Eat to Impact Performance: Disordered
Eating Challenges for Performance
Behavioral and physical consequences of
disordered eating in young athletes
Michelle Weinbender R.D.,
Clinical Dietitian/Food and Nutrition
Services
Providence Sacred Heart
Medical Center – Spokane
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What is Disordered Eating?
Any irregular pattern of eating that includes food
restriction or avoidance of certain types of foods or
consuming fewer calories than needed for health or
sports activity but may also include overeating
Often, disordered eating can result in a diagnosed Eating
Disorder, however, irregular eating that does not meet
criteria for an Eating Disorder should not be considered
less serious
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What Does An Eating Disorder
Look Like?
•
•
•
•
Anorexia Nervosa
Bulimia Nervosa
Binge Eating Disorder
Eating Disorder not otherwise specified
(EDNOS)
• unofficial terms: anorexia athletica, orthorexia
nervosa, diabulimia
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Prevalence and Prognosis of
Eating Disorders
Eating disorders affect males and females of all ages,
socioeconomic groups and ethnicities around the world
Athletes in certain sports may be at greater risk
3:1 ratio of girls to boys
Over the past decade, white, middle-to-upper class
females ages 13 to 30 have been most affected.
Only 5% of adolescents with disordered eating behaviors
go on to develop classic eating disorders
Recovery rates as high as 50% with early detection and
treatment
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What is Intention/Reason for Disordered
Eating?
• Control weight or body shape
• Receive positive feedback for weight loss or
appearance
• Intolerance to a type of food, perceived or actual
• Depression or anxiety
• Belief that certain foods can enhance or diminish
performance
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Concerning Behaviors
These disordered habits do not necessarily warrant a
diagnosis of an eating disorder, but could be
concerning:
– excluding whole food groups (for example, all fats or all
carbohydrates)
– eating only at particular times of the day
– eating only specific foods
– eating alone
– eating large amounts of food
– exercising excessively beyond recommendations
– exercising in secret or even when injured
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Here’s the GOOD NEWS
• YOU can make a
difference
– Teach healthy habits
– Create healthy body
image
– Improve self esteem
• YOU can help your
athlete
– Perform better
– Reduce risk of injury
– Enjoy life
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And the BAD NEWS…
YOU cannot make your
athlete lose weight,
gain weight, make
healthy choices, eat
their veggies, drink
water, pick up their
socks…
UNLESS THEY WANT TO!!
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YOU have the POWER
• An athlete’s #1 source for nutrition
information is their COACH
• Coaches can play a major role in
developing healthy eating habits for life
• Coaches can play a major role in the
prevention of disordered eating
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Does my athlete need to change
his/her weight?
Research does not support the idea that
lower body weight will increase
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performance
Lots to consider…
• Genetics, body weight history, bone
structure, sport, position, body
composition, health, stage of growth
• Growth and development can be
compromised
• Consult physician and registered
dietitian to set ranges that are
reasonable for the athlete as an
individual
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Weight vs BMI
Body Mass Index
• BMI = weight (kg)/height (m2)
– Underweight (< 18.5)
– Normal (18.5-24.9)
– Overweight (25-29.9)
– Obese (30 +)
• Muscular people (athletes) tend to have a
high BMI that may be misinterpreted as
obese
• BMI was designed for population studies
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Athletes, body weight and nutrition:
THE TRUTH
• Food is fuel, you can’t train without it
• “Healthy” is a range through which peak
performance can be achieved
• Underweight may be more problematic
than overweight
• Focusing on the scale is at best a
distraction and at worse a disease
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Athletes, body weight and nutrition:
THE TRUTH
• Poor nutrition can lead to increased
injuries, decreased immunity and
escalated mood changes
• Poor nutrition = hurt, sick and cranky
athletes!
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The period myth
• “My coach told me I
knew I was training
hard enough when I
stopped getting my
period”
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Factors contributing to menstrual
disturbance in female athletes
• Inadequate nutrition
– Calorie supply < demand
• Exercise intensity
• Low body mass index (BMI)
• High stress
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The period reality…
Female Athlete Triaddefined in 1993
• Disordered Eating
• Amenorrhea (no periods)
• Osteoporosis
American College of Sports Medicine
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The New Female Athlete Triad
• Components are interrelated but may
present on a continuum of severity
low energy availability
menstrual disturbances
bone loss
eating disorder
amenorrhea
osteoporosis
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Bone Mineral Density (BMD)
• Decreased BMD directly correlated with duration
and severity of menstrual dysfunction
• Resumption of menses results in an increase in
BMD
– Even with resumption, BMD may never fully recover
• Direct effect of inadequate caloric intake on
bone
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What’s a coach to do ?
