May 2009

ARTICLE HIGHLIGHTS

  • Disordered eating occurs when calorie intake cannot support workouts and the body’s basic needs.
  • Athletes whose sports focus on the individual are more at risk.
  • In women, a common sign is the absence of monthly periods.
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Running on empty. Eating disorders in athletes

Michelle Hoff, DO

You would expect athletes to be some of the healthiest people around. You assume they eat a healthy diet, don’t smoke and are in excellent shape. But sometimes, the best intentions can go too far.

“Some athletes are at risk for a medical condition known as ‘disordered eating,’” says Michelle Hoff, DO, Park Nicollet Melrose Institute (formerly Methodist Hospital Eating Disorders Institute). “It occurs when athletes don’t take in enough calories to support their workouts and their body’s basic needs.” Although unintentional, disordered eating may be the prelude into a full-blown eating disorder, which can seriously affect athletes’ physical and emotional health. The problem is that eating disorders often come on gradually and go undetected until the harm is done. At that time, behaviors are difficult to change.

Certain athletes more at risk
Eating disorders can affect both males and females. But, athletes who participate in certain sports, especially those that focus on the individual, are more prone to this condition.


  • Gymnastics, dance, figure skating and diving are judged on appearance, and some athletes go to unhealthy extremes to be thin.
  • Wrestling and weightlifting have strict weight classifications, and some athletes use unhealthy strategies to drop a few quick pounds.
  • Running, swimming and cross-country skiing require great endurance, causing some athletes to believe that weight loss will enhance performance.

“Being extremely driven, highly competitive and having a strong desire to please coaches also increase athletes’ risks,” Dr. Hoff adds.

Watch for red flags
“I think the medical community has come a long way in recognizing the harmful effects of unhealthy weight loss and educating people about eating disorders,” she continues. Still, she likes to remind parents, athletes and coaches to watch for common signs and symptoms.

The American College of Sports Medicine has recognized the relationship of three interrelated conditions in female athletes, which they defined as the “Female athlete triad.” When disordered eating occurs, the individual is at risk for two subsequent problems: absence of regular monthly periods and the loss of bone mineral density, which potentially leads to osteoporosis.

“A lack of adequate caloric intake causes a woman’s reproductive system to shut down,” Dr. Hoff explains. “This, in turn, leads to a lack of estrogen, a hormone that’s necessary for building strong bones. Without enough estrogen, women are at a risk for weak bones, which may result in stress fractures and potentially osteoporosis.”

Other symptoms that may indicate the need to screen for an eating disorder in male and female athletes include:

  • overexercising, even when sick or injured
  • emotional concerns, such as lack of concentration, moodiness, anxiety or depression
  • muscle weakness, caused by insufficient calories or electrolyte imbalances
  • social concerns, such as withdrawing from family and friends

Treatment requires team approach
“Because of the complexity of eating disorders, a multidisciplinary team, which includes doctors, dietitians, psychologists and exercise clinicians, is most effective in helping athletes achieve recovery,” Dr. Hoff explains. “Usually, the first step in treatment is to restore proper nutrition, which helps them start healing physically and emotionally.”

Melrose Institute has physical therapists certified by The American College of Sports Medicine as exercise specialists. Athletes with eating disorders work with exercise clinicians on both an inpatient and outpatient basis as part of our program. “Our staff also includes clinicians in all disciplines that have a special understanding of athletes’ needs,” Dr. Hoff adds. “They have a great respect for althletes’ motivation, but also help them balance that with what’s right for their health.”

To learn more about treating eating disorders or to schedule an initial assessment, call 952-993-6200 or visit parknicollet.com.


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