Out Of The Shadows

Eating disorders disrupt lives and cause serious medical issues. How to prevent, detect and deal with climbing's insidious illness.

 

Climbing offers lifelong benefits for young people. It builds strong bodies, self-confidence and social skills, but the pressures to excel can trigger psychological stresses that result in eating disorders, especially among individuals struggling with anxiety or depression. It doesn’t help that our online society is increasingly obsessed with comparisons, perfectionism and body image.

Eating disorders can affect anyone—young and old, male and female are all vulnerable. Problem is, while it is easy to talk about holds and moves, most people don’t want to discuss their struggles with an eating disorder. What can we as parents, coaches or athletes do to bring the topic out of the shadows? What does the IFSC say? Are there appropriate prevention and treatment mechanisms available, and if there are, how do we implement them?


Understanding eating disorders

Eating disorders involve extreme and unusual eating habits caused by underlying psychological and emotional issues. Athletes who suffer are invariably self-critical and compulsive over-achievers who feel guilty when they aren’t constantly studying, working or exercising. They develop an analytical attitude toward food and body image, and are unable to view themselves objectively. They may follow obsessive diets and secretly binge on food or purge (vomit) after eating. Eating disorders are a psychological, not a nutritional, diagnosis. For many sufferers, food is used as a way to gain control and deal with negative emotions and thoughts such as not performing as well as they had hoped to.


Common disorders

Anorexia nervosaPeople with anorexia will constantly strive to be thinner by taking extreme measures to deprive themselves of calories, sometimes including purging, consuming diet pills and exercising excessively.

BulimiaSufferers will succumb to a cycle of excessive binge eating followed by purging to avoid absorbing consumed calories. They may also fast or take laxatives as part of this destructive process.

Binge Eating DisorderSufferers compulsively overeat in short, rapid periods.


Myths dispelled

MYTH 1: Eating disorders aren’t dangerous. Fact is, eating disorders cause severe psychological damage, in some cases leading to suicide, and can lead to serious and irreversible growth stunting, bone and kidney damage, infertility and heart failure.

“The annual mortality rate associated with anorexia nervosa is more than 12 times higher than the death rate for females of 15–24 years old in the general population.”—Renfrew Center for Eating Disorders

MYTH 2: The problem is not widespread. A study of over 400 female college athletes by Beals and Manore in the Journal of Sports Nutrition found that 43 percent reported feeling terrified of becoming overweight, 31 percent had irregular or absent menstrual periods, 34 percent had experienced a bone fracture, and, most shockingly, 34 percent had or were at high risk for having bulimia, while 18 percent had or were at risk for anorexia.

MYTH 3: Only teenage girls are affected. Fact is, many sufferers are male or mature females. Indeed for males, societal stereotypes such as not displaying emotions can be particularly damaging amid the cocktail of associated pressures.

MYTH 4: A final damaging myth is that sufferers are vain. The reality is that eating disorders are deep-set psychological illnesses, which have little to do with the way people actually look.


Warning signs

Abnormal eating patterns can be difficult to detect within the culture of sports. Athletes can have strange eating rituals that may not be due to an eating disorder—they can be oddball, but healthy, eaters. Affected athletes often conceal their problems by telling their peers that they are merely eating in a way that is appropriate for their sport. At first, the warning signs might not be obvious, but as eating disorders advance, the symptoms become increasingly apparent. The following list is a brief summary:

General signs—Sufferers of eating disorders may experience significant and rapidly fluctuating weight losses or gains and be preoccupied with weight, notable by time spent on the scales or in front of a mirror. They may frequently comment about their weight or wear loose-fitting clothes to conceal their figures.

Food restriction—Signs of food restriction include obsessive calorie counting, restricting portion sizes, weighing food, and avoiding certain foods or foodt ypes such as fats. Other markers include making excuses to avoid meals or social situations where food is involved, abnormal rituals such as excessive chewing, playing with food on a plate, or taking diet pills or prescription or non- prescription stimulants.

Purging—A sufferer may be purging if they often disappear after meals or make frequent trips to the bathroom and shower or run the tap excessively. Additional signs include fasting, exercising immediately after eating, and consuming mouthwash, mints, laxatives or diuretics. They may also have discolored teeth and complain of sore throats or an upset stomach.

Bingeing—Evidence of bingeing can be eating in secrecy, food hoarding (especially high-calorie foodstuffs), hiding food packaging, and unexplained disappearances of food.

