Eating disorders and disordered eating behaviour are serious mental conditions “that manifest themselves in a variety of eating and weight-related signs and symptoms” (Thompson & Sherman, 2010, p. 7) and can affect both males and females of all age groups. The spectrum of eating disorders and disordered eating behaviour is broad and extensive; characteristics and behaviours are distinguished as medically recognised disorders should they correlate with criteria stated on the Diagnostic and Statistical Manual of Mental Disorders (APA, 2013). Both terms capture behaviours intended by the individual to lose or control weight (Collins, 2010), the key difference being behaviours of a certain severity which comply with the criteria of the DSM-V are classified as medically recognised disorders. Individuals whose eating characteristics are of a lower severity and do not comply with the DSM-V criteria are termed to be struggling with disordered eating behaviour.
Within a sporting context, not only is an athletes’ health and well-being threatened but also their sporting performance. Of all the conditions along the spectrum of eating disorders and disordered eating, anorexia nervosa has the highest mortality rate (Thompson and Sherman, 2010, p. 10) and cardiovascular problems, which account for around half of the deaths of anorexic patients, are the most common medical complication which is caused by starvation and purging techniques. The most widely known eating disorder associated with sport participation is the female athlete triad. This consists of the interrelated problems of disordered eating and also amenorrhea (the loss of the female’s menstrual cycle) and osteoporosis which are both consequences of an inconsistent diet and calorie intake (Yeager, Agostini, Nativ and Drinkwater, 1993). In addition to the physiological effects of these conditions, the psychological effects are also severe. Depression, decreased concentration and insomnia have been found to be effects of semi-starvation (Thompson and Sherman, 2010).
It has been estimated that the prevalence of disordered eating in athletes ranges from 15-62% (Walsh, Wheat and Freund, 2000) and 14-19% have subclinical symptoms (Greenleaf, Carter, Petrie, and Reel, 2009). There is not one specific cause for the development of eating disorders or disordered eating behaviour but rather a combination of socio-cultural, familial, personality and genetic factors (Thompson and Sherman, 2010). With this being known, who is in the best position to provide help and support to athletes and is there enough education within sport to teach coaches how to manage and treat athletes under their care struggling with these issues?
Studies have shown that sports coaches currently possess poor knowledge regarding eating disorders in athletes (Nattiv, Loucks, Manore, Sanborn, Sundgot-Borgen and Warren, 2007). This is supported by research conducted by Sherman, Thompson, DeHass and Wilfert (2005) that discovered that only 51% of coaches had attended lectures on the subject which is similar to research conducted by Turk et al (1999) which found that less than half of the coaches involved had attended educational programmes on eating disorders. The current state of education for coaches concerning detection and treatment of eating disorders and disordered eating behaviour in athletes was summarised by Currie in 2010 to be a “severe lack of knowledge in this area” and this “could be a serious implication for the welfare of athletes”.
As stated by Currie (2010), potential eating disorder and disordered eating problems should be approached “early, directly, supportively, and confidentially”. It has often been remarked within the literature that coaches are in the best position for early identification of eating disorders and disordered eating issues within their athletes due to their position and ability to observe them on a regular basis (Zimmerman, 1999). Coaches spend a large quantity of time with their athletes during training, competition and even travelling which provides ample opportunities to observe and monitor individuals’ habits. Coaches often also have a special relationship with their athletes consisting of trust and friendship which may also make athletes feel more comfortable disclosing close and personal information, such as if they are struggling with disordered eating issues, to their coaches rather than to parents or a medical professional.
A study conducted by Arthur-Cameselle and Baltzell in 2012 is concerned with what could be learned from athletes who had recovered from eating disorders and gives advice to coaches, parents and other athletes regarding the subject. They reached a very important conclusion; that there was a strong need for further education for coaches in identifying and treating athletes struggling with eating disorders and disordered eating problems. This is supported by a large amount of relevant literature such as Bratland-Sanda and Sundgot-Borgen (2013) who stated that for it to be possible for the appropriate identifications and referrals to be made, coaches required a full and working knowledge of eating disorders and disordered eating behaviour. Research conducted by Currie in 2010 stated that programmes that support athletes struggling with disordered eating issues and also prevent their occurrence should be developed to assist the management and treatment of the matter. Further to this, he also stated that responsibility lies with sporting organisations and individual sports governing bodies to develop and implement relevant preventative practises. As with any other medical conditions, prevention is key and so the sporting environment must acknowledge the risks associated with sport participation and the development of eating disorders and disordered eating problems so that preventative practises become the norm.