Disordered Eating (2003)


Eating disorders is a very serious, complicated and a much more prevalent issue than most coaches want to realize.  I am speaking on psychology versus nutrition and what I hope to do is show that there is a big continuum from disordered eating into the grand medical diagnosis of an eating disorder.  Along the way, I hope that I can help you to understand the signs and symptoms that will help identify a disordered eating pattern.  I want to lay the foundation and then get into some of the personality kind of characteristics, maybe family environment and different kinds of things that you may recognize in your athlete.


Eating disorders are not about food and so I am going to take it away from nutrition.  Our focus is the psychological underlying issues of what causes an individual to go from just a simple disordered eating issue to a full blown eating disorder.  Eating disorders are the symptom of a deeper pathological issue.  So to start out we want to look at the bio-psycho-social factors that underline an eating disorder.


If you start with the biological factors there are some things that research has shown that can contribute.  We have seen that in most eating disorders there is a history of depression, anxiety, different types of addictions in the family and obsessive compulsive disorder.  This does not necessarily mean that if you have an individual whose family has this history then they are going to have an eating disorder.  However, we did see that is very common for them to experience a severe level of depression.


Looking at the psychological factors; these are the type of things that come out in treatment.  If you look at self-esteem, depression, anxiety – there is also a lot of anger, loneliness, feelings of inadequacy or lack of control, difficulty expressing emotions and feelings.  There could be troubled family or personal relationships, a history of being teased or ridiculed based on size, weight and often a history of physical and/or sexual abuse.  These psychological factors are the root of the eating disorder.


The third part of this is the social factors.  When you look at the bio/psycho/social factors we have to just face it.  Our culture is a culture of glorified thinness.  We have very narrow definitions of beauty and there are ideal sizes that girls really want to fit into and that can be from the media, from magazines.  We see value on the basis of appearance and a belief that weight is directly tied to performance.  Thinness is a highly valued achievement.  For an individual with low self-esteem, this mindset can lead to an eating disorder.


The people that suffer from anorexia are very good at is denying their feelings, but these people are also very compliant.  They are very driven, high achievers, can be model children and are very conflict avoidant.  There is a desire for control, perfectionism, a desire for approval, very eager to overwork, and a denial of emotional and physical pain.  If you take these factors out of the eating disorder context, they can be very good characteristics in a person.  It is the type of person that a coach would probably love to coach.


If you go down into people that suffer from bulimia, there is some of the similar type personality characteristics.  However, people that suffer from bulimia tends to be a little bit more impulsive, very, very poor body image.  Again, the low self esteem, the depression, denial of feelings, very sensitive to rejection, still have high expectations, very self-doubting, have a desire for control and tend not to talk about feelings. Binging and purging is actually a way to relieve some of the feelings that they cannot talk about.


If you see someone whose motivation starts to decrease or their love for swimming starts to decrease that is a big red flag for depression.  Appetite changes, decreased energy, fatigue, sleeping too much, sleeping too little, isolation, low grades, crying spells, lack of concentration – these are all things that would tell you that there is something going on. Now that doesn’t necessarily mean an eating disorder but it is worth looking into and exploring with that person.


I wanted to get into family dynamics and often times there is a level of family dysfunction going on, in ways that we may never see.  Three types of families are typical.  The style itself is not the predictor, it is the severity of the style and also the lack of coping that the individual has been able to develop.


You may have the perfect family.  This kind of family places all of its worth in image, the externals are what matters, achievement.  There is a lot of bragging, a lot of awards, a lot of recognition and parents often use that as a way to increase their image and status quo.


You have your over-protective family – the mesh family.  Often these parents may be over-involved.  Very controlling, not allowing for much growth and independence in a person. This individual or child in a family that has a very over-controlling family may not be able to mature with any sense of confidence in themselves.  There is not a lot of control and an eating disorder actually may be part of that need for control.


Chaotic families are much more unstable, there may be alcoholism in the family and a lot of conflicts and poor communication.  This is the family environment of a typical anorexic – it is not all inclusive.  It is not 100% of the time, but often expecting obedience and superior performance in their children and that is how these children become the model children, the pleasers, want to make everything okay.  What happens is they are not allowed to mature and develop and stand their own ground with any confidence.  It really stunts their emotional development.