Differentiating between eating disorders and eating rituals. Athletes often avoid eating before practicing and this is generally regarded as normal. However, if an athlete also skips meals after training then this could indicate an eating disorder. Similarly, an elite athlete might suddenly eat a large amount of food after training, which may appear symptomatic of bingeing, yet they are merely responding to their appetite post exercise. But eating large amounts at irregular times can indicate a disorder. The key is to monitor eating rituals over time, and to be mindful of the different requirements and behaviors of athletes.


Advice for coaches

Coaches are influential figures for young climbers, and with that position comes a duty of care. Good coaching is the best way to prevent eating disorders, whereas bad coaching can cause them.

Educate yourself. Eating disorders are prevalent in virtually every sport and we must presume that climbing is no different. Coaches need to learn the warning signs and should take them seriously and act.

Don’t avoid the subject. Make a point of teaching young climbers about safe, healthy eating practices and the way nutrition affects health and performance in positive and negative ways.

Be careful with your words. Never underestimate your power. Weight is such a sensitive and personal issue for many young athletes that one careless comment can trigger someone who
is susceptible. Understand how your views may affect your athletes, sometimes inadvertently.

Shift the focus from body weight. Emphasize other areas where athletes can improve such as strength, endurance, technique, mental skills and tactics.

Talk straight on weight. If you are pressed on the subject, concede that someone who is overweight may improve by losing a bit of weight, whereas others who are at an optimum weight will climb worse if they adopt dangerous weight-loss protocol. If you try to tell a climber that body weight makes no difference, then you will lose their trust and respect.

“General discussions regarding health, recovery and athletic performance can be frank and to the point and as open as any other training protocol so it doesn’t become a taboo subject,” says sports nutritionist Glen Burrows. “For the underweight child we should be asking, ‘Have you eaten enough to stay strong and recover?’ and for the overweight child we should be asking if they consider all of their food choices to be healthy, allowing the athlete to take personal responsibility.”

Emphasize the health risks. It is likely that vulnerable climbers will be so obsessed with the perceived performance benefits of weight-loss that they will be blind to the health risks. Spell them out.

Promote positive self-esteem. Develop a coaching environment that is fun and sociable. Show kindness and celebrate your team as people rather than purely as talented performers.

Share information with other coaches. All coaches should help prevent eating disorders by spreading knowledge throughout the coaching community.

Promote healthy eating. Young climbers often have crazy ideas about which foodstuffs can be regarded as healthy and suitable for an athletic diet.

“Processed foods cause confusion because eating them gives the athlete the illusion that they are being healthy,” says Burrows, who adds that sports drinks are especially problematic. He recommends cooking from scratch “so you know exactly what you are eating.”

Burrows notes that athletes need more protein than sedentary people and  that young growing athletes especially need protein. “Every meal should provide a complete protein such as meat, fish or eggs,” he says. “Very active children often need to snack either before or during training, and a snack should be just enough to tide them over until meal times.” For snacks, Burrows recommends nuts, dates or fruit.

Test for body composition. Body composition is a key indicator in monitoring eating behaviors. Some climbers may appear honed, but they may be suffering from anemia, osteoporosis,
or in the case of females, not menstruating because they aren’t eating sufficiently. Thus, it is vital for coaches to periodically monitor body composition. This will include measurements for bone density and blood functioning, as well as percentage body fat and muscle mass.

Dr. Burtscher of the IFSC Medical Commission says that the IFSC uses body mass index (BMI) as a screening tool to detect underweight athletes. “If an athlete is below the healthy BMI bracket, the National Federation and athlete are informed and a medical statement must be sent to the IFSC to exclude anorexia athletica or another critical medical problem.”

Burtscher says that adolescent athletes should be regularly checked for height and weight by their trainers to recognize a growth spurt or an eating disorder, and “thus be able to adapt the athlete’s training plan or arrange support.”


Should coaches or parents intervene and assist overweight athletes in losing weight?

This is a contentious question, which should be treated case- by-case. Ultimately it will be a judgment call for the individual coach, and the coach will need to operate within their sphere of knowledge and experience. If in any doubt, refer to a qualified sports nutritionist or dietician. There are safe nutritional protocol that can be used.

