Parenting the Gymnast: Eating Disorder Prevention Edition

Parenting the Gymnast: Preventing Eating Disorders Edition

In honor of National Eating Disorder Awareness Week, I want to discuss a tough topic that has effected many of us and gymnasts. Brace yourselves, this is a long post.

Eating disorders come in all shapes and sizes, and you cannot “tell” by the look of a person a) how healthy they are and b) if they are or are not struggling with an eating disorder.

The gymnast who tracks lower on the growth chart percentiles doesn’t necessarily have a “food problem” or “eating disorder”; likewise, the gymnast with the bigger build is not necessarily “fat” or “obese”.

Genetic height potential and body shape is largely determined by our genetics (thanks mom and dad!). Wishing you were in a different body is futile. Comparing your body or your child’s body to another, especially another successful gymnast, is futile.

When parents and coaches understand the stages of growth, they are better able to support their tween and teenage gymnasts as their bodies grow and mature. We will talk about this more in another post.

An important factor in eating disorder prevention centers around the language we use around food and bodies.

Eating disorders are triggered by a variety of things, but are result are of a complex interaction between the biological, psychological, and environment. Parent of fostering an environment that discourages eating disorders is watching how we as adults talk food and bodies (including our own!).

For some reason, we feel as adults that it’s OK to tell our children and gymnasts things like “you’ve really had enough of that food”, “you’re eating like a pig”, or “aren’t you full already”. Yet, if our significant others told us those same things we would be crushed.

No one likes rules. And restrictive feeding practices (a parenting style that’s not successful) only impress upon the child that food is good or bad and that the “bad foods” are only available in limited quantities and thus “all the food” must be eaten when available, which thus morphs into food sneaking, “going overboard” at other kid’s houses, etc.

It’s starts with feeding. “But wait, I just want you to make a meal plan for my kid and they need to comply-or-die (meaning, do what it takes at all costs to perfectly adhere to the plan…)”

Nope, it’s still your job as the parent to provide the “what” and the child to choose “how much”. And, prescriptive meal plans allow for minimal “what” or “how much” as part of the plan since you must eat the prescribed amount, regardless of your hunger/fullness cues, etc. *This does not apply to eating disorders where prescriptive meal plans are often used for weight restoration*

Eating disorder prevention also starts with calling out misguided advice. Sometimes the parental approach (including coaches, largely parent-like figures to gymnasts who spend more time with them than their own families) to nutrition is “we don’t go there”. For others, they maintain polarizing views that are largely clouded by their own experiences and food issues (parental feeding competence).

I knew as a young dietetic student that I needed to “get my poop in a group” per one of my favorite professors; meaning, I needed to fully heal from my own eating disorder before I EVER counseled patients/clients, and that also related to how I would raise my own children one day in terms of feeding. Herein lied a lot of motivation for me to fully recover from my food struggles, as I would sit through these lectures on nutrition and child feeding with my skin crawling due to the dissension I felt. At the time, I was fully subscribed to “it’s the gluten, dairy, lectins, etc.” that cause all of our problems (hormones, weight, etc.), and gained 30 lbs. (in an already weight-restored body) in the process of trying to “diet my way to health”. That extra weight came from binging on “healthy foods”. And sure, the disordered eating behaviors had a role in this, but there was also this level of food dissatisfaction from sautéed spinach, ground beef, and coconut oil that led me to seek out other foods beyond the meal as mentally I was “still hungry”. This is a huge reason why I’m a big proponent of including “fun foods” in our nutritional patterns. Including “fun foods” helps to take away their luster and leave us feeling satisfied and not deprived.

As a young dietetics student, I was so confused and had easily bought into #dietculture which likes to villanize “this food and/or that food” because it makes for an alluring marketing campaign and easy-to-sell diet book. Sadly, a lot of the confusion I experienced stemmed from the athletic community who LOVES different diets, eliminating foods groups, etc. As a young gymnast I had “googled” the diets of olympic gymnasts and would often see meals like “grilled chicken and broccoli” or “egg whites and fruit” or “clean eating” and thought that was normal and healthy for an athlete.

Preventing eating disorders also starts with a culture change; a culture that unfortunately has been fraught with disordered eating and disordered practices for its entire existence.

-Coaches: Your words about food and bodies matter a whole lot more than just about anyone else’s—the parent’s, the pediatrician’s, the sport science professional. Ask most gymnasts how their eating disorder started and it was likely partially related to coach’s comments about their food or bodies.

