AASP Blog

Although there are several benefits to sport participation, achievement and performance pressures can be highly stressful especially in aesthetic activities such as gymnastics, diving, cheerleading and dance. Success depends on judges’ subjective evaluation of skill competency and presentation where comparisons across athletes or teams are made regularly. Similarly, in sports where females wear revealing uniforms (i.e., track and field, volleyball and tennis), perceived physique imperfections are frequently of concern. Naturally, this can infiltrate the thinking of the athletes, their parents and coaches. Often physical appearance, including physical size and physique, are subjects of conversation that can lead to negative self-perceptions of athletes.

Negative self-perceptions should be of concern because they are detrimental to the health and wellness of beholders. Being concerned with physical appearance can (1) detract attention from technically difficult elements that typically involve aerial rotation in aesthetic sports potentially resulting in injury; (2) restrict the artistic impression necessary for interpreting music or program themes and (3) lead to anxiety, dissatisfaction and motives which can be the indicators of disordered eating.

Given the pressures to perform and achieve success in sport, compounded by subjective evaluation or presenting bodies in revealing uniforms, many female athletes may resort to disordered eating to compensate for these pressures. Dietary restriction, binge eating and/or excessive exercise are behaviors involved in disordered eating. This article will help inform athletes, coaches and parents about factors leading to eating disorders and their consequences. Three young female college student-athletes affected by eating disorders were interviewed. They were given aliases of Jocelyn, Sophie and Jane. Their personal accounts along with some research evidence should be informative to everyone in the aesthetic sport community.

What are eating disorders?
An eating disorder is an emotional and physical condition associated with an obsession with food, body weight or body shape. According to the National Eating Disorder Association (NEDA), eating disorders are more common among females than males with as many as 10 million girls and women, and 1 million boys and men afflicted. Eating disorders such as anorexia and bulimia primarily affect people in their teens and twenties, making the majority of adolescent athletes vulnerable. Because of its secretive nature, not many athletes are known by their athlete community to have eating disorders and the incidence is higher than you would think.

Anorexia and bulimia are well known eating disorders. People with anorexia starve themselves to dangerously thin levels, weighing 15% (or more) below what is appropriate for their age and height. People with anorexia have an intense fear of gaining weight or becoming fat even though they are underweight and they use weight as the only source of self-worth. Other symptoms of anorexia are denying the medical seriousness of low weight, and for women who have reached puberty, missing at least three menstrual cycles in a row.

Warning signs of eating disorders in females include:

• loss of menstrual period;
• dieting obsessively when not overweight;
• claiming to feel "fat" when overweight is not a reality;
• preoccupation with food, calories, nutrition, and cooking;
• denial of hunger;
• excessive exercising;
• being overly active;
• frequent weighing;
• strange food-related behaviors;
• episodes of binge-eating;
• rapid weight loss;
• depression;
• slowness of thought/memory difficulties; and
• hair loss.

People with bulimia nervosa engage in binge eating, feeling a lack of control over eating behaviors during eating binges. Purging occurs after these bouts of over-eating to eliminate calories from the body through self-induced vomiting, starving, vigorous exercise, laxatives, or other methods to prevent weight gain. A minimum average of two binge-eating episodes a week for at least 3 months and persistent concern with body shape and weight help characterize bulimia.

Eating disorders often begin with weight restrictive behaviors but can have several health consequences, some which are irreversible. For example, anorexia and missing menstrual cycles are also associated with osteoporosis (bone loss). Other common medical complications include: erosion of teeth and gums, constipation, acid reflux, slowness of thought, abnormal liver functioning, anemia, abnormal blood pressure and brain shrinkage. People can die from eating disorders.

Eating disorder risk factors
What causes weight restriction behaviors that can lead to eating disorders? When asked about their personal experiences with eating disorders and their sport experiences three female athletes who have suffered from eating disorders had a lot to say.

Jocelyn, a 24-year old college senior was 17 when her eating disorders started. She experienced both bulimia and anorexia. “It began as a kind of crash-diet and I thought it would all stop once I reached my “goal weight.” That happened within two months, but I couldn’t stop, and it went on for five more years. An eating disorder slowly takes over a person’s life, until they are so preoccupied with food, exercise and weight that these things take precedence over other things such as school, work, family, or even life goals, which should be most important. In many ways, having an eating disorder is like an addiction—the ED becomes the sufferer’s main source of good feelings and they just crave more, all the time.”

Researchers have categorized eating disorder risk factors into four categories that everyone in aesthetic sport communities should know about. These are:

1. features of the sport task such as revealing uniforms or being physically evaluated;
2. the sport environment, which can include comments from teammates, coaches, parents or judges, as well as the audience;
3. biological characteristics such as metabolism and physical size; and
4. psychological characteristics of the individual which can include self-esteem, body image and anxiety about being evaluated by others (a.k.a. social physique anxiety).

Factors from each of these categories can interact, further fueling disordered eating behaviors.