Family environment of a bulimic contains more conflict, more anger, maybe more levels of aggression, again poor communication skills, poor problem solving skills.  A lot of times these individuals have really felt that their emotional needs were not met.  A lot of things were met, but not the emotional part of what they need as a child growing up in this family.  Mother can be hostile, depressed – father may be more impulsive, irritable and again could have different problems going on at a greater level.


I wanted to give an example of someone that I work with who struggled with an eating disorder for quite a while.  It wasn’t until she was in college and in treatment that she realized where the deeper issues were coming from.  She was weighed in, group weigh ins, and she was very angry about that.  She very much believed that it may have been a trigger.  I think we learned that it wasn’t the cause of her eating disorder after exploring some of the family history.  She grew up in a very rigid family, all about image.  She had no release for a lot of things that were going on.  She said, you know, my dad was an alcoholic and it was chaotic all the time, but to all of my friends, to my coaches, we looked like the absolute model family.  Walking outside my door nobody would have ever guessed that chaos was in my home.  The coaches would have never guessed.  She did very well in swimming.  She got a lot of recognition and soon kind lost herself in her sport. She didn’t want to be at home.  So what coaches may have thought as of a lot of dedication, this hard worker, high achiever, always here, never missing, on time.  That was a great thing, but for her that was not how it was.  It was – “I don’t want to be in my house.  I can’t deal with that.”  When she was in her house, she would binge and purge secretly.  It was her way to relieve emotions.


Puberty – a lot of girls don’t like to develop, to become a sexual person.  They have a fear of gaining weight and that a changing body may make them slower.  There are a lot of misconceptions about that and a lot of education really needs to be done I think for the swimmer, but also  for the coach.  Allowing the changes to happen without that fear of gaining weight or a coach saying your body is changing.  That is a huge fear that a lot of swimmers have from a very young age.


School – different schools, from high school to college is a huge transition, can put a lot of stress on kids.


Death of a loved one or any other kind of life transition can be a trigger to – they just don’t know how else to cope.  They might not be allowed to talk about things.


Traumatic events in someone’s life – often we see there is a very high percentage of people that have suffered from full blown eating disorders that have had some kind of past special trauma or physical abuse trauma.  The disorder becomes a way to protect themselves, to not have a body.


Fear of failure – with anyone suffering from an eating disorder there is a huge fear of failure.  Also high expectations are set, self standards are set that are so high that they are never really attainable because they are not realistic.


For the person that has of these high risk characteristics, the red flags that may or may not lead to an eating disorder – food turns into a way to deal with painful feelings in their own lives, family lives, success and failures in swimming, school, whatever.  Increasing focus on food allows you to not focus on a lot of other things.  If there is a fear of failure then weight loss can become one area where they are being successful.  This snowballs into more and more and more and they feel better and better and better and a lot of times people unintentionally will reinforce that by just noticing or commenting.


They begin to start to feel very successful in their eating disorder and will reinforce it going down a little bit further and a little bit further and a little bit further.  Soon you become numb to your body.  Your body becomes an object and it gets so deep and so pathological that there is no more logic – you can’t just say to this person you need to eat.  The cognitive ability of someone that is very malnourished, or is binging and purging, is not there.  There is no reasoning.  Logic does not matter.  It becomes very, very, very, very powerful.  I think is one of the hardest things for people that don’t know a lot about eating disorders or just know that it is very complicated to understand how powerful an eating disorder becomes.


I don’t believe that there are individuals that want to be eating disordered.  No one wants to get to the point of having an eating disorder – it takes on a life of its own and it becomes their identity.  It becomes a lifestyle.  It becomes an addiction.  An addiction such as an alcohol or drug addiction – it is very, very hard to break.  You cannot say as you would to the alcoholic, not drink a beer because these people have to eat and it is a very, very hard thing to break.  They no longer hear, see, feel, touch or taste things that they used to love.  Senses are gone.


You have to look at the behaviors first before you can go into all the underlying psychological issues that might be there.  You have got to change the behavior and get food into the body.  Cognitive ability needs to be restored before you can actually work through some of the underlying issues.