It is also important how you talk about YOUR own body, as this is easily modeled to the gymnasts. If you walk around the gym telling your gymnasts YOU are/feel fat, etc. (or demonstrate disordered eating behaviors), then they are likely to think these things are normal. As a gymnastics judge, it saddens me when I’m at a meet and while we’re eating between sessions I’ll often notice a coach standing somewhere in the corner by a trashcan taking bites of the “fun foods” and then spitting them out in the trashcan. That is not normal behavior. I understand maybe wanting only a half of a large cookie or the like, but having a plate full of chips, cookies, brownies, etc and taking one bite out of each and hurriedly throwing them away and spitting out the feed is disordered behavior. So yes, sadly a lot of coaches are still plagued with struggles and I so get that. But I also know that recovery is possible and whether you are a coach or a professional, there is a great ethical responsibility to make sure you’re a good place when you’re influencing others.

I want to say that a lot of these comments (about their bodies/food or yours) are unknowingly taken the wrong way, and that is not your fault. I also want to acknowledge that these days you feel like you can hardly speak, spot, etc without getting accused of improper behavior. Sadly that is where we are in the current culture, but that does not change the fact that the conversations around food and bodies needs to improve for most gyms.

Athletes are two to three times more likely to develop and eating disorder than the general public. In a 1992 NCAA survey, 51% of gymnastics programs responded reported eating disorders among its team members, which is a far greater percentage than any other sport. Even though this study is almost 20 years old, I cannot image the statistics are any better today. A 2019 systematic literature review (high quality summary of many research studies) in the American Journal of Clinical Nutrition showed that eating disorder prevalence in all genders/ages has increased from 3.5% in 2000-2006 to 7.8% in 2013-2018, so we know things aren’t getting better at a population level.  Another study showed that the majority of risk factors for eating disorders related to coaches are pressure for thinness, associated with weight control, especially through advice on food restriction, monitoring athlete’s weight, and negative comments, particularly about eating, and about weight and body image.

Coaches and parents, here are some red flags for eating disorders:

• Sudden weight changes, specifically weight loss. Weight gain with puberty is normal; a lot of athletes will also go through a rapid weight change if they have had suppressed puberty due to intense training/inadequate food and then are injured and cannot train at the same intensity). So, if an athlete seems like they’re “gaining a lot of weight”, that may not necessarily be related to disturbed eating behaviors.
• Sudden negative changes in endurance and work output, or inability to keep up with the rest of the team
• Athlete dressing in layers to hide weight loss or stay warm
• Preoccupation with weight, food, calories, macros, or dieting
• Making frequent comments about feeling “fat” or overweight despite weight loss or being at a healthy weight
• Complaints of constipation, abdominal pain, cold intolerance, or lethargy (we like to look to food as the culprit for GI issues, but eating disorders play a huge role in GI upset)
• Athlete cooks meals (especially desserts) for others without eating them
• Limited social spontaneity, concerns about eating in public
• Sudden changes in mood—during my eating disorder I cried in practice every single day. As a general rule, I never cried in gymnastics (thanks to the “tough girl” gymnast persona that has taken years to heal from. Crying is normal and cathartic). But, during starvation the brain cannot emotionally regulate was well and thus you may observe extreme mood changes that are not characteristic of that athlete. This could also just be related to puberty, etc. so tread lightly.
• Frequent trips to the restroom, especially right after a meal. Bulimia is still very alive and well, and can have serious medical consequences. The dentist can often tell if the teeth have had frequent contact with stomach acid from repeated purging. Facial and cheek swelling from enlarged glands after repeated purging is also a “tell”, along with sores, scars, or calluses on the knuckles or hands.
• Behaviors at team meals: These days, parents impress all sorts of dietary restrictions on their children, so disturbed eating behaviors may not be the athlete’s fault if they’re just doing what they’ve been told. But, if you suspect something is off, eating disorders lie and it’s a likely the gymnast has “the wool pulled over” their parents’ eyes and have convinced them their dietary approach is “normal” and a “necessary part of gymnastics”. How do I know…because I was that teen with an eating disorder and lied about food. So, if your athlete is refusing certain food groups at meals (likely carbs, but could be anything they’ve been lead to believe is “bad”), refusing to eat normal portions of foods that you’ve seen them eat before, claiming they’re “not hungry” at a main meal when they’re unlikely to have had any snacks before that could have “ruined” they’re appetite, than something could be going on. This is a hard judgement call, because as adults we often over-estimate portion sizes for children and through it’s not your job to be the “food police”, if your gut tells you something looks fishy, it could be. Again, this is where you refer the gymnast to a pediatric/adolescent registered dietitian and let the professional evaluate the food beliefs, meal patterns, intake, etc.

