working with is sending doctors who are really knowledgable about eating disorders to speak at continuing education seminars and educate primary care physicians about the seriousness of the problem and the latest information about warning signs and treatment.


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