1. 4-SAFETY
Sports Injury Prevention
Eating Disorders in Youth athletes
Erinn Reilly
8/12/2016
A literature review of studies that present a correlation between eating disorders and youth
athletics. Within the review, an action plan, that presents prevention and intervention strategies
to implement amongst the community and 4-Safety promotional content on the subject.

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Table of Contents
Defining the Problem Page 3
Eating Disorder Definition Page 3
Body Image Definition Page 3
Mortality of Eating Disorders amongst Adolescence Page 4
Eating Disorders and Body Image Issues for Athletes Page 4
Risk Factors and Prevalence of Disease for Athletes Page 5
Restrictive Dieting Page 5
High Risk Sports Page 6
Weight Class Sports Page 7
Leanness Focused Sports Page 7
Aesthetic Sports Page 9
Male V. Female Page 9
Compulsive Exercise Page 11
Results of Athletic Eating Disorders Page 12
Female Athlete Triad Page 12
Energy Deficiency Page 12
Low Bone Density Page 12
Amenorrhea/Oligomenorrhea Page 13
Male Athlete Triad Page Page 13
Prevention Page 14
Local and National Resources Page Page 14
Action Plan Page 17
Why should the community care Page 17
Website Content Page 18
PDFs Page 18
Websites Page 18
Videos Page18
4-Safety Promotional Posts Page 19
Did you know facts Page 20
Summary of importance Page 20
Social Media Posts Page 20
Prize Wheel Questions Page 22
Rhode Show Segment Page 24
Survey Page 26
PiktoChart Page 29
Community Event Page 30
Citations Page 32

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Defining the problem
General Definition of Eating Disorders
Eating disorders can be described as a serious emotional and physical problem, found
within both males and females, that surrounds weight and food issues (NEDA). Eating disorders
are considered clinical mental disorders where individuals present abnormal eating behaviors
(APA/WHO). These abnormal behaviors are described as starvation, fasting, frequently skipping
meals, overeating, and binge-eating to purge. Eating disorders are often chronic and have long-
term health consequences on the individuals who experience them. In order for an individual to
be diagnosed with an eating disorder, they must fit certain diagnostic criteria as observed by a
qualified health professional. The criteria tends to be extremely strict and may not account for
those who present pathological eating behavior (Coelho, 2014). The three main categories of
eating disorders are anorexia, bulimia, and binge-eating associated with purging.
General definition of Body Image
Body image is the way an individual views their physical self. For instance how an
individual perceives their physical body, how they feel about their body including desires to be a
taller high or lower weight, and how an individual senses their body as they move (NEDA). Low
body image can be associated with Body Dysmorphic Disorder. Body Dysmorphic Disorder is
the preoccupation with one or more perceived defects or flaws in physical appearance that appear
slight to others (DSM). An individual may have repetitive or excessive behaviors with this
disorder such as excessive or compulsive exercise regiments. Eating disorders and body
dysmorphic disorder are comorbid (DSM). Those who perceive that their body is inadequate can

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turn to a variety of outlets to compensate, such as restrictive dieting or other forms of pathogenic
weight loss controls.
Mortality Rates of Eating Disorders
Mortality rates of eating disorders were reported to be 5.9% within the general population
(Sullivan, 1995). Specific to pediatrics, eating disorder rates are increasing in the demographic of
younger children, boys, and minority groups (Campbell, 2014). Early-onset restrictive eating
behaviors, between the ages of 5 to 12 years old, have show to be 2.6 per 100,000 persons
(Pinhas, 2011). In adolescence, the male to female ratio of diagnosis with eating disorders are
6:1 (Pinhas, 2011). The mortality rates of anorexia nervosa is 5-6% in adolescence (Pinhas,
2011).
Eating Disorders and Body Image Issues for Athletes
Eating disorders and body dysmorphic disorder or poor body image are dangerous threats
to any individual's health. However, an extra factor of concern is applied when dealing with
athletes and these disorders. Athletes expend a certain amount of calories per day when
competing or practicing. It is imperative for these individuals to be mindful of what they eat so
that they are satisfying their bodies needs and replenishing the calories that they burn. However,
there is a growing rate of competitiveness in athletics that is beginning to effect athletes at
younger ages. Pressures to perform well, fit the physical criteria for their sport, and to be
mentally and emotionally satisfied with their execution and lifestyle are all factors that youth
athletes must be able to adhere to. With increased pressure to use their bodies to be highly
functioning at their sport, and adhere to the typical body shape of their sport, youth athletes are