One of the things that happens is that an eating disorder will “work” for a person.  I treated an athlete who’s mother died at a very young age.  The father remarried quickly and she was never allowed to talk about the death and how traumatic that was for her.  She became a mother to her younger siblings and just stored all that feeling in there.  She had a lot of anger, had lot of just unhappiness around that whole subject and was never allowed to talk about it.  She was also a very good athlete and poured herself into her athletics.  In college she would binge and purge and that was to purge the feelings.  When I spoke with her and tried to help decrease some of that binging and purging behavior she just couldn’t do it.  It was working for her and she would tell me that.  It was working for her because there was so much pain that she did not want to face.


Certainly in the beginning stages individuals tend to value their disorder.  There is a lot of actual chaos in a distorted way of thinking.  It doesn’t seem logical to you and I, but their disorder protects them from a lot of things in life.  It becomes a sense of security that they may not have had.  It becomes their friend and a very, very comfortable place to be.  They embrace the symptoms because they feel good. After they embrace these symptoms for a while it does become miserable at some point, whether or not they believe it or not.  They become very, very miserable and, at that point, even if they want to stop, the addiction has taken over


There are a lot of risks in giving up eating disorders.  They are terrified for giving it up.  It’s their only coping mechanism for dealing with emotion, stress and fears.  It is very, very, very terrifying for someone to give up their eating disorder because it has become such an identity for so long they are very fearful to give up that identity.  They lose their sense of accomplishment that they feel was being successful.


A lot of emotions and feelings are welling up inside.  They have to hold these feelings – hold the feeling of being full, of actually having food in their systems and at the same time losing this friend that they have had an intimate relationship with for so long.  Treatment can take five to seven years or more, depending on how severe.  It is a long, long process.


Protest – non-verbally:  a lot of times we see that as a way – if things are going on in their family and they are not allowed to talk about it and things have to be the status quo.  You don’t want to bring up conflict in the family – it is almost a way of acting out.


Drawing attention – there is a problem here but there is a bigger problem elsewhere.  Communication is not usually the best thing in families with people that suffer from eating disorders so it is easier to do it in a non-verbal way.


It becomes a competition and an achievement and I have even heard people that have been in-patients – a lot of time will compete with each other – who has been the best anorexic – who has lost the most weight – who has purged you know, more and how many times a day.  It becomes a straight sense of competition and that is where they are feeling their success.


It could be a huge defense against being ridiculed, being teased, a lot of times people are teased about weight, height, other things.  They may be a great athlete and I have worked with very, very elite athletes – especially at UC and their self-esteem seems solely based on their sport – they don’t think they matter and you would never know.  These are really elite athletes that don’t show a bit of weakness and you would never guess just by looking at them they hate themselves.  So much recognition has come to them by means of sport, which they have liked, but when you take that away there is noting there and they want to know if people care about them, not the swimmer – not the basketball player – and not this other person.


The things I just described are things that happen to everyone; athlete, non-athlete, so there is an even ground.  When you have an athlete there is a whole extra set of things that puts them in a much higher risk group.  A lot of it stems from the low body fat percentage that equals enhanced performance.  We have been trying to change the language of what that means.  When you tell someone to lose 5 pounds or have a 2% lower body fat – most of the time they are not going to do it in a healthy way.  If they don’t do it in a healthy way then I can guarantee that their performance isn’t going to be any better.


It is not the weight that matters; it is what you are putting into your body.  How do you fuel your body for performance?  That is what we need to stress to our athletes.  Your body needs to be fueled and there are certain things that your body needs to maintain the energy to recover, to be able to swim fast and do all the things we ask our athletes to do.  I like to look at their training and performance or training and what you do every single day.  There is strength and conditioning, land workouts that kind of thing.  Nutrition is something that is not often looked at as important and we are not experts in nutrition.  Some coaches may be, but it is recommended to seek the help from a sports nutritionist to help them find out what they need to fuel their body.


The other things that we can look at that would help performance are mental training.  You know, obviously sports psych professionals who can really do a good job in that and then the thing.


Another thing that we do is look at their emotional health.  So many of these athletes want to be known as a person.  How are they doing as a person?  How is school?  How are their extra-curricular things?  Look at them as a person and if you think something is just a little bit off kilter explore a little bit.  Anyone that has a lot of stresses in their lives – that stress is going to manifest somewhere in their body.


Characteristics of those with an eating disorder are also great traits for an athlete and you have to realize that some of these characteristics are very similar.  Fitness and appearance based sports obviously are a little bit more common to eating disorders – swimming is one of them just because they live in a bathing suit most of the day.


