REDs (part 2) Flashcards
although any athlete or active person can suffer from REDs, who is particularly at risk
- female athletes
- those in weight-sensitive and leanness-demanding sports
- aesthetically judged sports
- sports in which low BW might provide a performance advantage
- sports with high exercise energy expenditure
what is IOC REDs three step protocol
- sceening
- severity and risk assessment and stratification
- clinical diagnosis and treatment
what are example of step 1 screening
population specific questionnaires or clinical interviews
who proceeds to step 2 from screening
individuals with greater than low risk
step 2 of REDs severity/risk assessment characteristics
- high sensitivity
- more expensive
- clear scoring allows for easy and reliable implementation
who proceeds to step 3 REDs clinical diagnosis and treatment
yellow, orange, or red
characteristics of step 3 REDs clinical diagnosis and treatment
- physician diagnosis based on info from steps 1 and 2 along with clinical history and examination
- individualized treatment plan implemented by the multi-disciplinary athlete health and performance team
characteristics of step 1 REDs screening
- lower sensitivity and specificity
- inexpensive and easy to use
- questionnaires allow for large athlete group screening
when can screening tools be undertaken
part of annual periodic health examination when athlete presents with symptoms
what symptoms will ahtlete present with to use a REDs screening
- disordered eating/eating disorders
- weight loss and/or fluctuations
- lack of normal growth and development
- endocrine dysfunction
- recurrent injuries and illnesses
- bone stress injury
- decreased performance/performance variability
- mood changes
what does REDs not always mean
huge loss in weight
sensitivity/specificity of the tests for REDs
ability to accurately distinguish between patients who have or do not have the condition
what does disordered eating not always equal
they have LEA but does increase your risk
what does the DSM-5 recognize as ED
- anorexia nervosa
- bulimia nervosa
- binge eating disorder
- other specified feeding and eating disorders
- avoidant/restrictive food intake disorder (ARFID)
- other
what is the spectrum of eating behaviour that can change day to day or week to week
<-optimised nutrition - disorder eating- eating disorder->
eating disorder
behaviour that meets DSM-5 diagnostic criteria for a feeding and eating disorder
disordered eating
problematic eating behaviour that fails to meet the clinical diagnosis for an eating disorder
optimized nutrition
safe, supported, purposeful and individualized nutrition practices that best balance health and performance
diagnostic criteria for anorexia nervosa
a. restriction of energy intake relative to requirements
b. intense fear of gaining weight or becoming fat or persistent behaviour that interferes with weight gain
c. disturbed by one’s body weight or shape, self worth influences by BW or shape, or persistent lack of recognition of seriousness of low BW
what does restriction of energy intake relative to requirements lead to
significant low BW in the context of the age, sex, developmental trajectory, and physical health
what is not required anymore for the diagnostic criteria in menstruating females
absence of at least 3 consecutive non-synthetically induced menstrual cycle
what is taste fatigue
- type of anorexia that happens with athletes
- if eating same thing over and over, don’t want to eat it
- very common phenomena and can lead to restricting energy but not does mean you have fear of weight
what is the diagnostic criteria of bulimia nervosa
recurrent episodes of binge eating
in bulimia nervosa what are the recurrent episodes of binge eating characterized by
- eating within any 2 hr period, an amount of food that is definitively larger than most individuals would eat in a similar period of time under similar circumstances
- a feeling that one cannot stop eating or control what or how much one is eating
what are the 4 other disagnostic criteria of bulimia nervosa
- recurrent innapropriate compensatory behaviours in order to prevent weight gain
- binge eating and innapropriate compensatory behaviours occur at least once a week for 3 months
- self evaluation in unjustifiably influenced by body shape and weight
- disturbance does not occur exclusively during episode of anorexia nervosa
what are examples of recurrent inappropriate compensatory behaviours in order to prevent weight gain
self-induced vomiting, misuse of laxatives, diuretics, or other meds, fasting or excessive exercise
how many people have bulimia nervosa
~2-3% general population
side effects of bulimia nervosa
erosion of tooth enamel
tears in esophagus
aspiration pneumonia
electrolyte imbalances
heart failure
warning signs of AN
- dramatic loss in weight
- a preoccupation with food, kcal, weight
- wearing baggy or layered clothing
- relentless, excessive exercise
- mood swings
- avoiding food related social activities
warning signs of BN
-a noticeable weight loss or gain
- excessive concern about weight
- bathroom visits after meals
- depressive moods
- strict dieting followed by eating binges
- increasing criticism of one’s body
binge eating disorder
eat an unusually large amount of food and feel out of control during the binge
binge may include
- eat more quickly than usual during binge episodes
- eat until they are uncomfortably full
- eat when they are not hungry
- eat alone because of embarrassment
- feel disgusted, depressed, or guilty after eating
what is not the same as binge eating
overeating
- many people overeat on occasion
binge eating episode characterized by
consumption of an unusually large amount of food during a short period of time
