Eating Disorders Often 'Overlooked' in Elite Athletes

July 8, 2011 (Brighton, United Kingdom) — Eating disorders, which are highly prevalent among both male and female athletes, is a largely ignored problem, an expert says.

In a presentation at the International Congress of the Royal College of Psychiatrists 2011, sports psychiatrist Alan Currie, MD, consultant psychiatrist and honorary clinical lecturer for the Assertive Outreach Team, Northumberland Tyne and Wear NHS Trust, Newcastle, United Kingdom, said athletes get a "raw deal" when they develop mental illness.

Dr. Alan Currie

"If you rupture your ACL [anterior cruciate ligament], within about 10 minutes 6 guys have gathered around you, within 2 days you've had surgery and a treatment plan, and everybody helps you with your rehab."

"If you become depressed, or if you get an eating disorder, you pretty much get abandoned," Dr. Currie, himself a former athlete, said in an interview with Medscape Medical News. "It doesn’t get recognized, it doesn’t get picked up, there isn’t the same coordinated response to get people well again."

In his presentation, Dr. Currie highlighted a paper by Jorunn Sundgot-Borgen, PhD, from the Norwegian School of Sports Science, Oslo, and colleagues showing that the prevalence of eating disorders is higher in athletes than in nonathletes, higher in female athletes than in male athletes, and more common in athletes competing in leanness-dependent and weight-dependent sports.

The researchers evaluated the entire population of Norwegian male and female elite athletes — 1620 in number — as well as 1696 controls, and found that 13.5% of athletes and 4.6% of controls had subclinical or clinical eating disorders (P < .001).

The overall prevalence of eating disorders among male athletes was 8% — 16 times the prevalence rate among nonathletic males. Among females, it was 20% — double that of female nonathletes.

Unusual vs Problem Eating

Dr. Currie, who competed in track while in high school and medical school and who now does triathlons, said that he did not develop an eating problem himself, but he did have to eat in an "unusual way" compared with his nonathletic counterparts.

"We do have to eat differently, watch our weight, and watch how our weight affects our performance. One of the points I wanted to get across to psychiatrists who perhaps may not know very much about sport is to help them distinguish what is unusual but not abnormal eating," he said.

For example, Dr. Currie noted that Tour de France cyclists have to eat an enormous amount of food every day to fuel their bodies so that they can race up and down the Alps.

"They do stages that require them to eat 7000 or 8000 calories a day. That would fill a table. And they have to eat that in a day. So they have pasta for breakfast, they eat baked potatoes without getting out of the saddle; they drink and drink and drink."

"That Tour cyclist is racing at 25 miles an hour for 6 hours. They have to be very careful. Their food is all measured, they take chefs with them, they bring all their own food, they’ve got personal nutritionists, they weigh their meals," he said.

This is an example of athletic eating. It seems unusual to nonathletes but is perfectly normal for high-performing cyclists. "The trick for the psychiatrist is to recognize the difference," Dr. Currie said.

Aesthetic Sports Riskier?

"I couldn’t agree more," said Antonia Baum, MD, a psychiatrist in private practice in Chevy Chase, Maryland, and vice president of the International Society of Sports Psychiatrists.

"Psychiatrists need to be able to distinguish between usual eating for sports and problem eating," she told Medscape Medical News.

Athletes who are most vulnerable to develop eating disorders are those whose sports emphasize aesthetics, such as gymnastics, figure skating, diving, tennis, and swimming.

"Women, especially in those sports, are probably more vulnerable," said Dr. Baum. "They’re out there on a court or the deck of a pool in clothing that is quite revealing," she said.

Rowing and wrestling are 2 other sports that emphasize weight.

"If you get someone who is in a sport that might predispose them to develop an eating disorder, and they also have a genetic predisposition to an eating disorder, you have a convergence of risk factors that could be problematic," Dr. Baum said.

High Index of Suspicion

Most psychiatrists are trained to ask about eating disorders, but they might need to ask about them in a different way for an athlete, Saul Marks, MD, a sports psychiatrist from the University of Toronto, Ontario, Canada, told Medscape Medical News.

"The athlete might need to be spoken to away from the team. There should be a high index of suspicion in acrobatic sports or where weight matters, such as weigh-in sports, or in sports that demand that someone be very fit and thin, like in long-distance running," Dr. Marks said.

"They need to be told that they need treatment and that they will no longer be part of the team until they receive the treatment they need and deserve and that it will be difficult for them in the future if they don’t get help for it now. It’s being very kind and compassionate, caring, but firm. No bargaining," he said.

Athletes deserve the same quality of psychiatric care that every other citizen receives, but sadly that is not the case, Dr. Marks added.

"There is still the stigma attached to mental health problems. However, that is beginning to change. There are more people who are starting to see psychiatric illness in sports."

Dr. Currie, Dr. Baum, and Dr. Marks have disclosed no relevant financial relationships.

International Congress of the Royal College of Psychiatrists 2011. Presented July 1, 2011.