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Anorexia Nervosa in Female Athletes
By: Rebecca Roman


Anorexia Nervosa is on the rise in our society, strengthened by a culture that declares thin is beautiful. It is a serious disease that leads to a state of starvation and emaciation resulting in numerous amounts of medical problems that may lead to death. Anorexia affects many different populations, but female athletes are one of the more common. One NCAA study found that the number of female athletes who suffered form disordered eating within two years of the study was as high as 93 percent. (Athletes with eating disorders: an overview, 2001) The health problems associated with anorexia can severely hinder athletic performance, negatively affecting an athlete's career and ultimately her life. Coaches and trainers can help the athlete by catching the disease early and initiating treatment, which will benefit their tem and the player's life.

In order to understand how serious anorexia can be one must first know something about the disease. Anorexia starts off as disordered eating, which may develop into the actual disease. The onset of this disease may be the result of certain personality traits such as perfectionism, poor self-esteem, poor relationship with parents, problems discussing negative emotions, and/or the need to please others. (Personality Traits, 2002) Once a person develops Anorexia Nervosa their symptoms slowly become obvious. Anorexia patients have an intense fear of becoming fat and gaining weight. They obsessed with food; the thought of it invades their minds continuously, but at the same time they despise it. Some even enjoy collecting food and making beautiful dinners, but not eating any of the food. Some may hide their food or secretly get rid of it, while others have different rituals of slicing and arranging the extremely small amount of food they consume. (Symptoms 2002)

Anorexics are also obsessed with exercise, sometimes exercising until they pass out from exhaustion. The combination of incessant exercise and quick, severe weight loss causes female anorexics to have no menstrual cycle, or if the onset of the disease occurs before puberty, they will not get their period upon the age it is expected. (Symptoms, 2000) In order to be diagnosed as anorexic a person has to have lost at least 15% of their body weight due to starvation, but if the disease continues to go unnoticed, his/her weight can drop to 85% or less of what is assumed for a certain age and height. (Coming to terms, 2000) Anorexics use any trick they can to manipulate their body into losing more weight including the abuse of laxatives and/or diuretics. To make matters worse, anorexics are unable to decipher the seriousness of their actions, which contributes to the severity of the disease.

Anorexia can and will affect any and all races, ages, and sexes, but it is more prevalent in certain populations. Researchers slightly disagree on the most common age onset. The disease has been traditionally associated with white adolescence, but some studies have shown that the age is slowly shifting from adolescence to the ages of 20-29. (The contributions, 1999) During these age ranges society drives people to be thin. When a person is in high school he/she has to face the pressure of their peers, and between the ages of 20-29 a person faces other employees and employers. No matter when it starts, anorexia strikes women far more often than men. Within all age groups statistics show that " for every 20 females that develop anorexia, one male does." (Who is affected, 2000) The females who are diagnosed often include female athletes. Studies have shown that participation in athletics puts a woman at high risk of anorexia, especially if the woman is involved in a sport that focuses on the sleekness and thinness of the body. This need to be thin can be the driving force to a very dangerous, even deadly disease. Athletes focus on becoming perfect at what they do, and some feel they need to be thin in order to be good at their sport. In fact, according to a 1992 American College of Sports Medicine study "eating disorders affected 2 percent of females in sports like figure skating and gymnastics." (Athletes, 2001) Pressure to be thinner not only comes from within the athlete, but from their coaches who may encourage athletes to be thinner in order to be successful in competition. Sometimes coaches too suffer from eating disorders, which may have a grave influence on their players. A coach who suffers form an eating disorder or even disordered eating may inadvertently influence their players.

The seriousness of this disease within athletes is finally starting to be recognized, especially after the 1994 death of Christy Henrich. Christy was an amazing gymnast who had hopes of becoming a member of the US Olympic squad. During her try out in 1988 to make the Olympic squad, a judge declared that she had to lose weight in order to make the team. Already being thin at 90 pounds Christy was on a mission to lose weight. Christy was in and out of hospitals for two years dropping as low as 47 pounds. As she was in the final stages of the disease her boyfriend warned hospital employees that she lined her suitcase with laxatives. Four years after the judges comment she entered the psychiatric hospital weighing 63 pounds and never made it out alive.

