Disordered eating habits and prompts for prevention in at-risk populations

“Food is so fundamental, more so than sexuality, aggression, or learning, that it is astounding to realize the neglect of food and eating in-depth psychology”.

We live in a society where our relationships with food are not determined by availability or nourishment rather, instant weight loss and emotional healing. We are flooded with bad nutritional advice, and begin framing our principles on nutrition is during the onset of adolescence.

Today women have begun to enter sport with more social acceptance and individual satisfaction. Coincidentally both the number and gravity of sports injuries, nutritional and mental health concerns have increased dramatically and athletes are now in need of dietary information once limited to elite male athletes [1]. Even with great progress made over the last few decades’ attitudes towards women concerning nutrition have been slow to change because of many misunderstandings.

Body image consists of internalized thoughts, feelings, and attitudes an individual has about their physique and how others perceive them [2]. In more recent years, women have been expressing their beliefs in being just as good and skilled as a man can be in their athletic career…’ but still remaining attractive’ [3]. Our culture focuses on what the female’s body looks like rather than what it is capable of. Due to this, playing sports can improve one’s body image however, females struggle with the social ideals which emphasize certain types. Many people believe that eating disorders are physical problems, but what recent literature has shown is any type of disordered eating pattern stems from psychological issues [4].

Often times when people hear the term “disordered eating,” (DE) one may assume it’s interchangeable with an eating disorder (ED. As blurring as the names make it seem, these terms are not interchangeable. DE includes a range of irregular eating behaviors that do not necessarily meet the criteria for severe eating disorders, such as anorexia nervosa and bulimia nervosa [5].

Statistics can’t catch everything

Clinical practitioners generally only see patients with extreme symptoms. The statistics depicted in most cases represent only those cases known to medical professionals.

We are currently unaware of the number of individuals who experience mild to moderate manifestations [6]. Individuals that engage in such behaviors often have underlying psychological conditions, which may or may not always be severe enough for clinical diagnosis. [7].

DE is a multifaceted problem with various interlocking causes and social, familial, and genetic links [8]. The term is now used to refer to a range of complex behaviors instead of narrowly defining a pathological state. The condition comes in many forms which range from avoiding food altogether, to consuming a highly restricted and regimented diet, along with various forms of purging or binging, experience feelings of guilt about eating and over-exercising to compensate for excess food. Most often, disordered eating presents as a combination of two or more of these behaviors. This is because there is no single cause or standard type of disordered eating. [9].

The problematic scenario which arises in cases of DE is due to the fact that seemingly healthy individuals are not perceived as having behavioral issues with food. Athletes are at higher risk than the general population for unhealthy eating habits, and risk is heightened for athletes in weight controlled sports. Up to 70% of elite athletes competing in weight class sports (male and female) are dieting and have some type of disordered eating pattern with the goal to reduce weight before competition [10]. The differences in prevalence rates among studies are likely related to variability in the studies which include methodological differences [11].

Dissatisfaction is prevalent among US women and being worried about your body and weight is considered part of being female [12]. The risk of developing a classified eating disorder is about three times higher in women than men [13]. Sports that emphasize thinness culturally whether it aids in the performance or not as well as a weight-controlled sport have higher incidences of eating disorders [14]. The more competitive individuals are, the more likely they are to have the train of thought which is similar to those who display disordered eating patterns [15].

There are two time periods that are particularly crucial for proper development and preventing the onset of unbalanced eating habits. When an individual approaches adolescence one becomes extremely vulnerable due to the excess of changes and social interactions [16]. Trends begin to occur in puberty simply because of the vulnerable time period individuals face as well as that is when most athletes began to attempt competitive sport. Collegiate athletes are particularly vulnerable to disordered eating when the transition from home to the college environment adds to the stress of performance pressures and the high demands of the sports environment [17].

Two critical factors often initiate and may serve as red flags for disordered behavior: anxiety and the inability to adjust to environmental stressors. Females who are naturally prone to high anxiety, self-consciousness, obsessive characteristics of perfectionism are more likely to experience body image issues [18]. People with disordered eating aren’t just having problems with food. They typically may have one or more of the following: ineffective coping strategies, low self-esteem, personal identity issues, and lack of perceived control. In most cases, food is a symptom — disordered food behaviors are manifestations of deeper problems. The individual looks at food not as the necessary nutrition for performance enhancement but rather as a way to exert control [19].

Anything you can do, I should do differently

Proper diet is paramount for all individuals to maintain adequate energy during activity and for recovery. Due to the lack of nutritional knowledge, we base our ideal diet on other individuals who have been successful or look a particular way rather and an individualized approach that works best for our situation. Many individuals alter their nutritional intake for short-term-instantaneous goals. Referring to data which only represents males or sedentary women are ways to lead female athletes to an uphill battle of long term problems, even if there is an immediate gain in performance. The detailed approaches which may work for a male are positioned around underlying physiological factors that are not exact when compared to females. The success of selected women in such cases gives false hope and a poor perception which makes all women think they can do the same thing for similar results. Females have intrinsic factors both physiological and sociocultural, which males will never experience. However, although the behaviors tend to occur in females more often, the incidences of males are on the rise [20–25].

Conclusion

Inadequate nutrition can affect more than decrements in performance. Consequently, an inadequate amount of energy, as well as a surplus, will create problems. Due to the increased energy expenditure of exercise and/or the pressure to obtain an optimal training bodyweight, some female athletes may develop low energy availability, menstrual dysfunction

and a loss of bone mineral density [26–28.].

A study found that 67 percent of elite female athletes who dieted to improve their performance did so primarily to comply with their coach’s requests. Coaches who hold expectations regarding nutrition should be properly educated in not only dietary needs but psychological factors and preventive measures as well. It is the combination of improper information, neglect of mental health, and cultural expectations that dictate these thoughts and make it hard for athletes to fuel themselves for the specific goal [29].

The female athlete Triad is relatively common among young females participating in sports, however, the Triad is also present in non-competitive active females. Therefore, prevention of one or more components should be geared towards all physically active girls and young women [30]. Learning about personalized nutritional requirements which the individual needs to sustain their activity would be of great importance to coaches, athletes, and parents. Studies that aim to assess nutritional knowledge and body image in female athletes susceptible to disordered eating and high anxiety profiles may be beneficial for future research.

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