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turning to dangerous means to reach their goals. In turn, these behaviors can have serious, long-
term health consequences.
Risk Factors and Prevalence of Disease for Athletes
Although any individual can be at risk for an eating disorder, there are athletic specific
risk factors of developing an eating disorder. For example, sports that focus on leanness, weight,
or aesthetics can increase risk of an athlete developing an eating disorder. As a result, individuals
may turn to dieting and compulsive exercise in order to compensate for their perceived body
image or performance. Along with these pressures are socio-cultural pressures, genetics, and
psychological stressors which are only enhanced with athletics (Currie, 2010). Overall, it is
important to understand the risk factors and prevalence of disorder eating amongst those who
are in the at-risk population for prevention and intervention strategies.
Restrictive Dieting
Athletes are constantly looking for ways to improve and enhance their athletic
performance. In order to do so, they may turn to dieting or more extensive exercise regiments
with the intentions that they will be a more efficient participant and live a healthier lifestyle.
Restrictive dieting can be consider a socio-cultural pressure because it is expected that the athlete
be able to maintain appropriate and sport specific body image and athletic performance.
Athletes turn to dieting to achieve physical advancements. In fact, many athletes may not
fall under the category for all diagnostic criteria although their eating behaviors are abnormal. A
disordered eating behavior continuum explains why athletes are dieting and practicing abnormal
eating behaviors; this can help define the beginning stages of an eating disorder that may not be
measured under the current clinical diagnostic criteria. To begin, an athlete may start with

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healthy dieting. However, over time the diet will become more extreme (Sundgot-Borgen,
2010). Athletes begin to use different types of weight loss methods in conjunction with the diet;
these weight loss methods could be restrictive eating, fasts, frequent meal skipping, diet pills,
laxatives, diuretics, enemas, and purging (Goltz, 2013). The athlete will then begin to use passive
or active dehydration such as saunas, hot baths, exercise with sweat suits, etc. The continuum
ends with the athlete's onset of a clinical eating disorder (Sundgot-Borgen, 2010).
Overall, many sports require a certain body image or physique. If an athlete feels
pressures from coaches, peers, or parents to fit this requirement they may choose to diet. Many
athletes do not consult with physicians before dieting and this can lead to dangerously low levels
of caloric intake. Even further, athletes may feel that it is within their competitive nature to strive
for the perfect athletic performance, whether that is in regards to their body weight, shape, size,
or image.
High Risk Sports
There are studies that have proven certain sports put athletes at a higher risk of eating
disorders. For example, participation in sports that require a low body fat percentage, or low
body weight can put an athlete at high risk for developing an eating disorder (Goltz, 2013).
Specifically, some sports that fit this criteria are wrestling, where weight-class is important, long-
distance running ,which focuses on leanness, and sports that focus on aesthetics such as
gymnastics. Furthermore, many of the sports that can fit into these descriptions also focus on the
individual rather than the entire team. This can enhance the likelihood of an eating disorder
because performance is judged for one individual (NEDA). Below is data listed from a study
about elite sportswomen and sportsmen and the prevalence of eating disorders.

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Weight-Class Sports
About 70% of elite athletes competing in weight class sports are dieting and have
abnormal eating behaviors in order to lower weight before competition (Sundgot-Borgen, 2010).
This can be attributed to weight being a main reason an athlete can or cannot compete. For
example, if an athlete is not a certain weight in wrestling, judo, or boxing, they cannot compete
in certain categories. If they are targeted to perform in a lower weight class, but are above the
weighted requirements, they would not be able to participate in competition. Some athletes have
had to return from the Olympics due to being in the upper limits of the weight requirement
(Currie, 2010). Overall, the pressure to be a certain weight for competition can cause athletes to
try risky eating behaviors that will give them immediate results. During adolescents this is
dangerous due to the lack of nutrients being provided to the individual's body and the common
fluctuation in weight. It is important to note that although this is abnormal eating behaviors, it
may only occur during pre-competitive periods and does not reflect the athletes regular eating
patterns. However, according to a study conducted on male elite athletes, 30.8% of athletes had
a prevalence of disorder eating. (Goltz, 2013).
Leanness focused sports
In the culture of endurance sports, leanness is equated to better performance. This
motivates athletes to lose weight in order to compete at a higher level. According to a yearlong
longitudinal study, authors found that adolescent athletes, ranging from ages 11 years - 18 years,
who wish to be leaner to perform at a higher level in their sport had a higher prevalence of eating
disorder (Krentz, 2011). The study computed a cross-lagged correlation analysis to test for desire

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to be lean to improve performance as a predictive indicator of disordered eating (Krentz 2011).
The results are displayed below.
Furthermore the study found that there was increased social pressure for female athletes
to be lean than there was for male athletes to be lean. The study also that the desire to be lean
was the predictive factor of eating disorders and not vice versa. Therefore, the study shows that
the desire to be lean can be a risk factor of eating disorders amongst youth athletes. This is
especially important to note when dealing with youth adolescents in endurance sports. In an
article that compared results from various studies about weight controlled behaviors , leanness
was shown to have the most prevalence of pathogenic weight controlled behaviors amongst
youth elite athletes. Pathogenic weight-control behaviors are used to "manage emotions weight
and body size", focusing heavily on feelings (Werner, 2013). Therefore, this type of behavior is
not only for sport specific demands, but also for the individual's self-efficacy. With growing
pressures to lose weight in order to perform better, adolescents are at an increased chance of
taking dangerous measures through abnormal eating behaviors. In a meta-analysis study
conducted about female athletes and female non-athletes, dancers were especially found to have
a significant difference between comparison groups in association with eating disorders (Smolak,

