Eating Disorders & the Unhappy Female Triad

Labette Community CollegePE 116

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Eating Disorders Defined

Anorexia Nervosa: An emotional disorder characterized by an intense fear of becoming obese, lack of self-esteem, distorted body image which results in self-induced starvation.

Bulimia Nervosa: Recurrent episodes of binge eating in which a person feels unable to stop eating voluntarily followed by a variety of weight control methods such as self-induced vomiting, fasting, consuming diuretics, and purging with laxatives.

Eating Disorders Not Otherwise Specified (EDNOS):

Dysfunctional eating habits/poor nutrition/deficiencies

Eating Disorders• 20% DEATH RATE Anorexia• 90% Adolescent & Young Women/10%

Male & >middle class• 20% of ALL athletes/33+% of Female

Athletes/ 5-10% teens

• Anorexia- 1% and Bulimia- 1.5% of adolescent Females

• Eating Disorders Not Otherwise Specified (EDNOS) up to 50-60%... funky nutrition

 Chapter 8 4

Anorexia Nervosa• obvious thin/emaciated/sick appearance

• 12-21 females/competitive/perfectionist personality

• distorted body image/fat & food phobic (control of food)

• vv poor self-esteem & self perception • strong denial/depressed/easily agitated/angry • socially avoidant/cold/unemotional/lack of feeling

• often tightly controlled by parents or a COACH

• 3X normal rate of amenorrhea (loss of menses)Chapter 8 5

Bulimia Nervosa • binge & purge (10X day) to deal w/ life's

stressors

• total lack of control w/ food.. food controls them

• constant concern w/ body image/shape/appearance

• insecure/unjustified self-guilt/continually seeking approval

• secretive around food/steal & horde food/excessive use of restroom

• often alcohol + drugs involved  Chapter 8 7

What is the Unhappy Female Triad?

The unhappy female

triad is a combination

of three different

disorders that commonly

affect females & especially athletes:

osteoporosis, eating disorders,

and amenorrhea.

(wikipedia 2000)

Who’s At Risk? Adolescents and women training in sports in which low body

weight is emphasized for athletic activity or appearance are at greatest risk.

• Pressure to be thin (gymnastics, figure skating, diving & ballet)

• Stay within a weight class (rowing & martial arts)

• Keep body size and shape (distance runners & cross country skiing)

Female athletes who are pressured by their coaches to lose

weight. • 67% of all college gymnasts surveyed had been told by their

coach that they were too heavy. (Rosen and Hough 1988)

• 5 of 6 divers reported that their eating disorder started after a coach told them they were too heavy. (Martin 1994)

Collegiate Athletes

A 1989 NCAA survey indicated that 60% of all female college athletes use weight control pills before entering college.

1995 study by Martin found that 60% of NCAA Division 1 female volleyball, softball, and basketball athletes used weight loss products prior to participating in college sports.

Physical Warning Signs• Rapidly losing weight or body fat• Limiting food intake• Constantly weighing• Eating secretly• Consistently going to the restroom

after meals• Abusing laxatives: this impedes

performance and results in dehydration, malnourishment, and unhealthy weight loss.

Psychological Warning Signs

Vulnerable self-esteem

Distorted body image

Obsessed with food or body weight

Constant need for approval

Depression

Anxiety

Codependent

Enough Is EnoughEnergy Stores

Food provides cellular maintenance, warmth, immunity, growth, movement and reproduction.

Reducing dietary energy intake or increasing exercise energy outflows lowers energy availability so that the body's other processes cannot function properly.

Amenorrhea Defined Delayed menstruation in development or the absence

of repeated periods after menstruation begins.

Menstrual abnormality that may be caused by low caloric intake, strenuous training, low body fat, low weight, or an eating disorder.

Physiological BreakdownA reduction in the frequency of luteinizing hormone (LH) pulses form the pituitary gland is the direct cause of amenorrhea and subsequent ovarian suppression in physically active women.

Amenorrhea Facts The lack of energy which comes form food sources

contributes to menstrual disorders

Menstrual cycle is temporarily suppressed to conserve energy

Can lead to infertility problems

Loss of regular menstrual cycles often reduces the body's production of estrogen which leads to an increased risk of becoming osteoporotic

Regular exercise can offset bone loss because of menstrual disturbances

Osteoporosis Defined The loss of bone mineral density and inadequate formation of

bone, which can lead to increased bone fragility and risk of fracture.

