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Identifying Eating Disorders in Sport: Guidance for Coaches

Updated: Nov 10, 2020



Eating disorders can have a hugely negative impact on athlete health and wellbeing, as well as their sport performance. Early identificationis important for facilitating recovery and the earlier individuals get support, the lower the health risks. Coaches are in a good position to identify eating issues by way of their regular and close interactions with athletes. Being aware of the symptoms of disordered eating and eating disorders can help coaches to detect early warning signs, identify athletes who may be struggling and take steps to support their recovery. Below are some of the core characteristics and signs of the most common eating problems:


Characteristics and signs of disordered eating

  • Weight loss can indicate restricted food intake, but restriction is not always a feature of disordered eating

  • Changes in eating behaviour and attitudes, for example, using extreme, restrictive or faddy diets

  • Exercising more than usual, beyond what is set by the coach

  • Changes in psychological wellbeing such as becoming increasingly emotional, anxious, withdrawn or irritable

  • Reduced performance in training and/or competitions

  • Physiological issues such as frequent injury or illness, loss of strength and poor recovery from sessions


Characteristics and signs of Anorexia Nervosa

  • Food restriction, leading to significantly low body weight

  • Weight loss that may be gradual or sudden

  • Intense fear of weight gain/fatness (despite low weight)

  • Considerable preoccupation with food and weight

  • Disturbances in body image


Characteristics and signs of Bulimia Nervosa

  • Recurrent binge eating (consuming excessive amounts of food in short periods of time and feeling out of control)

  • Purging to compensate and prevent weight gain. Might include fasting, over exercising, self-induced vomiting, laxative abuse)

  • A binge-purge cycle that occurs at least once a week for three months

  • Self-worth and self-esteem are closely linked to weight/shape

  • Disappearing after meal times or evidence of secret eating behaviours

  • Gastrointestinal problems; evidence of vomiting unrelated to illness


Characteristics and signs of Binge Eating Disorder:

  • Recurring episodes of binge eating with episodes marked by feelings of lack of control

  • Eating very quickly and when not hungry

  • Evidence of hiding food

  • Significant weight gain (although this may not always be the case)

  • Likely to experience feelings of disgust, guilt, embarrassment and distress

  • Binge eating occurs at least once a week for three months


In addition, Other Specified Feeding or Eating Disorder (OSFED) captures non-typical eating disorders and refers to instances where individuals meet some, but not all of the criteria for an eating disorder. It is common for symptoms to not fit with the exact diagnostic criteria, as eating disorders may present in different ways. However, OFSED is every bit as serious as anorexia, bulimia or binge eating disorder.


If you notice any signs or symptoms that you are concerned about, it is important to discuss this with the athlete if you feel able. Coaches should encourage help-seeking for mental health concerns, including disordered eating. It’s important to know how to get support for an athlete you are concerned about. For adolescent athletes, it may be appropriate to involve a welfare officer or engage with the athlete’s parent/guardian about your concerns. Athletes with suspected eating problems should be encouraged to seek support from a qualified professional. Athletes should be encouraged to see their GP, who may then refer them to a specialist.


Approaching an athlete with a suspected eating problem is never an easy task, and many coaches may feel that the topic is too personal in nature. The guidance below from UK Sport may help to manage the situation.


Four suggestions for approaching athletes

  1. Early: Be prepared for denial, as the athlete may not recognise that they have a problem. Denial may increase as time goes on and physical health and performance will continue to deteriorate, so don't wait.

  2. Directly: Honesty is crucial and helps reduce the risk of unhelpful collusion with the athlete’s secrecy and denial. However, it can be helpful to avoid the term ‘eating disorder’ and instead focus on the athlete’s health and wellbeing.

  3. Confidentially: Respecting the athlete’s confidentiality around other team members is really important. However, you might make the initial approach with another member of the support team e.g. a nutritionist.

  4. Supportively: Being critical or judgemental is unlikely to be helpful. Gently mention that there appears to be a problem and invite the athlete’s views. Be emotionally supportive.


Some athletes may welcome an opportunity to engage with help and support. However, for many, considerable resistance and denial can be expected. The most important thing is to make the athlete aware that there are concerns about their health. The decision to get support has to come from them, but you can reiterate that you will support them through their recovery.


Expanding your understanding of disordered eating and eating disorders can help you to recognise and support athletes who may be struggling. However, although coaches might find themselves well-placed to detect issues with an athlete’s eating, they should not take full responsibility for an athlete's health or establish themselves in the position of ‘athlete therapist’. Coaches can help to create an environment that facilitates recovery, but the treatment of eating issues should be led by qualified professionals.


 

Further information and support can be found here:

BEAT, The UK's Eating Disorder Charity

Mind, The Mental Health Charity



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