What Do I Do If I Suspect My Figure Skater Has an Eating Disorder?

A reader recently sent me an e-mail about her figure skater who has an eating disorder:

I’m the single mum of a 14-year-old Novice level skater in the UK. She’s been skating since she was five and regularly competing since she was eight. Back in March, she did her first IJS competition in Paris, which included girls from all across Europe, and when she saw their standards and amazing skinny physiques she started to panic. She came in 11th overall and since then has been worried that her placing was thanks to her being “too fat”. As she has never been even vaguely close to overweight and has never had any real worries about her appearance, apart from a spot here and there, I just laughed it off and said something like, “You’re mad. Of course you’re not fat, and you know it.”

I’m really, really ashamed of the way I dealt with it now, and as a mother I should have known that she meant it, but it took the coach to come up to me at the end of her practice session in about April-May time and ask, “Is she eating?” I said, “Yes” because she was very much eating, though she was restricting her diet a lot more than she used to and yes, she did look too thin, even then. Not like the anorexics you see on TV, but still unhealthy. Coach realised this and told me to keep an eye on her, so I did. Obviously, now we’re in August and nothing has improved – it’s worse than ever. She’ll refuse to eat almost anything, and she’ll make herself sick after meals. She’s deathly pale, absolutely tiny, she’s been getting taunts to do with skeletons at school, and at the rink, things are no better. She’s behind on training, because she can’t seem to go a week without getting injured, and even her friends can’t look at her without nudging each other and whispering about how scary she looks. Coach is in despair, knowing there’s nothing she can do or say, and I know I’m in the same position.

We’ve tried booking appointments with doctors, nutritionists, psychologists, all this stuff, but when it’s time to leave, she’ll have run away with her mates, or to her father or to his parents (both of whom are helping me keep her in skating, along with my parents), and won’t come back, sometimes for days. A teacher cornered her at school on one occasion to chat about her obvious problem, and then I got a phone call later about my daughter’s insolent behaviour, when she’s always been so respectful and well-behaved.

I am absolutely heartbroken and at the end of my tether with skating and all this pressure, and I’ve got my 10-year-old and my 4-year-old to care for as well, so I was wondering if I should stop her skating until there’s a dramatic improvement. I know she’ll be furious and devastated if I do that, but I think it would be stopping the cause of the problem.

If Ice Girl – and of course, God forbid that this ever happens to Ice Girl, it’s the most horrible thing – had these problems, would you take her off the ice? Or would you wait until her coach said you know, this is getting very serious now? Coach has spoken along these lines, but has never forcefully said anything about stopping her practice. Speaking of Coach, she does her best to help me but, as we’re not close, there’s not much she can do.  I’m not closed to any of the rink parents either, and though my family and ex-husband complain about the problems, they don’t suggest anything or offer help.

It would be so helpful if you had any advice at all, there’s absolutely nowhere else I can go now.

I am grateful and relieved that just a day or two before I received this e-mail, someone from the National Eating Disorders Association contacted me about their new coaches & trainers toolkit (45 pages) and parent toolkit (80 pages). I turned this e-mail over to the experts at the NEDA. Here is their response:

“Thank you for writing about your daughter. The question is an important one that many parents face with young athletes in sports where weight is a factor. This includes sports where athletes must “make weight” such as wresting and rowing, swimming and diving, bodybuilding and wrestling, as well as sports where weight and body shape aesthetics are stressed such as figure skating, dance and ballet.

Yours is an important story for parents of children in competitive sports. Devoted parents who are loving and may still face some unexpected obstacles along the way. When it comes to children in competitive sports there are signs and symptoms that can indicate a problem and as parents you may have to intervene. If intervention is needed, waiting only gives time for the eating disorder to grow. Read more about signs and symptoms at the National Eating Disorders Associations website http://www.nationaleatingdisorders.org/information-resources/educators-and-coaches.php

For you and your daughter it is essential that you form a team including professional consultation with a treatment team that specializes in eating disorders. Just as your daughter uses a skating coach to encourage her growing skill as a skater, you must now turn to a professional eating disorders treatment team to help your daughter survive what might be a very serious biologically based life threatening disorder.

