People with an eating disorder have negative beliefs about themselves and about their eating, body shape and weight. This has an impact on their physical and mental health, education, relationships and quality of life.

Eating disorders are much more common among athletes than the rest of the population. An American study on college athletes suggested that 33% of female athletes had symptoms and attitudes that place them at high risk for anorexia. This was backed up by a 2001 UK study of distance runners that found out of 184 female athletes, 29 (16%) had an eating disorder. Of these, 3.8% had anorexia nervosa, 1.1% had bulimia nervosa and 10% had a sub-clinical disorder or EDNOS (eating disorder not otherwise specified). This is not to say that men are not affected at all, only that the incidence rate of these conditions seems to be higher in women. These statistics have lead UK Sport to consider running as a ‘high risk’ sport for eating disorders.

There are five main eating disorders:

  1. Anorexia Nervosa
  2. Bulimia Nervosa
  3. Binge Eating Disorder
  4. Other Specified Feeding or Eating Disorder (OSFED)
  5. Avoidant/Restrictive Food Intake Disorder (ARFID).

Most of these disorders develop in adolescence, but may not be recognized until adulthood. However, the earlier treatment starts, the better the long-term outcomes.

The exact cause of eating disorders is not known, but it’s likely that there are several factors at play, rather than one single identifiable cause; for example, a mix of social, biological, psychological and interpersonal causes.

Current research supports the use of several types of psychotherapies, including Cognitive Behavioural Therapy (CBT), interpersonal and family-based therapies, as well as some medications for the treatment of eating disorders.

View the BEAT eating disorders information poster.

Advice for athletes who suspect they have an eating disorder

Do I Have an Eating Disorder?

Eating disorders are complex mental illnesses. Anyone, no matter what their age, gender, or background, can develop one. Some examples of eating disorders include bulimia, binge eating disorder, and anorexia. There’s no single cause and people might not have all symptoms for any one eating disorder. Many people are diagnosed with “other specified feeding or eating disorder” (OSFED), which means that their symptoms don’t exactly match what doctors check for to diagnose binge eating disorder, anorexia, or bulimia, but doesn’t mean that it’s not still very serious. It’s also possible for someone’s symptoms, and therefore their diagnosis, to change over time. For example, someone could have anorexia, but their symptoms could later change so that a diagnosis of bulimia would be more appropriate.

Could you have an eating disorder?

If you haven’t had reason to know much about eating disorders previously, it may be that your understanding of them is based on the way they’re shown in the media, for example. This often portrays a particular type of story in terms of who gets eating disorders, what causes them, and what the symptoms are. This doesn’t necessarily reflect the full spectrum of eating disorders and people who can develop them.

  • Studies suggest around a quarter of people with eating disorders are male.
  • In 2015, 15% of the calls to the BEAT Helpline were about someone aged 40 or over.
  • According to a study (Fairburn & Harrison 2003), 80-85% of people with eating disorders are not underweight.
  • Stereotypes about who gets eating disorders might make them even harder to spot among older people, men and boys, and ethnic and cultural minority groups. The real number of sufferers overall could be much higher than we think, but particularly among groups like these.

Your circumstances, feelings, and symptoms may be very different to what you’ve seen or read about, but that doesn’t mean you can’t have an eating disorder. If you think you might be having problems with your eating or feel that difficult feelings or situations are making you change your eating habits or feel differently about food, you could have an eating disorder or be developing one.

You can read more about the symptoms of different eating disorders here. If you’re at all worried about yourself or someone else, it’s always best to seek help as quickly as possible, as this gives the greatest chance of a full recovery.

Eating disorders can be a way of coping with feelings or situations that are making the person unhappy, angry, depressed, stressed, or anxious. They are not the fault of the person suffering, and no one chooses to have an eating disorder. Sometimes people worry about talking to someone because they feel their eating disorder isn’t serious enough, they don’t want to worry people or waste their time, or because they feel guilty, embarrassed or ashamed. But no matter whether your eating difficulties began recently, you’ve been struggling for a while, or you were treated for an eating disorder in the past that you think might be coming back, you deserve to have your concerns acknowledged respectfully, to be taken seriously and to be supported in the same way as if you were affected by any other illness.

What can you do next?

Beat has lots of other information that you may find useful if you think you or someone you know has an eating disorder and as you start thinking about getting help:

The best next step is to book a GP appointment. The earlier you can get treatment, the better your chances of recovery. We have put together an information leafletfor people to take with them when they go for an initial appointment, with sections for people with eating disorders or concerned they have one, those supporting them, and the GP. The aim of the leaflet is to get you a referral to a specialist, who can assess your personal needs and develop a plan for your treatment.

Realising that you or someone you know might have an eating disorder can be very frightening, but remember that full recovery is absolutely possible, and Beat is always here to provide support.

