1

Behavioral and physical consequences of Behavioral and physical consequences of disordered eating in young athletesdisordered eating in young athletes

Michelle Weinbender R.D.,Michelle Weinbender R.D.,Clinical Dietitian/Food and Nutrition Clinical Dietitian/Food and Nutrition

ServicesServicesProvidence Sacred Heart Providence Sacred Heart

Medical Center – SpokaneMedical Center – Spokane

Eat to Impact Performance: Disordered Eating Challenges for Performance

2

Any Any irregular patternirregular pattern of eating that includes food of eating that includes food restriction or avoidance of certain types of foods or restriction or avoidance of certain types of foods or consuming fewer calories than needed for health or consuming fewer calories than needed for health or sports activity but may also include overeatingsports activity but may also include overeating

Often, disordered eating can result in a diagnosed Eating Often, disordered eating can result in a diagnosed Eating Disorder, however, irregular eating that does not meet Disorder, however, irregular eating that does not meet criteria for an Eating Disorder should not be considered criteria for an Eating Disorder should not be considered less seriousless serious

What is Disordered Eating?

3

What Does An Eating Disorder Look Like?

• Anorexia Nervosa• Bulimia Nervosa• Binge Eating Disorder• Eating Disorder not otherwise specified

(EDNOS)• unofficial terms: anorexia athletica,

orthorexia nervosa, diabulimia

3

4

Eating disorders affect males and females of all ages, Eating disorders affect males and females of all ages, socioeconomic groups and ethnicities around the worldsocioeconomic groups and ethnicities around the world

Athletes in certain sports may be at greater riskAthletes in certain sports may be at greater risk3:1 ratio of girls to boys3:1 ratio of girls to boysOver the past decade, white, middle-to-upper class Over the past decade, white, middle-to-upper class

females ages 13 to 30 have been most affected. females ages 13 to 30 have been most affected. Only 5% of adolescents with disordered eating behaviors Only 5% of adolescents with disordered eating behaviors

go on to develop classic eating disordersgo on to develop classic eating disordersRecovery rates as high as 50% with early detection and Recovery rates as high as 50% with early detection and

treatmenttreatment

Prevalence and Prognosis of Eating Disorders

5

• Control weight or body shapeControl weight or body shape• Receive positive feedback for weight loss or Receive positive feedback for weight loss or

appearanceappearance• Intolerance to a type of food, perceived or actualIntolerance to a type of food, perceived or actual• Depression or anxietyDepression or anxiety• Belief that certain foods can enhance or diminish Belief that certain foods can enhance or diminish

performanceperformance

What is Intention/Reason for Disordered Eating?

6

These disordered habits do not necessarily warrant a These disordered habits do not necessarily warrant a diagnosis of an eating disorder, but could be diagnosis of an eating disorder, but could be concerning:concerning:

– excluding whole food groups (for example, all fats or all excluding whole food groups (for example, all fats or all carbohydrates)carbohydrates)

– eating only at particular times of the day eating only at particular times of the day – eating only specific foods eating only specific foods – eating aloneeating alone– eating large amounts of foodeating large amounts of food– exercising excessively beyond recommendationsexercising excessively beyond recommendations– exercising in secret or even when injuredexercising in secret or even when injured

Concerning Behaviors

7

• YOU can make a YOU can make a differencedifference– Teach healthy habitsTeach healthy habits– Create healthy body Create healthy body

imageimage– Improve self esteemImprove self esteem

• YOU can help your YOU can help your athleteathlete– Perform betterPerform better– Reduce risk of injuryReduce risk of injury– Enjoy lifeEnjoy life

Here’s the GOOD NEWS

8

And the BAD NEWS…

YOU cannot make your YOU cannot make your athlete lose weight, athlete lose weight, gain weight, make gain weight, make healthy choices, eat healthy choices, eat their veggies, drink their veggies, drink water, pick up their water, pick up their socks…socks…

UNLESS THEY WANT TO!!

9

• An athlete’s #1 source for nutrition An athlete’s #1 source for nutrition information is their COACHinformation is their COACH

• Coaches can play a major role in Coaches can play a major role in developing healthy eating habits for lifedeveloping healthy eating habits for life

• Coaches can play a major role in the Coaches can play a major role in the prevention of disordered eatingprevention of disordered eating

YOU have the POWER

10

Does my athlete need to change his/her weight?

