Behavioral and physical consequences of disordered eating in young athletes

1. Eat to Impact Performance: Disordered Eating Challenges for Performance Behavioral and physical consequences of disordered eating in young athletes Michelle Weinbender R.D.,Clinical Dietitian/Food and Nutrition ServicesProvidence Sacred Heart Medical Center – Spokane

2. What isDisordered Eating? Any irregular pattern of eating that includes food restriction or avoidance of certain types of foods or consuming fewer calories than needed for health or sports activity but may also include overeating Often, disordered eating can result in a diagnosed Eating Disorder, however, irregular eating that does not meet criteria for an Eating Disorder should not be considered less serious

3. 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 3

4. Prevalence and Prognosis of Eating Disorders Eating disorders affect males and females of all ages, socioeconomic groups and ethnicities around the world Athletes in certain sports may be at greater risk 3:1 ratio of girls to boys Over the past decade, white, middle-to-upper class females ages 13 to 30 have been most affected. Only 5% of adolescents with disordered eating behaviors go on to develop classic eating disorders Recovery rates as high as 50% with early detection and treatment

5. What is Intention/Reason for Disordered Eating? • Control weight or body shape • Receive positive feedback for weight loss or appearance • Intolerance to a type of food, perceived or actual • Depression or anxiety • Belief that certain foods can enhance or diminish performance

6. Concerning Behaviors These disordered habits do not necessarily warrant a diagnosis of an eating disorder, but could be concerning: • excluding whole food groups (for example, all fats or all carbohydrates) • eating only at particular times of the day • eating only specific foods • eating alone • eating large amounts of food • exercising excessively beyond recommendations • exercising in secret or even when injured

7. Here’s the GOOD NEWS • YOU can make a difference • Teach healthy habits • Create healthy body image • Improve self esteem • YOU can help your athlete • Perform better • Reduce risk of injury • Enjoy life

8. And the BAD NEWS… YOU cannot make your athlete lose weight, gain weight, make healthy choices, eat their veggies, drink water, pick up their socks… UNLESS THEY WANT TO!!

9. YOU have the POWER • An athlete’s #1 source for nutrition information is their COACH • Coaches can play a major role in developing healthy eating habits for life • Coaches can play a major role in the prevention of disordered eating

10. Does my athlete need to change his/her weight? Research does not support the idea that lower body weight will increase performance

11. Lots to consider… • Genetics, body weight history, bone structure, sport, position, body composition, health, stage of growth • Growth and development can be compromised • Consult physician and registered dietitian to set ranges that are reasonable for the athlete as an individual

12. 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

13. 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

14. 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! 14

15. The period myth • “My coach told me I knew I was training hard enough when I stopped getting my period”

16. Factors contributing to menstrual disturbance in female athletes • Inadequate nutrition • Calorie supply < demand • Exercise intensity • Low body mass index (BMI) • High stress

17. Female Athlete Triad-defined in 1993 The period reality… • Disordered Eating • Amenorrhea (no periods) • Osteoporosis American College of Sports Medicine

18. The New Female Athlete Triad • Components are interrelated but may present on a continuum of severity low energy availability eating disorder menstrual disturbances amenorrhea osteoporosis bone loss 18

19. 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

20. 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

21. 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

22. Top 5 Tips to Promote Healthy Eating • Allow kids to see you eating healthy snacks • Decipher Fact from Fiction • Remind kids & parents FOOD=FUEL • When traveling & home eat meals together • Educate athletes on importance of CARBS, PROTEIN and FAT

23. Do CARBS make us fat?

24. NO! Carbs are an athletes #1 energy source! • Carbs come from whole grains, breads, cereals, fruits, dairy and some veggies • Dairy contains both carbs AND protein • Carbs also come from sugar • High sugar foods usually contain less nutrition - eat in moderation • Half of what we eat should come from carbohydrate

25. 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 25

26. Does eating more protein create bigger muscles???

27. Protein • Protein recommendations • Strength athletes .6-.9 g/lb bw • Endurance athletes .4-.7g/lb bw 150lb 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

28. 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

29. When should we use sports drinks? • For events < 1 hour, water is perfect • Use sports drinks if >60 minutes or multiple events • Look for: • Carb- 14g/8oz serving • Sodium- 100mg/8oz

30. #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

31. Healthy Weight Loss: NOGAIN • Nutrition: 250-500 calories less per day, high nutrients • Off-Season: Avoid strength loss and energy drain • Gradual: No more than .5-1lb/week • Activity: Increase in activity may be ok • Individual: Recognize unique differences • Never use “rapid results” techniques

32. Tips for Gaining Weight • Eat three meals/day, every day • In addition, at least two snacks (plus one before bedtime) • Drink caloric beverages between meals • Go for seconds- even if you don’t finish them • Make higher calorie choices • Choose banana instead of apple • Pick Granola over Cheerios • Always carry snacks

33. The BEST way to eat- to stay LEAN and STRONG • Breakfast • Snack • Lunch • Snack • Dinner • Snack (optional, are you hungry?) **Time meals and snacks no more than 3-4 hours apart**

34. Snack Attack Low in fat – High in carbs • 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

35. Try this! • Provide a nutritional game plan: Have a sports dietitian talk to your team • Encourage athletes to adopt a physically active lifestyle (even outside practice) • Focus on accepting all body shapes and sizes • Hand out appropriate materials to provide your athletes with nutrition information. Quiz them!!

36. EAT, DRINK, WIN!

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41. Michelle Weinbender, RD Clinical Dietitian/Food and Nutrition ServicesProvidence Sacred Heart Medical Center – Spokane