Athletes and Eating Disorders- Part 2

If you missed part 1 of Athletes and Eating Disorders, you can scroll down a little to read it, or you can click here! I had the honor of interviewing Nancy Matsumoto (co-author of The Parent's Guide to Eating Disorders and a free-lance writer in NYC--follow this link for more on Nancy!), who is working on completing Toolkits for NEDA (National Eating Disorders Association) that are geared towards coaches and trainers. Both disordered eating and eating disorders impact many athletes, and one of the ways to promote health amongst athletes is to educate coaches and trainers, who are in unique positions of influence to point athletes towards the proper treatment and care of their bodies. Nancy, in my previous post, mentioned a phenomenon called the Female Athlete Triad, that I wanted to expand on (courtesy of NEDA).

Below is NEDA's description of this term/phenomenon:

The Female Athlete Triad includes 1) disordered eating, 2) loss of menstrual periods and 3) osteoporosis (loss of calcium resulting in weak bones). The lack of nutrition resulting from disordered eating can cause the loss of several or more consecutive periods. This in turn leads to calcium and bone loss, putting the athlete at greatly increased risk for stress fractures of the bones. Each of these conditions is a medical concern. Together they create serious health risks that may be life-threatening. While any female athlete can develop the triad, adolescent girls are most at risk because of the active biological changes and growth spurts, peer and social pressures, and rapidly changing life circumstances that go along with the teenage years. Males may develop similar syndromes.

The Female Athlete Triad puts female athletes at risk, and also inhibits their athletic performance. I am glad Nancy mentioned this because it is something that not many people know about (even in the field of eating disorders!). Below are the last few questions/answers of my interview with Nancy- I hope that you will find this informative (like I have)!

Me: What are some things that you have been struck by or learned about eating disorders and athletes through this process?

Nancy: One thing I’ve learned about athletics and eating disorders is that for the coach, the line between encouraging athletes to achieve peak performance levels and promoting unhealthy eating and training behaviors is blurred. For this reason, when coaches and trainers, are told they need to be more vigilant in spotting and addressing dangerous behaviors it can sound to them like their ability to do their jobs is being questioned and curtailed. They want to create winning athletes, and the traits that create champions—perfectionism, the desire to please coaches, and strong drive to succeed—are those often associated with eating disorders. They may fear that in order to encourage healthier behaviors among their athletes, they will have to discourage the very traits that make their athletes excel. What we hope the Toolkit will do is show that the better nourished and healthier the athlete is, the better her or his performance will be, and that although eating-disordered behaviors may seem to improve performance in the short run, in the long run they do not support athletic excellence.
Me: For many elite athletes who are competing at world class levels (whether collegiately, professionally, in the Olympics, etc), particularly in sports that may encourage (implicitly or explicitly) a high degree of scrutiny over body composition and weight for performance purposes (gymnastics, ice skating, running, wrestling, etc), eating disorders and disordered eating are increasing. Do you have any thoughts about how we might work towards helping athletes approach their performance and bodies from a more healthy standpoint?

Nancy: Yes, education and support for both athletes and coaches is very important. Some coaches are still not fully aware of the risks for and dangers of eating disorders among their athletes. We hope that once they do understand the facts, they will be open to discussing these risks with the team, stop making negative comments about weight or size, establish a zero tolerance policy for eating disordered behaviors, and foster a climate in which an athlete feels she or he can discuss these issues without fear of reprisal. For athletes, it’s great to have a sports nutritionist speak to the team about the importance of adequate fueling and hydration in their sport, to go over the warning signs for problem eating and exercise behaviors, and to encourage them to seek help at the earliest signs of a problem.

A lot of these strategies are about de-stigmatizing eating disorders, making athletes understand that disordered eating and eating disorders are a common problem among athletes, and that they can and should be discussed. Athletes should also know where there is help available, and that these problems can be solved with the right professional treatment. In many athletic settings, lack of knowledge about eating problems creates a climate of fear among eating-disordered athletes that makes it very difficult for them to admit to this problem. This causes a lot of suffering in silence. All the recovered athletes I spoke to talked about the tremendous stress of having to perform while also sustaining their disorder in secret.

