PUSHING THE LIMITSCONSEQUENCES OF GETTING

TO THE “IDEAL” BODYStephanie Chu, DOAssociate Professor

University of Colorado SOMTeam Physician Colorado Buffaloes

AS AN ATHLETE YOU ARE CONSTANTLY BEINGPUSHED TO YOUR LIMITS, EVERY PART OF YOUIS MEASURED – DIET, STAMINA, PACE, TIME,POWER… THE WORLD SEES YOU AS HAVINGTHE PERFECT FORM… YOU ARE SUPPOSED TOBE PERFECT, A CHAMPION, THE EMBODIMENTOF CONFIDENCE AND STRENGTH.

InfluencePub 2014

Objectives

■ Sports most “at risk” for having athletes with disordered eating

■ Injuries and medical complications associated with ”aesthetic sports” and “endurance sports”

Gracie GoldTop U.S. Woman in Figure Skating at Sochi OlympicsHas not competed since Jan 2017 U.S. Championships in treatment for an eating disorder, depression and anxiety

Sports/Events Included as High-Intensity Sports

High-Intensity Sports

■ Middle distance running■ Rowing■ Tennis■ Speed Skating■ Swimming■ Ballet■ Wrestling

■ Skiing■ Badminton■ Figure Skating■ Gymnastics■ Judo/karate/Taekwondo■ Kickboxing

Heidi Guenther(1975-1997)■ Ballet dancer who struggled

with anorexia after being advised by the Boston Ballet to lose 5lbs

■ Heidi died at the age of 22 because of complications associated with anorexia

■ After her death a program was created to raise awareness and reduce eating disorders in dancers

STRESS FRACTURESCause, Locations, Diagnosis and Treatment

Stress Fractures

Dieting athletes

Disordered eating

Serious eating

disorder

Disruption of normal

menstrual cycle

Imbalance bone

remodeling

Osteopenia/Osteoporosis

Stress Fractures

Common Stress Fracture Locations■ Metatarsals, Navicular, Tibia/Fibula

– Ballet, Cross Country, Track & Field, Figure Skating

■ Femur– Cross Country, Track & Field

■ Lumbar Spine/Pelvis– Swimming/Diving, Wrestling, Ballet, Gymnastics, Cross Country,

Track & Field

■ Forearm, Elbow– Rowing, Gymnastics

Stress FractureImaging■ X-rays are typically NEGATIVE

■ Usually needs MRI or Bone Scan

Stress FracturesTreatment

Stress FracturesRehabilitation

■ Resistance training

■ Muscular endurance training

■ CORE and pelvic girdle stability

■ Balance and proprioception

■ Flexibility training

■ Gait retraining

Nadia Comaneci■ Romanian gymnast best know for

the first to achieve a score of a perfect 10

■ Won 9 Olympic Gold medals

■ Struggled with BOTH anorexia and bulimia

■ She has overcome these eating disorders today through eating disorder treatment

GYN and Reproductive■ Secondary amenorrhea

– Weight loss of between 10-15% of normal weight disrupts menstrual cycle

– Weight gain restores menstrual cycles (~9mos, 90-95% of ideal body weight)

– NOT suggested to use hormones for purposes of treatment

– ”Vigorous exercise” or ”athletic women” is not cause for amenorrhea, menstrual cycles should return with less activity and weight gain

Christy HenrichU.S. Gymnast with Anorexia and Bulimia

She was told by a judge she was too fat to excel in gymnastics, died at age 22, weighing 47 lbs

GI DisordersAnorexia Nervosa■ Gastroparesis

– Delayed gastric emptying– Develops with food

restriction and weight loss of 10-20lbs

■ Constipation– Frequently accompanies

weight loss– Usually treated incorrectly

with laxatives– Weight restoration will

restore previous bowel patterns

Mia St. JohnFemale Boxer Lightweight Champion

Overcame anorexia during career

Gastroparesis■ Symptoms

– Bloating usually occurring AFTER eating and worsened with high fiber diet or fiber laxatives

– Early satiety, fullness, nausea and vomiting (not self-induced)– Heartburn– Bloating usually used by athletes as a “reason” why they can’t eat more to

gain weight

■ Management– Reassure athletes the eating does NOT cause gastroparesis– Usually resolves with weight restoration around 4-6 weeks– Generally improves with partial weight gain, significant improvement occurs

with 10lb weight gain– Resolves with weight gain to 80% ideal body weight, or if BMI gets to 17 or 18

Bulimia Nervosa

Cathy RigbyFirst U.S. gymnast to win a medal at WorldsBattled bulimia for 12 years

Zina GarrisonU.S tennis player who won 2 Olympic goldsAge 19 developed bulimia likely due to stress

BulimiaElectrolyte Imbalances■ Dehydration

■ Hypokalemia– Muscle weakness, cardiac

arrhythmias, impaired renal function

– In healthy athletes is highly specific for bulimia

■ Hypochloremia

■ Hyponatremia

■ Metabolic Acidosis

Routine screening detects electrolyte abnormality. Corrected by discontinuing

purging behavior.Martina Eberl

German golfer with bulimia from ages 14-24 before seeking any treatment

Consequences of the “Ideal Body”■ Recognition that underlying cause

of certain injuries and medical issues may be due to eating disorder

■ Multidisciplinary treatment team necessary to manage these athletes

■ Treatment of eating disorder typically will correct medical issues

■ Recurrent stress fractures would need further assessment of RED-sNancy Kerrigan

Winner of 2 Olympic medalsStruggled with eating disorder possibly due to Tonya Harding drama

Multidisciplinary Treatment Team

Athletic Trainer

Strength Coach

Take Home Points■ Recognize High Intensity Sports associated with disordered

eating■ Consequences of getting to the “Ideal Body” for sport

– Stress Fracture– Amenorrhea– Gastroparesis– Constipation– Electrolyte Abnormalities

■ Multidisciplinary Team approach for treatment

QUESTIONS???

References■ Sundgot-Borgen, S, Torstveit, MK. “Aspects of disordered eating continuum in elite high-intensity

sports.” Scand J Med Sci Sports. 2010 Oct;20 Suppl 2: 112-21.■ Rizzone, KH, et al. “The Epiemiology of Stress Fractures in Collegiate Student-Athletes.” 2004-

2005 Through 2013-2014 Academic Years. Journal of Athletic Training. 2017;52(10):966-975.■ Saunier J, Chapurlat R. “Stress fracture in athletes.” Joint Bone Spine. 2017 May 13.■ http://www.influencepublishing.com/top-20-famous-athletes-eating-disorders/■ http://www.dancemagazine.com/the-cult-of-thin-2307026233.html■ Hail, Lisa, and Daniel Le Grange. "Bulimia nervosa in adolescents: prevalence and treatment

challenges." Adolescent health, medicine and therapeutics 9 (2018): 11.■ Joy E, Kussman A, Nattiv A. “2016 update on eating disorders in athletes: A Comprehensive

narrative review with a focus on clinical assessment and management.” Br J Sports Med. 2016 Feb;50(3):154-62.