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Background: Research suggests that the prevalence of eating disorders in athletes may increase with the level of competition. This presentation will focus on the recommended components of an intensive treatment program for athletes at the college and elite levels of competition. Discussion will include staff make-up, nutritional, psychological, and medical recommendations.
Athletes and Eating Disorders: Intensive Treatment for High Level Athletes
Ron A. Thompson, PhD, FAED, Lori Richardson, RD, LD, and Roberta Sherman, PhD, FAED
I. Introduction
A. A special subpopulation
B. High level athletes
C. Intensive treatment
D. Resistance to treatment
E. How injury can facilitate treatment
II. Treatment Staff
A. Philosophy
1. Understanding importance of sport
2. Appreciation for importance of sport
3. Make sport performance a treatment issue
B. Intensive treatment staff
1. Experience/expertise in treating athletes
2. Experience as an athlete
C. Sport Psychologist
1. Clinical
2. Mental training
D. Athletic Trainer
1. Rehabilitation
2. Training consultation
3. Managing training
E. Sport Dietitian
III. Sport Nutrition Therapy
A. Female Athlete Triad
1. Low energy availability
2. Amenorrhea
3. Osteoporosis
B. Meal scheduling/timing
1. Pre-competition
2. Recovery nutrition
C. Hydration
D. Ergogenic aids
IV. Special Treatment Components
A. Body image
1. Body image within sport
2. Body image outside sport
B. “Good Athlete” traits
1. Traits that enhance performance may increase risk
2. Use by therapist
C. Sport family
1. Role in disorder
2. Role in recovery
D. Medications
1. Effects on sport performance
2. Drug banned list
E. Sexual Abuse/Harassment
F. Relapse prevention
1. Emphasis on leanness and performance
2. Revealing uniforms
3. Competitive thinness with teammates/competitors both inside/outside sport
4. Issues with coaches (i.e., assertiveness regarding weight, sexual harassment, etc.)
V. Special Treatment Issues
A. Treatment resistance
1. Withholding training to motivate the athlete
2. Does the athlete want to return to sport?
B. Decisions regarding training/competition
1. Training/competition don't increase risk
2. Treatment progress
3. Desire to stay in sport
C. Rationales for training during treatment
1. Attachment
2. Identity, self-esteem, etc.
3. Monitoring
4. Facilitates eating
5. Motivation
Eating disorders continue to be a significant problem for many athletes. Research suggests that the prevalence of such problems in athletes may increase with the level of competition. Increased risk is likely due to the fact that the differences in performance at high level competitions may be as small as a fraction of a second in timed sports or a fraction of a point in judged sports. Athletes at the college and elite levels of competition are looking for an "edge." With the continued belief in sport that the leaner athlete performs better, serious athletes are willing to do whatever is necessary to attain that "edge," including engaging in the use of restrictive dieting, pathogenic weight loss methods, and excessive training. Sometimes the severity of the problem for athletes is such that it requires intensive treatment. This presentation will focus on the recommended components of such a treatment program for athletes at the college and elite levels of competition. Topics to be discussed will include but not be limited to: Treatment philosophy of treatment staff, expertise and experience of treatment staff, treatment resistance, special nutritional issues and needs, injury rehabilitation, medication issues, training decisions, body image, mental training, sexual abuse/harassment, relapse prevention, and aftercare recommendations. Time will be allotted for questions and discussion.
Ron Thompson is Co-Director of the Victory Program at McCallum Place. He has been a consultant on eating disorders to the NCAA, where he coauthored the "NCAA Coaches Handbook: Managing the Female Athlete Triad." He also coauthored the Disordered Eating section of the IOC Medical Commission’s Position Stand on the Female Athlete Triad. His publications include "Bulimia: A Guide for Family and Friends," "Helping Athletes with Eating Disorders," "The Exercise Balance," and "Eating Disorders in Sport." He is a Fellow in the Academy for Eating Disorders (AED). Dr. Thompson and Dr. Roberta Sherman jointly received the AED’s 2008 Leadership Award.
Lori Richardson, RD, LD, completed her BS in Nutrition and Dietetics and dietetic internship at St. Louis University. She has worked in eating disorders, sport nutrition, and wellness since 2003. She is a member of the Academy of Nutrition and Dietetics, Missouri Dietetic Association and St. Louis Dietetic Association (SLDA). She served as the SLDA president from 2011-2012. She is a member of the dietetic practice group Sports, Cardiovascular and Wellness Nutrition (SCAN). She is a participant of the Missouri Eating Disorders Panel and St. Louis Eating Disorders Network. She is currently employed as a dietitian at McCallum Place.
and
Roberta Trattner Sherman, PhD, FAED
Roberta Sherman is Co-Diretor of The Victory Program at McCallum Place. She has served as a consultant on eating disorders to the NCAA, where she coauthored the NCAA Coaches Handbook: Managing the Female Athlete Triad. She also coauthored the Disordered Eating section of the IOC Medical Commission’s Position Stand on the Female Athlete Triad. Her publications include Bulimia: A Guide for Family and Friends, Helping Athletes with Eating Disorders, and Eating Disorders in Sport. She is a Fellow in the Academy for Eating Disorders (AED). Dr. Sherman and Dr. Ron Thompson jointly received the AED’s 2008 Leadership Award.