Advice for coaches who suspect an athlete has an eating disorder

Food and diet are an important part of any athlete's training and competitive programme. For an athlete in any sport to perform well, they must get an optimum balance of nutrients and energy to maintain their health and then to support the amount of exercise they do.

Experimenting with diet is common in sport. Searching for a diet to improve performance is perfectly normal.

However, some athletes develop eating habits which will not only put their sports performance at risk, but can also endanger their health. As a coach, you may be aware that eating disorders exist in your sport, but may not know how to spot the warning signs and the best way to approach an athlete you suspect has problems with their eating.

Some of my athletes want to diet. Should I let them?

Only if the athlete is significantly overweight. Any diet should be compiled and monitored very carefully, ideally by an accredited sports dietician. The method of weight loss, the rate of loss and the intended target weight all need careful thought.

A diet that results in more than 1 - 2 lbs weight loss per week will cause loss of muscle mass. In order to maintain performance and health, weight loss should be monitored carefully.

Can an athlete really be too thin?

Yes. Ultimately, training and competing at a very low body weight with insufficient energy and nutrient intake can be dangerous and even fatal.

At the very least, the long-term effects of under-eating may cause a drop in performance and an increased risk of stress fractures. Ultimately it could mean that an athlete has to stop running or competing altogether.

Are eating disorders common in athletes?

Yes. Recent research shows that eating disorders are more common among athletes than non - athletes, and especially in endurance sports like distance running, sports where the body shape is scrutinised and weight category sports. The causes are seldom straightforward and differ with every case. In some cases athletes may develop an eating disorder because they see weight loss as a means to better performance (e.g. running faster); in others, people with an eating disorder become athletes because they see it as a means to faster weight loss. But not every athlete who diets will develop an eating disorder, just as thin athletes are not necessarily anorexic. It is important to be aware that the problem exists and that it is best to take action early.

Are there obvious signs I can look for?

An athlete may not be aware (or willing to accept) that their eating behaviours could be harmful.

Those that are aware may try to keep their condition secret. However there are physical, emotional and behavioural signs to look out for:

Anorexia

Physical signs

  • Severe weight loss
  • Periods stop or are irregular
  • Difficulty sleeping
  • Frequent dizzy spells
  • Stomach pains, constipation or bloating
  • Growth of downy hair on face, legs and arms

Emotional signs

  • Insists they are fat when they are actually underweight
  • Irritable
  • Sets unreasonably high standards
  • Obsessed with training harder and longer
  • Wants to run alone
  • More aware of food and calories
  • Becomes socially withdrawn (e.g. from team mates)

Behavioural signs

  • Starts exercising excessively beyond the training plan
  • Suspect they are lying about eating meals and refuses to eat in company
  • Willingly supplys food for others

Bulimia

Physical signs

  • Suffers frequent dehydration even when isn’t training or competing
  • Dental and gum problems
  • Extreme weight fluctuations
  • Menstrual irregularities
  • Muscle cramps and weakness
  • Swollen salivary glands at the side of face
  • Abrasions on back of knuckles from induced vomiting

Emotional signs

  • Depression
  • Increasingly self-critical, especially about their body and performance
  • Noticeable mood swings
  • Becomes socially withdrawn (e.g. from team mates)

Behavioural signs

  • Eats large quantities of food and is sick after meals
  • Starts diets which are unnecessary for appearance, health or performance
  • Visits the toilet or ‘disappears’ after eating
  • Takes laxatives or diuretics
  • Steals food and laxatives
  • Becomes secretive and lies about eating

I think they may have an eating disorder

Even if you're sure that an athlete has an eating disorder, they may not be willing to acknowledge it at first. Accept that they may deny a problem whichever approach you take. But don't let this deter you if you feel your suspicions are right. The best action is to raise the problem early, directly, supportively and confidentially.

Be prepared to listen and give time. Let them know that you are there if they want to talk to you. Your athlete will need support. They will want to feel accepted not just for their performance in sport, but for their existence as a person. Low self esteem is a common characteristic of eating disorder sufferers.

Should I seek professional help for him or her?

Only with their agreement. However, an athlete with an eating disorder will need to get professional help and support. It may be that by listening and being supportive, you can help them take the first step and encourage them as they recover. Some services may allow you to discuss your worries with them, keeping the confidentiality of the athlete, whilst also providing you with advice.

How do I support them as they get better?

The best way to help is to develop trust and friendship by being open, honest and supportive. However, recovering from an eating disorder can be painful and frightening. It will be difficult for them to hear comments from training partners like: "You are looking better", or "Good, you are putting on weight". Their reaction is likely to be, "Oh no, I am getting fat I will never be a good runner again - help - if I don't lose weight quickly I will get fat and slow."

Can I prevent eating disorders in my group of athletes?

