Advertisement

Athlete-Specific Treatment for Eating Disorders: Initial Findings from the Walden GOALS Program

Published:October 04, 2019DOI:https://doi.org/10.1016/j.jand.2019.07.019
      Eating disorders are a public health concern because of the high levels of comorbidity with other mental health diagnoses such as anxiety, depression, and the associated suicide risk.

      Demmler JC, Brophy ST, Marchant A, John A, Tan JOA. Shining the light on eating disorders, incidence, prognosis and profiling of patients in primary and secondary care: National data linkage study [published online ahead of print July 1, 2019]. Br J Psychiatry. doi: 10.1192/bjp.2019.153.

      Athletes are at increased risk for eating disorders compared with the general public
      • Sundgot-Borgen J.
      • Torstveit M.K.
      Prevalence of eating disorders in elite athletes is higher than in the general population.
      • Martinsen M.
      • Sundgot-Borgen J.
      Higher prevalence of eating disorders among adolescent elite athletes than controls.
      and unique features of both the athlete mindset and the sport environment have been shown to relate to risks for eating pathology, body dissatisfaction, and compulsive exercise.
      • Arthur-Cameselle J.
      • Sossin K.
      • Quatromoni P.A.
      A qualitative analysis of factors related to eating disorder onset in female athletes and non-athletes.
      • Arthur-Cameselle J.
      • Quatromoni P.A.
      Factors related to the onset of eating disorders reported by female collegiate athletes.
      • Bratland-Sanda S.
      • Sundgot-Borgen J.
      Eating disorders in athletes: Overview of prevalence, risk factors and recommendations for prevention and treatment.
      • McLester C.N.
      • Hardin R.
      • Hoppe S.
      Susceptibility to eating disorders among collegiate female student-athletes.
      • Petrie T.A.
      • Greenleaf C.
      • Reel J.
      • Carter J.
      Personality and psychological factors as predictors of disordered eating among female collegiate athletes.
      • Petrie T.
      • Galli N.
      • Greenleaf C.
      • Reel J.
      • Carter J.
      Psychological correlates of bulimic symptomatology among male athletes.
      • Galli N.
      • Petrie T.A.
      • Greenleaf C.
      • Reel J.J.
      • Carter J.E.
      Personality and psychological correlates of eating disorder symptoms among male collegiate athletes.
      Eating disorders in sport have a range of serious metabolic and physiologic consequences with negative effects on nearly every organ system in the body.
      • Mountjoy M.
      • Sundgot-Borgen J.
      • Burke L.
      • et al.
      The IOC consensus statement: Beyond the Female Athlete Triad – Relative Energy Deficiency in Sport (RED-S).
      • Joy E.
      • Kussman A.
      • Nattiv A.
      2016 update on eating disorders in athletes: A comprehensive narrative review with a focus on clinical assessment and management.
      • Mountjoy M.
      • Sundgot-Borgen J.K.
      • Burke L.M.
      • et al.
      IOC consensus statement on relative energy deficiency in sport (RED-S): 2018 update.
      Ultimately, chronic energy deficiency predisposes athletes to injuries and compromises performance in sport. Early identification and timely intervention are essential
      • Thompson R.A.
      • Sherman R.
      Reflections on athletes and eating disorders.
      yet often delayed in athletes for many reasons, including low awareness of perceived risk inside the culture of sport. Untreated eating disorder symptoms have significant health, performance, and cost implications.
      • McArdle S.
      • Meade M.M.
      • Moore P.
      Exploring attitudes toward eating disorders among elite athlete support personnel.
      Eating disorders in sport are receiving increased recognition and attention at all levels of sport, in a wide variety of sports, and in both national and international arenas since a number of elite athletes, including Olympians, began sharing personal stories on social media. Although awareness of the problem is growing and the serious consequences to physical and metabolic health, mental health, and performance in sport are well documented, research to guide treatment services that effectively engage and treat athletes with eating disorders is lacking.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of the Academy of Nutrition and Dietetics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. Demmler JC, Brophy ST, Marchant A, John A, Tan JOA. Shining the light on eating disorders, incidence, prognosis and profiling of patients in primary and secondary care: National data linkage study [published online ahead of print July 1, 2019]. Br J Psychiatry. doi: 10.1192/bjp.2019.153.

