Disordered Eating In Athletes

Question 1

Define eating disorder

Answer 1

A potentially life threatening mental illness that can have long standing adverse consequences on the individual’s psychosocial and physical health and reduces quality of life

Question 2

What is the most common eating disorder in the United States

Answer 2

Binge eating disorder

Question 3

Does avoidance of exercise or excessive exercise alone qualify as an eating disorder

Answer 3

No

Question 4

List criteria for exercise addiction

Answer 4

Continued exercise regardless of physical injury, psychological, or social consequences

Related to intrinsic rewards and rewards experience disturbing sensations of deprivation

Question 5

List self report instruments for identifying eating disorders and are they reliable in athletic populations

Answer 5

Eating Attitudes Test (EAT)

Eating Disorder inventory (EDI)

Three Factor Eating Questionnaire

Bulimia Test Revised (BUILT-R)

Eating Disorder Examination Questionnaire (EDE-Q)

They likely underestimate prevalence and have not been validated in an athletic population

Question 6

What sports have the highest level of eating disorders in males and females

Answer 6

Males: weight dependent sports

Females: endurance sports

Question 7

Undernutrition refers to what

Answer 7

Deficiency of energy

Deficit of one or more essential nutrients

Low energy availability

Question 8

Degenerative changes in lean tissue lead to

Answer 8

Compromises in the heart

Reduced erythropoiesis

Immune system depression

Impaired capacity of the liver to metabolize drugs and other toxic substances

Question 9

Severe energy deficit diets may lead to

Answer 9

Elevated ALT and AST

Fatal hypoglycemia

Estrogen and testosterone deficiency in men and women, respectively

Muscle fiber atrophy and weakness

The neuromuscular system (brain, spinal cord, and nerves) is the most significantly affected in severe AN

Question 10

What is the most common cardiovascular symptom of anorexia nervosa

Answer 10

Bradycardia

Question 11

What is superior mesenteric artery syndrome

Answer 11

Partial blockage of the upper bowel caused by loss of the fatty tissue that normally serves as a pad between the gut and the superior mesenteric artery and aorta

Question 12

What should be done if menstruation ceases due to an ED

Answer 12

Restore nutrition and maintaining body weight at a health range (may need to gain slightly more to restore menses)

Question 13

What does body dysmorphic disorder fall under

Answer 13

Obsessive compulsive disorder

Question 14

Why may those engaging in DE behavior experience an initial increase in performance

Answer 14

Starvation and purging produce an upregulation of the fight or flight response (hypothalamic pituitary adrenal axis)

Increase adrenal hormones (cortisol, epinephrine, norepinephrine) which may mask fatigue and evoke feeling of euphoria

Decrease in body weight may enhance VO2 max and make one feel lighter

Question 15

List issues that manifest from chronic vomiting

Answer 15

Dehydration

Electrolyte abnormalities

Increased risk of anemia due to GI blood loss

Question 16

What is recognized as one of the gold standard instruments used in the validation of eating disorder screening tools

Answer 16

Eating Disorder Examination Interview

Question 17

List self report surveys more appropriate for screening ED and DE in athletes

Answer 17

Survey of Eating Disorders among Athletes (SEDA)

Female Athlete Screening Tool (FAST)

BUILT-R

Brief Eating Disorder in Athletes Questionnaire (BEDA-Q)

Athletic Milieu Direct Questionnaire (AMDQ)

Question 18

List screening tools to identify maladaptive exercise

Answer 18

Obligatory Exercise Questionnaire (OEQ)

Exercise Dependence Scale (EDS)

Frequency, Intensity, Time Index Scale (FIT)

Question 19

What eating disorders does CBT best address

Answer 19

Bulimia nervosa

Binge eating disorder

Question 20

What is the leading evidence based treatment for adults with ED

Answer 20

Cognitive behavior therapy

Question 21

Explain CBT, DBT, and ACT

Answer 21

Cognitive Behavioral Therapy (CBT) - focus on managing self defeating thought patterns and engage in planned strategies that lead to healthful, recovery oriented behavioral patterns

Dialectical Behavior Therapy (DBT) - learn rational thinking and decision making skills that allow individuals to move beyond black and white thinking to develop coping strategies for perceived crises

Acceptance and Commitment Therapy (ACT) - teaches recognition and tolerance of negative thoughts and feelings in an effort to live a better life in the face of distress accepting pain as a normal part of living

Question 22

Low serum phosphorus may cause

Answer 22

Muscle breakdown (rhabdomyolysis)

Blood cell dysfunction

Respiratory failure

Seizure

Cardiac arrest

Question 23

What labs are low prior to feeding in those with eating disorders

Answer 23

Potassium

Phosphorus

Magnesium

Question 24

List criteria for red, yellow, and green lights for returning to training for those with an ED

Answer 24

Red light - ED diagnosis, serious psychological or physiological condition, engagement in extreme dieting, bradycardia

Yellow light - maintaining an abnormally low body fat for an extended period of time, 5-10% loss of body weight in a month, interrupted growth and development, LEA, low bone density, abnormal menstruation, and stress fractures due to hormonal abnormality or LEA

Green light - engage in health promoting behaviors, maintain healthy weight

Question 25

List categories of RED-S

Answer 25

Impaired physiological functioning caused by relative energy deficiency

Metabolic rate

Menstrual function

Bone health

Immunity

Protein synthesis

Cardiovascular health

Question 26

Nutrition intervention following RED-S diagnosis

Answer 26

Individualized energy needs
20-30% greater than baseline needs
Macros - start with general recommendations

Intakes of vitamin D, iron, and calcium may be low

Question 27

The DSM V includes what eating disorders

Answer 27

Anorexia nervosa

Bulimia nervosa

Binge eating disorder

Avoidant/restrictive food intake disorder

Pica

Question 28

Health risks of eating disorders

Answer 28

Undernutrition

Over nutrition

Cardiovascular consequences

Gastrointestinal consequences

Reproductive consequences