The idea behind knowing the factors that can lead to eating disorders is to help separate those that are within people’s control and those that are not. With this information, various people in the athlete community can strive towards controlling their actions. More specifically, athletes can realize that some issues are not in their control and require positive ways of coping.

Sport task-related pressures
The most important aspect of sports such as dance, synchronized skating, and swimming is to move as one. Sticking out in any way can be a problem. Sophie reports, “When you go out there, you are not (it\'s) not only for you, it’s for your team. If you make a mistake you are letting down all of your teammates.” “Your mistakes affect everyone” Jane adds. For athletes like Sophie, who competes in international events, representing her country is an additional stressor. Jocelyn points out that some sports are “expensive and associated with wealth” and this can magnify the need to do well.

Although many athletes get used to competitive attire, wearing skimpy outfits is stressful for some. “Especially in some of our more revealing outfits…I feel so incredibly fat in them and embarrassed,” says Sophie. Based on Sophie’s disclosure, when there is a choice, uniforms that make athletes feel comfortable should be chosen. Involving athletes in the decision making process is also a healthy way to boost motivation and team cohesion.

With the evolution of technical elements in many sports that now include jumping and lifting, being thin can be even more important than just for aesthetics. Being thin is thought to make the rotation and the height of jumping easier. But if you think about it, one of the consequences of having an eating disorder is to reduce the amount of energy your body stores and needs to perform. It’s not worth it. “I got to a point where I had to quit because physically I wasn’t strong enough to do it anymore, and I became quite depressed and gained a lot of weight afterward. I began to miss practicing and my teammates very much but even more than that, I missed feeling healthy, happy and active,” says Naiomi who missed a year and a half of her season because of anorexia.

Environmental pressures
Environmental pressures generally involve people who interact with athletes including teammates, peers, coaches, parents, parents of other athletes, judges and the audience. In many aesthetic sports scores for artistry are tied to appearance. According to Jocelyn, “Girls compare themselves to one another, but they also want to look better than each other”. Judging is a pressure in and of it’s self and is involved in pressures from others. Oftentimes comments made to athletes are geared towards what is thought to be ideal from a judges’ perspective. Jocelyn states that a coach “might cut you if you are too big”, they want judges to see that their athletes are fit and in shape.”

Spectators are also implicated in making comments about athletes’ appearance. “Spectators are quick to point out the “fat girls” on teams, even when they aren’t fat. Anyone who sticks out is fair game for ridicule,” says Jocelyn.

Much of the appearance and weigh-related pressures aesthetic sport athletes experience are from coaches. Jane explains that her coach often emphasized abdominal workouts saying, “we need to look good in our dresses,” instead of “we need to get stronger.” Jocelyn’s coach would hint for her to “lose 5-10 pounds.” She further stated, “The all-time worst was when a coach who knew I had an ED told me, “You look beautiful now BECAUSE you lost weight.”

Consistent with research on female athletes, those interviewed also reported coach practices such as weigh-ins, cutting athletes based on weight, and diet restriction warnings around the holidays as stressful.

Coaching is difficult because they are being paid a lot of money to develop a winning team and they make team selection decisions accordingly. During the season, it can be hard to focus on needs of individuals who comprise the team. It is important to point out that there are many coaches out there who realize the consequence of such negative statements and practices. Sophie indicates that she has never had a coach make negative comments about needing to lose weight. “They always talk about taking care of our bodies, and making sure we are eating right.” Although Jane has found some pressure from her coaches, she confirms that her coaches “would never want us to have a disorder or to be too skinny.”

Pressures related to biological characteristics
Aesthetic sports are considered an early-entry sport where young girls often specialize in the sport as early as eight years of age. This means that in many sports, girls grow up in front of the sport community where many are quick to point out changing bodies. Growing, becoming more muscular and fat are inevitable and often the reason athletes ‘lose’ their technical elements, especially those involving aerial rotation.

A changing body is stressful, especially in the face of constant comparisons. “It’s really hard not to compare yourself to your teammates. There is always someone who seems to be able to eat whatever they want and they are still so skinny and I always wondered, “Why can’t I be like that?” I envied them so much because I had to work so hard to keep my weight down,” reveals 22 year old Sophie. While these growing pains are common among non-athletes, the sport environment magnifies adolescent insecurities.

According to 20-year old Jane, “I grew faster then everyone else I went to school with. I thought I was huge, but I was normal-just bigger than them because I had hit puberty earlier in life. All I knew was that when people want to lose weight, they eat less and exercise more. So I started doing that. I started losing weight, so I though to myself “If I eat even less, I will lose even more.” Losing weight became addicting. Pretty soon, I was skipping breakfast and dinner whenever I could, and only eating an apple and yogurt for lunch. I ran 3-5 miles everyday, on top of at least two hours of practice. I also would get on a stationary bike for about an hour. I didn’t understand that what I was doing wasn’t healthy. I just wanted to be thin.”