Sports can actually attract individuals who are at risk – very easy to hide their illness through athletics.  Individuals at risk for disordered eating or eating disorders will somehow get into a sport to hide and mask what is going on.  People that suffer from eating disorders are very, very, very secretive and they are very good at hiding it.  They learn to justify and manipulate everybody, including their parents so you have got to be real careful about that.  There is a lot of pressure to lose weight, and body fat, certain body fat percentages are often stressed.


I want to end by saying that one of the biggest messages that we can send to the coaches is that we need to look at our athletes and teach them to fuel their bodies appropriately.  Fuel their body for a performance and that language is so, so important.  It is very hard for an athlete to hear they have got to lose weight or the body fat percentages are not correct and they are going to swim better if they are just a few pounds lighter.  That is really difficult to hear




Our next discussion is on the clinical implications of disordered eating and eating disorders. We have with us Dr. Becky Morgan.


What I want to do is talk to you about some of the medical and physiological aspects of how an athlete, particularly a swimmer, can start with disordered eating.  I’ll then move to the more severe changes that occur when an athlete actually gets into a full blown eating disorder.


I think it is really important for you to understand the difference between disordered eating and full blown eating disorders.  Disordered eating is just a spectrum of unhealthy eating patterns, restricting, preoccupation with food, calorie or fat gram counting, preoccupation with weight, skipping meals, fasting… When I say fasting, I am talking about the kid who gets up and goes all day without eating and finally they come home after practice and eat.  They are getting one meal a day.  Rigid food patterns and that can include elimination of a whole food group, like meat.


Now, an eating disorder is when these behaviors advance into a very pathological point and is characterized by food intake that is not adequate to meet the body’s needs.  So, you are not getting enough food to fuel your body for activities of daily living, much less training.  This can occur through many different means; either severe restricting, binging followed by purging, taking laxatives so that you get the food out more quickly, taking diuretics or by compulsively exercising.


The purpose of this talk is to teach coaches, parents, and other individuals in this room how to recognize signs of disordered eating and to educate people of the potential consequences if these eating behaviors continue to become more and more extreme.


So, let’s talk about the thing that coaches really want to talk about and that is performance.  What happens when disordered eating starts to mature and they really start getting out of hand?  Well, you have to look at a couple of things:  #1 is a discussion of energy balance and the other thing is overuse injuries.


If you look at performance you have to look at the energy balance and I am going to break this down very simply – many of you in this room could probably define this better than myself, but if you are going to do work, work is going to be performed based on the availability of energy to perform that work so in a human body energy comes from diet – meaning food and water.  Well, if you are working harder than you are able to supply energy for, your body is going to get into a negative energy balance.


So what happens when you are in negative energy balance?  Well, a body in a negative energy balance that stays in the negative energy balance for a prolonged period of time is going to start breaking down.  As you train hard, as you stay up late, you don’t get enough sleep, you are not eating enough food your body – there is just normal breakdown that occurs.  Every time that you go swim a hard workout – a 10,000 meter workout, you are going to have muscle breakdown.  You are going to have tissue breakdown and if you don’t have adequate rest and you don’t have adequate energy availability, building blocks – you are not going to have repair and if you don’t repair that injury and then you go back the next day and you swim another how every many thousand meters, that breakdown keeps building up and building up and what do coaches see?  Well coaches are going to see poor performance.  They are going to see suboptimal swims and they are going to see a kid that is fatigued.


A child that comes to the pool every day and just looks like they haven’t had sleep in weeks.  Their strokes start to breakdown and you start to see overuse injuries.  Again, tissue breakdown is a normal process when you are training hard.  The harder you train the more tissue you breakdown.  You have to have the repair process occur in order for you to continue to maintain that level of performance and the body that stays in a negative energy balance does not repair itself so what do you start seeing in swimming?  You see shoulder problems.  You see shin splints.  You see muscle strain.  You see something that I have seen at UT way too many times and that is stress fractures.  Why in the world would a swimmer get a stress fracture?  These kids go out and train and they train by running because they can do that away from the other folks and they can get away with exercising more because nobody knows where they are going.


Then they are doing dry land and they are swimming and all of a sudden they have shin pain and they are in my office for shin pain and I ask them what are you doing?  Well, I am just doing what I am supposed to be doing.  I am working out.  So I call the coach – what are these kids doing – well they shouldn’t be running and I say, well, this is a running injury so we start investigating and sure enough, the kid had a stress fracture and she was out running.