When the Toolkits are completed and available, I will be sure to post a link so that any of you who may be interested in passing this information on to a coach you know, an athlete that you know, or if you are a coach/athlete yourself that desires this information, that you will be able to access it! By raising more awareness and promoting education for coaches and trainers, we can hopefully provide more care and restore health to those who are suffering from eating disorders and disordered eating. For more information on eating disorders, follow this link to access the National Eating Disorders Association site.

Athletes and Eating Disorders- Part 1

Just a few days ago, I was saddened to read about a 16 year old high school sophomore named Krista Phelps, who recently lost her battle to anorexia. A talented, high school athlete from Des Moines, Iowa, Phelps collapsed and died while running. Just a few days prior, she had been 'healthy' (according to this article) and competing in her second state track meet. The community is grieving this devastating loss, and in the midst of their grief, some interesting questions about athletes and eating disorders are being raised. This is not a new topic of discussion- many athletes have come forward to share their experiences with eating disorders and disordered eating (read about Tanith Belbin's story here). An anonymous coach is quoted in this article about Phelps as saying "anyone who's coached girls sports long enough knows of at least one [girl who has had an eating disorder]."

There seems to be a very fine line among athletes who train to be as fit as possible to achieve their best performance, while also remaining healthy and taking good care of themselves. It seems to me that coaches are in a unique position to pick up on warning signs and act as a liason for their athletes who may be struggling with an eating disorder by directing them towards the proper treatment. The challenge is that many coaches do not know what to look out for, and do not always know how to handle such fragile and potentially life-threatening situations! For that reason, the National Eating Disorders Association (NEDA) has initated a project to make toolkits for trainers and coaches. Nancy Matsumoto, who co-authored The Parent's Guide to Eating Disorders and has written for publications such as People Magazine, The LA Times, The NY Times and The Wall Street Journal (among others), has been appointed to create these toolkits. I had a chance to ask her a little more about how she got involved and what NEDA is doing to help come alongside coaches to support athletes who struggle with eating disorders. In light of Krista Phelps tragic death, I think this is something that would benefit us all to hear.
Me: I have been excited to hear that you are working with NEDA to make toolkits for trainers and coaches to help educate them about eating disorders. I know that this is still a work in progress and is not yet available, but can you share a little bit about your involvement with this project?

Nancy: Sure! Through my work as a former People magazine correspondent and as co-author with Marcia on The Parent’s Guide to Eating Disorders, I have reported various articles on eating disorders and body image. NEDA asked me to bid on the job of Toolkit Coordinator for their newest online Toolkit for coaches and trainers, and I was lucky enough to be contracted to do the job. NEDA’s existing online Toolkits are the Parent Toolkit and the EducatorToolkit. I started working on the Toolkit in January. At the moment, the Advisory Committee, made up of about a dozen experts in the field, is reviewing the Toolkit. We hope it will be online in late spring or summer, and will be publicized at the NEDA conference in New York City in the fall. We are now brainstorming on ways to publicize the Toolkit, so you can definitely help with that by telling your readers about it. If you have other ideas of ways to publicize the Toolkit, please let me know!
Me: What kind of information is being provided to trainers and coaches in these toolkits, and what are the goals of such a project?
Nancy: The first sections of the Coaches Toolkit will provide basic information on the different eating disorders: anorexia, bulimia and EDNOS, binge-eating disorder and disordered eating. It will answer frequently asked questions and debunk common myths about eating disorders; detail factors that put athletes at risk for eating disorders (for example participating in a weight-class sport, such as crew or wrestling, aesthetic sports, such as gymnastics or figure skating, or endurance sports, cross country, Nordic track skiing); discuss eating disorder symptoms common to athletes, and the Female Athlete Triad (a syndrome of three interlocking symptoms, disordered eating, irregular periods and low bone mass). There will be sections on encouraging healthy exercise among athletes, the role of the coach in eating disorders, and prevention among middle and high school athletes. Oh, and there will also be athletes’ own stories and conversations with professionals: nutritionists, psychologists and coaches themselves. The goal is to reach out to, educate and offer support to coaches and trainers who are on the front lines of eating disorders, but often do not know how to recognize or handle the problem.

I think that Nancy highlighted very well an issue that is all too common- coaches and trainers, who are on the front lines, need education and support to properly handle athletes with eating disorders. To see what else Nancy had to say, check back here soon for the rest of her interview! And to find out a little bit more about Nancy, follow this link to view her website!