“To shed a few pounds of body fat, the easiest way is to up protein intake,” says Burrows. He notes that protein is the least calorific of the macros and is often hard to over eat. “Choose lean protein such as chicken and fish and make sure each meal contains at least 30 grams of protein which would equate to 120 grams or so of meat or fish.” Burrows encourages the athlete to also consume a large amount of low-calorie vegetables such as leafy greens or whatever they like to eat. “There’s no need to calorie count,” he says, “and they won’t even know they’re on a diet, just tell them that eating a more healthy diet will improve their performance.”


What to do if you suspect an athlete has an eating disorder

Coaches are often in the best position to detect if a climber is affected by an eating disorder.

Don’t look the other way. Coaches don’t always act on their suspicions, especially if an athlete is still performing well. Yet early detection increases the chances of a successful cure, and if an eating disorder goes untreated, an athlete risks losing their climbing career and permanently damaging their health.

Don’t automatically curtail participation. The athlete is already in a dark place and it is vital to consider their emotional well-being and physical safety. Await instruction from a qualified practitioner.

First speak with parents or guardians. Parents are key figures in the process of tackling eating disorders. They may have concerns too, but might not be sure if they should be the first to voice them. Parents can arrange medical care or phone hotlines for eating disorders for confidential advice (see end of this article.)

Speak to your athlete privately. Reassure them that you’re there for support and can facilitate help. If they open up to you, commend them for their bravery.

Monitor the situation. Check that appropriate health care has been arranged and if it has not, then follow up. If nothing is done and you perceive that the level of risk has increased, contact social services.


Tips for speaking to athletes

Show concern and empathy, and avoid direct statements and confrontation when you speak to athletes with eating disorders. For example, don’t correct them if they tell you they are fat, and instead share your concern that they are struggling. If an athlete denies the problem, don’t try to prove them wrong, and instead try to understand why they are hiding things from you, whether through shame or fear of being excluded from sessions. A good way to go about recommending counseling is to explain that this is no different than having a mental-training coach.


Advice for parents

Eating disorders are deep-set psychological conditions that take time, patience and care to resolve. You can’t force a person with an eating disorder to change, so aim to offer support and encourage treatment. Don’t be afraid to speak up. It is worth risking a confrontation even if you are mistaken.

Pick a good time when you can speak privately without distractions. Explain why you’re concerned, but avoid grave warnings about the dangers, blaming, criticism, ultimatums, comments about their weight, confrontational questions or simplistic solutions such as, “just eat more!” Never try to force your child to eat normally. Say why you’re worried and refer to specific behaviors you’ve noticed. The conversation is likely to feel threatening, so be prepared for denial and if this happens, remain calm, focused and respectful. You may find that your child is receptive and had been looking for a way to reach out for help. Don’t try to offer solutions at this stage, but reinforce your love, concern and desire to help. It may take several attempts before your child is willing to open up. Once they engage, ask if they have reasons for wanting to change and if they do not, then try to help them to identify some. The aim here is to convince them to seek help. It may tip the scales if you offer to go along on the first visit to a medical professional.


Treatment

If your child or squad athlete is put forward for treatment then you will be provided with more detailed information.

“Should an eating disorder be diagnosed,” says Dr. Burtscher, “multiple support methods must be offered from health professionals including a sports physician, nutritionist, psychologist, physiotherapist and of course, the athlete’s parents (regarding minors only).”

The first priority is to address and stabilize any serious health issues and, in some cases, hospitalization or residential treatment may be required. Outpatient treatment is an option when the patient is not in immediate danger. Therapy sessions may include nutritional counseling, individual therapy and group or family therapy. Parents will be advised on how best to support their child during the recovery process. Strategies may include serving healthy balanced meals and making meal times relaxing and fun, focusing on inner qualities and promoting self-esteem, encouraging socializing in non-competitive environments, and taking the emphasis off performance and helping your child to feel human again.


Prevention

It may seem as if not enough is being done to educate climbers about eating disorders. However, there are winds of change. The IFSC has noted this situation and is working with its Medical Commission to provide educational information on athlete health and BMI, which is soon to be published on the IFSC website.

From my perspective as a coach, parent and someone who cares about climbers, there is no time to waste. I have witnessed the damage eating disorders do to climbers, and have also seen the risks of copy-cat syndrome. When impressionable youngsters see severely underweight climbers winning competitions, the temptation is to emulate them. If climbing permanently damages the health and well-being of just one person, then that is one person too many.

Emergency Help Line 

National Eating Disorders Association (800) 931-2237


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  • The British all-arounder and longtime coach Neil Gresham (www.neilgresham.com) avoided hangboards for years, but shot up a couple of grades when he started using them, and is now a convert.

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