Although sport is not to blame for causing an eating disorder, there are some ways in which the environment may increase the risk for the development of an eating disorder in a predisposed athlete. As a coach, you should be aware of the following factors:

  • Weight is largely determined by genetics, and bodyweight is only one of many components of overall fitness. Do not place too much emphasis on weight, especially publicly. For example, group 'weigh- ins' should be avoided.
  • Percentage body fat varies between individuals, but there is no ideal weight or percentage body fat for any event. The top performer in an event may happen to be one of the thinnest, but this is not necessarily the reason for their success.
  • Careful thought should be given to the value of measuring body fat in endurance athletes. It is not necessarily a reliable or valid measure on its own and it could be unhelpful in focussing unnecessary attention on weight.
  • Athletes are naturally very competitive. Avoid extending this competitiveness to include bodyweight or body fat percentages.
  • Eating disorders can 'spread' among the members of a training group. If one athlete loses weight, another may attempt to copy them; or if a naturally thin athlete is performing well, the others may think weight loss is the answer. Each athlete is different, so treat them individually.

The earlier the athlete seeks help, the sooner they can begin the road to recovery. As a result of recovering they can gain new confidence and begin to realise that there are other ways of coping.

This will also help to minimise the effect on their performance. They should never give up hope. Eating disorders can be beaten.

Download the coach/trainer guide here.

Source and credit: https://www.connectedcoaches.org/spaces/10/welcome-and-general/blogs/general/96/eating-disorders-a-coach-s-guide

Advice for teammates who think an athlete has an eating disorder

If you’re concerned a team member or athlete from another club might have an eating disorder, it can be difficult to raise the issue with them. You may worry you’ll say the wrong thing, that it’s none of your business, or that you’re insulting the person. Remember eating disorders are serious mental illnesses and are not the sufferer’s fault.

Often people with eating disorders deny or don’t realise there’s a problem, but that doesn’t mean they’re not ill. Eating disorders thrive on secrecy, and countless people who are in recovery agree that breaking the silence is the right thing to do, even if they didn’t feel that way at the time. The sooner someone can get treatment, the greater their chance of a full and sustained recovery.

Here are some things you can do when talking to someone you’re worried about:

  • Think about what you want to say and make sure you feel informed. You can read about the symptoms of eating disorders here. You could also take a look at the BEAT booklet: “Eating disorders: a guide for friends and family.
  • Choose a place where you both feel safe and won’t be disturbed. If you’re one of several people who have felt concerned, don’t talk to the person together as they may feel you’re ambushing them. Decide who they are most likely to open up to.
  • Choose a time when neither of you feels angry or upset. Avoid any time just before or after meals.
  • Have some information with you that you can refer to if you’re able to. You could share it with them, or leave it with them to look at by themselves.
  • Try not to centre the conversation around food and/or weight. While it may be necessary to bring this up to explain why you’re worried, these may be things they’re particularly sensitive about. At their roots, eating disorders are about what the person is feeling rather than how they’re treating food.
  • Mention things that have concerned you, but try to avoid listing too many things as they may feel like they have been “watched”.
  • Try not to back them into a corner or use language that could feel accusatory. “I wondered if you’d like to talk about how you’re feeling” is a gentler approach than “You need to get help”, for example.
  • They may be angry and defensive. Try to avoid getting angry in response, and don’t be disheartened or put off. Reassure them that you’ll be there when they’re ready, and that your concern is their wellbeing.
  • Don’t wait too long before approaching them again. It might feel even harder than the first conversation, especially if they didn’t react well, but if you’re still worried, keeping quiet about it won’t help. Remember, eating disorders thrive on secrecy.
  • If they acknowledge that they need help, encourage them to seek it as quickly as possible. Offer to go with them to the GP if they would find that helpful.
  • If they tell you there’s nothing wrong, even if they seem convincing, keep an eye on them and keep in mind that they may be ill even if they don’t realise it. Denial that there’s a problem is common – in the case of anorexia, it’s considered a symptom of the illness. You were worried for a reason, so trust your judgment.
  • If you need some support or have unanswered questions, call the BEAT Helpline on 0808 801 0677, or the Youthline on 0808 801 0711.

Below are some specific situations that you might encounter or be worried about during conversations with someone who has an eating disorder, and guidance about how to respond in a positive and encouraging way.

What if someone has told me they think they have an eating disorder?

If this is the first time you’ve needed to read about eating disorders, remember they are treatable illnesses, and full recovery is possible. The fact that the person has come to you suggests they would like to get better.

However, they have a much higher chance of recovery if they can get help quickly. They may have been experiencing symptoms for some time before speaking to you, so the sooner they can get treatment, the better. If there are other people they want to tell first, ask if there’s a way you can support them to do that.

