In-depth interviews of women with subclinical eating diaorders delineate these characteristic eating behaviors

1. They restrict their caloric intake in order to lose weight, and eat a very repetitive diet, with little or no variety in the types and amounts of foods they consume.
2. They follow strict dietary rules and experience guilt and self-anger if they break one of their dietary rules.
3. They limit thier intake of "bad foods," and almost always choose low-or non-fat foods. (Maore. Int'l J Sports Nutr. June, 2000)

Almost all of these women perceive themselves as being slightly to very fat, and are preoccupied with weight. If any of this sounds familiar, keep reading!

A survey of 24 women (ages 18-36) who exercised about 10 hours/week and had subclinical eating disorders reports thay had 2.5% higher body fat than normal eaters who exercised only 6 hours/week. They also reported consuming less dietary fat than the normal eaters. These findings challenge two common beliefs.

1. the more you exercise, the thinner you'll be, and
2. avoiding dietary fat helps you lose body fat.

The eating disordered women reported under consuming calories to lose weight - but to no avail. The deficit did not contribute to weight loss. That is, the women theoretically deserved to eat 2,500 calories and reported eating only 2,000 calories. They seemingly adapted to the combination of a high calorie expenditure via exercise + restricted calorie intake. The big deficit caused the body to shut down and conserve energy (similar to hibernation). This is nature's survival technique to save women from getting too thin to reproduce.

Thin at any cost.

This struggle to be perfectly thin creates health problems for casual exercisers and competitors alike. The restrictive intake can greatlyy reduce the intake of vitamins, minerals, and protein; this places the athletes at risk for poor nutritional status. The restrictiveness can also lead to health problems such as chronic fatigue, compromised immune function, poor or delayed healing, anemia, electrolyte imbalance, menstrual dysfunction, reduced bone density, and a four times higher risk of stress fractures.

At SportsMedicine Brookline, I councel too many people with eating disorders / disordered eating; they fill the majority of my counseling hours. They come believing "If only I were thinner. I'd be a better athlete." I disagree. Their efforts to achieve their disired thinness reduce their energy and performance. They would be better athletes if they fed themselves better.

Why do eating disorders happen?

Eating disorders commonly occur in athletes with low self-esteem. They believe thinness will make them into a better and more perfect person. The truth is, their smaller body does not make them better; there is simply less of them to love. They are the same person, just obsessed, withdrawn, and tired. And when they severely restrict food, they lose muscle, strength, and stamina. This is not the way to become a champion.

When an athlete with low self-esteem is physically beautiful plus has traits of perfectionism and an underlying tendency to be hypercritical and anxious, the risk of developing an eating disorder increases dramatically. Add to the scenerio a mother who may have had (or still has) food and weight issues, and the daughter is a prime target for developing a full-blown eating disorder.

Athletes with eating disorders are less available to their friends. After all, when a person is constantly counting calories (calories eaten at meals, burned during exercise, saved by skipping lunch, about to be eaten at dinner, etc.) as well as counting grams of fat and dozens of sit-ups, his or her brain has little energy left to manage bigger issues like problems and relationships. The eating disorder creates a smoke screen that masks the underlying issues.

What can I do?

If someone you know is suffering from a full-blown or a subclinical eating disorder, you may feel frustrated with your unsuccessful efforts to resolve the problem. You may think "If only my friend would eat normally, everything would be OK." Likely not. Food is just the symptom. The problem is this person is unhappy. To help you understand more about these underlying issues, you might want to read "Surviving an Eating Disorder: A survival Guide for Parents and Friends," by J. Siegal and J. Brisman. This helpful resource can teach you what to say to your friend.

Your job is to help your friend or loved one by taking them to get professional guidance. This might mean finding a registered dietitian in your area who specializes in sports nutrition and eating disorders. (See the American Dietetic Association's referral network at Eat Right or
call 800-366-1655). You can also locate a mental health counselor skilled with eating disorders at Something Fishy . Remind your friend that no weight will ever be good enough to create happiness. Happiness comed from within, nor from a number on the scale.