Anorexia Athletica

1 January 2017

In the United States today, as many as 10 million females and 1 million males are fighting a life and death battle with an eating disorder (Collins). The two most commonly known eating disorders in America are anorexia nervosa, an eating disorder characterized by extremely low body weight, distorted body image and an obsessive fear of gaining weight and bulimia nervosa, an eating disorder characterized by recurrent binge eating, followed by purging.

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While eleven million is a startling number, eating disorders are even more prevalent among athletes, particularly those involved in types of sports that place great importance on the athlete’s weight and the need to be thin. The reasons for this higher percentage of eating disorders among athletes in comparison to non-athletes had been explained in several studies. However, there are several conflicting models of how athletic participation might be related to eating problems (Smolak).

Some studies have posited that there is no difference between anorexia in non-athletes and anorexia athletica, the common term for eating disorders frequent among athletes. While there are similar psychological factors at play in both cases, there are several unique features to athletes’ eating disorders that earn anorexia athletica a distinction from other disorders. Some studies suggest that the link between athletics and eating problems is nothing more than a greater frequency of common problems evidenced in non-athletes.

Certainly there are similarities in athletes and non-athletes suffering from eating disorders; in fact, there are many personality characteristics and attributes associated with eating problems that might also be descriptive of athletes: competitiveness, concern with performance, compulsive concern with body shape, and perfectionism (Brownell). The same competitive, perfectionist attitude that all elite athletes share can lead to distorted body image and ultimately lead to serious eating disorders.

While there is some credence to this theory, some studies go so far as to discount the label “anorexia athletica” completely which I believe to be an oversimplification of a serious disorder. The fact of the matter is eating disorders extremely high prevalence of eating disorders in athletes, especially female athletes, cannot be explained away by oversimplifications and generalizations. While the eating disorders in athletes and non-athletes have the same result: eduction in body fat mass, the reasons behind the changes are different. In anorexia athletica, the reduction in body mass is based on performance and accomplishment above all and not unwarranted distress about body shape and appearance (Sudi). When it comes down to it, athletes worry about weight to enhance their athletic performance, not to to fit into the latest fall fashions. There’s also a huge difference in the expectations of both groups – the athletes and non athletes.

While the expectations of non-athletes may be vague (“I’ll feel better” or “I look so hot in a bikini”), the athletes have a set of rewards and achievements they believes they’ll get if they lose weight whether it be lowering their 100 meter time or finally landing that triple axle (ANRED). The importance of thinness and demands for self-discipline invite the female athlete to believe that she is being “good” when she limits her food. It causes the belief that if she is good for a long enough period of time, she will improve her performance, win more often, and achieve more glory.

She associates weight loss with becoming quicker, faster, and stronger (Smolak). Another factor is that some athletes can perform well for a considerably long period despite the disorder. That influences their merit system and causes a belief that the eating disorder is required for the success and accomplishment. When their performance is begins to suffer, that in turn causes a belief the athletes need to cut back even more drastically than before to get the desired results (Mirror-Mirror). Athletes often have better excuses for not eating than non-athletes.

For example, on of the most common excuses for uncontrollable weight loss in athletes is that they simply don’t have time to eat because of competitions, training schedules, practice sessions, and traveling. Eating before practice or competition is impossible because the athlete is nervous, because it will make her feel heavy and slow, because it will leave her bloated, because it will make her sick to her stomach. Afterwards, she can’t eat because she would feel nauseated and hopefully she is to busy celebrating for anyone to think about food (ANRED).

Another difference between the two situations is that athletes can hide eating disorders more easily than non-athletic patients. The emphasis in athletics on low body fat and thinness, the stress, and the devotion and discipline required to comply, make it relatively easy for a female athlete to hide an eating disorder. It is quite easy to mistake weight loss due to not eating for weight loss due to eating right and exercising. Indeed, athletes may even receive praise and admiration from unwitting coaches and teammates for their self-control and denial of appetite (Mirror-Mirror).

Even within the group of athletes there are marked differences based on both gender and type of sport. Eating problems are more common amid female athletes than male athletes. A lot of female athletes descend into eating disorders in a desperate effort to be thin in order to gratify trainers (who may not be even educated enough abut eating disorders) and judges (Turk). Many trainers are responsible of compelling these athletes to become thinner by passing judgment on their weight or criticizing them. Those remarks could bring an athlete to choose hazardous means of weight control and can cause serious emotional damage to the athlete (ANRED).

