| The Female Athlete Paradox | | | | contradictory conclusions. Abnormal nutritional findings |
| There is indeed a paradox when it comes to female | | | | in patients with anorexia nervosa are primarily a |
| athletes and energy intake. On the one hand, they may | | | | consequence of semi-starvation. Neuroendocrine |
| need to consume a high calorie diet because of their | | | | abnormalities, degree of recovery, and the phase of |
| extreme training intensity. On the other hand, they may | | | | treatment can affect the interpretation of the data. |
| feel that they are eating too much compared to | | | | Despite the importance of nutritional rehabilitation, few |
| non-athletes, they may develop self-imposed weight | | | | controlled studies that address the clinical efficacy of |
| restrictions, and coaches may propose team-imposed | | | | various dietary treatment regimens have been |
| weight limits. These factors can influence behaviors to | | | | conducted. |
| the point where an athlete can develop disordered | | | | In the case of anorexia nervosa, the initial nutritional |
| eating patterns. Lori Gross describes disordered eating | | | | strategy should involve the cessation of weight loss |
| and its relationship to The Female Athlete Triad. In this | | | | and improvement of the nutritional state. During this |
| article, I presents treatment and nutritional strategies for | | | | period weight may be maintained while nutritional status |
| eating disorders. | | | | is improved. Over time the focus is shifted towards |
| Treatment | | | | gaining weight gradually through normal self feeding. |
| The general principles of treating an athlete afflicted | | | | Supplemental foods or parenteral feeding (delivering |
| with a disordered eating behavior (i.e. anorexia nervosa | | | | nutrients through the vascular system) is not |
| or bulimia nervosa) involve education about the | | | | necessary. It must be remembered that since anorexic |
| physiological and psychological consequences, | | | | patients have hypometabolic rates, their energy needs |
| encouragement to begin eating a healthy diet and | | | | and nutrient needs may be quite low. So initially, |
| control eating behaviors, and emotional support for the | | | | unusually small quantities of food may be sufficient. |
| patient and family. Mild cases of disordered eating | | | | Calorie needs should be adjusted based upon the |
| behavior can be managed by the family physician, but | | | | measured basal metabolic rate. The initial use of small |
| a great deal of time and sincere interest are required. | | | | quantities is sound therapeutically because it meets the |
| More severe cases are best treated by those | | | | psychological needs of the patient who may be |
| experienced in treating the disorder. These cases | | | | guarding against gaining weight. Encouraging the patient |
| require various combinations of support, psychological | | | | to consume large quantities of food or high calorie |
| counseling, and diet counseling. | | | | products like weight gain shakes is counter-therapeutic |
| Outpatient treatment addresses the patient's fears and | | | | at this stage. As the patient becomes less fearful of |
| misconceptions surrounding eating. Psychological | | | | gaining weight, physiologically acceptable weight goals |
| counseling addresses personal, family, and social issues | | | | can be established based upon the patient's height, |
| that exist. For younger patients under parental | | | | frame size, and weight history. |
| supervision, the parents must be involved in the | | | | In the case of bulimia nervosa, the initial nutritional |
| treatment program. While a variety of treatment | | | | strategies are for the patient to gain control over |
| techniques exist, none appear to be better than the | | | | eating binges, to encourage regular eating habits, to |
| others. Important factors in determining the success of | | | | avoid fasting, and to minimize the likelihood of eating |
| the treatment program are considering the individual | | | | binges. The emphasis during the early stages should |
| needs of the patient in planning the treatment program | | | | be on weight stabilization while a normal, healthy eating |
| and the characteristics of the patient and the illness. | | | | pattern is developed. Treatment plans used in anorexia |
| When weight loss, binging, or purging continue despite | | | | nervosa can be adapted for use with bulimia nervosa. |
| outpatient treatment efforts, intensive hospital | | | | The treatment plan should include an educational |
| treatment is required. The decision to hospitalize a | | | | component about the nutritional and health |
| patient is based on the extent of weight loss, the | | | | consequences of bulimic behaviors. After the patient |
| inability to control a self-destructive eating behavior, | | | | has demonstrated confidence in controlling binges and |
| presence of a severe electrolyte disturbance, | | | | follows a consistent eating pattern, the need for a |
| depression, family conflicts, and the patient's lack of | | | | weight loss plan can be assessed. |
| motivation for change. Hospital treatment requires the | | | | Important Reminders for the Female Athlete |
| teamwork of a physician, psychiatrist, social worker, | | | | It may be helpful in treating athletes with disordered |
| nurse, and dietitian. All of the involved personnel should | | | | eating patterns to discuss the fact that poor nutrition |
| be familiar with the patient's treatment plan and | | | | and weight loss can eventually result in poor sports |
| individual needs. While the patient does not need to be | | | | performance. The combination of low caloric intake |
| admitted to an "eating disorders unit", the hospital unit | | | | and the resulting fluid and electrolyte reduction |
| that is treating the patient should be geared towards | | | | decreases endurance, strength, reaction time, speed, |
| treating eating disorders. | | | | and concentration. These conditions impair athletic |
| Nutritional Strategies | | | | performance and increase the risk for injuries [4]. In |
| Treatment of disordered eating syndromes involves | | | | addition, the harmful physiological side effects of food |
| the joint efforts of a physician and a dietitian. They | | | | restriction can manifest themselves in amenorrhea, |
| usually meet with the patient separately, once per | | | | osteoporosis, and possibly even death. |
| week. With anorexic patients, the dietitian deals with | | | | Prevention |
| the effects of semi-starvation diets, energy needs, | | | | To reduce the potential for disordered eating, |
| nutrient needs (allowing for growth if an adolescent) | | | | everyone involved with the female athlete, including the |
| and the dietary modifications necessary to reestablish | | | | athlete herself, should make decisions regarding weight |
| normal eating patterns and the restoration of normal | | | | loss. The coach, athlete, medical, and nutritional |
| weight. Given the lack of calories and nutrients in | | | | personnel should all agree if weight loss is necessary, |
| anorexic patients, it is not surprising to find nutritional | | | | the amount of weight loss needed, and the method. All |
| deficiencies. Increased oxidative stress due to | | | | weight loss plans should be designed for an individual, |
| inadequate Vitamin E intakes, elevated plasma | | | | not a team. Eating disorders begin when athletes are |
| total-homocysteine due to a folate deficiency, and | | | | made to conform to unrealistic weight goals or when |
| various other deficiencies have been reported in the | | | | coaches, friends, or parents comment negatively on an |
| scientific literature. In addition, resting energy | | | | athlete's weight. Athletes should be discouraged from |
| expenditure is reduced, but often increases markedly in | | | | fad and crash diets as that will promote disordered |
| association with refeeding. | | | | eating patterns and result in unhealthy weight loss. |
| A review of previous studies that examined | | | | Remember that disordered eating patterns have |
| micronutrient status in anorexia nervosa concluded that | | | | psychiatric, physiological, and social factors that make |
| due to the tremendous variability of the population, the | | | | a team approach the most effective treatment |
| cross-sectional nature of the investigations, and the | | | | strategy. |
| use of inappropriate methods to determine nutrient | | | | References upon request. |
| status reported inconsistent and sometimes | | | | |