weight history of the parents and siblings should
be obtained. The eating-disordered athlete’s
weight and bodybuild expectations may be
beyond that which is genetically possible. After
gaining the athlete’s trust, the dietitian should
conduct body-fat measurements. It is crucial to
obtain a measure of body fat in order to establish
realistic goals, which also depend on the athlete’s
sport (Eisenman et al. 1990).
Laboratory tests
Blood and urine laboratory tests will provide
differential diagnoses for observed symptoms.
Such values as haemoglobin, haematocrit,
albumin, ferritin, glucose, potassium, sodium,
total and high-density lipoprotein cholesterol,
and oestrogen (if applicable) should be obtained
initially and monitored over time. These can
be shared with the athlete during treatment to
indicate restoration of health (Beumont et al.
1993).
Self-esteem of eating-disordered athletes who
have suffered for a longer period tends to be
quite low and this may be associated with an
experience of decreased performance level and
often unrealistic expectations. Therefore, one
important issue is to determine the athlete’s
motivation for continuing competitive sport. The
author’s experience is that some athletes even try
to simulate an eating disorder to legalize the end
of their career.
Treatment goals and expectations
The primary focuses of the nutrition counselling
are normalizing eating behaviours, body weight
and exercise behaviour. Athletes have the same
general concerns as non-athletes about increas-
ing their weight, but they also have concerns
from a sport point of view. What they think is an
ideal competitive weight, one that they believe
helps them be successful in their sport, may be
significantly lower than their treatment goal
weight. As a result, athletes may have concerns
about their ability to perform in their sport fol-
lowing treatment.
518 practical issues
Training and competition
Once an athlete has been found to be in need of
treatment, an important question is whether she
should be allowed to continue to train and
compete while recovering from the disorder.
To continue competition and training, the
following list represents what Thompson and
Trattner-Sherman (1993) believe are the minimal
criteria in this regard.
1 The athlete must agree to comply with all treat-
ment strategies as best she can.
2 She must genuinely want to compete.
3 She must be closely monitored on an ongoing
basis by the medical and psychological health
care professionals handling her treatment and by
the sport-related personnel who are working
with her in her sport.
4 The treatment must always take precedence
over sport.
5 If any question arises at any time regarding
whether the athlete is meeting or is able to meet
the preceding criteria, competition is not to be
considered a viable option while the athlete is in
treatment (Clark 1993; Thompson & Trattner-
Sherman 1993).
Some athletes should be allowed to compete
while in aftercare if not medically or psychologi-
cally contraindicated. As mentioned previously,
it is extremely important to examine whether the
athlete really wants to go back to competitive
sport. If so, she should be allowed to do so as
soon as she feels ready for it when finishing treat-
ment and if she is in good health.Limited training and competition
while in treatment
If the criteria mentioned above for competing
cannot be met, or if competition rather than
physical exertion is a problem, some athletes
who are not competing may still be allowed to
engage in limited training. The same criteria
used to assess the safety of competition (i.e.
diagnosis, problem severity, type of sport,
competitive level and health maintenance) apply
(Thompson & Trattner-Sherman 1993).