Male Runners and Eating Disorders

Contributed by: Ron A. Thompson, PhD, FAED, CEDS, Consulting Psychologist at The Victory Program at McCallum Place

Eating disorders are more prevalent in “lean” sports than “non-lean” sports. Lean sports have traditionally included weight-class, aesthetic, and endurance sports.

Distance running has been included with endurance sports, although the term “endurance” has recently been replaced with “gravitational.” Gravitational sports are those in which moving the body against gravity is an integral part of the sport (Sundgot-Borgen et al., 2013).

The Attitudes and Beliefs Interfering with the Sport

In discussing risk factors for male runners, it is important to understand that the sport of running is not the problem, but rather some of the attitudes, beliefs, and practices often associated with the sport.

The specific risk associated with distance running is that a lean body is believed to provide a biomechanical advantage in sport performance (Thompson & Sherman, 2010), a belief held by coaches and athletes for the past 25 years. Another possible risk associated with distance running is that training loads have been increasing.

Coaches believe that training is the most important factor in improving athletic performance and that success in endurance/gravitational sports depends on progressive increases in training load. While typical training loads of 70+ miles per week for male college distance runners may seem excessive to the lay person, they are considered to be “normal” in sport today.

Additional Risk Factors Preventing Treatment

Additional risk factors involve identification. Affected male runners must be identified before they can be treated. Because of the thin/lean sport body stereotype (Sherman & Thompson, 2001) associated with distance running, at-risk runners may be more difficult to identify in the sport environment.

Such difficulty was reported in a recent study of track coaches who indicated difficulty distinguishing between athletes whose appearance met their sport-type expectations (lean distance runner) from athletes with a potential eating disorder (Plateau et al., 2014).

Identifying Eating Disorders in Men

Because most eating disorders occurs in females, healthcare professionals (and sport personnel) may not view an eating disorder as a possibility in males as quickly as with females. Hopefully, that is changing.

We have known of the “female athlete triad” for more than 20 years (Yeager et al., 1993), but only recently in an IOC position statement have the medical and psychological consequences associated with the Triad been extended to males (Mountjoy et al., 2014).

Just as “low energy availability” (energy available to fuel all bodily systems after the body accounts for all physical activity) is the key concept in the Female Athlete Triad (Nattiv, et al., 2007), it is presumed to explain many of the medical and psychological consequences that occur in male athletes.

Low Bone Marrow Density

As in females, low energy availability in males can disrupt gonadotropin releasing hormone and luteinizing hormone pulsatility, which can decrease testosterone production (Dolan et al., 2012; MacConnie et al., 1986). Bone health is dependent on testosterone in males.

Low spine bone mineral density (BMD) has sometimes been linked to nutrient energy deprivation in male distance runners (Hind et al., 2006), but even in the absence of disordered eating, such athletes appear to be at high risk for low BMD (Hetland et al., 1993; Stewart & Hannan, 2000).

Educational Efforts

Although most research in this area involves college and elite runners, a recent study with high school male cross country runners (Wadas & DeBeliso, 2014) suggests that younger male runners also may be at risk.

Given the aforementioned risks to male athletes, it is imperative that educational efforts be focused on providing parents, coaches, and healthcare professionals with information they need to better identify, refer and treat what appears to be an under identified and underserved special subpopulation of at-risk individuals.

Community Discussion – Share your thoughts here!

Do you have experience with running and eating disorders? What advice do you have to share regarding how we can better identify eating disorders in an at-risk population?

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References:

1. Dolan, E., McGoldrick, A., Davenport, C., Kelleher, G., Byrne, B., et al. (2012). An altered hormonal profile
   and elevated rate of bone loss are associated with low bone mass in professional horse-racing
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2. Hetland, M.L., Haarbo, J., & Christiansen C. Low bone mass and high bone turnover in male long distance
   runners. Journal of Clinical Endocrinology and Metabolism, 1993, 77, 770–775.
3. Hind, K., Truscott, J.G., & Evans, J.A. (2006). Low lumbar spine bone mineral density in both male and
   female endurance runners. Bone, 39, 880-885.
4. MacConnie, S.E., Barken, A., Lampman, R.M., Schork, M.A., & Beitins, I.Z. (1986) Decreased
   hypothalamic gonadotropin-releasing hormone secretion in male marathon runners. New England
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5. Mountjoy, M., Sundgot-Borgen, J., Burke, L., Carter, S., Constantini, N., Lebrun, C., Sherman, R., et al.
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6. Nattiv, A., Loucks, A.B., Manore, M.M., Sanborn, C.F., Sundgot-Borgen, J., & Warren, M.P. American
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7. Plateau, C.R., McDermott, H.J., Arcelus, J., & Meyer, C. (2014). Identifying and preventing disordered
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8. Sherman, R.T., & Thompson, R.A. (2001). Athletes and disordered eating: four major issues for the
   professional psychologist. Professional Psychology: Research and Practice, 32, 27-33.
9. Stewart A.D., & Hannan J. Total and regional bone density in male runners, cyclists, and controls. (2000).
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10. Sundgot-Borgen, J., Meyer, N., Lohman, T.G., Ackland, T.R., Maughan, et al. (2013). How to minimize the
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12. Wadas, G., & DeBeliso, M. (2014) Disordered eating, eating attitudes, and reasons for exercise among
    male high school cross country runners. The Sport Journal. Retrieved from http://thesportjournal.org/article/disordered-eating-eating-attitudes-and-reasons-for-exercise-among-male-high-school-cross-country-runners.
13. Yeager, K.K., Agostini, R., Nattiv, A., & Drinkwater, B. (1993). The female athlete triad: Disordered eating,
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About the Author:

Ron Thompson, PhD, FAED, CEDS
Consulting Psychologist and Co-Founder of The Victory Program at McCallum Place

Ron A. Thompson is a psychologist in Bloomington, Indiana, specializing in the treatment of eating disorders. He is also a consulting psychologist for the Athletic Department at Indiana University and has served as a consultant on eating disorders to the NCAA and on the Female Athlete Triad with the International Olympic Committee Medical Commission (IOCMC).

He coauthored the Disordered Eating section of the IOC MC’s Position Stand on the Female Athlete Triad, the NCAA Coaches Handbook: Managing the Female Athlete Triad, and Managing Student-Athletes’ Mental Health Issues for the NCAA. Dr. Thompson recently became a member of the NCAA Mental Health Task Force as the eating disorder representative on the committee.

Dr. Thompson also assisted in the development of the Healthy Body Image Project for the 2010 Youth Olympic Games. His publications include the books Bulimia: A Guide for Family and Friends, Helping Athletes with Eating Disorders, The Exercise Balance, and Eating Disorders in Sport.

He has presented lectures and workshops at more than 110 regional, national, and international meetings, including presentations at the United States Olympic Training Center, the Dutch Olympic Training Center, and the Swedish Sports Federation.

Dr. Thompson is a Fellow in the Academy for Eating Disorders (AED), where he cofounded the AED’s Special Interest Group on Athletes. Dr. Thompson and colleague Dr. Roberta Sherman jointly received the AED’s 2008 Leadership Award for Clinical, Administrative, and Educational Service.

The opinions and views of our guest contributors are shared to provide a broad perspective of addiction. These are not necessarily the views of Addiction Hope, but an effort to offer discussion of various issues by different concerned individuals.

Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on March 13th, 2015
Published on EatingDisorderHope.com