Encourage the person to make an appointment with their GP. You could offer to go with them so they’re not alone. They may also find the BEAT “First Steps” GP guide helpful – this is intended to help people with eating disorders get a referral to a specialist from their GP. It contains guidance for the person who’s ill, anyone supporting them at the appointment, and the GP.

If you hadn’t suspected the person was ill, try not to blame yourself – this isn’t what the person you’re supporting needs. The best thing you can do now is take their concerns seriously, listen to what they have to tell you, and ask what you can do to help them get better.

If you’re feeling stuck as to how best to help, reading more about eating disorders and what the person you know might be going through is a good start. You can find out more here.

What if I say the wrong thing?

Not knowing the right thing to say to someone with an eating disorder can be daunting, and sometimes fear of saying something that may be accidentally upsetting can cause people to pull away and not say anything. It’s important not to do this – eating disorders can be very isolating, and the person will need support. If you aren’t sure what to say, just being there to listen makes a big difference.

While every person is different, there are ways you can try to keep conversations positive:

  • Try to avoid saying things that could feel critical, accusatory, or dismissive.
  • Asking how the person is feeling, rather than questions about eating or weight changes, is often more productive – it gives them the opportunity to talk about the feelings behind the eating disorder without making them feel their eating habits are being scrutinised.
  • Remember comments on appearance that you mean to be complimentary can sometimes be interpreted negatively – for example, “You’re looking well” may sound like a comment on weight. Compliments on things other than appearance can help the person feel valued and is less likely to cause these worries.
  • If the person is open to having conversations about their illness, you could talk to them about how those conversations can be useful, and invite them to let you know if you’ve said something that they don’t find helpful.

What if the person I’m worried about reacts negatively when I raise my concerns, or says they’re not ill?

It’s possible they don’t know they’re ill. Especially if they’ve been experiencing symptoms for a while, these symptoms have had time to become the person’s norm, which can make them difficult to recognise as part of an illness. Continued honest and open conversations with the person about your concerns, at a time when you have privacy and are feeling calm, can encourage them to realise that they need help.

If the person you’re worried about does respond negatively:

  • Try not to get angry or upset in response – this can feel like an attack, and it may add to the feelings of guilt and shame that those suffering from eating disorders may already be experiencing.
  • Be gentle but firm, and clear that the reason you’ve raised this is not to criticise – it’s that you’re concerned and care for them.
  • Try to give it time and encourage them to talk about what they’re experiencing. However, if you don’t feel the conversation can continue productively, don’t force it.
  • You could leave them with information about Beat’s website and Helpline, giving them the opportunity to see if any of this information is relatable to their experience.
  • Think about whether there’s anything you can learn from the conversation. Was there anything specific that the person found upsetting? Could you approach it differently?
  • Let them know that they can talk to you about any difficulties they’re facing at any time, and try to raise the issue again as soon as possible.

What if the person I’m worried about doesn’t feel able to go to the doctor?

There are many reasons someone might feel unable to seek treatment. For example, it can be difficult to give up what may be a way of coping, the illness can feel all-encompassing and make it hard to think about life beyond it, feelings of shame and low self-esteem can make people feel they don’t deserve help, and uncertainty about what treatment consists of can make people feel anxious.

  • It can be helpful to explore their reason for not seeking treatment further in a calm and supportive manner.
  • Reassure them that you want to see them get better and that you’re here to support them through treatment – they don’t have to do it alone.
  • You could make an appointment with the GP for them, and offer to go with them so that you can speak on their behalf if they’d find it helpful.
  • You could help them learn more about what treatment might involve by showing them the BEAT help and treatment page, which explains the different types of help available.
  • Providing details about the BEAT message boards and online support groups can also be beneficial, as they can hear from others who are in a similar position and can provide them with reassurance and guidance.

What if I’m supporting someone and they don’t feel their treatment is working, or don’t feel they want to carry on with treatment?

If the person you’re supporting is not finding their treatment effective, an open conversation with them could help them think about ways their treatment could better meet their needs. Encourage them to talk with the team delivering their treatment, and offer to go with them to talk about their options if they’d find that useful.

Sometimes the issue isn’t with the type of treatment they’re having, but that they’re struggling with the idea of recovery. Eating disorders are not, at their root, about food or weight; they are about feelings. For many people the eating disorder is a means of coping or feeling in control, and giving up something that may feel familiar and safe can be very challenging. Try to help the person explore these conflicted feelings and think about their motivations to recover. Encourage them to keep speaking to people about what they’re experiencing, rather than trying to deal with it on their own.

Who can I talk to about my own experiences?

Eating disorders can have a serious impact not only on the person suffering but the people around them too. If you’re feeling isolated or worried, BEAT support services are here for you as well – call the Helpline or join one of the support groups.

Adapted from: https://www.beateatingdisorders.org.uk/recovery-information/worried-about-friend