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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
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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?
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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
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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
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• 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?
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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
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• 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
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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!!
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• 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
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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
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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
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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
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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
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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!
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The period myth
• “My coach told me I knew I was training hard enough when I stopped getting my period”
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Factors contributing to menstrual disturbance in female athletes
• Inadequate nutrition– Calorie supply < demand
• Exercise intensity• Low body mass index (BMI)• High stress
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Female Athlete Triad-defined in 1993
• Disordered Eating• Amenorrhea (no periods)• Osteoporosis
The period reality…
American College of Sports Medicine
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The New Female Athlete Triad• Components are interrelated but may
present on a continuum of severity
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low energy availability eating disorder
menstrual disturbances amenorrhea
bone loss osteoporosis
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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
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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
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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
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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
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Do CARBS make us fat?
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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
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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
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Does eating more protein create bigger muscles???
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• 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
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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
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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
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#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
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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
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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
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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**
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• 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
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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!!
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EAT, DRINK, WIN!
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About WINForum
For more information visit www.winforum.org or e-mail questions/ comments to [email protected]
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WINForum Online
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Make the Game Plan Work for You
Find it in Downloadable Materials at www.winforum.org
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Where to Go for More Info
www.winforum.org
www.eatright.orgwww.choosemyplate.gov
www.bestteendiets.org
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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
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