Ninety-three percent of athletes who reported eating disorders according to one research were in women’s sports (Smolak). The sports that had the highest number of participants with eating disorders, in descending order, were women’s cross country, women’s gymnastics, women’s swimming, and women’s track and field events. The male sports with the highest number of participants with eating disorders were wrestling and cross-country (Collins). The female athlete is twice as at risk for the development of an eating disorder. She is influenced by relentless sociall strain to be lean that affects all females in westernized countries.

However, unlike non-athletes, she also part of a sports environment that may overvalue performance, low body fat, and an idealized, unrealistic body shape, size, and weight. Persistent exposure to the burden of the athletic subculture added to the shower of media and cultural images in the daily life may make her particularly susceptible to the trap of weight loss and unhealthy ways of achieving that loss. Males also develop eating disorders but at a much reduced incidence (90-95% female; 5-10% male). Males may be protected somewhat by their basic biology (Brownell ). Many fields of sports require low percentages of body fat.

As a general rule, men have more lean muscle tissue and less fatty tissue than women do. In addition, males tend to have higher metabolic rates than females for the reason that muscle burns more calories faster than fat does. Consequently, women, who overall carry more body fat than men, with slower metabolisms and smaller frames, require fewer calories than men do (ANRED). Several studies imply that those active in sports that underline appearance and a lean body are at higher risk for developing an eating disorder than those who are non-athletes or those involved in sports that require muscle mass and bulk (ANRED).

Eating disorders are more common in sports such as gymnastics, figure skating, dancing and synchronized swimming. It is also a problem in types of sport that require lean body, but do not stress “appearance”, like running, rowing, horse racing, and riding. Wrestlers, usually thought of as strong and massive, may binge eat before a match to carbohydrate load and then purge to make weight in a lower class (Sudi).

According to an American College of Sports Medicine study, eating disorders affected 62 percent of females in sports like figure skating and gymnastics. On the other hand, sports such as basketball, skiing and volleyball have noticeably lower rates of eating disorders (American College of Sports Medicine). In sports like cheerleading, figure skating and dance so much emphasis is placed on appearance and expression that athletes in those sports feel a great deal of pressure not only to compete well but to look good doing it.

While anorexia athletica is not the same disorder as anorexia nervosa, it can have some of the same long-term effects if it goes on for an extended amount of time. For some female athletes, the pressure to achieve and maintain a low body weight leads to potentially harmful patterns of restrictive eating or long-term dieting. The health status of athletes is therefore must be closely monitored because the energy and nutritional inadequacies combined with the use of purging methods often found in young athletes have negative long-term effect (Sudi).

Long-term dieting affects body composition, increases the risk for cardiovascular disease, and leads to endocrine abnormalities associated with reproductive function In female athletes, delayed onset of menarche, menstrual irregularities, decreased bone formation (also recognized as the Female Athlete Triad), and a high frequency of injuries have been reported. Skeletal abnormalities, notably scoliosis, decreased bone density, failure to reach peak bone mass, and stress fractures, may be the result of prolonged hypoestrogenism- lower than normal estrogen levels which can result from continuing dieting.

Long-term energy restriction can lead to endocrine abnormalities, and the long-term adherence to low-energy diets leads to multiple changes and adaptations at the metabolic and neuroendocrine levels. Energy restriction is associated with a substantial loss in body fat mass, and hormones related to fat mass are not only part of the endocrine system but important for the regulation of energy intake and energy expenditure.

Low energy availability has been shown to disrupt the hypothalamic pituitary axis, leading to irregular menstrual cycles and possibly amenorrhea, thereby shutting down a function not necessary for survival. The disruption of the luteinizing hormone pulsatility can be restored by refeeding, however, at a much slower rate. Changes in these variables may be manifested in enhanced energy efficiency, as the body seeks to protect and replenish its energy stores.

This may explain the surprisingly low caloric intakes of some athletes still competing at a high level with great success, although studies on energy balance in athletes may also be biased due to undereating and/or under-recording, because restrained eaters are more prone to under-report daily food intake. Although some studies discount the difference between anorexia athletica and anorexia nervosa, the differences in motivation and expectation of anorexia athletica and common eating disorders among non-athletes warrant a separate category for anorexia athletica.

This distinction is vitally important so that doctors and therapists can recognize the differences between the disorders and correctly diagnose both anorexia nervousa and anorexia athletica. Young athletes must be carefully monitored to guarantee that they maintain adequate energy intake which is crucial to maintain growth and development of tissues and to support energy requirements of competitive sports. Hopefully, this will ensure that athletes receive the proper treatment before they suffer any harmful long-term effects of their disorder.

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