If you see a food restrictor you are going to see weight loss and initially in an individual that may be heavier that is great.  Everybody compliments them.  Ah, you look wonderful.  You look great, but as they get really into this and they love the fact that they are getting all this attention and that they are losing weight they are going to start more than just body fat.  They are going to lose muscle mass and they are going to start getting really thin.  They are going to have dark circles under their eyes, hollow cheeks – eventually, if they continue to do this – they are going to get something called “Lanugos” or this really baby soft hair on their cheeks and their neck and often on their shoulders and then you are going to have bony prominences that are really visible.  They are standing in a swim suit and their hip bones are just sticking out and they are often going to be wearing really baggy clothes because they are trying to hide the fact that they are getting so thin.


Alright, what about the bulimics?  What about the binge and purge group?  Well, you may or may not see weight loss.  Many times you may see weight gain.  You will see puffy eyes, maybe bloodshot eyes.  If they are throwing up a lot you will see bloodshot eyes. They may get really swollen cheeks and they look like they have just had their wisdom teeth out.  They will start getting lots of cavities.  Their teeth may turn yellow or their teeth may just look darker or discolored.  They may start getting calluses on their knuckles because a lot of these kids will force themselves to throw up by sticking their hand in their mouth.  They can also get yellow nails from the stomach acids on their nails.  This is an easier pathological behavior to hide and let me tell you, they are the masters.  They can hide it.


So what happens to body functions?  Now, these are the things that a lot of times are the easiest for people to miss because girls don’t talk about them and they are not visible.  The first thing that should send up a red flag is something called amenorrhea or absence of the menstrual period and that is not something that a coach is generally going to know, particularly male coaches with their female athletes.  That is something that a physician should and will know so if there is a young lady who starts showing some of these signs then you would encourage them to go to a physician.  I have a whole page of stuff that I do on my entrance physical for athletes that deals with periods and I know that that sounds a bit excessive, but let me tell you – every year I diagnose at least one or two eating disorders in brand new athletes who hit campus because they have just never been asked the question.  So amenorrhea – absence of a period of at least three months, sometimes up to six months, this is caused by a negative energy balance. Your body sees the menstrual period as a luxury when it gets into the starvation mode, a lot of times it will just cut that right out.


Persistent fatigue and loss of concentration.  School work will suffer.  They can’t concentrate.  They can’t do their homework.  They fall asleep doing their homework.  They are tired all the time.  You start seeing personality changes.  Their interpersonal relationships may suffer.  They may not get along with their friends or their roommates or their parents or their family and then bone development suffers and this is very closely linked to the hormonal secretions for the menstrual period.  Estrogen or the female hormone, when the levels drop, the estrogen is strongly linked to bone development in females.  When that stops you quit making bone and unfortunately when young ladies get severely disordered in their eating or actually flip over into an eating disorder is the time when they need to be making bone the most.  Adolescence and early adulthood is the time that most of your mature bone is developed.  You stop making bone when you are about age 30 or 35 so it is critical that bone is made through those teenage years and early 20’s.  If that stops you don’t ever get it back. We can do things that can slow bone loss, but we don’t know anything that really promotes bone health more than having a normal energy balance and having a normal hormonal cycle and this is pretty new information.  We used to think that birth control pills really did something great.  Birth control pills still have a role because you are replacing estrogen which means you may stop some of the bone loss that occurs, but you never get back that bone development so staying in a normal energy balance is critical.  What happens if these girls do not get normal bone by the time that they reach 35 and the bone development stops?  Well, they are starting off behind and when they get to be 45 or 50 – they may be looking at hip replacements so you have to really be concerned about their eating behaviors at a young age because the implications later are very, very severe.


The invisible, but dangerous changes:  These are the ones in the kids who are really developed in their eating disorder and they are very sick.  What happens is in the binge and purge group they have massive fluid shifts.  They will eat all this food.  They will get all these fluids from the food and then they throw it up.  So you have got all these electrolytes and plasma volume from the water that is shifting in and out and it drives the control of your body systems nuts.


