Eating behaviour lays on a spectrum. On one end of the spectrum is intuitive eating. Intuitive eaters eat when hungry and stop when satisfied. Intuitive eaters view eating as pleasurable and include a variety of healthy foods in their diet. They have a positive body image and peace with their body.
On the other end of the spectrum is a clinical eating disorder. Eating disorders meet the clinical diagnostic criteria according the Diagnostic and Statistical Manual of Mental Disorders (DSM). Some categories of eating disorders include:
Anorexia Nervosa: Restriction of calorie intake leading to a low body weight. A person with anorexia has an intense fear of gaining weight or becoming fat and disturbances in self-perceived weight.
Bulimia Nervosa: Eating a large amount of food in a discrete period of time (i.e 3 hr-period) followed by inappropriate compensatory measures to prevent weight gain such as, vomiting, fasting, laxative and/or diuretic usage, excessive exercise. A person with bulimia negatively evaluates their weight and shape and feels that this matters more than anything else.
Binge eating disorder: Eating a large amount of food in a discrete period of time (i.e 3 hr-period) with no inappropriate compensatory measures. A person with binge eating disorder often feels extreme embarrassment, self-disgust and guilt.
Orthorexia: An obsession with “pure” or “healthy eating” that leads to cutting out foods that are deemed unhealthy such as sugar, salt, animal products, foods treated with pesticide etc. People with orthorexia often feel extreme anxiety or guilt when healthy food is not available. While not formally diagnosable, this can still have a serious impact on health.
In between intuitive eating and an eating disorder, lays disordered eating. Signs and symptoms of disordered eating is very similar to what is seen in those with an eating disorder, and is still a major concern. This may include restricting food intake in order to control their weight, chaotic or compulsive overeating, distrust of body and food, not listening to hunger and fullness cues, inflexible food intake, stringent dietary rules, and/or compulsive exercise.
Athletes may move back in fourth on the spectrum of eating behaviour. Changes in career or training cycle may trigger movement from one end of the spectrum to the other.
Below are some signs and symptoms of an eating disorder or disordered eating. Most athletes struggling will not have all these signs and symptoms. Some athletes struggling may have no signs and symptoms and appear fine.
- Preoccupation with food, calories, body shape and weight
- Avoiding food related social activities
- Secretive behaviours in regards to food and exercise
- Refusing to eat certain foods or new practices with food such as cutting out entire food groups
- Skipping meals or taking small portions of food at meals
- Frequent bathroom visits after meals
- Wearing baggy or lathered clothing that hides body
- Dramatic or rapid weight loss or gain
- Excessive or compulsive exercise
- Exercising through injury or illness
- Missing or irregular periods, low libido, and decreased erectile function
- Fine hair on body
- Low body fat
- Bad breath, sore gums, or signs of enamel loss on teeth
- Swelling around jaws
- Calluses on the knuckles
- Dry skin and hair, and brittle nails
- Poor or declining mental health
- Increased criticism of one’s body
- Feeling out of control with food
- Body image dissatisfaction and distortion
Disordered eating or a clinical eating disorder can occur in athletes of any sport discipline regardless of gender, age, body size, caliber or athletic ability. Early identification and treatment of disordered eating and eating disorders is essential as this leads to better health outcomes. Treatment often requires a multidisciplinary team of health care professionals including a medical doctor, registered dietitian, and a psychiatrist.
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