Male Athletes and Eating Disorders

Abstract

The vulnerability of male athletes to unhealthy weight management practices and eating disorder symptoms is controversial. A number of authors have suggested such a relationship, and some of the empirical literature supports these conclusions. Among wrestlers, researchers1 found that 52% reported binge-eating behavior, and 11% described symptoms suggestive of a subclinical eating disorder. Several researchers describe higher scores on the Eating Attitudes Test (EAT), a self-report measure of eating disorder pathology, among male athletes. Stoutjesdyk and Jevne2 found that nearly 5% of male college athletes scored in the EAT range suggestive of anorexia nervosa, which is considerably higher than the general male population. However, some of these abnormal findings may be transient and related to the seasonal demands of the sport rather than persistent and enduring eating pathology. If present, pathologic findings may be more common in sports that emphasize a lean body shape or low body weight.3 In contrast to the preceding observations, other investigators do not find a relationship among males between participation in athletics and eating disorder symptoms. Finnish researchers4 found that male athletes did not want to lose weight. In comparing aesthetic versus endurance and ball game participants, Hausenblas5 found no differences on eating disorder measures. Among undergraduates, Wilkins et al6 found that, compared with nonathletes, athletes actually relied less on dieting behaviors for weight control and were less likely to perceive themselves as overweight. Finally, Johnson et al7 surveyed 1445 student athletes and concluded that the prevalence of anorexia or bulimia nervosa among males was 0%. Collectively, the preceding studies suggest that while participation in sports may stimulate eating pathology among some males, few seem to develop bona fide eating disorders. However, there appears to be a small risk, and the reasons for the occasional intersection between athletic involvement and eating disorders remain unclear. Participation in sports that demand a lean or low body weight may be a risk factor; this does not exclude other contributory causes such as a perfectionistic personality; accessing less competitive weight classes through weight loss (eg, wrestlers); and external pressure from coaches, teammates, and parents for athletic success. Given that the authentic risk for eating disorders among male athletes warrants further clarification, a meta-analysis of current data would seem to be an initial starting place. However, the samples available in the literature represent diverse ethnic populations and types of sports, making robust comparison difficult. A future study of male collegiate athletes might include (1) large numbers of participants from several colleges (for regional comparison) as well as from both lean and nonlean body sports, (2) comparison with nonathletic male controls, (3) interview strategies rather than self-report measures, and (4) examination for the presence of eating pathology during the off-season. In addition to the assessment of eating pathology, additional measures might explore obsessive-compulsive personality, internal versus external loci of control (ie, responsiveness to internal and external expectations), and general body satisfaction. If future studies confirm that a substantial minority of male athletes is at risk for eating disorders, several approaches to intervention might be undertaken. First, coaches and their staffs can rely on established guidelines. Such guidelines exist at several levels: the National Federation of State High School Associations' wrestling rules book8 states that, “at anytime, the use of sweat boxes; hot showers; whirlpools; rubber, vinyl, and plastic-type suites; or similar artificial heating devices…is prohibited and shall disqualify an individual from competition” (p. 15). In addition, the National Collegiate Athletic Association9 has adopted new weight control rules that emphasize competition, not weight control; reduction of incentives for rapid weight loss; and the elimination of tools used to accomplish rapid dehydration. In addition, athletes, coaches, and related staff can foster an atmosphere in which appropriate nutritional practices and the dangers of eating pathology are emphasized. This can be readily achieved by providing educational in-services and placing informative posters in practice areas. All personnel need to be alert to the signs and symptoms of an eating disorder (eg, acute and excessive weight loss; light-headedness; cold intolerance; restrictive eating patterns; self-induced vomiting; the use of laxatives, diuretics, or appetite suppressants; intense preoccupation with weight), which can be reviewed regularly. Coaching staffs might also encourage young men to share their concerns about body image and weight. Some investigators believe that coaches may benefit from more training in the area of nutrition (there is evidence that only 36% of coaches ever attended a nutrition workshop10). Our knowledge of the risks of eating disorder pathology among male athletes is limited. We need to encourage further investigation of the prevalence of these disorders among male athletes and an exploration of interventions that might deter their development. As we prepare athletes for heightened performance, we need to protect them as well.