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1999). This could be attributed to the preferred leanness and aesthetic appeal that dancers are
expected to have to perform well and fit sport specific body norms.
Aesthetic focused sports
Sports that focus on aesthetics are gymnastics, figure skating, and any sport that can be
categorized as anti-gravitational. There are multiple factors as to why participating in aesthetic
focused sports can increase an athlete's risk an eating disorder. First, much like sports that focus
on leanness, aesthetic based sports find low body fat composition desirable, whether that be for
vertical or horizontal movement (Sundgot, 2010) . In an article, the author states, female athletes
who participate in aesthetic sports have a higher prevalence of eating disorders than the general
population (Coelho, 2014). It is important to note that many aesthetic sports have peak
performance ages earlier in life, therefore pushing adolescents to train harder and work faster at a
young age. Furthermore, in a study conducted on the risk factors for disordered eating in
aesthetic sports, sports-related social pressure, increase in appearance-related norms, and role-
modeling by friends were prevalent amongst girls (Krentz, 2011). This attributes to socio-
cultural pressure for women to look a specific way as a non-athletic or athletic adolescent. Along
with this topic, aesthetic sports clothing are revealing. This can encourage an individual to want
to achieve thinness which is associated with disordered eating (Currie, 2010). Finally disordered
eating in aesthetic sports occurs in about 40% of the population (Coelho, 2014).
Male V. Female
Primarily when the general population hears eating disorders, it is most commonly
associated with females. Although there is a large prevalence of eating disorders and body image
issues within female populations including non-athletic and athletics, there is also a prevalence

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of eating disorders and body image issues with males. Predominantly it is not screened for or it is
difficult to diagnosis. However listed below is data collected from a study of sportswomen and
sportsmen in accordance to prevalence of eating disorders (Currie 2010) :

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Although women have a higher prevalence of eating disorders, this does not discount the
growing population of men. According to a study that analyzes nationwide data from yearly
psychological evaluations on athletes, 17% of all athletes have at least one on-going
psychological disorder, predominantly generalized anxiety disorder. this disorder can be
associated with eating disorders. In a study conducted on male elite athletes, more than half of
the athletes who had disordered eating behaviors also were dissatisfied with their body image
(Goltz, 2013).
Compulsive Exercising
In many cases, especially in the sports listed above, athletes will train extremely hard to
achieve their physical goal. However, there is a point when a lack of calories and an increase in
physical activity can cause serious consequences. Compulsive exercise can be explained as
exercising to manage emotions, as an excuse to eat, a means of purging, exercising as a secret,
feeling as though you are not good enough, fast enough, or not pushing hard enough during
exercise, feeling intense anxiety when unable to exercise and exercising that interfere with
important life activities (NEDA). In a systematic review of compulsive exercise and eating
disorders, the authors addressed that there are four key constructs that create the compulsion to
exercise: psychopathology, obsessive compulsiveness, affect-regulation and perfectionism
(Meyer, 2011) . Psychopathology is important to understanding the relationship between eating
disorders and compulsive exercise because it is the study of mental disorders . Furthermore, in a
study conducted on adolescent females, compulsive exercise was significantly associated with
eating disorder symptom logy (Noetel, 2016). The combination of exercise without proper
nutrition is dangerous to athletes because it can cause issues such as overuse injuries and stress
fractures.

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Results of Athletic Eating Disorders
Female Athlete Triad
The female athlete triad is a combination of three factors that cause severe health issues
for youth athletes. 78% of the athletic population had experienced one component of the triad (
Hoch, 2009). The factors that contribute to the triad are a loss of menses (amenorrhea), bone
density loss, and energy deficiency. With increasing pressures from sports, athletes are beginning
to train more competitively at a younger age. According to an article about the female athlete
triad, "A distorted body image, disordered—for example, restrictive—eating and underweight, in
essence, have been implicated as the primary factors in the etiology of the female athlete
triad"(DiPietro, 2006). Without proper nutritional guidance, and with some sports, a large focus
on leanness, aesthetics, and body weight goals, many athletes are at risk of the triad because they
are either dieting or training extensively.
Energy Deficiency
To summarize, energy deficiency is when an individual's caloric intake, consumed from
their diet, is depleted or is of a much lesser amount. When an individual is exercising, this
depletion of calories or low energy availability can be explained as energy deficiency. Low
energy availability can be achieved with or without an eating disorder. If an individual is trying
to control their weight, or maintain a healthy diet without recommendations or monitoring from a
physician, they can put themselves at risk for low energy availability. Athletes at highest risk for
low energy availability are those who have restrictive eating behaviors and who exercise for
prolonged periods of time (Coelho, 2014).
Low Bone Density

