the importance of meal planning and to make
it possible to have the meals fitted into their
schedule.
Eating-disordered athletes, except for the
bulimic athletes, consume a diet that is too low in
energy and nutrients. The mean levels of energy
and carbohydrate intake for anorexia athletica
are lower than recommended for active females,
and a significant number of eating-disordered
athletes do not reach the protein level recom-
mended for athletes. In addition, low intakes
of several micronutrients are reported, most
notably calcium, vitamin D and iron (Sundgot-
Borgen & Larsen 1993a). The inadequacy
reported, combined with the use of different
purging methods, are of major concern since
a number of eating-disordered athletes are
young and still growing individuals. Again,
the guidance of qualified nutritionists for the
athletic population in general and specifically
for the athlete at risk for eating disorder is
crucial.
Athletes representing sports emphasizing
leanness such as the rhythmic gymnasts are
exposed to nutrition and weight-control myths.
The author has worked specifically with national
level rhythmic gymnasts and these athletes
reported a number of nutritional myths that
partly explain why such a high number of
those athletes are suffering from eating dis-
orders. These include: never eat after 5 p.m.;
3360 kJ · day–1 (800 kcal · day–1) is enough for
rhythmic gymnasts; eat only cold food because
you spend more energy digesting cold food; do
not eat meat, bread or potatoes; and drinking
during training will destroy your practice.
Athletes, coaches, and in some sports also
the parents, need to be educated about weight
control, sound nutrition, and ‘natural’ growth
and development. The focus on leanness must be
de-emphasized and the unwritten rules in some
sports changed. Eating disorders are likely to be
a special problem within those sports where the
competitors are young (still growing) and lean-
ness is considered important for top perfor-
mance, unless limits are placed on age and
percentage fat for participants in sports.
516 practical issues
Effect of eating disorders on
sport performance
The nature and the magnitude of the effect of
eating disorders on athletic performance are
influenced by the severity and chronicity of the
eating disorder and the physical and psychologi-
cal demands of the sport. Loss of endurance due
to dehydration impairs exercise performance
(Fogelholm 1994). Absolute maximal oxygen
uptake (measured as litres per minute) is
unchanged or decreased after rapid body weight
loss, but maximal oxygen uptake expressed in
relation to body weight (millilitres per kilogram
body weight per minute) may increase after
gradual body weight reduction (Ingjer &
Sundgot-Borgen 1991; Fogelholm 1994).
Anaerobic performance and muscle strength
are typically decreased after rapid weight reduc-
tion even after 1–3 h of rehydration. When tested
after 5–24 h of rehydration, performance is
maintained at euhydrated levels (Klinzing &
Karpowicz 1986; Fogelholm et al. 1993). Loss of
coordination due to dehydration is also reported
to impair exercise performance (Fogelholm
1994).
Reduced plasma volume, impaired ther-
moregulation and nutrient exchange, decreased
glycogen availability and decreased buffer
capacity in the blood are plausible explanations
for reduced performance in aerobic, anaerobic
and muscle endurance work, especially after
rapid weight reduction (Fogelholm 1994).Psychological effects
Studies on the psychological effect of dieting and
weight cycling are lacking in female athletes, but
it is reported that many young wrestlers experi-
ence mood alterations (increased fatigue, anger,
or anxiety) when attempting to lose body weight
rapidly (Fogelholm et al. 1993).Long-term health effects
The long-term effects of body-weight cycling and
eating disorders in athletes are not clear. Biologi-