The wheels were probably already turning before her tryout in 1988 because she probably had personality traits and continuous pressure from her environment, thus the judge's comment probably acted only as a catalyst in the advancement of her disease. Christy is not the only gymnast who is affected by the disease, a 1992 NCAA report showed that 51% of the women's gymnastics programs that responded reported eating disorders among team members. (Dying to Win, 1994) Gymnastics is only one of the appearance sports in which Anorexia Nervosa is becoming an epidemic. A more recent NCAA report from 1999 involving all female athletes showed that "more than half the Division I athletes surveyed were diagnosed with some kind of eating disorder." (Coming to terms, 2000) Other appearance sports that anorexia is found include ballet, bodybuilding, cheerleading, figure skating, jockeying and diving. (Athletes and eating disorders, 2002) Some endurance sports also may encourage this eating disorder, such as cross-country skiing, distance running, rowing and swimming. (Athletes and eating disorders, 2002)

Although these sports may be more infected with anorexia, the disease is not limited to them. Shea Ralph, a former University of Connecticut basketball player, was diagnosed with anorexia her sophomore year of high school. With her, as with most, the disease started with a simple diet and lead to self-starvation combined with excessive exercise. Ralph's excessive exercise sometimes included a ten-mile run after her practice. Her mother and her coach soon noticed her odd and unhealthy behavior. She was so weak, that it became hard for her to get out of bed. Her high school coach made the comment that she would not be able to play in college if her behavior continued. She began to eat, but the disease haunted her even when she was recruited to play basketball at the University of Connecticut. After a knee injury occurring her sophomore year, her anorexia became more intense and obvious. She only ate broccoli, salad, and fat free yogurt. Her college coach noticed her strange eating habits right away and found help for Ralph. Shea Ralph was lucky, she was able to pull through this deadly disease. Not only that, but during her senior season of college she was selected MVP of the year's final four. (Coming to terms, 2000) Her story shows that coaches can save athlete's lives. However, this does not mean that her fight is over. An anorexic continues to fight for their health and life each day they live because the disease stays with them forever. Anorexics can learn to harness their disease, as Shea Ralph did. (Coming to terms, 2000)

The infamous anorexic athlete cases have increased public awareness of the disease in the past 10 years. However, medical researchers began studying this disease before this time period. The Taub and Blinde study in 1992 examined how much athletic participation interacted with anorexia. (Eating disorders among adolescent, 1992) They sampled female ninth and twelfth graders who were currently attending physical education class. The sample group included athletes and non-athletes. Female athletes who were not currently attending gym were also asked to participate in this study. The final sample contained 100 athletes, 26 of whom participated in more than one sport, and 112 non-athletes. Seventy-six percent of the students involved in this study were white. Each participant was given a questionnaire, which consisted of four sections. The first section of the questionnaire assessed behavioral and psychological traits that are related to eating disorders through the Eating Disorder Inventory, also known as EDI. This commonly used test is declared by researchers to be valid and reliable as a predictor of an eating disorder. (Eating disorders among adolescent, 1992) The EDI is broken up into eight subscales, including drive for thinness, bulimia, body dissatisfaction, ineffectiveness, perfectionism, interpersonal distrust, interceptive awareness, and maturity fears. Taub and Blinde used these answers to discover if the athletes were on a borderline anorexic level, which could lead to an anorexic state later in the student's years of life. The second section of the questionnaire investigated how often the person attempted to control her weight through dieting, starvation, laxatives, or vomiting. The third and fourth section gained demographic information, which included age, race, grade level, and athletic status. (Eating disorders among adolescents, 1992) The last section, gender-role orientation, was examined by administering the PRF ANDRO Scale. This is a test consisting of 85 true and false questions that show what sex a person leans towards. Taub and Binde used the information from these questionnaires to compare athletes with non-athletes, Caucasians with non-Caucasians, and the different age groups.

The test also studied the correlation between different sports. Because of the small number of tennis players involved in the study, only basketball, track/cross country, and volleyball were compared. Results of the different subscales of EDU showed that some sports were more plagued with anorexic personality traits through the percentage each sport recorded for being at or above anorexic level. For instance, over half of the basketball players involved in this study were dissatisfied with their bodies. Even more alarming, two-thirds of the softball players were dissatisfied with their body on a level of anorexia or above. One-third of the track and cross-country runners had a high level of perfectionism, while volleyball had the lowest. In five areas of the EDI softball players scored the highest out of all sports.

