cal maturation and growth have been studied in
girl gymnasts before and during puberty: there
are sufficient data to conclude that young female
gymnasts are smaller and mature later than
females in sports which do not require extreme
leanness, e.g. swimming (Mansfield & Emans
1993; Theintz et al. 1993). It is, however, difficult
to separate the effects of physical strain, energy
restriction and genetic predisposition to delayed
puberty.
Besides increasing the likelihood of stress frac-
tures, early bone loss may prevent normal peak
bone mass from being achieved. Thus, female
athletes with frequent or longer periods of
amenorrhoea may be at high risk of sustaining
fractures.
More longitudinal data on fast and gradual
body-weight reduction and cycling in relation to
health and performance parameters in different
groups of athletes are clearly needed.
Treatment of eating disorders
Eating-disordered athletes usually are involved
in outpatient treatment and are likely to be
included in several modes of treatment. Typi-
cally, these include individual, group and family
therapy. Nutritional counselling is usually
combined with cognitive therapy. For some
athletes, pharmacotherapy may be included as
an adjunct. The different types of treatment
strategies have been described elsewhere
(Thompson & Trattner-Sherman 1993). Nutrition
counselling is discussed in this chapter.
Since most athletes with eating disorders are
females, the athlete/patient will be referred to as
she.
The formal treatment of athletes with eating
disorders should be undertaken only by health
care professionals. Ideally, these individuals
should also be familiar with the sport environ-
ment. Treatment of eating-disordered athletes
ideally involves a team of a physician, physiolo-
gist, nutritionist and, in some cases, a psycholo-
gist. The dietitians should be trained and
experienced in working with individuals with
eating disorders and understand the demands of
the specific sports. The nutritionist must under-
stand how strongly the athlete identifies with the
sport as well as what the athlete perceives as
demands from coaches and ‘important’ others.
Once the eating disorder is diagnosed, the goal
is to modify the behavioural, cognitive and affec-
tive components of the athlete’s eating disorder
and to develop a rational approach for achieving
self-management of healthy diet, optimal weight
and integration of these in the training pro-
gramme (Clark 1993).Nutritional counselling
Individuals with eating disorders do not remem-
ber what constitutes a balanced meal or ‘normal’
eating. The major roles for the nutritionist seems
to be an evaluator, nutrition educator and coun-
sellor, behaviour manager, and active member of
the treatment team. The suggested nutritional
counselling programme is the one developed by
Hsu (1990). This nutritional programme is based
on the assumption that eating disorders are initi-
ated and maintained by semistarvation, and that
adequate nutrition knowledge will, in most
instances, result in healthy eating behaviour,
which in turn will eliminate the semistarvation
and the binge–purge cycle. The aims of the nutri-
tional counselling programme are: (i) to enable
the patient to understand principles of good
nutrition, her nutritional needs, and the relation-
ships between dieting and overeating and (ii) to
establish and maintain a pattern of regular eating
through meal planning.Nutritional status and body-weight history
Nutrition counselling can help the athlete over-
come an eating disorder by clarifying misconcep-
tions and focusing on the role of nutrition in
promoting health and athletic performance. For
athletes who have been suffering for years, readi-
ness to listen should be assessed in conjunction
with a mental health professional. Before nutri-
tional counselling can begin, training volume,
training intensity, body-weight history and
nutritional status should be determined. Body-