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Furthermore, a symptom of the Triad is low bone density. This can increase the risk of
having stress fractures, overuse injuries, or cause adolescent athletes to not build enough bone
mass at an early age, causing early onset of osteoporosis. (Stop Sports Injuries) . Low bone
density occurs when there is not enough hormonal production to support protective facts of bone
growth. Athletes who have inadequate or poor nutritional habits during early adolescent years
can become at-risk for poor bone growth development. For sports that are focused on having
athletes be lean in order to enhance performance,. According to an article about bone health in
youth athletes, adequate dietary habits will help prevent stress fractures or overuse injuries. It is
also imperative to peak bone mass when considering the levels of calcium and protein being
consumed by the athlete (Ackerman, 2011).
Amenorrhea/Oligomenorrhea
The most common component of the Triad is loss of menses for female athletes. It is the
easiest component to detect when screening for the issue, and can help physicians investigate
into an athlete's eating habits further. Abnormalities in the menstrual cycle can be a result of the
body trying to preserve energy (Raymond-Barker, 2007). The lack of estrogen created by the
menstrual cycle can cause calcium loss and reduce bone mineral density (Miller, 2003).
Male Athlete Triad
While men would not present a loss of menses in order to diagnosis the Triad, they are
still susceptible to low bone density and energy deficiency. Males may experience deficits in
nutrition, reduction in sex hormones, and impaired bone health (Tenforde,2015). Therefore,
they are at an increased risk of stress fractures and overuse injuries, alike female athletes. If any
athlete is not consuming the proper amount of calories in relation to the amount they are

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expending, they may not only have patterns of disordered eating, but also are creating life-long
health concern.
Prevention
Preventing the issue of sports related eating disorders and body image issues stems from
within the culture of athletics. In order to improve the issue, athletes, coaches, and parents need
to become more educated. According to an article focused on preventing eating disorders in
female athletes, the author states that education should be implemented to coaches, athletes, and
parents; athletes as early as 9-11 years old would be the target of the primary prevention
(Coelho, 2014). As primary prevention, coaches and athletes need to be taught the risk factors of
eating disorders and how to detect early onset of disorder eating behaviors and body image
issues, it could help with early detection of the disease. It should be required that all coaches, no
matter the age or skill level of their athletes, are certified in an educational class about body
image issues and eating disorders in adolescent athletes. Furthermore, school systems should
implement nutrition, the harms of playing sports and not having an adequate diet, and body
image specific to sports into health class curriculums.
National and Local Resources
National resources available include an online website that is accessible by the general
public called nationaleatingdisorders.org. The website provides educational information along
with self-reported screening methods to help individuals understand if they are at risk or
experiencing disordered eating behaviors. Specifically, the website discusses eating disorders
with athletes and provides a Coach and Trainer's Toolkit on how to approach athletes with eating

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disorders. This is imperative to those who have minimal training or experience with the disorder
or with body image issues.
Resources that are local to Rhode Island and South Eastern Massachusetts were limited.
However, one resource available is Hasbro Children's Hospital Eating Disorder Clinic. Many
athletes can be referred to this program to deal with eating disorders. The clinic itself is not
specific to athletes only, however the director of the program, Allison Hall, did state that the
program has had a large population of youth athletes. Risk factors observed by the clinic are poor
nutritional advice from coaches or other resources. Due to the influx of obesity in the youth
population, many people have an opinion about nutrition, but do not have actual knowledge or
the credentials to give out medical advice on how to diet. In turn, coaches and parents can
encourage athletes to try dangerous restrictive eating behaviors, lessen the amount of calories
they intake on a daily basis, encourage athletes to try supplements, or give advice on exercises
that they are not trained in.
The clinics main approach to treatment is family based interventions. This can take place
for their patients that are 18-25 years old. The main focus on family based interventions is to
involve more people in the recovery to lessen the load and pressure of the athlete. Also, it helps
encourage accountability for recovery and the family can increase the patients self-efficacy.
There are 4 levels of care, depending on how severe the diagnosis is. The first appointment at the
clinic is a psychosocial medical appointment, where a physician will screen for other diseases in
order to rule out an eating disorder. For example, diabetes and issues pertaining to the thyroid
would lead a medical professional to believe that eating behaviors are coming from a physical
issue. Finally, the clinic does not only see clinically diagnoses patients, but also athletes or non-
athletes who are on the borderline of having a clinically diagnosed eating disorder. For example,

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if someone is presenting a dangerous behavior such as restrictive eating, they can be referred to
the clinic to help correct the issue.
More local resources that could be beneficial to the community would be a sports
psychologist and a sports specific eating disorder program. With the rising increase in eating
behavior issues and body image issues within the athletic community, it is important to have
athletic specific professionals deal with athletes directly.