The results of these tests showed that athletes tend toward perfectionism, a personality trait that can be a factor in anorexia. Also, athletes were more likely to have problems with overeating, which sometimes resulted in self-induced vomiting. These test results acted as good predictors for future years. For example, a study done by Borgen and Corbin showed that college women who participated in athletics were more likely to purge than non-athletes. The gender-role orientation test also administered by Taub and Blinde also showed another reason why athletes were more likely to exhibit eating disorders than non-athletes. The test showed that athletes leaned towards masculinity and androgynous personality types, while non-athletes leaned toward feminine and interdeterminate personalities. The term androgynous describes respondents who get high-test scores in both masculine and feminine parts of the test, while interdeterminate respondents with relatively equal score in both. Although all students with an androgynous personality tended to have a higher self-esteem, they also tended to display more perfectionist characteristics than students with an interdeterminate personality. Students with a masculine personality also tended to be more of a perfectionist than those with interdeterminate personality.

The EDI tests showed that athletes are more likely to possess psychological and behavioral traits that lean toward eating disorders. While Taub and Blinde's findings did not show a huge difference between athletes and non-athletes they do register some traits that can cause eating disorders. These traits, in the future years may be encouraged by their coaches, judges or by themselves, especially the trait of perfectionism.

College coaches often demand perfection and some demand their players be extremely thin, criticizing the player's weight and appearance. (Athletes, 2001) Ironically a study showed that despite the "trend toward thinner athletes performing better, the athletes who performed best were neither the thinnest nor the heaviest." (Sherman 1993) This study also declared that a person may initially become a better athlete by losing weight, but if a person's body mass index becomes too low her performance will start to decline. An athlete may focus on becoming perfect and think that she needs to lose weight, or she may feel their life is out of her hands and into her coaches. At that point the player may control her weight to feel that she has control over something. One researcher declared, "I look at this problem as being more than eating disorders. I look at it as a total imbalance of the way these women live their lives. It seems like when the pressure comes on, the only thing left to control in their lives is eating." (Many Women Athletes Suffer, 1995) Whether the underlining reason is criticism or control, eating may turn into an obsession leading to an easting disorder. Coaches need to be educated in this area in prevention of becoming a launch pad for anorexia. Coaches may not only be hurting an athlete during her career on the team, but as a study done on gymnasts showed, 15 years after retirement athletes were still shoeing symptoms of anorexia. A coach may think they are making their athlete become a champion by encouraging her to lose weight, but in the long run anorexia greatly hinders her performance.

Athletes are continuously under extreme physical and emotional stress. Therefore, the medical problems associated with anorexia can occur more quickly and at a more serious rate than those found in a non-athlete. There is such a prevalence of athletes with eating disorders, and ultimately medical problems, that there is a syndrome called the female athlete triad. The female athlete triad consists of disordered eating, amenorrhea, and osteoporosis. (The Female Athlete Triad, 2000) Athletes who develop disordered eating cause a change in their hypothalamus, which is part of the brain that controls the release of estrogen. The lack of estrogen stops menstruation, amenorrhea, in the woman. Amenorrhea leads to infertility and even worst, the loss of bone density resulting in osteoporosis. This causes their bones to be extremely fragile, leading to stress fractures. The loss of bone density can be irreversible if the athlete is amenorrheic, and even with hormone treatments the athlete can be seriously affected. The damage can be less devastating if the triad is caught early.

Osteoporosis and amenorrhea are definitely not the only two medical problems that are associated with eating disorders. Athletes with eating disorders can experience irregular heart beat, cardiac arrest, electrolyte imbalance, kidney damage, liver damage, weakened immune system, muscle atrophy, decreased endurance, decreased coordination, destruction of teeth, excess hair, cold hands and feet, fainting spells, poor sleeping patterns, dry skin, and unfortunately, death. (Medical and Psychological 2002) Coaches, parents, and trainers must educate themselves and react to any behavior leading to the suspicion of disordered eating. Coaches need to direct their athletes in a positive manner, especially in appearance sports. One study showed that 75 percent of gymnasts who were told by their coaches that they needed to lose weight used pathogenic behaviors to do so. (The Female Athlete Triad, 2000) Instead of encouraging destructive behaviors, coaches should react two ways, catch the symptoms and involve a dietician for the athlete having trouble or have a nutritionist speak to the team before the season on the proper amount of food intake. The coach also needs to enforce proper nutrition within their athletes, instead of requiring athletes to lose weight at an unhealthy rate.