feeling out of control over what and how much is eaten and when to stop
binge eating is not followed by
compensating behaviours seen in other EDs (exercise, vomiting, laxatives, diuretics)
when is binge eating seen as a disorder
when occurs at least once a week for three months or more
what is the difference between other specified feeding and eating disorders and AN or BN
does not meet criteria
Exhibit some but not all, characteristics associated with clinical eating disorders
OSFED
- regular use of inappropriate compensatory behaviour by an individual of normal body weight after eating small amounts of food (vomiting after two cookies)
- repeatedly chewing and spitting out, not swallowing, large amounts of food
- night eating syndrome
what is night eating syndrome
eating in excess following evening meal or waking from sleep which causes extreme psychological distress and interferes with daily functioning
anorexia athletica
disordered eating that impacts athletes
take on a limited number of calories despite high level of PA
become overly concerned with weight and exibit some diagnostic criteria of AN and BN
5 criteria of anorexia athletica
- excessive fear of becoming obese
- restriction of kcal intake
- weight loss
- no medical disorder to explain leanness/weight loss
- GI complaints
when do symptoms of ARFID usually show up
infancy or childhood, child may avoid food with certain textures or colours
traumatic response involving food, such as becoming physically ill
what does ARFID not include
feelings of body dissatisfaction in way BW or shape are perceived
what can happen if ARFID is left untreated
can develop into AN or BN later in adolescence or adulthood
orthorexia nervosa
unhealthy fixation about eating so-called “healthful foods”
what is term orthorexia derived from
greek word ortho which means right or correct
what may orthorexia lead to
elimination of entire food groups (dairy or grain products) later eliminating another group or food
all in quest for a perfect and clean eating diet
in severe cases what does orthorexia lead to
malnourisment when critical nutrients are elminated
what is the difference for orthorexics from anorexia
the quality instead of quantity of food is severely restricted
which eating disorder does not officially recognized in current APA diagnostics manual
orthorexia nervosa
4 level traffic system of step 2 REDs severity/risk assessment
green, yellow, orange, red
where does everyone want to be in 4 level traffic system
green
severity/risk: none to very low
yellow of REDs diagnosis severity/risk assessment
risk is mild
1 or 2 primary indicators and max 1 secondary
treatment, training and competition reccomendations for yellow
- treatment, monitoring and regular follow up at appopriate intervals
- full training and comp
treatment, training and competition reccommnedations for orange
- treatment, close monitoring and follow-up required
- some aspects of training and/or comp may need to be modified
treatment, training and competition reccomendatiosn for red
- immediate treatment at daily to monthly intervals depending on severity
- significant training and comp modifications required and in majority of cases removal of training or comp is indicated
what is treatment of REDs depending on
severity and risk
what does REDs require
interdisciplinary team (athlete in middle)
- medical
- mental health
- sport dietician support
what is treatment of REDs
increase EA via increased intake or decreased energy output (reduce training volume/intensity)
when increasing EA for REDs what should focus be on
increase by 300-600 kcal/day
focus on energy intake timing around training sessions
what is critical foundation of training diet
energy intake
nutritional treatments of REDs that are mental
- flexibility around eating and thoughts about food
- ability to eat in social settings
- healthy body image
- no restrictive or rigid behaviours
- identification of influencers
nutritional treatments of REDs that involve eating
- eating practices that meet the physical and mental health needs
- ability to adapt dietary intake to meet the specific and changing demands of sport
- enjoyment of foods
- a well balanced diet with slow and steady increase in caloric intake
- increase in CHO intake
- improved within-day energy balance, meal and snack timing and inclusion of energy dense foods
Supplementation for treatment of REDs
may be indicated with medical supervision
- B12 or iron if indicated
- vit d may be needed for athletes in northern latitudes and who train indoors
treatment targets with LEA
- reversal of recent weight loss
- return to normal BW with normal menses
- weight gain to achieve BMI >18.5 or >90% predicted BW
- energy intake at 2000 kcal/day or more for training demands (slow increase in cal intake)
what should coaches or support staff look for for prevention
- unexplained weight loss
- frequent weight fluctuations
- sudden increases in training volume
- obsession with exercise
- excessive concern with BW and body comp
- appearance and evidence of bizarre eating practices
- chronic injuries
- delayed recovery
prevention strategies from NCAA coach handbook
- de emphasize weight
- recognize individual difference in athletes
- coach supported education: awareness is first step in changing behaviour
- involvement by sport governing bodies
how to de emphasize weight as coach
- avoid player comparisons for weight, body composition and performance markers
- weight does not equal good performance and does not equal health
what moderating factors with problematic LEA exposure can lead to various REDs symptoms
- personal characteristics
- medical history
- training characteristics
- dietary/nutritional characteristics
- other (stress)