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Action Plan
Why should the community care?
Athletes are considered heroes in American society. They are noted for their
perseverance, excellence, commitment, dedication, relentlessness, and work ethic. Athletes
constantly push themselves to be better, stronger, and faster. This means practicing long hours,
eating well balanced and sometimes strict diets, and sacrificing their bodies. Not only do they
depict what hard work means, they set the example for the younger demographic. While it is
imperative for athletes to compete, at what point is it safe to continue to push one's body for
athletic purposes?
Many youth athletes are competing at an elite levels during early years in their
development. Athletics is associated with healthy living, but there is a fine line between
enhancing health and hurting oneself. Many young athletes are not consuming enough calories
and are still training at an elite level. This puts them at risk for energy deficiency and low bone
density. These conditions have long term health consequences such as cardiovascular disease and
overuse injuries leading to stress fractures and osteoporosis.
Furthermore restrictive dieting, compulsive exercise, and a dependency on sacrificing
your body to reach the next level can lead to eating disorders. An eating disorder is a chronic
mental illness that will affect the athlete for the rest of their life. Early detection and prevention
tips can help stop the issue from harming adolescent athletes' mental and emotional health.
Prevention will also allow for proper growth and development during a crucial period.
With the use of education, eating disorder will not be able to stop any athlete from achieving
their goals. It will continue to promote high self-efficacy and positive body image.

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WEBSITE CONTENT
PDFs
10 Steps to Positive Body Image https://www.nationaleatingdisorders.org/index-handouts
Athletes and Eating Disorders https://www.nationaleatingdisorders.org/index-handouts
Compulsive Exercise https://www.nationaleatingdisorders.org/index-handouts
Female Athlete Triad
http://www.stopsportsinjuries.org/STOP/Prevent_Injuries/Female_Athlete_Triad.aspx
Sports Nutrition http://www.stopsportsinjuries.org/STOP/Prevent_Injuries/Sports_Nutrition.aspx
Websites
Eat right is an organization focused on promoting healthy nutritional and fitness guidelines for
children.
http://www.eatright.org/resources/for-kids
MyPlate is an interactive website that educates individuals about healthy eating choices and how
to better plan meal choices.
www.choosemyplate.gov
National Eating Disoders Association is an organization focused on promoting preventative tips
for people with eating disorders and also help for those who are suffering with eating disorders.
Furthermore, there are education tools to assist relatives, friends, and peers of indviduals who
struggle with body image and eating habits.
www.nationaleatingdisorders.org
Associated with NEDA, this website is an online screening to help individuals assess their
behaviors for eating disorders.
http://screening.mentalhealthscreening.org/NEDA
Videos:
1. A story of a young gymnast along with other athletes and their struggles with eating
disorders
https://www.youtube.com/watch?v=hRuCI5PvApU
2. Suggestions on how to keep your child athlete safe through nutritional habits
http://www.eatright.org/resources/for-kids
3. Serena Williams discussing her experiences with negative comments about her body and
how she has overcome Start at 2:20
http://abcnews.go.com/GMA/video/serena-williams-seeks-make-history-us-open-
33430321

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4. News broadcast stating what puts athletes at an increased risk for eating disorders
http://www.abc2news.com/sports/thursday-at-11-athletes-have-high-risk-for-eating-
disorders-know-the-signs
5. News broadcast about the effects of eating disorders on athletes after they have finished
competing
https://www.youtube.com/watch?v=Zp25ipiSZxY
6. News broadcast displaying the prevalence of eating disorders amongst men
http://www.cbsnews.com/news/the-skinny-on-manorexia/
7. Billie Jean King negative body image in sports
https://www.youtube.com/watch?v=vQy5Fg2RLPY
4-safety Program Promotional Posts
1. Keeping your child safe and protected is the main mission of the 4-safety program. Please
visit www.4-safety.org to learn about more information about our program and for safety
tips!
2. Do you love Iced Coffee? Participate in iced coffee day and $1 of your proceeds goes
towards helping the 4-Safety program keep your community and families safe!
3. Summer, Fall, Winter, and Spring! We need tips all year round for protecting! Visit 4-
Safety.org for more information!
4. For your child, for your family, for your health, for your protection. 4-Safety is for you to
stay on top of all matters safely!
5. Forgot sun block? Forgoing regular helmet usage? 4-Safety.org can demonstrate exactly
what you need to remember to keep your kids safe!
Did you know facts
1. Did you know that almost half of all female athletes have had an eating disorder?
Eating disorders in athletes: Overview of prevalence, risk factors and recommendations
for prevention and treatment by solfrid bratland sanda 15 december 2011 european
journal of sport science vol 13 issue 5 2013
2. 78% of the athletic population, male or female, has experienced one component of the
triad (Hoch et al., 2009)