Busting an Eating Disorder Myth..

We've all heard the saying "Don't judge a book by it's cover." When it comes to weight and eating disorders, I don't know if we have really operated this way. What I mean by this is represented in a commonly held myth about eating disorders-- which is that you can usually tell when someone has an eating disorder because of their size. Yes, when someone is very underweight, that is typically an obvious indicator that someone is anorexic. However, someone who struggles with either bulimia or an eating disorder not otherwise specified (also known as EDNOS- the third and only other current eating disorder (aside from anorexia and bulimia) recognized in the Diagnostic and Statistical Manual of Mental Disorders) is typically of average weight or overweight. In fact, you might be surprised to learn that you can't tell by looking at someone if they struggle with bulimia or not.

A recent article published on Newsweek.com addressed this myth. The article, entitled Finding A Healthy Medium: Eating Disorders Don't Discriminate Based on Size, by Kate Dailey, is one worth reading. It is so important to be aware of the facts and to know that eating disorders affect people of all shapes and sizes. This article also addresses BED (binge eating disorder). Follow this link to read the article.

I read a great blog entry a few days ago on parents, adolescents and body image-- topics that have been on my mind a lot lately due to the nature of my work! For parents who are trying to navigate the rough waters of a child or teenager who is struggling with an eating disorder and poor body image, it can be daunting and difficult to know how to respond. For this reason, I often recommend a great book to parents called The Parent's Guide to Eating Disorders, written by Marcia Herrin and Nancy Matsumoto. I had a chance to ask Dr. Herrin a few questions which I will share with you below; she happened to also write the blog entry that I mentioned. Whether or not you are a parent, I think this information can be helpful because you likely have parents yourself, or parental figures in your life, or maybe you know young adults, children or teenagers that you work with, mentor, teach, volunteer with, etc.. While some of this info may not apply directly, some of it can be adapted to encourage healthy attitudes with food. To access the blog that Dr. Herrin writes with Nancy Matsumoto (who is doing some exciting work with athletes and eating disorders that I look forward to sharing with you soon), follow this link- the blog entry is copy and pasted below as well.

Watch Dieting and Bad-Body Talk in front of your Kids

In brand-new, not yet published research, my friend and colleague Dianne Neumark-Sztainer and colleagues at the University of Minnesota and the University of California, San Diego have found that messages from parents about weight and body image have a significant effect on adolescent body image. I have worked with a number of families in which a child, usually a daughter, is all of a sudden worried about her weight triggered by a parent who is dieting and/or talking a lot about how much she (or he--dads can have an affect here too) doesn’t like her body. I tell parents that if they are going to diet, DON”T TALK ABOUT IT!! in front of the kids. Dianne’s group also found that when parents when parents eat well, overweight teens tend to follow their example. Watch for this study: Family Weight Talk and Dieting: How Much Do They Matter for Body Dissatisfaction and Disordered Eating Behaviors in Adolescent Girls? in next issue of the Journal of Adolescent Health.

I think that it is important to point out that parents are not to blame for eating disorders!- however, there are ways that a parent can impact her child for the better and support the child in such a way that is effective! I had the awesome opportunity to ask Marcia Herrin, a nutritionist specializing in working with eating disorders and weight issues, a few questions, and wanted to share some of the helpful tips that she suggests for parents. Dr. Herrin is very respected in the eating disorder field- she founded the Dartmouth College Eating Disorders Prevention, Education and Treatment Program. She has a masters in public health as well as a doctorate in nutrition education. She currently runs a private practice and works with children and adults struggling with eating disorders and weight issues. For more information on Marcia, follow this link.

Me: You and Nancy have partnered together in your book The Parent's Guide to Eating Disorders. This book provides a lot of very helpful information for parents who may be worried about their children's eating attitudes and behaviors. If you could share two or three helpful tips for parents raising children, what might you say to them to help them to encourage healthy attitudes about food?

Marcia: Do not comment on your child's weight. Eat together as a family as often as possible. Do not talk about dieting or weight issues (yours or anyone else's) in front of your child. Do make sure lunch and dinner meals include protein and dessert.

Me: If you are a parent who suspects that your child is struggling with food, whether an eating disorder or disordered eating, what steps might you encourage them to take to help their child?