The other thing is if you get severe electrolyte problems, for instance from repetitive vomiting you can get very low potassium.  You can start seeing heart rhythm disturbances and this is where you see sudden death.  They can get into a heart rhythm that is not compatible with life and they are gone.  Starvation also causes breakdown of vital organs.  You can see the liver start malfunctioning.  You can see kidney failure.  And again, these are the really, really sick kids, but if they are allowed to continue through all these other stages they can get to this point.


So, what do we do about this?  Well, if the kid has a really severe eating disorder they are going to need a group of professionals to take care of them.  That is not something that a swim coach can do.  What can a swim coach do?  Well, start identifying some of these behaviors that we have talked about and hopefully intervene at a time where this can be a reversible process.  Most of us are not going to be able to change the underlying problem that may take a kid from disordered eating into an eating disorder, but if it is identified as a problem they can get the help they need and hopefully not progress into such a pathological state.


So recognizing that it is a spectrum and that this funny little eating that is going on at age 13, if it is not addressed, it may progress into an eating disorder by the time they get to college.  I see kids who come in and they have had this kind of weird eating and they have got a lot of stress.  All of a sudden they leave their little protective nest at home and they get to college.  So identifying this stuff early on a lot of times you can teach them these coping skills; or you can get them counseling; or you can work on some of the problems that they are having; and hopefully reverse some of these behaviors before they become so out of control.


So, what do we do – what do swim coaches do?  Well, you watch the kids that start having poor swims.  You watch the kids who for a year cannot make their time and they are doing everything else right.  You watch the kids who are tired all the time, a kid that was really energetic and happy and all of a sudden they are dragging into the pool.  You look at the kids who have repetitive overuse injuries – the shoulder problems – the shin splints – muscle strains.  You know, a breaststroker that initially starts having knee trouble and then they have a groin pull and then they have ankle problems.  There might be something going on – maybe not – but you need to think about it.  You need to assess their nutrition.  Assess their stress levels.  Look at how they are coping with life.


I know that sounds like a lot to do, but just a coach saying hey, what’s going on here?  Do you need to go and see the doctor? So again, be observant.  Discuss healthy eating habits and get assistance if you have suspicions.


Okay, I am going to quickly go over the next part which was identification of an eating disorder.


It is a really, really difficult thing to deal with.  It is very frustrating, very complicated and is often very hard to see – for coaches to see their athletes in such a state of deterioration and really a lot of pain.  Early warning signs you may notice a lot of talk about weight.  Typically they will get on the scale once or several times a day, exercise for long periods of time and even over and above the requirements of their sport.


More obsessed with appearance and weight, a lot of talk about it.  Comparing themselves with others.  Wanting to look like this athlete – not happy with themselves.  A lot of emotional eating, eating when fat or eating when upset, refuses food because they are fat.  A need to eat really, really healthy, very plain foods – salads without salad dressings, bagels with nothing.  A lot of counting of calories. A lot of avoiding eating with the family.  Maybe they panic when they can’t exercise.


How can coaches help?  And that is a really difficult question.  It is really hard to know what to do – it’s like walking on an eggshell – do I say something, do I not say something. The first and most important thing is to do what you guys are doing right now and that is educate yourselves to become aware of the signs and symptoms, the early warning signs.


Something that is really important to do is explore your own attitudes about language and your own attitudes regarding weight and so kind of look at what you are dong, how do you talk to your athletes about weight issues – nutritional issues.


After our talk in our meeting in Colorado Springs – I had a coach come up to me and say you know, after listening to all this I just need to confess to you because what I need to get off my chest is that I had a fat lane and if I thought my swimmers were overweight they got in lane #1.  It was called the fat lane and he said there are a lot of us that do those kinds of things and he said, I promise I am going to stop – I am not going to do it.


Look at – really look at what you are doing and if this is something that is going to hurt somebody you know, this is a sensitive issue – is it going to hurt them?  Is my language such that it really going to help?  You know, I am looking at their performance and all of it is not just body fat and body weight.  De-emphasize weight de-emphasize weight, the group weigh in have to go.


Don’t assume that reducing body fat or weight will enhance performance. It may or may not and I know that is a big issue, but looking at how you fuel your body and making sure gets what it needs is a much better way to go about that and I can guarantee you they will swim faster if their body is getting what they need than if they lost five pounds in an unhealthy manner – there is just no comparison.