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3. 33% of men male athletes participating in aesthetic sports are affected by disordered
eating (NEDA)
4. Risk factors that contribute to eating disorders are low self-esteem, depressive symptoms,
perfectionism, and coaches attitudes and behaviors toward athlete weight (Plateau et al.)
5. 15% of girls and 4% of boys that are high school aged have a prevalence of eating
disorders. (Austin et. al, 2008)
Summary of Importance
For physically active children, eating well is synonymous with performing at a high level.
However, as more sports are focusing on physical appearance or obtaining a certain goal
weight, unhealthy habits such as rigid diets or eating disorders are becoming more prevalent
amongst youth athletes. Not only can eating disorders cause physical damages, but it also can
take a toll on an individual's emotional and mental health.
Eating disorders are widespread between male and female athletics. Not eating enough
nutritious food can cause low bone mass which will lead to bone breaks. Also, poor eating
habits are directly correlated to dissatisfying body image. However, there are prevention and
treatment plans such as educating youth athletes to safely maintain body weight, build high
self-esteem, and for coaches and parents to recognize key signs or symptoms of troubling
eating habits.
A large majority of children partake in sports. It is important to ensure they are participating
at their healthiest and in the safest way possible. In order to train your body right, you must
treat your body right!
Social Media Posts for Eating Disorder Topic
1. Always putting in extra hours after practice? Eating a rigid diet to maintain weight or
certain appearance? Take a look at NEDA's Free Online Survey to make sure you are
treating your body right!
http://screening.mentalhealthscreening.org/NEDA
2. It is FABulous being a female athlete! Visit the Female Athlete Body Project (FAB) to
learn more about being a healthy, high performing, athletic woman!
3. Focused on healthy eating? Make sure you're getting all the right nutrients for yours port
by using http://www.choosemyplate.gov/. Always seek advice from your doctor!
4. Are you a coach or parent? Check out the Coach and Athletic Trainer Toolkit to
understanding how to help children avoid or overcome eating disorders!
5. Hear stories about Olympic athletes who have overcome struggles of poor body image!
Check out the "Hungry for Gold" campaign! https://www.olympic.org/hbi

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6. Helmet? Check. Shin guards? Check. Water bottles? Check. Are we being as safe and
prepared as we can be? Make sure your child has a pre-participation exam before getting
out onto the competitive field!
7. Boys' bones are almost entirely developed by age 20! Girls by age 18! It's important to
eat a well balanced meal in order to strengthen your bones!
8. Check out MEDA if you are having issues with eating disorders! Resources, Recovery,
and Redemption for your body and mind! https://www.medainc.org
9. Experiencing a lot of stress fractures? Have a nagging injury? You might be at risk for
the Female/Male Athlete Triad. Speak with your primary care physician!
10. 78% of the athletic population has experienced one component of the triad!
11. Fatigued? Can't go a day without being at the gym? Constant injuries? Feeling like you
have to eat a very strict diet? Check out http://kidshealth.org/en/kids/eatdisorder.html
about more information for help!
12. While eating disorders are prevalent in woman, 55% of men had an eating disorder in a
study conducted! Check out more information on how to prevent being a statistic at 4-
Safety.org
13. Feeling like you need to lose weight to run faster? Need to be more muscular to be
stronger? Unsure of how to do it safely? Talk to your physician or visit 4-Safety.org to
understand the importance of maintaining a healthy weight and diet.
14. Eating disorders as an athlete has serious long term consequences such as heart disease
and osteoporosis!
15. Listen to Billy Jean King talk about pressures she's dealt with as an athlete!
https://www.youtube.com/watch?v=vQy5Fg2RLPY
16. Pathogenic weight-control behaviors are used to "manage emotions weight and body
size", focusing heavily on feelings. If you feel that you are emotionally upset about your
weight or body, check out nationaleatingdisorder.org for resources!
17. Noticing an issue with healthy weight management for your child athlete? Reach out to
Hasbro Children's Hospital Eating Disorder Clinic to learn of resources near you!
18. Every child should have a pre-participation exam before every new season of sports to
prevent injury!
19. Treating and Training your body right through healthy nutritional habits and proper rest
and technique will help you be a better athlete for a longer time! Check our more
information at 4-Safety.org
20. 62% of female athletes and 33% of male athletes competing in aesthetic focused or
weight class sports reported disorder eating behaviors! Learn how to avoid this statistic at
4-Safety.org.