Marcia: First call your child's doctor or your area's most respected expert for their assessment of the situation. Then talk directly (calmly and kindly) to your child about your concerns and observations. Let them know that you are worried but not mad. In our book we say if you are "open, receptive, curious, honest, tentative, and work hard at understanding your child's point of view... no matter what words you use, your chances of success will be greater."

Me: Chapter 8 in your book is wonderful. It touches on body image and the ways that our own body image affects the body image of our children (and by extension those around us). Can you share a little bit about how a parent's negative or unhealthy view of their body or food can affect a child? Do you have any advice for parents who struggle with their body image or self-esteem?

Marcia: "Keep it to yourself" is the advice I give parents about their own struggles with body image or self-esteem. One of the riskiest situations is when a child observes one parent teasing the other about their weight or eating habits. Parents, even if they struggle to believe it themselves, need to preach "it is not what you look like that matters; it is who you are as a person and what you do."

Me: You write about PAMS (Parent-Assisted Meals and Snacks) and appear to have much success with this model, which has been adapted slightly from the Maudsley method. Can you share the heart behind this method and the success that you have seen with teenagers that you have worked with?

Marcia: One strength of PAMS comes from "saving face." When parents take over responsibility for the eating disordered child's food, the child has to eat even if she doesn't want to. She doesn't have to give up her eating disorder. She can relax knowing her parents aren't going to let her starve to death. She doesn't have to agree to eat, she is made to eat. PAMS helps parents know what and how much to feed their child. Some parents can figure this out on their own, but PAMS helps parents who are stressed and overwhelmed by their child's eating disorder hit the ground running with an approach to food that works. I have been in the field of eating disorders for nearly 25 years and I have never seen any other technique turn an eating disorder around as dramatically as PAMS does.

For more information on PAMS and other related topics, check out The Parent's Guide to Eating Disorders. If you are a parent who struggles with body image or food, the most important thing that you can do for your child is to work towards being healthy yourself! Whether that means seeking out a nutritionist, a therapist, or a consultation with your doctor, it is critical for you to be the very best you that you can be, for you and for your children! When Marcia says 'keep it to yourself' regarding your struggles, she means do not talk to your children about it. But it is okay and vital to talk about it with professionals, friends and family members if you are dealing with these feelings and behaviors.

App-orexia??

Apple has secured a pretty dominant place in pop culture (and the world of technology!) and continues to do so with every increasing product that they put out--it's hard to imagine life without the iPod:). Just yesterday, the iPad came out and people woke up in the middle of the night to go wait in line to purchase one. There are many perks of having an iPad (or an iTouch, or an iPhone, etc)- one of them is that you can download applications, or 'apps' as they are commonly referred to. There are over 3 billion (!!), and they serve a variety of purposes (entertainment, news, health, finance, etc).

Something that I have noticed lately is the increased attention being given to apps that are designed to assist people in their dieting endeavors... by tracking their daily intake of food and calories. I read a really good article recently (which you can read here) that challenges the notion that these apps cause eating disorders. A lot of articles have come out saying that these apps cause eating disorders, but many people use these apps to count their daily caloric intake and never develop an eating disorder (although this does not elevate my opinion of them- more on that in a minute). Eating disorders are not usually 'caused' by one thing (for more on this and other eating disorder myths, follow this link). People with a genetic predisposition to developing an eating disorder may be triggered by using a calorie counting app, but the app is not usually the culprit. One phrase that I have heard often (as related to causes of eating disorders) is that 'genes load the gun, and environment pulls the trigger.'

While these apps may not cause eating disorders, I think that they can foster an unhealthy dependence, as well as an unhealthy attitude towards food and calories. It is important to be able to fuel our bodies and get what we need nutritionally, and it is good to be knowledgeable about healthy portion sizes! But if we cling too tightly to numbers, whether it is how many calories we are eating, or the number that is on the scale, I think that we run the risk of being occupied with the wrong things. Health is important. And our health does not just consist of our physical health- it consists of our emotional health, our mental health, and our spiritual health as well. I think that each component of our health is extremely important and without one piece, we cannot function at an optimal level. Rather than getting hung up on numbers, it might be to our benefit to focus on our overall health- how we feel, how quickly we can recover when we are active, building character, finding lasting significance, identity and purpose through faith, and working to maintain stability and positive coping skills through the ups and downs of life!