The coach should also be aware of all the psychological and behavioral symptoms of anorexia. Understanding and educating themselves on the psychological issues may aid a coach in catching anorexic tendencies early, and in turn prevent long-term physical and mental problems for their athletes. An athlete may resort to disordered eating because she thinks this weight loss will help her improve her performance and increase her self-esteem. Actually a person with an eating disorder will more likely become depressed, which may even lead to suicide. The athlete may feel shame and fear that she may be discovered. She may have obsessive thoughts on certain topics, especially of food. She will most likely have compulsive behaviors, including rituals during meal times and she may also skip team meals in order to avoid food. An anorexic athlete feels alienated and does not keep friendships, even with her teammates. Without the proper nutrition, the athlete will miss practice or perform poorly, lack concentration, and no longer love the sport that she once was passionate about. She may begin to exercise past the point of healthiness, working out after and/or before practice. If a coach notices these behaviors along with the physical symptoms it may be easier for psychologists to diagnose the individual because of the valuable information the coach can offer. (Many Women Athletes Suffer, 1995)

Coaches and players alike must recognize the fine line between obsession and passion for a sport. Coaches not only accept excessive exercising, but they encourage it. Some coaches accept fasting and vomiting as a routine of certain sports, instead of discouraging it. Coaches believe that if a player participates in excessive exercising or unhealthy weight loss that she is just very passionate about her sport. They also focus on a low body fat percentage; many coaches encourage reaching 10-14 percent body fat, while the United States Olympic committee declares that 20-22 percent body fat is a healthy range. (Athletes with Eating Disorders: identification and intervention, 2002) Coaches and players insist that athletes will perform better if they weigh less. Coaches push their athletes to a point where it becomes unhealthy, and for both the athlete and the coach the sport becomes an obsession.

Instead of coaches being a contributor to anorexia, they should become involved in treating eating disorders. Coaches play a variety of important roles in each player's life, and they shape their athlete's careers. Players spend more time with their coach than their family, and coaches have more time to observe athletes' behaviors. The most important thing a coach can do to help the epidemic of anorexia in athletes is prevention. Coaches need to show their athletes the fine line that separates "the pursuit of excellence and the pursuit of perfection." (Eating Disorders and female athletes: how coaches can help, fall 2002) A coach needs to monitor athletes, taking note of their attitudes about their bodies and their playing abilities. One red flag that a coach should notice is if an athlete is eating very little, and using food as a reward or punishment due to their performance. Challenging her body and striving to do better is good for an athlete to do, however it is not healthy for an athlete to challenge her body to the point of injury and/or focus on her mistakes despite trying her best. Making sure that their athletes are eating well and staying healthy throughout the season is beneficial to the coach. Coaches need to remind the athlete that she needs to have certain nutrients in her system to gain muscle, and losing more than 1-2 pounds weekly is unhealthy and will hinder her performance. (Eating disorders and female athletes: how coaches can help, fall 2002) Coaches should relay to the athlete that muscle weighs more than fat, so gaining weight may not be a hindrance.

A coach needs to talk to his/her athletes and let the athletes know that they can always come to them with a problem. A coach who displays a welcoming attitude will make an athlete feel more comfortable about talking over a problem she is having or that she sees in another player. Inviting a woman who has recovered from anorexia to talk to the team about the disease and the importance of taking care of themselves may also be beneficial. (Eating disorders and female athletes: how coaches can help, fall 2002) This will educate the team, and will allow team members to know what to watch for in their teammates.

Also, coaches need to realize that they act as role models for their athletes. A coach's attitude towards food, exercise, and body image is noticed and noted by his/her athletes. (Eating disorders and female athletes: how coaches can help, fall 2002) The way a coach feels about these topics in general, and how he/she feels about them at a personal level will reflect on his/her athletes. If a coach uses exercise as a form of punishment or demands an extreme amount of exercise, a player may begin to adopt the coach's viewpoints, which may lead to anorexia. Over exercising relates to self-punishment and control, and may also lead to serious injuries, which will curtail an athlete's playing season.