What many people in sport communities may not realize is that individuals are all on their own pathway to their genetically pre-determined size. Although extreme dietary restrictions and exercise can influence this pathway, growth is inevitable and severe caloric restriction leads to severe health consequences noted earlier. It is also important to keep in mind that a lot of energy can be expended while participating in a sport. Nutritional requirements adequate for developing bodies are influenced by body type and metabolism.

Physical characteristics such as height, physique and leg length are tied to the timing of puberty. For example, the growth plates (bones) of early maturers close sooner than late maturers. Late maturers spend a longer time growing and thus end up being taller, leaner, with longer legs compared to their body. Growth spurts are more noticeable among early maturers who are also characteristically more muscular than late maturers. Because muscle weights more than fat, early maturers can expect to weigh more without worrying about being fat. It is important to note that weight and the Body Mass Index (BMI: weight (kg)/height (m2)), a popular indicator of weight-related health, are not indicators of body composition, or fatness.

Psychological characteristics
In addition to changing bodies, psychological characteristics such as self-perceptions and self-esteem are developing during adolescence and can be influenced by the way people react to changing bodies. It is common for athletes to experience social physique anxiety (SPA) – anxiety about presenting oneself in front of others. It is important to avoid heightening SPA because researchers have found that people with SPA have a tendency to develop eating disorders and have low self-esteem. Perceptions such as satisfaction with health, strength, endurance, physical activity as well as appearance-related issues are important building blocks of self-esteem, which can improve confidence and buffer the effects of SPA.

Confidence and mental toughness are some of the most important psychological characteristics in any sport. They result from participation and are essential for performing your best. Like positive self-perceptions, they can also protect people during stressful life events. Eating disorders often stem from losing control over other areas of life especially during stressful situations such as applying for college or when parents are going through a divorce. Mental toughness is particularly important for coping with criticism, bad advice and overcoming disordered eating. “I had to want it. Not my parents wanting it for me or my doctors or my therapists. Me. Because ultimately I’m the only one who can overcome it…no one can do it for me and it took me a very, very long time to come to that realization” reveals Sophie.

Each athlete interviewed was asked to provide three pieces of advice for athletes, parents, coaches, and sport officials. Here is a summary of their recommendations.

Advice for athletes:

• Remember you are a unique individual first before you are an athlete.
• Let your happiness and enjoyment of your sport take precedence over criticisms you may face. Your health is so much more important to your sport than your weight!
• If a teammate has an eating disorder, treat her with respect and dignity, and be sensitive to her illness. Above all, be there for her as a friend and teammate.
• Avoid obsessing about the numbers on a scale. They are only numbers.
• If you know a teammate or friend is having problems with food, it is not something they can “just stop” and they are not doing it for attention. All you can do is be supportive, you can’t make them quit…they have to do it themselves.

Advice for parents:

• Never criticize your children or other athletes for their weight.
• Build self-esteem by making positive comments concerning physical abilities and appearance often, they are the building blocks of self-esteem.
• Make sure your child knows the importance of good nutrition and appropriate exercise as an athlete.
• Monitor the way your athlete’s coach treats issues of weight, diet and self-esteem. Protect your child from becoming the target of a coach who discriminates based on weight.
• Consider how you evaluate your own appearance, health-related behaviors and communications concerning diet. Children can learn that food is an enemy at a very young age.
• Avoid over-emphasizing beauty based on outward appearance. Make sure your child knows that they are loved at whatever size or shape they may be.
• Avoid comments like “Do you think you should be eating that?”
• If your child has signs of an eating disorder do not become the “food police” in a power struggle because it could backfire.

Advice for coaches:

• Be aware that you are role model to your athletes. Your influence goes a long way in their lives.
• Be sensitive in making comments about your athlete and/or team expectations and how you address body image.
• Avoid discriminating against athletes because of their weight. Refrain from weigh-ins, and asking athletes to lose weight or diet.
• Provide educational resources concerning nutrition, growth and development, exercise and disordered eating.
• Be positive and empathetic.

Sport officials and the media

• Seek and share information about nutrition, growth and development, exercise and eating disorders. This information should be mandatory training at judging, coaching and administration seminars.
• Consider implementing policies on unhealthy coaching practices and parent behaviors at sport related activities.
• Celebrate athletes with diverse body types, backgrounds and ethnicities at all times.
• Don’t always profile and reward the thinnest, most beautiful athlete in your magazines and other venues. The “ideal” of the white, thin, beautiful athletes needs to be challenged.

If you think you may have an eating disorder, deciding that you want to help yourself is the first step towards becoming healthy. Know that there are many resources out there and people who can help you. Both Jocelyn and Sophie found working with dieticians helpful in re-learning healthy eating habits. You just have to take that first step even if it’s scary and admit that you need help. You can learn more by going to the following websites:

• http://www.ncaa.org/sport-science-institute/mind-body-and-sport-eating-disorders
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2231403/
• https://www.nationaleatingdisorders.org/eating-disorders-athletes
• https://www.nationaleatingdisorders.org/help-support/contact-helpline

This article was adapted from Monsma, E. (2006). Disordered eating and the controlling aspect of synchronized skating. Synchronized Skating Magazine, Issue 2.