Eating Disorders in Athletes: What Coaches, Parents and Athletes Need to Know

Next Level Podcast with Host Tavis Piattoly, MS, RD, LD

Allison Mankowski- Podcast

Allison Mankowski, MPH, RD
Currently works as the Sports Dietitian and head of the Eating Disorder Management Team for Eastern Michigan University Athletics and as the consultant dietitian for the Detroit Lions.

Eating Disorders in Athletes are on the rise. Allison breaks it down so others can understand this complicated disorder. Allison is a life-long athlete and sports enthusiast. She was an all-state track and field athlete and competitive cheerleader prior to attending the University of Michigan, where she was a four-year member and senior captain of the cheerleading team. Her experience in and love of athletics led her to pursue her bachelors degree in Movement Science from the School of Kinesiology and then to continue on to get her master’s degree in Human Nutrition from the University of Michigan’s School of Public Health, with the goal of helping other athletes through sports nutrition. She has continued her involvement in athletics by training and competing as a CrossFit athlete and has also run two half marathons, numerous 5K and 10K’s, a triathlon and multiple adventure races.

Allison brings important experience to the topic of eating disorders in athletes, not just as a former athlete and current professional in the field of sports nutrition, but also as a successful cheerleading coach at the high school level for the past 10 years. This gives her the personal perspective of being on the front line, coaching and working with young athletes every day. She has spoken at numerous coaching conferences on the unique aspects of Eating Disorders in Athletes, helping coaches, administrators and trainers to understand their role in promoting healthy athletes and helping those athletes who may be struggling with this issue.

Allison currently works as the sports dietitian and head of the Eating Disorder Management Team for Eastern Michigan University Athletics and as the consultant dietitian for the Detroit Lions. In addition to this, she works for Regional Alliance for Healthy Schools through the University of Michigan Health system, counseling middle school and high school students on healthy eating and physical activity behaviors. She also meets regularly with many local high school and youth sports teams to share her expertise in sports nutrition. When she is not working or training, Allison enjoys being with her husband and son, hiking, attending sporting events and spending time on the lake sailing or wakeboarding.

In this podcast you will learn:

1. Allison's interest in working with athletes that have an eating disorders.
2. The different types of eating disorders that are common among athletes.
3. Explanation of the types of eating disorders.
4. The side effects from an eating disorder and how could it impact athletic performance and health.
5. The causes of an eating disorder?
6. Whether coaches and parents play a role in causing a young athlete to develop an eating disorder.
7. What types of sports are most commonly associated with eating disorders?
8. Are all athletes with eating disorders underweight or do we see overweight athletes with eating disorders?
9. Treatment strategies used for athletes with eating disorders?
10. The length of time it takes to fully recover from an eating disorder?
11. What can be done to prevent an eating disorder?
12 Tips to give parents who are obsessed about their son, daughter, or athlete’s weight?
13. Strategies for coaches, parents, or medical professionals to recognize an eating disorder.
14. Her new book titled “Eating Disorders and Athletes – How to Recognize, Intervene, and Prevent".

Links and Resources

Podcast Transcript

0:00 Tavis Piattoly Introduction

3:01 Allison's interest in working with athletes that have eating disorders.

  • Allison grew up as a cheerleader and a track athlete and experienced first hand the pressures that athletes can have around their body. Allison also had a lot of close friends that struggled with disordered eating and eating disorders. These personal experiences are what gave her the desire to want to learn more about eating disorders and help others who might be struggling.

3:58 The different types of eating disorders that are common among athletes.

  • The two big ones that most people tend to know about are anorexia and bulimia. Another one is binge eating disorder, which is actually the most common eating disorder in general, but isn’t one that Allison sees with most of her athletes.
  • The third one that Allison often sees is other specified feeding and eating disorder (OSFED) (previously named eating disorder not otherwise specified). This diagnosis is used when an individual doesn’t clinically fit in either anorexia or bulimia, and is often a precursor to anorexia or bulimia.

5:06 Explanation of the types of eating disorders.

  • Anorexia:
    • Consistent restriction of energy intake; intense fear of weight gain; distorted perception of body size; significantly low body weight for their age
  • Bulimia:
    • Binge eating (rapidly eating a lot of food in a short period of time); lack of control around the amount of food they’re eating; compensating with self-induced vomiting, excessive exercise, and/or laxatives once a week for three months; concerned with body shape and weight

6:15 The side effects from an eating disorder and how it could impact athletic performance and health.

  • Anorexia:
    • Some side effects include dry skin and fine hair all over the body.
    • In terms of performance, with extreme weight loss comes muscle loss and loss of strength. Other side effects include lightheadedness, dizziness, fainting, fatigue, longer time to recover, and, in females, loss of period.
    • Without a menstrual cycle, females experience a decrease in estrogen, which leads to a decline in bone mass (female athlete triad). This can result in stress fractures and broken bones.
    • New research is showing that males may actually experience something similar to the female athlete triad, but with a decrease in testosterone when there's a chronic energy deficiency.
  • Bulimia:
    • These individuals don't tend to have extreme weight loss, but they still could have complications with fatigue, chronic GI issues (irregular bowel movements, constipation), electrolyte imbalances, and cardiac problems.
  • Eating disorders have the highest death rate of any mental illness, and that's sometimes from the physical complications, such as cardiac or organ failure, or from the mental illness that may go hand in hand with depression, anxiety, addiction, which may lead to suicide.