        • Sundgot-Borgen J.
        • Torstveit M.K.
        Prevalence of eating disorders in elite athletes is higher than in the general population.
        Clin J Sport Med. 2004; 14: 25-32
        • Martinsen M.
        • Sundgot-Borgen J.
        Higher prevalence of eating disorders among adolescent elite athletes than controls.
        Med Sci Sport Exerc. 2013; 45: 1188-1197
        • Arthur-Cameselle J.
        • Sossin K.
        • Quatromoni P.A.
        A qualitative analysis of factors related to eating disorder onset in female athletes and non-athletes.
        Eat Disord. 2017; 25: 199-215
        • Arthur-Cameselle J.
        • Quatromoni P.A.
        Factors related to the onset of eating disorders reported by female collegiate athletes.
        Sport Psychologist. 2011; 25: 1-17
        • Bratland-Sanda S.
        • Sundgot-Borgen J.
        Eating disorders in athletes: Overview of prevalence, risk factors and recommendations for prevention and treatment.
        Eur J Sport Sci. 2013; 13: 499-508
        • McLester C.N.
        • Hardin R.
        • Hoppe S.
        Susceptibility to eating disorders among collegiate female student-athletes.
        J Athl Train. 2014; 49: 406-410
        • Petrie T.A.
        • Greenleaf C.
        • Reel J.
        • Carter J.
        Personality and psychological factors as predictors of disordered eating among female collegiate athletes.
        Eat Disord. 2009; 17: 302-321
        • Petrie T.
        • Galli N.
        • Greenleaf C.
        • Reel J.
        • Carter J.
        Psychological correlates of bulimic symptomatology among male athletes.
        Psychol Sport Exerc. 2014; 15: 680-687
        • Galli N.
        • Petrie T.A.
        • Greenleaf C.
        • Reel J.J.
        • Carter J.E.
        Personality and psychological correlates of eating disorder symptoms among male collegiate athletes.
        Eat Behav. 2014; 15: 615-618
        • Mountjoy M.
        • Sundgot-Borgen J.
        • Burke L.
        • et al.
        The IOC consensus statement: Beyond the Female Athlete Triad – Relative Energy Deficiency in Sport (RED-S).
        Br J Sports Med. 2014; 48: 491-497
        • Joy E.
        • Kussman A.
        • Nattiv A.
        2016 update on eating disorders in athletes: A comprehensive narrative review with a focus on clinical assessment and management.
        Br J Sports Med. 2016; 50: 154-162
        • Mountjoy M.
        • Sundgot-Borgen J.K.
        • Burke L.M.
        • et al.
        IOC consensus statement on relative energy deficiency in sport (RED-S): 2018 update.
        Br J Sports Med. 2018; 52: 687-697
        • Thompson R.A.
        • Sherman R.
        Reflections on athletes and eating disorders.
        Psychol Sport Exerc. 2014; 15: 729-734
        • McArdle S.
        • Meade M.M.
        • Moore P.
        Exploring attitudes toward eating disorders among elite athlete support personnel.
        Scand J Med Sci Sports. 2016; 26: 1117-1127
        • de Bruin A.P.K.
        Athletes with eating disorder symptomatology, a specific population with specific needs.
        Curr Opin Psychol. 2017; 16: 148-153
        • Arthur-Cameselle J.
        • Quatromoni P.A.
        A qualitative analysis of female collegiate athletes’ eating disorder recovery experiences.
        Sport Psychologist. 2014; 28: 334-346
        • Arthur-Cameselle J.
        • Quatromoni P.A.
        Eating disorders in collegiate female athletes: Factors that assist recovery.
        Eat Disord. 2014; 22: 50-61
        • Innes N.T.
        • Clough B.A.
        • Casey L.M.
        Assessing treatment barriers in eating disorders: A systematic review.
        Eat Disord. 2017; 25: 1-21
        • Quatromoni P.A.
        A tale of two runners: A case report of athletes’ experiences with eating disorders in college.
        J Acad Nutr Diet. 2017; 117: 21-31
        • Papathomas A.
        • Lavallee D.
        Athlete experiences of disordered eating in sport.
        Qual Res Sport Exerc. 2010; 2: 354-370
        • Sherman R.T.
        • Thompson R.A.
        Athletes and disordered eating: The four major issues for the professional psychologist.
        Prof Psychol Res Pract. 2001; 32: 27-33
        • Fewell L.K.
        • Nickols R.
        • Tierney A.S.
        • Levinson C.A.
        Strength and power improvements in athlete and non-athletes during intensive eating disorder treatment.
        J Clin Sport Psychol. 2018; 12: 562-577
        • Mountjoy M.
        • Sundgot-Borgen J.
        • Burke L.
        • et al.
        The IOC relative energy deficiency in sport clinical assessment tool (RED-S CAT).
        Br J Sports Med. 2015; 49: 1354
      2. Glovsky E. Wellness, not Weight. Health at Every Size and Motivational Interviewing. Cognella, San Diego, CA2013
        • Conviser J.H.
        • Tierney A.S.
        • Nickols R.
        Assessment of athletes with eating disorders: Essentials for best practice.
        J Clin Sport Psychol. 2018; 12: 480-494
        • Conviser J.H.
        • Tierney A.S.
        • Nickols R.
        Essentials of best practice: Treatment approaches for athletes with eating disorders.
        J Clin Sport Psychol. 2018; 12: 495-507
        • American Psychiatric Association
