Written by Ron A. Thompson, PhD, FAED, CEDS
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). 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 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).
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. 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). 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.
References
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 jockeys. Journal of Bone and Mineral Metabolism, 30, 534-542.
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.
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.
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 Journal of Medicine, 315, 411-417.
Mountjoy, M., Sundgot-Borgen, J., Burke, L., Carter, S., Constantini, N., Lebrun, C., Sherman, R., et al. (2014). The IOC consensus statement: beyond the female athlete triad—relative energy deficiency in sport (RED-S). British Journal of Sports Medicine, 48, 491-497.
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Plateau, C.R., McDermott, H.J., Arcelus, J., & Meyer, C. (2014). Identifying and preventing disordered eating among athletes: Perceptions of track and field coaches. Psychology of Sport and Exercise, 15, 721-728.
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.
Stewart A.D., & Hannan J. Total and regional bone density in male runners, cyclists, and controls. (2000). Medicine & Science in Sports & Exercise, 32, 1373-1377.
Sundgot-Borgen, J., Meyer, N., Lohman, T.G., Ackland, T.R., Maughan, et al. (2013). How to minimize the health risks to athletes who compete in weight-sensitive sports review and position statement on behalf of the ad hoc research working group on body composition, health and performance, under the auspices of the IOC medical commission. British Journal of Sports Medicine, 47, 1012-1022.
Thompson, R.T., & Sherman, R.T. (2010). Eating disorders in sport. New York: Routledge.
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 https://thesportjournal.org/article/disordered-eating-eating-attitudes-and-reasons-for-exercise-among-male-high-school-cross-country-runners.
Yeager, K.K., Agostini, R., Nattiv, A., & Drinkwater, B. (1993). The female athlete triad: Disordered eating, amenorrhea, and osteoporosis. Medicine & Science in Sports & Exercise, 25, 775-777.
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.