Research does not support the idea that Research does not support the idea that lower body weight will increase lower body weight will increase

performanceperformance

11

Lots to consider…• Genetics, body weight history, bone Genetics, body weight history, bone

structure, sport, position, body structure, sport, position, body composition, health, stage of growthcomposition, health, stage of growth

• Growth and development can be Growth and development can be compromisedcompromised

• Consult physician and registered Consult physician and registered dietitian to set ranges that are dietitian to set ranges that are reasonable for the athlete as an reasonable for the athlete as an individualindividual

12

Weight vs BMIBody Mass Index

• BMI = weight (kg)/height (m2)– Underweight (< 18.5)– Normal (18.5-24.9)– Overweight (25-29.9)– Obese (30 +)

• Muscular people (athletes) tend to have a high BMI that may be misinterpreted as obese

• BMI was designed for population studies

13

Athletes, body weight and nutrition: THE TRUTH

• Food is fuel, you can’t train without it• “Healthy” is a range through which peak

performance can be achieved • Underweight may be more problematic

than overweight• Focusing on the scale is at best a

distraction and at worse a disease

14

Athletes, body weight and nutrition: THE TRUTH

• Poor nutrition can lead to increased injuries, decreased immunity and escalated mood changes

• Poor nutrition = hurt, sick and cranky athletes!

14

15

The period myth

• “My coach told me I knew I was training hard enough when I stopped getting my period”

16

Factors contributing to menstrual disturbance in female athletes

• Inadequate nutrition– Calorie supply < demand

• Exercise intensity• Low body mass index (BMI)• High stress

17

Female Athlete Triad-defined in 1993

• Disordered Eating• Amenorrhea (no periods)• Osteoporosis

The period reality…

American College of Sports Medicine

18

The New Female Athlete Triad• Components are interrelated but may

present on a continuum of severity

18

low energy availability eating disorder

menstrual disturbances amenorrhea

bone loss osteoporosis

19

Bone Mineral Density (BMD)

• Decreased BMD directly correlated with duration and severity of menstrual dysfunction

• Resumption of menses results in an increase in BMD– Even with resumption, BMD may never fully recover

• Direct effect of inadequate caloric intake on bone

20

What’s a coach to do ?

• Understand that our “pop” culture misleads athletes regarding nutrition

• Empower your athletes with good information- THE TRUTH

• Emphasize performance, not appearance– Watch the 3 letter words: fit and fat

21

What’s a coach to do ?

• If you feel an athlete’s weight is unhealthy or affecting their performance, recommend they consult with a sports nutritionist or physician

• Promote healthy, sports based eating• Be a source of support

22

Top 5 Tips to Promote Healthy Eating

1.1. Allow kids to see you eating healthy Allow kids to see you eating healthy snackssnacks

2.2. Decipher Fact from FictionDecipher Fact from Fiction3.3. Remind kids & parents FOOD=FUELRemind kids & parents FOOD=FUEL4.4. When traveling & home eat meals When traveling & home eat meals

togethertogether5.5. Educate athletes on importance of Educate athletes on importance of

CARBS, PROTEIN and FATCARBS, PROTEIN and FAT

23

Do CARBS make us fat?

24

NO! Carbs are an athletes #1 energy source!

• Carbs come from whole grains, breads, Carbs come from whole grains, breads, cereals, fruits, dairy and some veggiescereals, fruits, dairy and some veggies

• Dairy contains both carbs AND proteinDairy contains both carbs AND protein• Carbs also come from sugarCarbs also come from sugar• High sugar foods usually contain less High sugar foods usually contain less

nutrition - eat in moderationnutrition - eat in moderation• Half of what we eat should come from Half of what we eat should come from

carbohydratecarbohydrate

25

Balance Carbohydrates

• Grain servings: 1/2 cup pasta, 1 slice bread, 1 pancake, 3/4 cup cereal

• Each meal should provide 3-4 grain servings, 1 fruit, 1 vegetable and 1 dairy serving

• Snacks should contain carbs and protein

25

26

Does eating more protein create bigger muscles???

27

• Protein recommendations – Strength athletes .6-.9 g/lb bw – Endurance athletes .4-.7g/lb bw150lb football player: 150lb x .6g/lb = 90

grams • 4 oz chicken breast 30g • 2c. milk 16g• Turkey Sandwich 40g

• Protein shakes or bars may be helpful• High protein diets not advocated as

performance enhancing

Protein

28

What’s the Skinny on Fat?