• Understand that our “pop” culture
misleads athletes regarding nutrition
• Empower your athletes with good
information- THE TRUTH
• Emphasize performance, not appearance
– Watch the 3 letter words: fit and fat
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What’s a coach to do ?
• If you feel an athlete’s weight is unhealthy
or affecting their performance,
recommend they consult with a sports
nutritionist or physician
• Promote healthy, sports based eating
• Be a source of support
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Top 5 Tips to Promote Healthy
Eating
1. Allow kids to see you eating healthy
snacks
2. Decipher Fact from Fiction
3. Remind kids & parents FOOD=FUEL
4. When traveling & home eat meals
together
5. Educate athletes on importance of
CARBS, PROTEIN and FAT
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Do CARBS make us fat?
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NO! Carbs are an athletes
#1 energy source!
• Carbs come from whole grains, breads,
cereals, fruits, dairy and some veggies
• Dairy contains both carbs AND protein
• Carbs also come from sugar
• High sugar foods usually contain less
nutrition - eat in moderation
• Half of what we eat should come from
carbohydrate
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Balance Carbohydrates
• Grain servings: 1/2 cup pasta, 1 slice
bread, 1 pancake, 3/4 cup cereal
• Each meal should provide 3-4 grain
servings, 1 fruit, 1 vegetable and 1 dairy
serving
• Snacks should contain carbs and protein
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Does eating more protein create
bigger muscles???
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Protein
• Protein recommendations
– Strength athletes .6-.9 g/lb bw
– Endurance athletes .4-.7g/lb bw
150lb football player: 150lb x .6g/lb = 90
grams
• 4 oz chicken breast 30g
• 2c. milk 16g
• Turkey Sandwich 40g
• Protein shakes or bars may be helpful
• High protein diets not advocated as
performance enhancing
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What’s the Skinny on Fat?
Good Fats
• Bad Fats
– Unsaturated Oils
• Canola, Olive
– From nuts and plants
– Omega 3 Fats
• Fish, walnuts, flax,
supplement
– Hydrogenated
• OK Fats
– Trans
– Some saturatedanimal fat
Fat gets a bad rap but is essential for good health
Need both unsaturated and saturated fats
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When should we use sports drinks?
• For events < 1 hour, water is perfect
• Use sports drinks if >60 minutes or
multiple events
• Look for:
– Carb- 14g/8oz serving
– Sodium- 100mg/8oz
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#1 RULE:
“Book End” your Workouts
• Eat before and after your workouts
• If possible, include carbohydrates and
some protein in snacks and meals
– Yogurt and Fruit
– Chocolate Milk
– String Cheese and Crackers
– Boost meal replacement drink
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Healthy Weight Loss:
NOGAIN
• Nutrition: 250-500 calories less per day, high
nutrients
• Off-Season: Avoid strength loss and energy
drain
• Gradual: No more than .5-1lb/week
• Activity: Increase in activity may be ok
• Individual: Recognize unique differences
• Never use “rapid results” techniques
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Tips for Gaining Weight
• Eat three meals/day, every day
• In addition, at least two snacks (plus one
before bedtime)
• Drink caloric beverages between meals
• Go for seconds- even if you don’t finish them
• Make higher calorie choices
• Choose banana instead of apple
• Pick Granola over Cheerios
• Always carry snacks
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The BEST way to eat- to stay
LEAN and STRONG
• Breakfast
• Snack
• Lunch
• Snack
• Dinner
• Snack (optional, are you hungry?)
**Time meals and snacks no more than 3-4
hours apart**
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Snack Attack
Low in fat – High in carbs
• Sports Bars that provide a little fat and protein (i.e. Luna or
Clif Bar)
• Low-fat muffin and skim milk
• Microwaved egg (1.5 min) on English muffin
• Hot cereal in a cup with 1 cup milk
• Fruit and yogurt with whole wheat bagel
• Yogurt with granola
• Toaster Waffle with peanut butter and jam
• String cheese and fruit
• Boost meal replacement drink
• Whole Grain Fig Newtons
• Crackers with peanut butter
• Carnation Breakfast Essentials
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Try this!
• Provide a nutritional game plan: Have a sports
dietitian talk to your team
• Encourage athletes to adopt a physically
active lifestyle (even outside practice)
• Focus on accepting all body shapes and sizes
• Hand out appropriate materials to provide
your athletes with nutrition information. Quiz
them!!
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EAT, DRINK, WIN!
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Where to Go for More Info
www.winforum.org
www.choosemyplate.gov
www.bestteendiets.org
www.eatright.org
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Michelle Weinbender, RD
Clinical Dietitian/Food and Nutrition Services
Providence Sacred Heart Medical Center – Spokane
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