Personalized diets crucial to eating disorder recovery in athletes

15 Mar 2022 --- Tailoring the diet plan of an athlete in recovery for an eating disorder (ED) is essential to supporting their nutritional rehabilitation. However, the role of supplements is little-understood and comes with challenges to treatment, according to a US review.

Rachael Flatt, former Olympic figure skater and head author of the paper, speaks to NutritionInsight on the role of personalized nutrition for recovery.

“Nutritional rehabilitation is unique to each person depending on their dietary, nutritional and caloric needs as well as the type and severity of the ED,” Flatt explains.

“For elite-level athletes who keep training while recovering from an ED, they may have higher caloric needs than a layperson simply because of the calorie expenditures that occur during intense and hours-long training sessions.” She notes, however, that training during treatment is not always recommended depending on the severity of symptoms.

Professional athletes have to be incredibly careful about which supplements they use, lest they risk their careers.Personalized nutritional rehabilitation
Flatt's article notes the main evidence-based ED treatment in adults is cognitive behavioral therapy, with a key focus on establishing regular meal patterns. Flatt says this generally consists of three meals and at least two snacks a day, and that these plans must be personalized to each individual patient.

“This is why dieticians are such a key part of the treatment team. For example, our teams try to tailor each patient’s meal plans based on their age, current BMI, labs, growth curves, weight trajectories and caloric and nutrient needs, among other variables, on top of their personal preferences and re-introducing challenging foods.” 

She shares that patients often have “off-limits” foods or binge foods, which are generally “unhealthy” foods like sweets. During recovery, patients are gradually supported in creating a more balanced approach to eating, to change their relationship to food altogether.

“One other important note is that for individuals with a low BMI who are receiving inpatient or residential care, they are typically on high-calorie meal plans that are carefully tailored and monitored based on their medical history and current panels to prevent refeeding syndrome.” 

Elite athletes have to be careful with supplements
Supplements can be used to help with the weight regain process in high levels of care, Flatt continues. This is often the case when a patient is having difficulty eating all their planned meals and snacks. But not much research exists on the topic, she notes.

“I poked around the research and couldn’t find much about overlaps between those two groups, so it’s definitely an opportunity for future research.” However, Flatt flags there is also the potential for abuse. 

“This is something that we see often when patients start using supplements and diet pills to replace meals altogether in service of losing weight.”

According to Flatt, supplements pose a particular challenge to the diets of elite athletes. “Most elite athletes are required to complete drug tests throughout their competitive years. Using unregulated and/or unapproved supplements can risk not only physical harm if being used improperly but also a positive drug test, potentially leading to severe consequences for their athletic career.” 

While regulated supplements are not inherently harmful when taken according to recommended guidelines and under the care of a professional, athletes have to make sure whatever they take are cleared by whichever association they are part of, or avoid taking them altogether.

Recovery entails long-term maintenance work to retain key skills learned during treatment, Flatt adds.Flatt says eating disorders occur most commonly among those who identify as women.

“Specific to sports, having a supportive environment and team that prioritizes athletes’ physical and mental health over results is incredibly helpful to maintain treatment gains and balanced eating habits throughout recovery.”

Research still out
According to Flatt, the differentiation between normal eating and exercise and disordered behavior in elite athletes still hasn’t been fully worked out within the field.

“Sometimes it’s difficult to tell at first glance if an athlete’s level of exercise might be concerning. In most cases, it’s not that clear-cut, and the line between excessive exercise and a typical athlete training regimen can seem a little blurry, which is why careful assessment is essential.”

She says that other disordered behaviors like binge eating, vomiting and misuse of diuretics or laxatives can be more easily identified. 

Despite athletes engaging in these behaviors to enhance their performance, Flatt warns athletes who take up extreme measures will only harm their performance in the long-term. “None of these behaviors, including excessive exercise, are advantageous long-term to performance, so it’s incredibly important for athletes to seek help if they are engaging in these behaviors.”

By Olivia Nelson