Be prepared to talk to your athletes.  Some athletes just want you know, if you go up and ask them are you okay?  Are you eating okay?  Its okay to be direct you know, some athletes may not respond that well and some will and if they don’t you can you know, just talk about your concerns.  Let them know some of the factual observations that you might feel, especially with being weighed you know, when we are at team gatherings I really don’t see you eating and this is a concern of mine.


Provide resources and that is the number one thing to be able to do.  Learn what kinds of resources are available in your community.  A lot of communities have a task force on eating disorders.  Contact sports nutritionists, counselors if there is a bigger problem.  Get to know the doctors that may be someone that you can refer to and how they feel about eating disorders.  Get to know what you can offer them because you can’t do it on your own.  You have to have a team of people that are experts in the field of eating disorders.


Provide support.  Check in with your athlete and then just go on with making sure they are okay as a person, that you care about them too as people and one of the things that I think – coaches often do not realize is that your athletes are absolutely in awe of you.  Everything that you say or do will stick, even if it is an athlete that you don’t think you have a great relationship.


Really watch how you are saying, and what you are saying, and be supportive and discuss concerns with parents, especially if they are under 18, age group swimmers.  Parents need to know what you are seeing in this.  There is a lot of fatigue.  They are not swimming fast.  You are seeing a lot of talk about their weight and some of the other red flags.  Talk with parents.


Now that doesn’t mean that the parents are not going to be in denial too because often they are and often they don’t want to know and they don’t want to hear about it.  If it gets to be more of a severe issue and parents are still very much in denial you may actually have to say – hey, this person needs to go to a doctor or they can’t swim this week.


In college we have a system in place to work with them and often parents will still be involved.  Coping strategies again – that is really hard.  It is very, very frustrating to deal with someone that has an eating disorder – especially if they are severely into their disorder behaviors.


Remember, the recovery is very, very slow.  We mentioned earlier that it could be 5-7 years or longer or it may not be that long, but along the way is not perfect.  Along the way there are a lot of relapses.  Along the way is very hard.  It has been such a comfortable way of coping that even two years out and things are going really well if something happens the most comfortable coping skill that they have had in their life is this eating issue and it is very easy to slip back into that even if you have been recovered for two, or three or four years.


So, remember the recovery is not going to be perfect and that it is okay to have the ups and downs – that is part of it and you know, if your athlete might be open to you about some of those relapses or about some of those bumps in the road, make sure you let them know that that is okay.  It is okay.  It is normal – what can you learn from it?


Remember that setbacks are going to happen and it is not about you, it is not about the team, it is just what is going to happen.  Recognize how powerful eating disorders are.  It is really hard, again, getting inside the mind of an eating disordered individual, but it completely takes over.  It completely takes a life of its own.  Nothing logical about it – it is a deep pathological issue, very, very, very powerful.  It is an addiction that is very, very hard to break and it is going to be very slow.


Be as supportive as you can to the athlete.  Logic doesn’t work.  Just talk about feelings if they want to. They may just want you to listen.  They may not want to talk about it at all with you because there is a place for them to do that with their counselor or doctor or whoever may be involved in their little treatment team.


Treat your own frustrations and talk to other coaches that have dealt with it or other people that have dealt with it.  There are a lot of people out there – you would be surprised – who have dealt with it.  You know, talk about it and get it off your chest.  See how other people work with an athlete, how you can handle it as a coach.  Your athlete may be open to you talking to their therapist.  That would be a great thing to do – just to see where she is – bouncing things off with the therapist and see if the therapist can help you in dealing with her.  That may not be possible sometimes, but often it is.


The biggest thing to realize is that you can’t fix it.


A challenge to coaches – change your attitudes and language.  Actually I should say, learn about your own attitudes and if they need to be changed.


Kids can be cruel, middle school age, grade school, even up through high school.  It is a hard period.  It is a hard time of life and if you hear some of this negative talk going on then let the kids know that it is not acceptable.  Don’t allow it.


Remember athletes are human and I say that because I work with so many very top level athletes who feel like they are not allowed to have any problems.  They feel like they are not allowed to talk about things because they are strong, they are role models for the community, role models for other people in their sport


Don’t base performance on weight and body fat percentage and that is a big issue.  That could be a very controversial issue but I think it is really important to look at fueling their body.  Talk with a sports nutritionist, have them come.  Educate yourselves, educate your teams on what their body needs for performance.


Educating on fueling their bodies is probably the most important thing you can do – get rid of the whole weight language.


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