Another way a coach can prevent the disease from infecting his/her team is by teaching stress management. An athlete faces many stresses emotionally, physically, and mentally and she needs to know how to balance these stresses in order to stay healthy. Some stress management techniques include deep breathing, yoga, meditation, stretching, appropriate amounts of sleep, keeping a daily planner, and participating in leisure activities. (Eating disorders and female athletes: how coaches can help, fall 2002) A coach can use these techniques before game time. Coaches can have players take deep breaths before they compete in order to relax. Also, a coach may have his/her athletes visualize themselves participating in the sport, making the goal, or even making a mistake and realizing that it is alright. These activities can also be incorporated into team activities that will help players sports as a reliever from stress rather than stressorful. A coach needs to focus on the fun element of the game beyond the final score. (Eating disorders and female athletes: how coaches can help, fall 2002)

Despite a coach trying to prevent the disease, it may still infect his/her team. The coach's involvement should not stop at prevention. If an athlete is suspected of disordered eating, the first step a coach can take is arranging a meeting with this athlete and discussing observations and the problem. (Athletes with eating disorders: identification and intervention, 2002) A coach intervening when he/she notices that a player is displaying unusual eating habits may prevent a player's disordered eating from escalating into an actual eating disorder. And, if her disordered eating has already developed into an eating disorder quick intervention will lead to fewer complications and a faster recovery. (Helping Athletes with Eating Disorders, 1996) The coach who has the best relationship with the athlete should be the one to have the meeting with her. When confronting the athlete the coach needs to be careful not to attack the player, but express his/her concern for her well-being. The coach needs to be very caring and empathetic, emphasizing that admitting having an eating disorder will not result in automatic expulsion from the team unless the player is in medical danger or she continues with her eating habits. When talking to the athlete, the coach should list all the reasons that he/she is concerned for their well-being, but also listen fully to the player's responses. The athlete needs to feel she is important and that the coach wants to know what they are thinking and feeling. A coach does not want the player to feel any more alienated than she already does. Of course, with this kind of disease the athlete is probably going to deny having her problem, which may be related to feeling shame and fear. The anorexic athlete will be terrified of treatment; she does not want to gain weight in fear that this will effect her performance. (Helping Athletes with Eating Disorders, 1996) However, if the athlete does admit she has an eating disorder, the coach should attempt to assess the athlete's ability to abstain from their unhealthy eating habits. The coach needs to realize that the athlete may have already failed to stop her unhealthy behaviors. If an athlete fails at stopping these behaviors she may feel hopelessness and depression, especially in athletes who always want to win and despise the feeling of defeat. The coach should recognize the possibility that a previous coach may have triggered the athlete's disorder. While talking to the athlete, a coach should encourage her to go for a consultation with an expert. Asking for her to commit to a consultation will be easier rather than having her commit to treatment. (Helping an athlete with an eating disorder, 1996)

A coach should always be prepared to take advantage of the help provided by the campus and community, such as counselors and nutritionists. The coach can suggest these different types of help, and offer to stay with the athlete when she calls the counselor. The coach should continue to have meetings with the athlete to check up on her behaviors. If a professional is involved, the coach needs to determine from the counselor and/or physician what they can do to help their athlete recover. (Athletes with eating disorders: identification and intervention, 2002)

If the coach is unable to get the athlete to admit her problem or if the athlete does not accept treatment, a coach is in a awkward detrimental situation. The player should not be pressured because this will increase her aversion to any kind of help. If the player is in medical danger, a coach should require a check-up by the doctor; the player should not be allowed to participate until they have the examination. (Helping athletes with eating disorders, 1996) The doctor at this point should suggest a psychiatric evaluation to the athlete. If the athlete still refuses the coach should wait a couple weeks and try the same approach again. Continued refusal may result in the appropriate individual insisting that she find treatment.

Coaches need to be involved in the treatment process once an athlete is diagnosed. If a coach is not aware of the treatment plan, he/she can hinder the process of recovery. Also, if a coach does not realize the extent of their athlete's sickness, he/she may push the athlete beyond their limits causing injury and/or death. If the disease has been going on for a while the athlete may have to take a break from the sport, in this case the coach needs to be very supportive and encouraging. Other treatment team members must instill within the coach that the ultimate concern is the athlete's health, not the coach's career.

A coach needs to realize how the disease will be treated after identification. There are three different levels of care, determined by the severity of the case. If the athlete has lost 75 percent or more other body weight, and/or she has experienced a loss of 30 percent within a month then she will be admitted into a hospital. (Eating disorders and female athletes; how coaches can help, summer 2002) Although such stays are generally short, they will experience intense weight gain and they will have a strict plan for meals and exercise. Her vital signs will be monitored and stabilized. The athlete will be involved in individual and group therapy daily, and will be medicated during her hospitalization. The family will also be involved, so they can provide support and come to an understanding of the disease. Somewhat less severe cases are treated through partial hospitalization. The athlete will no longer be at an acute risk of injury, although her weight is still abnormal. She will still be gaining weight, but at slower, less intense rate. Her medications will be adjusted and she will be allowed to do more activities. The last level is outpatient care. The athlete is able to go to school and/or work, but she will still be seeing a nutritionist, doctor, therapist, and psycho pharmacologist on a regular basis in order to assure her recovery. Typically people stay at this level for several years, and their weight is carefully monitored. (Eating disorders and female athletes: how coaches can help, summer 2002)

