Anorexia Nervosa is an eating disorder where someone deliberately reduces the amount of food consumed to lose weight or maintain a desired image. The individual has an intense fear of weight gain and would go to extreme measures to maintain their desired image, which may lead to long-term consequences.
Anorexia Athletica is a similar type of eating disorder that occurs in athletes involved in sports that pay keen attention to their physique. The main difference between the two is that with anorexia athletica, the individual engages in a high level of physical activity. There is sufficient caloric restriction to facilitate weight loss, coupled with intense physical activity or exercise. With anorexia athletica, most of the caloric restriction is due to a specialised diet but like anorexia nervosa, some athletes may engage in self-induced vomiting and the use of laxatives as means of weight loss and weight maintenance, which places further physical stress on the body.
Athletes who participate in weight class and aesthetic sports that place great emphasis on weight and physique are at greatest risk. These athletes include gymnasts, swimmers, bodybuilders, dancers, long-distance runners and boxers. This does not mean that other athletes may never be affected by anorexia athletica.
Anorexia Athletica may be difficult to detect, as the signs and symptoms can disguise themselves as just another dedicated athlete who goes above and beyond during training and never eats outside of their restrictive diet. It is our responsibility as coaches, teammates, parents, physiotherapists and physicians to be able to recognise early signs and symptoms of anorexia athletica.
It may differ from athlete to athlete, but a common sign is where an athlete always feels the need to exercise, often appearing as though they are addicted. They engage in exercise whether they are physically or emotionally energised, and if a workout routine is missed, they feel profound guilt and anxiety. Some athletes may go as far as exercising in private to avoid alarming those around them of their unhealthy exercising habits. They are often obsessed with their physical appearance and how they are viewed by others. They pressure themselves to maintain that ideal physique and if this isn’t achieved by their intense exercise routine, then they take it a step further by subjecting themselves to a strict, restrictive diet.
This type of behaviour may progress to the unimaginable, self-induced vomiting and the use of laxatives as a means of purging for weight loss. In extreme cases, their exercise routine starts to affect other aspects of their daily life. The athlete may become withdrawn from their support system, either to mask their unhealthy behaviours or because of their low self-esteem and emotional lability.
The long-term consequences of Anorexia Nervosa are far more devastating than its signs and symptoms. Let’s remember, these athletes are having a restrictive diet and are engaging in exercise exceeding their physical capacity. Some of the complications include malnutrition or nutritional deficiencies, as well as overuse injuries. Overuse injuries may include stress fractures that are common in certain sports, so imagine how much this risk may increase in an athlete who is partaking in excessive exercise coupled with poor nutrition. For example, a long-distance runner who is constantly training and going on long runs to increase peak performance would be at risk for Anterior Tibial Stress syndrome, more commonly known as shin splints. If this unhealthy athlete continues excessive training, it may progress to a stress fracture. To make matters worse, a well-restricted diet may delay the healing process of this fracture due to inadequate nutrients for healing. Other injuries may include arthritis, ligamentous sprains and muscle and tendon strains.
Additionally, there is impaired immune function. The cells responsible for fighting off infections are no longer functioning at the optimum, which puts the athlete at an increased risk for infections, especially those of the respiratory system. Bahne Rabe was a competitive German rower with two Olympic Medals who suffered from anorexia for some time. In August 2001, he was admitted to a hospital in critical condition secondary to extreme malnutrition and unfortunately died of pneumonia.
It is important to be able to recognise warning signs of Anorexia Athletica, but it is even more important for us to prevent it from occurring. The cornerstone of prevention is education, and everyone involved in sports should be aware of the condition and its various manifestations. Although there may not be many well-known, documented cases of Anorexia Nervosa within the Caribbean, we cannot fool ourselves into thinking that it does not occur. Sports like gymnastics, synchronised swimming and cheerleading are being pursued at increasing levels of competition and as the aesthetic sport options increase, we must be alert for Anorexia Athletica and not turn a blind eye saying we do not have these problems in the Caribbean.
Dasima Martin is a medical doctor who is pursuing her master’s degree in Sports Medicine in the Faculty of Sport at UWI.