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Prize Wheel Questions Sources/Questions
https://www.nationaleatingdisorders.org/athletes-and-eating-disorders (Questions 1,2)
NEDA Coaches and Trainers Toolkit (3-7)
Male Athletes and Eating Disorders - Global Sports Development. (2014). Retrieved August 09,
2016, from http://globalsportsdevelopment.org/athletes-eating-disorders/ (8)
http://kidshealth.org/en/kids/eatdisorder.html (12)
Parents/Coaches
1. True or False. I have had a discussion with my child/athlete about positive body images.
Protective factors of a young athlete being susceptible for eating disorders is educating
your child on bodily changes as they are developing and promoting healthy weight or
shape.
2. When my athletes are performing poorly in practice in a game I
a. punish the entire team
b. single out the poor performance
c. encourage them
d. talk to those performing poorly one-on-one
The best way to protect your athletes from low-self esteem and poor dietary habits is to
encourage them one-on-one. Building a relationship where they feel safe and free to
express themselves can help them achieve better performance and high self-esteem
3. If my athlete/child has an eating disorder I should remove them from playing sports in
order to prevent further damage to their body?
Unless a physician has noted otherwise, do not pull your athlete from their sport. Most
likely the athlete's health is physically and emotionally tied into their sport. Removing
them can make their recovery much more difficult.
4. Reducing body weight and body fat percentage will increase athletic performance.
In some cases, a lower but healthy body far percentage will increase performance.
However, this is not the case with all athletes and healthy eating habits should always be
encouraged.
5. If I say something to my athlete/child, I will make their eating disorder worse.
While the conversation can be really uncomfortable, you cannot make the condition
worse. It may take a few conversations before the athlete is ready to listen to concerns.
Instead of saying "eating disorder" in your statement, just try to focus on healthy eating
habits.
6. What should I do if I suspect my child or athlete has an eating disorder?
We recommend seeking help from a primary care physician and speaking with the
coaches of that team. It is best to receive help immediately in order to prevent further
damage.

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Child/Athlete
7. What is body image?
What you see and how you feel about yourself when you look in the mirror or how you
think about yourself.
8. True or false? Only girls can get an eating disorder?
While it is more common in women than in men, men are still susceptible to eating
disorders. About 1 million men have an eating disorder in the United States.
9. I do not always eat when I am hungry and I do not always eat until I am full because I
have to eat healthy.
It is perfectly okay to eat until you are full and to eat whenever you are hungry!
Differentiating between hunger and boredom can be tough, but it is very important to
listen to your body!
10. What are some healthy snacks you can eat during the day or before going to practice?
Fruits, granola bars, peanut butter and jelly sandwich, vegetables
11. How many times per day do you eat?
Great! We recommend about 3 regular meals with 2-3 snacks in between. Eating enough
is very important when you play sports because you are using up energy! Energy can be
gained through eating enough food.
12. What is an eating disorder?
Having an eating disorder is when someone is not eating enough, eating a lot of bad
foods, or are eating food and throwing it up because they want to look a certain way or
they want to be better at their sport.
13. If I am losing weight only for my season or a short period of time, then it is not that
dangerous?
Losing weight quickly, even for a short period of time, causes you to lose water weight
which will cause dehydration!

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Rhode Show Segment
SET THE SCENE: A medical professional such as Dr. Feden or Dr. Raukar (from the
sports injury video), or Dr. Morrissey sitting down in studio or at office desk. Clips of pre-
participation exam, tips of prevention, and clips of young athletes are shown throughout
the segment.
INTRO:
About half of the youth population participates in a sport. Participating in sports from a young
age can promote healthy behaviors and encourage an individual to remain active for the rest of
their life. However, as sports are becoming more competitive, parents must be more aware of
what their children are eating, how they are "dieting", and how they are caring for their bodies on
and off the field. In certain cases some athletes can become obsessed with their body image and
weight due to worrying about thinness, weight requirements, stereotypes of what their body
should look like, and so forth. This can cause eating disorders, which are when an individual is
changing their diet to manipulate their appearance. It is important to know the warning signs of
unhealthy body image or eating disorders to protect your growing adolescent from dangerous
behaviors.
FACTS:
 1/3 OF COMPETITIVE FEMALE ATHLETES HAVE HAD AN EATING DISORDER.
 1 OUT OF 5 MALE ATHLETES HAVE AN EATING DISORDER
 PARTCIPATING IN SPORTS THAT FOCUS ON APPEARANCE SUCH AS
WRESTLING, GYMNASTICS, SWIMMING, DANCING, ETC. CAUSE ATHLETES
TO BE SUSCPITBLE TO UNHEALTH EATING BEHAVIORS
 EATING DISORDERS CAN CAUSE ATHLETES TO HAVE STRESS FRACTURES
BECAUSE OF WEAK BONES
 ALL ATHLETES, MALE OR FEMALE, ARE SUSCEPTIBLE TO HAVING THE
FEMALE ATHLETE TRIAD:
-LOSS OF MENSES (FOR WOMEN) OR CHANGES IN SEX HORMONES
(FOR MEN)
-ENERGY DEFICIENCY
-LOW BONE DENSITY (EARLY ON SET OF OSTEOPOROSIS)
 ALL OF THESE SYMPTOMS CAN HAVE LIFE LONG HEALTH
CONSEQUENCES

