Eating Disorders and Active People

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Eating disorders among active people seem to be on the rise. The staff at health clubs commonly express concerns about some of their clients, as do coaches about their athletes, especially athletes in sports that emphasize weight, such as running, gymnastics, and wrestling. Research indicates that eating disorders are widespread among athletes in all sports. An estimated 15 to 30 percent of collegiate female athletes have some type of disordered eating pattern, be it anorexia, bulimia, laxative abuse, excessive exercise, crash diets, or other unhealthy weight-loss practices that place them at risk of developing a full-blown eating disorder (Beals and Manore 2002). Most people with eating disorders exercise compulsively, either to create a calorie deficit and be thinner or to burn off the calories consumed during a binge.

Approximately half of all dieters report abnormal eating binges. Many of these dieters abuse exercise as a means to help control their weight. Some call themselves athletes, when in reality they could be better named compulsive exercisers. Many live in fear of becoming fat, and they constantly restrict their food in hopes of losing weight. They live with chaotic eating patterns and body hatred.

I estimate that at least 40 to 50 percent of my clients are obsessed with food, and they represent only a minority of people who seek professional nutrition guidance. Most people who are obsessed with food struggle on their own for years before asking for help. They are embarrassed that they can't seem to resolve their food imbalances. One 65-year-old woman, a regular at the health club, confided that I was the first person in 50 years to whom she had talked about her bulimia.

For these people, food is not fuel. It is the fattening enemy that thwarts their desire to be perfectly thin. Their goal is thinness at any price, and that price is often guilt, shame, mental anguish, physical fatigue, injuries that fail to heal, anemia, weakened bones, stress fractures, and impaired athletic performance. These athletes perform suboptimally because they eat poorly. One high school runner failed to connect her inability to finish track workouts with her one-banana-a-day diet. She thought she fell asleep in classes because she had stayed up too late studying, not because she was underfed.

If you struggle with anorexia or bulimia, I recommend that you seek help from a professional counselor experienced with eating disorders and obtain nutrition guidance from a registered dietitian. (See Eating Disorders in appendix A for Web sites that offer referral networks.) Extreme eating disorders usually reflect an inability to cope with the day-to-day stresses of life.

For example, a woman in charge of fund-raising for a charitable organization smothered her stress with homemade chocolate-chip cookies, warm from the oven. This treat certainly diverted her attention from her problems, but it didn't resolve any of them. Afraid of gaining weight, she'd burn off the calories with a long workout that was pure punishment. She became injured from the excessive exercise, panicked at her inability to exercise, tried to eat next to nothing, became ravenous, binged, and then resorted to self-induced vomiting as a means of purging the calories because she could no longer exercise the way she desired. She came to me looking for help with food. I insisted that she also get psychological counseling to help her deal with stress and her feelings of being out of control.

Eating disorders plague all types of casual exercisers and competitive athletes, males and females alike, and perhaps even you or one of your friends. About 4 percent of female athletes struggle with anorexia, 39 percent with bulimia. Among male athletes, an estimated 1.5 percent struggle with anorexia, 14 percent with bulimia. These numbers (Beals and Manore 2000), if anything, are conservative because people who feel ashamed about their eating habits commonly give inaccurate self-reports.

These numbers also exclude the large group of people with subclinical eating disorders who do not fit the diagnosis of anorexia (because they have a seemingly normal weight) but have an abnormal relationship with food and spend too much time thinking about food and weight. They fritter away each day, trying to get thinner.

In-depth interviews of women with subclinical eating disorders delineate these characteristic eating behaviors:

  • They restrict their calorie intake to lose weight and eat a repetitive diet, with little or no variety in the types and amounts of foods they consume.
  • They follow strict dietary rules and experience guilt and self-anger if they break one of their rules.
  • They limit their intake of "bad foods" and usually choose low-fat or fat-free foods.
  • Almost all these women perceive themselves as being slightly to very overfat and are preoccupied with weight (Beals and Manore 2000).

Surprisingly, women with subclinical eating disorders tend to have higher body fat than normal eaters do, despite exercising more and reportedly eating less than their normal-eating counterparts. They also tend to consume less dietary fat than the normal eaters do. These findings challenge the two commonly held nutrition beliefs: (1) The more you exercise, the thinner you'll be, and (2) avoiding dietary fat helps you lose body fat.

The women seemingly adapt to the combination of intense exercise with high calorie expenditure and restricted calorie intake. The big deficit causes the body to shut down and conserve energy (similar to hibernation). As mentioned in chapter 13, this seems to be nature's survival technique to prevent women from becoming too thin to reproduce.

Research suggests that those women who maintain a stable weight actually do get the calories they need, but through chaotic binge eating (Wilmore et al. 1992). Yet, if you believe that your body is hibernating, and you think that you eat less than you "deserve" to eat given your exercise level, the solution in both cases is to increase your daytime calorie intake gradually to an appropriate level, stop living in calorie deficit, and curb binge eating. You can do this by adding about 100 calories to your daily intake for four days, then adding another 100 calories for the next four days, and so on until you approach your calorie requirements as outlined in chapter 15. A registered dietitian can be very helpful in this process.

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