        Diagnostic and Statistical Manual of Mental Disorders.
        5th ed. American Psychiatric Association, Arlington, VA2013
        • Fairburn C.G.
        • Cooper Z.
        • O’Connor M.
        Eating Disorder Examination (Edition 16.0D).
        in: Fairburn CG. Cognitive Behavior Therapy and Eating Disorders. Guilford Press, New York, NY2008
        • Lohse B.
        • Satter E.
        • Horacek T.
        • Gabreselassie T.
        • Oakland M.J.
        Measuring eating competence: Psychometric properties and validity of the ecSatter Inventory.
        J Nutr Educ Behav. 2007; 39: S154-S166
        • Stotts J.L.
        • Lohse B.
        Reliability of the ecSatter Inventory as a tool to measure eating competence.
        J Nutr Educ Behav. 2007; 39: S167-S170
        • McNulty K.Y.
        • Adams C.H.
        • Anderson J.M.
        • Affenito S.G.
        Development and validation of a screening tool to identify eating disorders in female athletes.
        J Am Diet Assoc. 2001; 101: 886-892
        • Redgrave G.W.
        • Coughlin J.W.
        • Schreyer C.C.
        • et al.
        Refeeding and weight restoration outcomes in anorexia nervosa: Challenging current guidelines.
        Int J Eat Disord. 2015; 48: 866-873
        • Lohse B.
        • Krall J.S.
        • Psota T.
        • Kris-Etherton P.
        Impact of a weight management intervention on eating competence: Importance of measurement interval in protocol design.
        Am J Health Promot. 2018; 32: 718-728
        • Greene G.W.
        • White A.A.
        • Hoerr S.L.
        • et al.
        Impact of an on-line healthful eating and physical activity program for college students.
        Am J Health Promot. 2012; 27 (e47-58)
        • Lohse Knous B.
        • Shaffer K.
        • McCabe A.
        • et al.
        Examining eating competence change in a general nutrition course reveals gender and food preparation issues.
        Soc Nutr Educ Ann Conf Proc. 2003; 36: 43
        • Lohse B.
        • Belue R.
        • Smith S.
        • Wamboldt P.M.
        • Cunningham-Sabo L.
        About eating: An online program with evidence of increased food resources management skills for low-income women.
        J Nutr Educ Behav. 2015; 47: 265-272
        • Fewell L.K.
        • Nickols R.
        • Tierney A.S.
        • Levinson C.A.
        Eating disorders in sport: Comparing eating disorder symptomatology in athletes and non-athletes during intensive eating disorder treatment.
        J Clin Sport Psychol. 2018; 12: 578-594
      3. Eating Disorders: Core Interventions in the Treatment and Management of Anorexia Nervosa, Bulimia Nervosa and Related Eating Disorders. National Institute for Health and Care Excellence, London, UK2004 (NICE Clinical Guideline CG9)
        • Cachelin F.M.
        • Striegel-Moore F.M.
        Help seeking and barriers to treatment in a community sample of Mexican American and European American women with eating disorders.
        Int J Eat Disord. 2006; 39: 154-161
        • Hart L.M.
        • Granillo M.T.
        • Jorm A.F.
        • Paxton S.J.
        Unmet need for treatment in the eating disorders: A systematic review of eating disorder specific treatment seeking among community cases.
        Clin Psychol Rev. 2011; 31: 727-735
        • Vanheusden K.
        • Mulder C.L.
        • Van Der Ende J.
        • Van Lenthe F.J.
        • Mackenbach J.P.
        • Verhulst F.C.
        Young adults face major barriers to seeking help from mental health services.
        Patient Educ Counsel. 2008; 73: 97-104
        • Oakley Browne M.A.
        • Elisabeth Wells J.
        • Mcgee M.A.
        Twelve-month and lifetime health service use in Te Rau Hinengaro: The New Zealand mental health survey.
        Aust N Z J Psychiatry. 2006; 40: 855-864
        • Thomspon A.
        • Hunt C.
        • Issakidis C.
        Why wait? Reasons for delay and prompts to seek help for mental health problems in an Australian clinical sample.
        Soc Psychiatry Psychiatric Epidemiol. 2004; 39: 810-817
      4. Brown G.T. Mind, Body and Sport. Understanding and Supporting Student-Athlete Mental Wellness. National Collegiate Athletic Association, Indianapolis, IN2014
        • Corrigan P.
        How stigma interferes with mental health care.
        Am Psychol. 2004; 59: 614-625
        • Gray A.J.
        Stigma in psychiatry.
        J R Soc Med. 2002; 95: 72-76
        • McArdle S.
        • Meade M.M.
        • Burrows E.
        Service providers’ attitudes toward athletes with eating disorders.
        Clin J Sport Med. 2018; 28: 51-55
        • Smink R.F.
        • Van Hoeken D.
        • Hoek H.W.
        Epidemiology of eating disorders: Incidence, prevalence, and mortality rates.
        Curr Psychiatry Rep. 2012; 14: 406-414
        • Arcelus J.
        • Mitchell A.J.
        • Wales J.
        • et al.
        Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies.
        Arch Gen Psychiatry. 2011; 68: 724-731
        • Mond J.M.
        • Mitchison D.
        • Hay P.
        Prevalence and implications of eating disordered behavior in men.
        in: Cohn L. Lemberg R. Current Findings on Males with Eating Disorders. Routledge, Philadelphia, PA2014