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TALKING POINTS
 sports that focus on belief that weight will improve performance, have weight
requirements, or require elite training from childhood put children at higher susceptibility
of dangerous eating behaviors
 most children and teenagers do not need to be on a restrictive diet
 signs your child may need help
-Excessive exercising: when an individual is over working their body to look a
certain way.
-constant dieting
-focused on losing weight when at a healthy weight/fear of gaining weight
-only eats safe or healthy foods
-self-esteem is dependent on body weight
-constantly fatigued
-has trouble recovering after exercise
-loss of menstrual cycle (dependent on age)
-constant stress fractures
TIPS:
 if your child plays sports that are focused around body image, such as aesthetic sports,
weight class sports, or sports that leanness is equated to performance value/you have
noticed any of the symptoms as one of their behaviors seek medical attention
immediately
 always have child complete pre-participation exam before a season
 avoid allowing your child to play one sport all year round
 promote healthy eating behaviors
 encourage your child to be proud of their body type, and image
 support changing bodies

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Survey Questions
Page 1
1. I am a parent or athlete
a. parent
b. athlete
Page 2 (if athlete)
2. What is your age?
a. Athlete between the ages 12-14
b. Athlete between the ages 15-17
3. What sport do you play?
-open question
Page 3
4. What is your gender?
a. male
b. female
Page 4 (If female)
5. In the past year, I have changed my eating habits to perform better at my sport
a. true
b. false
c. unsure
6. In the past 6 months, my period has been irregular
a. true
b. false
c. unsure
d. does not apply
Page 5(if male)
7. In the past year, I have changed my eating habits to perform better at my sport.
a. true
b. false
c. unsure
8. I am unhappy if I do cannot train, practice, or compete for my sport.
a. true
b. false
c. unsure

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Page 6 (if true to any questions)
9. I have had a stress fracture or other overuse injury from my sport.
a. true
b. false
c. unsure
Page 7(if false to any questions or after answering questions 6-8)
10. I have a check-up with my doctor before I play any season of any sport
a. true
b. false
c. unsure
11. I have had a conversation with my coaches or parents about eating healthy as an
athlete.
a. true
b. false
c. unsure
***END OF SURVEY FOR ATHELTE***
Page 8 (If parent only)
12. I have had a conversation with my child about body image.
a. true
b. false
c. unsure
13. I have had a conversation with my child about eating well as an athlete.
a. true
b. false
c. unsure
Page 9 (applies to all)
14. My child has had fractures or overuse injuries in the past.
a. true
b. false
c. unsure
Page 10 (if true)
15. My child is underweight for their age.
a. true

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b. false
c. unsure
16. My child has had a bone density scan.
a. true
b. false
c. unsure
Page 10 (if 15-16 true or after answering question 14)
17. A coach or myself requires my child have a pre-participation exam before starting a new
season of any sport.
a. true
b. false
c. unsure
***END OF SURVEY FOR PARENT***

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PIKTOCHART

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Community Events
Target Demographic
Due to the nature of the topic, it is very difficult to reach out to a younger demographic.
The ideal age group of athlete's targeted is about male and female that are about 12-17 years old.
However, if the program is at an event that has a diversified group of attendees, it is still
acceptable to try to educate younger athlete's or children to have positive body image and healthy
nutritional habits such as snacking well, making sure they are well hydrated, finding something
they like about their physical self, along with their personality. Also, it is imperative to reach out
to parents and coaches of youth athletes, as they set the example for the children. With a better
sense or at least an awareness of eating disorders in youth athletics, parents and coaches can see
the warning signs and detect early onset of eating disorders. Even if the symptoms aren't clear,
parents can screen for any issues.
Locations of Events
A location that a majority of the target demographic will be is sports tournaments. At
many tournaments there are vendors selling shirts, concession stands, etc. Therefore it would be
easy for 4-Safety to set up tables and chairs inside a gymnasium at a basketball tournament, or
outside at a soccer field. Furthermore, school fairs and family school events are great places for
4-safety to educate the community. Many coaches for middle and high school teams are also
teachers. Therefore, the program would be able to reach a wide variety of people. Another
location that would be suited for this type of event would be PawSox games and Providence
Bruins games because many youth athletes would be in attendance, most likely accompanied by
their parent, teammates, or coaches.

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Activities at event
An activity at a sports injury event could be a Velcro ball toss where individuals toss a
felted ball at a Velcro board and land on a number. The number would correlate with a trivia
question and could be rewarded with a prize if available. A prize to give away would be small
sports balls with the 4-Safety logo. Further, for younger kids, the program could have plastic toy
foods and ask the children to pick out 3 great choices for snacks before practice, and snacks that
would not be great before exercising or playing a sport. Also, another activity is the mirror of
positivity, used to promote body image. A parent, athlete, or coach can write something they like
about themselves, a positive quote, or their name on the mirror. The program could take a picture
of the mirror and post it on social media. Finally, another activity to have at events is a cut out
board that people could take pictures in. It could have athletes with all different body types
depicted and the 4-safety program could use the pictures for social media promotion or hand out
Polaroid pictures to attendees.

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