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Eating Disorders and the Swimmer

9/17/2012

By Jill Castle, Registered Dietitian and Child Nutrition Expert

We’ve heard the term eating disorder used in the world of swimming. Dara Torres told of her struggles with bulimia in Age is Just a Number, Amanda Beard chronicled bulimia in her book, In The Water They Can’t See You Cry: A Memoir, and Dagny Knutson recently went public with her story in Swimming World Magazine, "Dagny Knutson’s Journey: How a Troubling Eating Disorder Consumes a Rising Star."

These brave stories bring awareness and hope to other swimmers, parents and coaches.

Dara, Amanda and Dagny remind us that eating disorders are a real challenge, even among fit, strong, elite athletes. These swimmers are not the first, nor likely the last to suffer under the mental and physical grip of an eating disorder.

Why do some swimmers struggle with eating disorders?

A 2004 review study showed that eating disorder rates are higher in athletes than their non-athlete counterparts, higher in female athletes than males, and more common in those who compete in lean-focused and weight-dependent sports than other sports. Further, it is estimated that up to 35% of female athletes are at risk for anorexia and 38% for bulimia.

And, for many athletes with an eating disorder, the seeds were planted at a young age.

Swimming has its own set of risk factors. A study in 2007 summarized that over 50% of swimmers agreed with the statement, “There are weight pressures in swimming,” and went on to describe the top five stressors: 

  1. The belief among swimmers and coaches that lower body weight and body fat leads to improved swimming times.
  2. Skimpy swim team uniforms.
  3. Weight status and fluctuation awareness from teammates.
  4. Body scrutiny from spectators.
  5. The sense that lighter swimmers have a performance advantage.

While the very underweight swimmer is a red flag for possible anorexia, other eating disorders exist which are less obvious, such as bulimia or binge eating disorder. With these, weight status may not overtly indicate a problem.

Coaches and parents must be aware of the signs and symptoms, so they can take action:

Significant weight change: A sudden or significant weight change indicating inadequate or excessive food intake, and/or water retention or dehydration resulting from bingeing or purging.

Lack of growth: In the child swimmer, growth marches on, but prolonged lack of weight gain eventually stalls height growth.

Fatigue: Extreme tiredness, exhaustion, or slow recovery after workouts may be a red flag that energy or nutrient needs aren’t being met, or a nutrient such as iron is deficient. Sleep disturbances may occur due to poor nutrition and contribute to fatigue.

Frequent illness: Poor nutritional status makes it difficult to ward off illnesses.

Other physical changes: Thinning hair, hair loss or extra hair growth on extremities; skin problems like acne, excessively dry skin or problematic rashes; dental enamel erosion or tooth decay; temperature instability (feeling cold); swollen glands in the jaw area; boney appearance of the joints in the arms/legs, spine, hips and/or shoulder area; and a swollen belly may be indicators of extended poor nutritional intake and disturbed eating behaviors.

Mood swings: Changes is mood can be magnified due to low nutrition, or erratic eating.

Any of these signs can exist alone and simply be part of an individual’s attributes. An eating disorder will showcase several co-existent signs.

Parents and coaches can help prevent and address eating disorders, before they take over, with these pointers:

Parents:

Stay Involved. Without being too overbearing, stay on top of what is going on in a swimmer’s life. An awareness of how a swimmer is doing both in and out of the pool (physically, emotionally, socially) can help determine deviations from the norm.

Stay on top of nutrition. Set expectations for eating meals and snacks, stay on track with providing them, and help swimmers prepare for exercise and recovery with nutrition. Make sure exercise and eating complement each other and stay in balance.

Communicate concerns. Don’t be afraid to show concern. Provide emotional support and trust the swimmer to make good decisions, but intervene with professional help if necessary.

Approach the Coach. Coaches see swimmers in the water, and are often first to notice a decline in performance or changes in physique. The coach is a key partner in not only helping swimmers be the best they can be, but also in keeping them stay healthy.

Coaches:

Set the expectation for nutrition. Set the tone for hydrating practices, proper fuel and timing of eating. A coach has a powerful influence on healthy nutrition.

Tone down negative body messages. While nobody intends to start the cycle of an eating disorder, the reality is that repetitive messages about leanness and low body fat can translate to “lose weight,” and inadvertently contribute to dieting, a leading risk factor for eating disorder development.

Talk with the Swimmer. Share observations and concerns about a suspected eating disorder. In one study, athletes who had recovered from an eating disorder stated this was one of the most important things a coach could do.

Be knowledgeable and aware of eating disorders. Early detection and action ultimately helps preserve a swimmer’s health (and their swimming career). You can find more information about eating disorders at the National Eating Disorders Association (http://www.nationaleatingdisorders.org/).

Communicate with parents. Coaches are often ‘first-responders,’ having a bird’s-eye view of physique and performance, long before a parent may pick up on unhealthy trends. It’s an obligation to communicate these observations to parents.

Not every swimmer will face an eating disorder, though many, especially females, will face the pressures that may trigger a disorder. Parents and coaches together can team up to prevent, identify and address eating disorders in the swimmer, no matter the age.

References:
Sundgot-Borgen J and Torstveit MK. Prevalence of eating disorders in elite athletes is higher than in the general population. Clin J Sport Med. 2004.
Bonci et al. National Athletic Trainer’s Association Position Statement: Preventing, detecting, and managing disordered eating in athletes. J Athl Train. 2008.
Reel JJ and Gill DL. Slim enough to Swim? Weight Pressures for competitive swimmers and coaching implications. The Sports Journal. 2001.

Jill Castle, MS, RD is a registered dietitian and child nutrition expert. She is the co-author of the upcoming book, Fearless Feeding: How to Raise Healthy Eaters from High Chair to High School (2013), and creator of Just The Right Byte, a child and family nutrition blog. She lives with her husband and four children (one swimmer!) in New Canaan, CT. Want to contact Jill? Email her at Jill@JillCastle.com.