Young athletes often set themselves apart with their intense drive to succeed and ability to push through physical discomfort. Those traits may lead to wins on the field or high scores from judges. But those same characteristics can also contribute to the development of eating disorders, including anorexia, bulimia, binge eating and excessive exercise disorders.
“Athletes have a very specific personality type,” said Jennifer Lentzke, MS, RD, CEDRD, CSSD, a registered dietitian with specialized training in eating disorders and sports nutrition. “They are overachievers. They push themselves to the limit. And they will often do anything to give themselves that edge. Those are high risk factors for eating disorders.” Rosewood Centers for Eating Disorders has a long track record of successfully treating young athletes with eating disorders. Lentzke, a former college cross-country runner and triathlete, shared her insights on preventing and treating eating disorder in young athletes.
Q. Are there specific sports most associated with eating disorders?
We see a lot of eating disorders in weight-specific sports, where the belief is that lighter is better. Cross-country running. Wrestling. Cycling. Then there are the aesthetic sports, where you’re judged in part on your appearance. Gymnastics, ballet, competitive cheer, diving. But there are eating disorders in every sport. Soccer, football, you name it. Just by the nature of participating in a sport someone is at a higher risk of acquiring an eating disorder, or exacerbating an eating disorder.
Q. How reliable is the way someone looks an indicator of an eating disorder?
There are times when it’s very obvious someone is too thin. But as a general rule, the way someone looks isn’t reliable. I’ve worked with many athletes you would never know were struggling. They may not fit the body type you’d imagine is associated with an eating disorder.
Q. Can athletes who go to treatment at Rosewood return to their sport?
Many can, yes. But it has to be done very carefully, on a case-by-case basis.
Some who enter into treatment are medically compromised and vigorous exercise isn’t possible. As they recover, we focus on light, mindful activity, like getting out and enjoying a walk. Those with less advanced disease may still be capable of significant exercise, but we avoid it because it can be a trigger.
It’s important to identify whether the exercise is fueling the eating disorder. We’ve had patients who run marathons not because they love running, but because it’s a way to achieve a certain body type. With adolescents, if they truly love their sport and they got into the sport not as a means to over-exercise or get a certain body type, we can work toward reintegrating their sport with their life in a healthy way.
Q. What is the process to help athletes return to their sport?
One thing I explain to teens is that their life is going to look very different than it did before. We help our young athletes with eating disorders learn to fuel their bodies for their health and nourish their brain. From a dietary standpoint, we establish a meal plan in treatment and determine what it will look like outside of treatment.
We work to optimize body composition and re-balance the endocrine system. We optimize blood levels of vitamins and minerals, such as iron, that are conducive to performance, and reduce stress hormones to allow the body and mind to heal and rejuvenate. It’s a mind-body transformation.
We also help them manage their recovery after treatment. We put parameters on how much they can train so they don’t over-train and go down that slippery slope of reacquiring their eating disorder. A cross-country runner might begin by doing the warm up with their team, then doing half the practice. We will pull back if they start to struggle again. Sports can be extreme. So are eating disorders. So you have to find that balance of allowing them to return to sport without setting them up for relapse.
Q. What about when returning to a sport isn’t possible?
There is a grieving process for many when they come into treatment. They feel they have lost their identity. We help all of our teen athletes identify who they are outside of their sport. If we can help them discover that, their odds of recovery and staying in recovery are better.
Not having your entire identity wrapped up in a sport is good for all young athletes, including those without eating disorders. What we want to equip them with is that resiliency so they don’t fall to pieces if they don’t get that scholarship, or things don’t work out as they were hoping for, which is just the nature of sports.
Q. What does getting control over an eating disorder do for an athlete’s performance?
99% of the time, their performance improves. Usually when they come in for treatment, their performance has declined. They feel terrible, but they just can’t stop purging or restricting or over-exercising. Much of the reason their performance is suffering is due to the physiological impact of eating disorders. They have lost muscle mass. Their hormones are out of balance. Tendons, ligaments and bone start to break down. Some have osteopenia and osteoporosis. Some have cardiac issues – the heart is a muscle. As it starts to break down, it’s able to pump less blood. Fortunately, these cardiac issues are reversible.
There is also the focus factor. When engaging in an eating disorder, research shows you actually lose gray matter in the brain. Athletes find that over time, especially if it’s a sport like gymnastics that takes a lot of technical skill, their performance decreases due to what’s happening in the brain.
Q. Does athletes’ inherent drive bode well for their recovery?
Yes! They do very well in the recovery process because they’re able to deal with adversity. They know how to do difficult things. That’s the energy we want them to channel into their recovery. The prognosis for athletes is quite good because they have that personality type.