Tailored treatments could help athletes with eating disorders

Athletes face an increased risk for eating disorders, and a treatment program tailored to their specific needs can help them regain a healthy relationship with food, a small study suggests.

Researchers tested a program developed to focus on psychology and nutrition in helping athletes with their body image - as an athlete and in society – as well as understanding the role of food as fuel for their body, the study team writes in the Journal of the Academy of Nutrition and Dietetics.

“Disordered eating and eating disorders actually sabotage the one thing athletes are in pursuit of, which is athletic performance,” said Paula Quatromoni of Boston University, the study’s senior author.

“An eating disorder in an athlete can remain hidden or invisible, and that is where it wreaks havoc,” she told Reuters Health by email. “Eating disorders in sport are ‘metabolic injuries’ that, when left untreated, have devastating consequences to physical health, mental health and athletic performance.” Quatromoni and colleagues began working with Walden Behavioral Care, an eating disorder treatment program in Waltham, Massachusetts, in 2015 to create a program for athletes. A year later, they launched Walden GOALS, an intensive outpatient program designed for competitive adult athletes that includes best practices from a group of mental health clinicians, registered dietitian nutritionists, sport psychologists and exercise science professionals.

The program, which runs three nights a week for three hours each night, features psychology and nutrition education sessions and therapeutic food exposure in a shared dinner.

A six-week series of lessons also addresses five pillars of the program: fueling for sport and for life, eating competence, body esteem, recovery skills and resilience. The lessons focus on understanding nutritional needs, interrupting disordered behaviors, rebuilding a healthy relationship with food, exploring body image, managing co-existing mental health diagnoses and refocusing on recovery when relapse occurs.

In this pilot study, 15 women, ages 17-35, mostly runners and ball players, completed the program in 2016 and 2017 for eating disorders such as anorexia, bulimia and atypical anorexia, including some who used exercise or purging as restrictive behaviors.

Entering the program, the women had low eating competence scores and high levels of distress about their body shape and weight. Leaving the program, they had lower behavioral eating disorder risk scores, higher eating competence scores and lower levels of distress. Most gained a few pounds during treatment.

“I would consider my biggest accomplishment just the fact that I got myself into treatment after so many years,” one participant wrote after the program. “I felt like everyone that was in the program spoke my language, and I felt so understood.” Participants also wrote about positive changes in their self-worth, mindset and social dynamics.

“I do not question as much whether I ‘deserve’ to take care of myself,” another wrote. “I recognize that needs to be a priority so I can accomplish other things.”

Quatromoni and colleagues are also studying a treatment program for elite male athletes.

“The literature on eating disorders in male athletes is almost non-existent, it is so small,” she said. “This is a rarely talked about situation that deserves time and research because it affects a lot of male athletes.”

In a 2018 consensus statement, the International Olympic Committee advocated for research around treatment and return-to-play guidelines for athletes with eating disorders and a condition known as relative energy deficiency in sports, or RED-S. The condition occurs when an athlete’s body doesn’t have enough energy because food intake is too low or energy expenditure is too high. Eating disorders and highly disciplined eating regimens can lead to RED-S.

“Eating disorders impact people of all ages, sexes, races, body sizes and sexual preferences,” said Cheri Levinson, director of the Eating Anxiety Treatment Laboratory and Clinic at the University of Louisville in Kentucky.

“If you struggle with your relationship with food, please reach out for professional help,” Levinson, who wasn’t involved in the current study, said by email. “No one should have to live a life that is consumed by thoughts about body image, weight or food.”