This year's #NEDAwareness week is February 21- February 27, 2022. It is "an annual campaign to educate the public about the realities of eating disorders and to provide hope, support, and visibility to individuals and families affected by eating disorders", hosted by the National Eating Disorders Association (NEDA).
Eating disorders are a commonly overlooked aspect of mental health. In the United States alone, over 20 million women and another 10 million men will suffer from eating disorders during their lifetime. In the NCAA,
"Up to 84% of collegiate athletes report engaging in maladaptive eating and weight control behaviors, such as binge eating, excessive exercise, strict dieting, fasting, self-induced vomiting, and the use of weight loss supplements."
(Power, Ksenia. “Disordered Eating and Compulsive Exercise in Collegiate Athletes: Applications for Sport and Research.” The Sport Journal, 31 Jan. 2020, https://thesportjournal.org/article/disordered-eating-and-compulsive-exercise-in-collegiate-athletes-applications-for-sport-and-research/)
If you're surprised - rightfully so. 84% is a huge number.
This means, more than likely, someone you know has suffered from disordered eating behaviors. It may have been your teammate, or an athlete you coached. Maybe it was the SEC player of the year, or the Olympian you've looked up to since you were a child. Maybe it's you.
Eating disorders don't just look like what we see in movies and media. They affect people of all genders, and all sizes, and all races, and while they are more commonly diagnosed in athletes who participate in "aesthetic" sports (gymnastics, skating, swimming etc.), they happen in every sport.
My purpose in publishing this article is to educate the athletics community - coaches, staff, administrators, athletic trainers, and even fans - and to help athletes recognize and understand warning signs, and know that they are far from alone.
What Are Eating Disorders & What Causes Them?
NEDA defines eating disorders as "serious but treatable mental and physical illnesses that can affect people of all genders, ages, races, religions, ethnicities, sexual orientations, body shapes, and weights".
Causes and risk factors of eating disorders often include a combination of biological, psychological, and sociocultural factors. This means that there may be a genetic component to eating disorders, such a as close relative with an ED or other mental illness, as well as psychological predispositions such as anxiety, perfectionism, and body dysmorphia.
Sociocultural factors likely also play a large part in eating disorders, such as society's weight stigma, in conjunction with a mental health stigma. This also includes bullying, historical trauma, and acculturation.
The Consequences of Eating Disorders
Eating disorders are the most deadly mental health disorder, and carry with them serious adverse effects on the body.
Most significantly, insufficient caloric intake leads to the breakdown of muscle - including cardiac muscle. This often leads to low blood pressure and heart rate, significantly raising the risk of heart failure. Additionally, purging and laxative use common in sufferers of bulimia nervosa can lead to an electrolyte imbalance, which can cause irregular heartbeats and consequently also heart failure.
Neurologically, eating disorders can result in altered abilities to concentrate, focus, and sleep. It can also lead to numbness and tingling in hands, feet, and other extremities, as well as fainting, dizziness, seizures and muscle cramps.
Other effects include dry skin, hair loss, reduced ability to fight infection, and anemia, among others.
Why Athletes Are Particularly at Risk
Athletes are held to incredibly high standards of performance, and often these can become intertwined with physical expectations.
NEDA states, "the pressure to win and an emphasis on body weight and shape can create a toxic combination. Athletic competition can also be a factor contributing to severe psychological and physical stress. When the pressures of athletic competition are added to an existing cultural emphasis on thinness, the risks increase for athletes to develop disordered eating".
Not only is there an existing cultural emphasis on thinness, but there is a double standard for athletes. Female athletes are expected to meet both the standard of an ideal athlete - defined muscles and six-pack abs - while also adhering to societal idealizations of the female body - thin and curvy.
This is particularly prevalent in sports that emphasize appearance, weight requirements, or muscularity such as gymnastics, diving, bodybuilding, or wrestling, often called "aesthetic" sports. However, athletes in every sport are susceptible to the negative effects of cultural standards and toxic athletic environments.
Specific Concerns for Athletes
While all of the aforementioned health consequences are particularly concerning for athletes, they are also susceptible to conditions specific to athletic performance.
The Female Athlete Triad is defined as the combination of disordered eating, amenorrhea and osteoporosis by the American Family Physician Journal. This means a loss of bone density - which can lead to stress fractures and other skeletal injuries, alongside a pause or irregularities in the female menstrual cycle, which in the long term can lead to infertility.
Recently, the term Relative Energy Deficiency in Sport (RED-S) has been coined to encompass all of the same symptoms, while being inclusive of athletes of both genders. The good news is that, when caught early, the effects are reversible - hence why it is so important that all those in the sports community are educated about these conditions and able to identify the signs.
What Can We Do?
As parents, coaches, athletic, administrators, athletic trainers, sports medicine physicians and fellow athletes, it is our responsibility to turn the tide within sports culture. It can be incredibly frightening for athletes to acknowledge that they have a problem, and even more so to seek help and treatment in fear of being seen as physically or mentally weak.
Dr. Kathryn Ackerman of the Female Athlete Program at Boston Children's Hospital lays out guidelines for creating a safe environment for our athletes:
Increase awareness of the negative effects of low energy availability
Create safe standards for monitoring athletes’ body composition and weight
Eliminate toxic training environments in which athletes are shamed for the size and shape of their bodies
For this year's #NEDAwareness Week, I ask that all those in the sports community take the time to further educate themselves on eating disorders and their effect on athletes. It is imperative that we have a greater understanding of their signs and consequences if we want to effectively identify and treat them, and to create a safer environment for our athletes who may be struggling.
Over the course of the week , you will find an abundance of educational content regarding eating disorders on my personal Instagram, @emilydurigan - and more significantly on @tho_setonhall, who will be collaborating with @spoon_shu to bring you fun challenges (yes, with prizes!), stories, and education surrounding eating disorders.
Interested in getting involved? You can find out more about #NEDAwareness week here.