Osteoporosis (Weak Bones)

Defined as a bone mineral density more than 2.5 standard deviations below the average with a reduction in bone mass with no alteration in the mineralization of bone tissue

Low energy reduces rate of bone formation by suppressing metabolic hormones such as estrogen (slows turnover of bone)

Osteoporosis (Weak Bones)

Poor eating habits decrease the intake of calcium, vitamins, and minerals that we

need to build and repair bone

Bone Mineral Density Amenorrhoeic patients: lower at the spine (-5%), hip (-6 %), and whole body (-3%)

Patients with disordered eating patterns: lower at the spine (-11%), hip (-5%), and

whole body (-5%)

GETTING A BONE TEST ON HER FOOT

Physical Signs of Developing the Triad

Physical signs• cold hands and feet• dry skin• hair loss• absent or irregular

menstrual periods• increased rate of

injury• delayed healing

time for injuries• Stress fractures

Emotional Signs of Developing the Triad

Emotional signs • mood changes • decreased ability to

concentrate• depression

Consequences of the Triad

Nutrient deficiencies and fluid/electrolyte imbalance lead to impaired growth and mental functioning,

increasing the risk of other injuries

Long-Term Consequences

• Loss of reproductive function• Irreversible bone loss• Decrease in estrogen levels

• Dehydration• Starvation• Premature death

Developing the TriadDieting to lose weight or fat for participation to

improve performance & appearance, binge eating induced vomiting, and excessive use of laxatives.

Adolescents should gain body mass during their teenage years, except when losing body fat under the supervision

Triad Treatment

Be aware of causes

Inform family for support

Medical assistance

Nutritional support

Psychological intervention

Specified TreatmentEating Disorders

Treatments will vary individually on the basis of psychology and

environment – Increase the nutritional status– Increase muscle strength – Decrease risk of injury– Increase training and sports

performance

Specified Treatment

Menstrual disturbances

• Regular medical assessments• Decrease intensity/duration of training

by 10%• Estrogen replacement with the

contraceptive pill • Hormone replacement therapy, as

provided for postmenopausal women, not be used for long periods

Specified Treatment

For bone weakness

• Estrogen receptor modulators and intranasal calcium

• Calcium intake: increase to 1500-2000 mg a day to be taken along with vitamin D

Preventative MeasuresEducation related to eating healthy & lifestyleKeep track of menstrual periods Foods containing protein, fat, and carbohydrate

are healthy choices for the athleteVisit a dietitian if you need suggestions No skipping mealsNever aim to lose lean body massAny effort to lose body fat should be guided by a

healthcare professional

Prevention from a Coaches Perspective

De-emphasize weight Eliminate group weigh-ins Treat athletes individually Use guidelines for appropriate weight loss (1-2

pounds/week) Use objective measures when determining weight

ranges Reduce competitive thinness Teach safe nutritional practices

Treatment Programs

• Intervention by someone close to the subject (friends, family, teachers) is needed

• Be non-threatening when you address them & have access to a professional care immediately available

• Expect denial & refusal… be persistent! • Pro Treatment

– easily treated if detected early

– readily treated if moderately advanced

– V hard to treat in advanced stages

 

Chapter 8 31

How to Approach a Friend with an ED• DO approach them-vvv serious problem-

young people die

• Focus on health and unhappiness- NOT weight or appearance

• No simple cure exists

• A life problem exists (alcohol/stress/abuse)

• Professional help & empathy is essentialChapter 8 32

Attendance Questions

1- Who is more likely to develop an eating disorder? Men or women?

2- Having distorted eating habits and poor nutrition is a condition known as??

3- Identify the three main problems associated with the Unhappy Female Triad???

Final Study Questions• 1- Anorexia Nervosa has a potential death rate of _______%.• 2- EDNOS is an acronym for

__________________________________________.• 3- Identify the components of the Unhappy Female Triad

a. b. c.• 4- What can athletic coaches do to help prevent students from

developing the Triad?• 5- Which is most prevalent? Anorexia, Bulimia, the Female

Triad or EDNOS?

ResourcesRosen, L.W., McKeag, D.B., Hough, D.O., & Curley, V. (1986). Pathogenic Weight Control Behavior in

Female Athletes. Physician and Sports Medicine 14, 79-86.

Female Athlete Triad. Teens Health Online(Answers and Advice). http://www.kidshealth.org/teen/food_fitness/sports/triad.html

DiPietro, L., Stachenfeld, N. (2006). The Myth of the Female Athlete Triad. British Journal of Sports Medicine 40, 490-493.

A. Nattiv, M.D., A.B. Loucks,Ph.D., M. Manore,Ph.D., C.F. Sanborn, Ph.D., J. Sundgot-Borgen, Ph.D.; & M.P. Warren, M.D. The Female Athlete Triad [SPECIAL COMMUNICATIONS: Position Stand]. (2007). Medicine & Science in Sports & Exercise:Volume 39(10): 2007pp 1867-1882.

The Triad. Female Athlete Triad Coalition. http://www.femaleathletetriad.org/faq.html

Definition of terms. www.wikipedia.org