Good Fats– Unsaturated Oils

• Canola, Olive– From nuts and plants– Omega 3 Fats

• Fish, walnuts, flax, supplement

• Bad Fats– Hydrogenated

• OK Fats– Trans– Some

saturated- animal fat

Fat gets a bad rap but is essential for good health

Need both unsaturated and saturated fats

29

When should we use sports drinks?

• For events < 1 hour, water is perfectFor events < 1 hour, water is perfect

• Use sports drinks if >60 minutes or Use sports drinks if >60 minutes or multiple eventsmultiple events

• Look for:Look for:– Carb- 14g/8oz servingCarb- 14g/8oz serving– Sodium- 100mg/8ozSodium- 100mg/8oz

30

#1 RULE: “Book End” your Workouts

• Eat before and after your workouts• If possible, include carbohydrates and

some protein in snacks and meals– Yogurt and Fruit– Chocolate Milk– String Cheese and Crackers– Boost meal replacement drink

31

Healthy Weight Loss: NOGAIN

• NNutrition: 250-500 calories less per day, high utrition: 250-500 calories less per day, high nutrientsnutrients

• OOff-Season: Avoid strength loss and energy ff-Season: Avoid strength loss and energy draindrain

• GGradual: No more than .5-1lb/weekradual: No more than .5-1lb/week

• AActivity: Increase in activity may be okctivity: Increase in activity may be ok

• IIndividual: Recognize unique differencesndividual: Recognize unique differences

• NNever use “rapid results” techniquesever use “rapid results” techniques

32

Tips for Gaining Weight• Eat three meals/day, every dayEat three meals/day, every day• In addition, at least two snacks (plus one In addition, at least two snacks (plus one

before bedtime)before bedtime)• Drink caloric beverages between mealsDrink caloric beverages between meals• Go for seconds- even if you don’t finish themGo for seconds- even if you don’t finish them• Make higher calorie choicesMake higher calorie choices

• Choose banana instead of appleChoose banana instead of apple• Pick Granola over CheeriosPick Granola over Cheerios

• Always carry snacksAlways carry snacks

33

The BEST way to eat- to stay LEAN and STRONG

• BreakfastBreakfast• SnackSnack• LunchLunch• SnackSnack• DinnerDinner• Snack (optional, are you hungry?)Snack (optional, are you hungry?)**Time meals and snacks no more than 3-4 **Time meals and snacks no more than 3-4

hours apart**hours apart**

34

• Sports Bars that provide a little fat and protein (i.e. Luna or Clif Bar)

• Low-fat muffin and skim milk• Microwaved egg (1.5 min) on English muffin • Hot cereal in a cup with 1 cup milk• Fruit and yogurt with whole wheat bagel• Yogurt with granola• Toaster Waffle with peanut butter and jam• String cheese and fruit• Boost meal replacement drink• Whole Grain Fig Newtons• Crackers with peanut butter• Carnation Breakfast Essentials

Snack Attack

Low in fat – High in carbs

35

Try this!• Provide a nutritional game plan: Have a sports Provide a nutritional game plan: Have a sports

dietitian talk to your teamdietitian talk to your team• Encourage athletes to adopt a physically Encourage athletes to adopt a physically

active lifestyle (even outside practice)active lifestyle (even outside practice)• Focus on accepting all body shapes and sizesFocus on accepting all body shapes and sizes• Hand out appropriate materials to provide Hand out appropriate materials to provide

your athletes with nutrition information. Quiz your athletes with nutrition information. Quiz them!!them!!

36

EAT, DRINK, WIN!

37

About WINForum

For more information visit www.winforum.org or e-mail questions/ comments to info@winforum.org

38

WINForum Online

39

Make the Game Plan Work for You

Find it in Downloadable Materials at www.winforum.org

40

Where to Go for More Info

www.winforum.org

www.eatright.orgwww.choosemyplate.gov

www.bestteendiets.org

41

Michelle Weinbender, RDMichelle Weinbender, RD

Clinical Dietitian/Food and Nutrition ServicesClinical Dietitian/Food and Nutrition ServicesProvidence Sacred Heart Medical Center – SpokaneProvidence Sacred Heart Medical Center – Spokane