9:08 The causes of an eating disorder?

  • Despite the research that has been done, it's hard to narrow down to one specific cause of an eating disorder. The best thing we can say is that it's really a complex mix of certain personality traits that tend to lead to developing these disorders.
  • Some causes may include low self-esteem, overly concerned with acceptance, perfectionistic, impulsiveness, cultural factors, societal pressures to fit a certain body standard, team pressure, family dynamics, trauma, injury, etc. There is also research looking into genetics.

10:56 Whether coaches and parents play a role in causing a young athlete to develop an eating disorder.

  • Coaches and parents may underestimate the effect they can have on their athletes. Some comments may be handled well among some athletes, but you really can't know how the athlete is going to react. Certain comments can be the tipping point, so it’s important for coaches and parents to be cautious.

12:34 What types of sports are most commonly associated with eating disorders?

  • While eating disorders can be more common in certain sports, such as endurance sports, aesthetic sports (gymnastics, dance, cheerleading), and weight class sports (wrestling, rowing), it’s important to understand that it can happen in all sports and among both male and female athletes.

13:24 Are all athletes with eating disorders underweight or do we see overweight athletes with eating disorders?

  • Not all athletes with eating disorders are underweight, as we do see overweight athletes struggle with eating disorders and disordered eating patterns.

14:15 Treatment strategies used for athletes with eating disorders?

  • Outpatient appointments are the first step. The treatment team should include a registered dietitian, a mental health professional, and a physician.
  • In more severe cases where outpatient treatment isn’t working, they may need to enroll in a partial inpatient program, where the athlete will spend the majority of the day at the treatment center, eating most meals and snacks there, then go home at the end of the day, and go back the next morning. These programs can last a couple of days to a few months.
  • In the most severe cases,  the athlete may need to go into an inpatient treatment center, where they'll stay there for 24 hours a day, seven days a week.

15:57 The length of time it takes to fully recover from an eating disorder?

  • The length of time for recovery depends on the individual. Typically, the longer the athlete has struggled with the behaviors, the longer it takes to recover. Catching disordered eating patterns early, before they’ve progressed into a clinical eating disorder, can lead to a quicker recovery.
  • It’s important to know that a lot of times recovery doesn't mean never having disordered thoughts again. Instead, it may be learning to cope with the thoughts and learning healthier behaviors.

17:25 What can be done to prevent an eating disorder?

  • First, it’s important to break the myths around sports and performance nutrition. There's a lot of misinformation about nutrition, so as someone who works with athletes, it’s important to challenge those unhealthy practices.
  • Second, we can work to de-emphasize weight, and focus on other areas, such as strength, physical conditioning, and the mental and emotional parts of the sport. Reinforce the idea that being thin doesn't always equal a better performance, but instead, being a well fueled athlete is always going to out-perform an under fueled athlete.
  • Lastly, be sensitive about weight and body image. Try to promote positive body image and positive self-esteem in the athletes. Ensure that if you’re working with these athletes, make sure that your own attitudes about food and weight are in the right place. 

19:30 Tips to give parents who are obsessed about their son, daughter, or athlete’s weight?

  • Since weight is one indicator of performance, it is important to have that in a healthy place. If you have a concern about an athlete’s weight for actual health reasons, such as they’ve gained weight too fast and it might be impacting their joints, then they should be referred to a registered dietitian who specializes in sports nutrition. If weight loss is needed, the sports dietitian can not only make sure that it's done in a safe way without impacting performance, but also to make sure the mental piece of it stays at a good spot.

20:44 Strategies for coaches, parents, or medical professionals to recognize an eating disorder.

  • First, it’s important to understand that eating disorders can happen to anyone. It’s common for individuals to push some really obvious signs aside. Next, being aware of the risk factors that can cause an eating disorder and the symptoms. The most telltale sign is someone who's overwhelmingly preoccupied with food, their weight, and their body.

21:49 Her new book titled “Eating Disorders and Athletes – How to Recognize, Intervene, and Prevent".

  • In general, most coaches, parents, and even medical professionals don't know enough about eating disorders. Allison wanted to get the information out and make it more of a mainstream topic to help people prevent eating disorders and to be aware of one if it is happening.
  • In her book, Allison talks about the different causes of eating disorders, risks involved, how to treat them, and how to prevent them. She also talks a little bit about the history of eating disorders, including how they first diagnosed, as well as recovery and interventions for if you think your athlete might have an eating disorder.
  • You can find her book at www.eatingdisordersandathletes.com

24:42 Tavis Piattoly Closing Remarks

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