During any treatment, especially outpatient treatment, the coach can be very helpful. He/she needs to be supportive because the athlete is going through emotional stress. The coach should not allow the athlete to participate in the sport until a health professional tells him/her that it is safe. Because the athlete is not allowed to participate, she may feel as if she has abandoned her team. The coach needs to continually remind her of the long-term affects of anorexia, and how beneficial treatment will be to her game and, ultimately to her team. She will be more alert and have more energy, and will be able to give more to her team than what she gives now. The coach can communicate her feelings about the treatment clearly by setting goals that the anorexic athlete can work towards. Some of these goals can include increased participation on the team as she meets her weight goals. A coach who does this will show the athlete that her health is very important in her performance, and will give the athlete more incentive to work towards her goals to become healthy. The coach also needs to stress health issues with the whole team. He/she needs to make it clear how important being healthy is while playing sports. However, if the anorexic athlete does not want the coach to share any information about her absence, the coach needs to respect that.

If a coach does not understand how to take action when concerned about an athlete, he/she may cause a lot of damage. There are many ways a coach should not act when suspecting a player has an eating disorder. Coaches may ignore the problem. They may not realize how serious it is, and their ignorance may lead to a major tragedy. (Athletes with eating disorders: identification and intervention, 2002) They need to confront the problem as soon as possible. Also, once the disease is recognized the coach needs to realize that he/she can help the treatment, but the athlete also needs other professionals to be involved. Coaches cannot be the only one to help an anorexic recover. Also, a coach should never question the athlete's teammates to discover information about her eating habits or behavior, the athlete having the problems should always be the one approached. Coaches need to make sure they confront the athlete with evidence, rather than just automatically accusing her without explaining the details. A coach should never give off the aura of trying to threaten or manipulate the athlete; this behavior will only cause the athlete to become defensive and to shut out the coach. Accusing behavior may cause the athlete to become worse because of increased stress. A coach also needs to realize that anorexia is a disease that is not easily controlled, if a player is failing to gain weight it may not be because she is not trying. Coaches need to realize that they can do things to severely hinder the treatment. (Sherman, 1993)

Coaches and athletes should realize that despite the fact that losing too much weight can be very unhealthy, if one understands safe weight loss it can be done in a healthy manner and the athlete's performance can improve. Any weight loss needs to be done very carefully and the coach needs to monitor progress as well as behavior. The American College of Sports Medicine recommends that high school female athletes maintain 12-14 percent body fat in order to stay healthy. In order for an athlete to lose weight they can increase exercise and decrease calorie intake at a healthy level. In any case, the coach should not encourage any quick weight loss programs. An athlete can lose 1-2 pounds per week, but if the athlete loses more she will experience a decrease in muscle mass. If an athlete starts to lose weight at a faster rate, she will become dehydrated, and will begin to lose muscle strength and endurance. A coach must make sure that the athlete is consuming enough fluids during her weight loss program. The fasting of liquids as a means of quick weight loss is the most dangerous way to lose weight. Dehydration puts the athlete at great medical risk, and greatly hinders her performance. Diuretics and restricting fluid intake will cause the body to retain even more fluid once the body is hydrated and causes severe weight fluctuation. (Safe weight loss, 1998) If an athlete goes beneath the safe body fat percentage weight a coach should not let the athlete participate in her event until she is at a healthy weight. A general rule of thumb for athletes is to consume 15% protein, 30% fat, and 55% carbohydrates daily to maintain a healthy body. (Eating disorders among active athletes, 1997)

Anorexia nervosa is an extremely dangerous disease for any person, but can be especially dangerous for athletes. The emotional and physical stress put on an athlete will heighten and quicken any affects the disease has on a person's physical and mental health. Coaches play a very important role in identifying and treating athletes with eating disorders. Athletes are affected by their coach's attitudes and perceptions towards health and eating, so coaches should examine their values. Coaches need to become educated on the possibility of eating disorders plaguing their teams, and they need to understand their importance in helping their athletes.


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