In terms of discussing nutrition, it’s a fine line. It is not your job to tell your athlete if their diet is good or bad, leave that to the registered dietitian sports nutritionist. It is not your job to monitor their calories, etc. It’s also not your job to weigh the athletes. In the case eating disorders, confronting an athlete about your concerns re: a suspected eating disorder and coming up with a plan to restrict activity until certain goals set forth by their medical team (registered dietitian, pediatrician/sports med with eating disorder experience, and licensed mental health counselor) are met will be appropriate at some point. You should be involved. But, this needs to be handled VERY carefully and there are resources available that give some guidance on how to walk through these delicate situations. Eating disorders are very powerful, and although sometimes “love for the sport” can help motivate an athlete to change (like in my case, start eating some again, but didn’t “fix” the issue for long after I retired from sport), this is not always the case. And, eating disorders are so intertwined in various aspects of life that it’s never just “one” issue that needs to be solved.

Many collegiate athletic programs have “low body weight policies” that stipulate a timeline and goals for “return-to-play” in the context of weight-restoration and resolution of medical issues. As a Junior Olympic or Elite gymnastics coach, you should largely take your cues from the medical team as you do not have the infrastructure for such policies unless you employee a team physician, dietitian, etc. And, low bodyweight in children is different than post-pubertal adults. We cannot treat children like small adults.

So, in terms of “how do we actually talk about nutrition without causing eating disorders”, I’d suggest the following:

I do think you can encourage your athletes and parents to employ appropriate nutrition practices around fueling their bodies for sport. I absolutely think you can have a pre-workout and intra-workout snack policy that is evidence-based and provided by a professional (just like I did for a gym last night). I educated the coaches that it was not their job to tell a gymnast if their snack was “good or bad”, “healthy or unhealthy” but to compare their foods to the prescribed template I provided. This template listed pre-workout snacks as mostly carbs, minimal protein/fat and intra-workout as fruit or quick carbohydrates in appropriate portions. It gave them starter food portions with the disclaimer that you can always eat more that the specified portion if hungry, etc. Obviously, a blanket policy may not address the needs of all athletes, but it’s a good objective start to help discourage athletes coming to practice and trying to eat full meals in the middle of workout (which was causing too many tummy issues for this gym). By having a policy that encourages appropriate pre and intra-workout snacks, you are demonstrating to the athletes that fueling for sports is necessary and appropriate. The “what” of the food should be based on physiology and not opinion. So, I don’t care that you think sugar is bad; simple sugars are the quickest fuel source for intra-workout and in an anaerobic sports like gymnastics it can be appropriate to use. Don’t argue with me, get mad at science.

I also think you should involve sports science professionals (a neutral third party) who can speak appropriate truth into the lives of these young athletes from an early age. From the beginning, having these professionals involved with your gym shows that nutrition is an important aspect to training and this lessens the feelings of “being singled out” if a specific gymnast needs 1:1 attention with this professional. Feeding begins with the parents, so empowering them to feed their athletes in appropriate ways  is where the nutrition education should begin.

This also means that the nutrition education should not come from the bodybuilder from the gym next store who is secretly struggling with binge eating in effort to always look shredded and “eat clean”. Or, come from the coach. It’s hard to serve as coach and “team nutritionist” and I’d argue this isn’t appropriate. This also does not mean the shredded cross-fit coach who was a former gymnast and is “all-in” with Paleo is a good fit as they will tell the gymnasts they cannot eating dairy, sugar, gluten, etc. as there is no evidence to support this pattern in young athletes and only teaches that foods are good/bad and sets up individuals for a life-time of psychological struggle. This also does means nutrition education should not come from the self-taught alternative medicine practitioner who shill diets and supplements that have not been proven or studied in children (this is unethical). You as a coach or gym owner are responsible for who you employe to treat your athletes. Hire with care.

Also, for all of us, staying “in your lane” is a beautiful thing and allows for specialization. I am not nor will I ever be a certified strength and condition specialist equipped to work with your gymnasts. I can talk about the nutrition piece all day long, but outside of that in the realm of gymnastics training and I’m out of my scope. I’m also not qualified to coach your athlete just because I was a gymnast and am now a level 10/NCAA judge.  Metaphorically speaking, my “plate is full”.

There is so much we can be doing as parents, coaches, and professionals to decrease the rates of eating disorders in our athletes. Prevention and early detection is key. If you have any questions or need to talk through a scenario that seems “fishy”, I’m happy to talk and help point you towards professionals in your area that would be a good fit. I’d love to work with your athletes and gym, Skype/Zoom video sessions are an easy, low-cost way to start having the conversations that are so needed in our society and culture today.