Swimmers are pretty well-known for being comfortable, perhaps too comfortable for some non-swimmers, with their bodies. Yet the pressure to keep improving performance, and perhaps the extent to which young swimmers’ bodies are on display, contribute to the risk of disordered eating. While the clinical eating disorders Anorexia Nervosa and Bulimia Nervosa gain much needed attention, swimmers can also experience problems due to what is known as Anorexia Athletica.
What is Anorexia Athletica?
Anorexia Athletica is a subclinical eating disorder that can be found in athletic populations, that shows similar behaviour patterns to Anorexia Nervosa. By subclinical, it means that the eating behaviour or attitude to food is not the underlying medical problem, but left unattended it could have serious consequences. It also suggests that Anorexia Athletica will not necessarily lead to a clinical eating disorder and should subside with cessation of the sport. The desire to lose weight is a consequence of participating in the sport and not a primary motivation for participating.
While anorexia athletica does not, in itself, require medical treatment, if left unmanaged will most likely lead to other help problems due to the lack of nutrients required to support an intense swim training programme, or premature drop-out from the sport (which can lead to its own emotional or psychological difficulties). Despite the ‘subclinical’ label it should be considered dangerous and taken seriously.
Note: This does not mean that swimmers, whether male or female, do not suffer from either Anorexia Nervosa or Bulimia Nervosa
Criteria for assessing Anorexia Athletica
Must be met for Anorexia Athletica (from Herbrich et al, 2012)
- Weight loss of >5% of expected body weight
- Gastrointestinal complaints
- Absence of medical illness or affective disorder explaining weight reduction
- Excessive fear of becoming obese
- Restriction of caloric intake to below 1200 kcal/day
May be present in Anorexia Athletica
- Delayed puberty (no menstrual bleeding at age 16)
- Menstrual disfunction (amenorrhoea)
- Disturbance in body image
- Use of purging methods (self-induced vomiting, laxatives, diuretics)
- Binge eating
- Compulsive exercising (beyond normal range of programme)
In comparison, the criteria for Anorexia Nervosa described in the psychiatric ‘bible’ DSM-IV are:
- Refusal to maintain body weight at or above a minimally normal weight for age and height, for example, weight loss leading to maintenance of body weight less than 85% of that expected or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected.
- Intense fear of gaining weight or becoming fat, even though underweight.
- Disturbance in the way one’s body weight or shape is experienced, undue influence of body weight or shape on self evaluation, or denial of the seriousness of the current low body weight.
- In postmenarcheal females, amenorrhea, i.e., the absence of at least 3 consecutive menstrual cycles. A woman having periods only while on hormone medication (e.g.estrogen) still qualifies as having amenorrhea
This definition describes both a greater quantitative weight loss, and a greater intensity in the psychological symptoms and signs compared to anorexia athletica.
What should I do if I am concerned?
If you are concerned that a swimmer may show signs of anorexica athletica, this should be discussed with nutritional or medical staff if available, for example in a professional swimming programme. Bear in mind that anorexia athletica does not, in itself, require medical treatment and appropriate nutritional advice and monitoring may help, as may psychological counselling.
Finally, if you are at all in doubt, and believe that there is a chance that your child or swimmer is suffering from a clinical eating disorder please professional medical advice (for example your family doctor, psychiatrist or clinically trained psychologist*).
* Note that many sport psychologists, including myself, are not clinically trained so please check first.
HERBRICH L, Pfeiffer E, Lehmkuhl U, Schneider N, et al. Anorexia athletica in pre-professional ballet dancers. J Sports Sci. 2011;29:1115-23
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.