We receive calls everyday on our Information and Referral Helpline to help parents locate treatment teams. We are here weekdays 8:30-4:30 PST at 800-931-2237. Given your location, I would suggest contacting the UK organization beat http://www.b-eat.co.uk/Home to help you locate your team.

The question of whether to pull her from skating is an important clinical one that needs to come out of an integrated plan with MD, counselor/psychologist, nutritionist and possibly a psychiatrist. Your team may choose to pull your daughter from practice until she restores her weight and medical condition. This may be a matter of medical urgency at this point. They also may choose to guide her carefully using her return to skating as an incentive to recover. If skating is something your daughter is passionate about, it may be possible to help her return and find a way to maintain her passion. On the other hand, it may be too much of a risk factor for relapse at this point in her life. The answer to this question of what strategy to use has to come from your daughter’s unique situation and not be based on some general rule of thumb for such patients. There is no single piece of advice I can give you more important than–seek professional help.”

Eating disorders are a serious problem among teens, especially teens in sports who want to be lean and fit so they can perform athletically. I submitted questions to the NEDA for an e-mail interview and NEDA board member Ovidio Bermudez, MD has responded.

Ice Mom: As a parent, what signs should I be looking for in a child who might have an eating disorder?

Dr. Bermudez: The direct answer is you look for signs of restriction or changes in eating habits. You look for signs of dissatisfaction with body image or with size and shape, dieting and weight loss. You look for signs of excessive exercise or exaggerated health consciousness. Depending on age, you should look for signs of overeating or purging by self-induced vomiting, the use of laxatives or other means to get rid of calories from the body for fear of weight gain.

A less direct and more important answer is that you are really looking for change in behavior and self concerns.  Children are growing and changing all the time. You want to look for change that may represent a problem, such as the examples given above. Changes towards negative self perception, negative body image and dissatisfaction with oneself that lead to a desire for weight loss and behaviors that the young person believes will get them there.

Ice Mom: My daughter just has a physical and she’s 10 pounds underweight. She’s very, very active and I see her eat. Should I be worried?

Dr. Bermudez: Well, there are a couple of ways to answer this. First of which is if everything else seems right and this has always been her body habitus and she is maintaining her growth patterns and emotional wellbeing, than I would be watchful, but not worried. On the other hand, if you have a child who is very active and very thin and you are seeing other changes and this is not part of her normal pattern than you should be concerned.   It is better to err on the side of closely monitoring such concerns and seeking professional advice and perhaps an evaluation by her Pediatrician or family physician.

Ice Mom: How can I encourage healthy eating without having my skater become too self-conscious about her weight?

Dr. Bermudez: Good question that a lot of people are asking which is a bit of a parallel with the issues of how to address the risks of obesity and the risks for an eating disorder. Focus on healthy living, appropriate nutrition, appropriate exercise, and being active but not over active. Being passionate about the sport but not consumed by it. It is about having a balance in life and we need to teach, model and guide our young people in how to find that balance. The main message needs to be healthy living. It is important to take care of our bodies and to be active without necessarily giving message about dieting, excessive exercise or to be the best in their sport at all costs.

Ice Mom: If my daughter skips a meal once or twice a week, should I, as her parent, be worried?

Dr. Bermudez: I would say that we go back to the previous question where we talk about patterns. If there is a busy week and she comes home and says “Gosh I was so busy today that I couldn’t have lunch,” but she eats healthy all of the time and there are no other signs of concern, then life goes on. But if she has a pattern of regular meal skipping than it is something to worry about it. If you see a pattern, be observant. If it is correlated with other worrisome behaviors, then I would be concerned.

Ice Mom: My daughter’s coach told me that my daughter needs to lose 10 pounds, but I know that she’s at a healthy weight. What should I do?

Dr. Bermudez: First and foremost I would have a conversation with the coach. Ask what is the justification for such a request and why. Even if I settled the issue with the coach, I would then address it with my daughter. You do not want a negative message to be internalized and just lay there. Coaches can be powerful people in a child or teenager’s life. Even though the coach may not say it again, the message may still have resonated with your daughter. Speak to a Pediatrician and make sure that your daughter is at a healthy weight. Losing weight is not always healthy in sports. As we lose weight, we lose strength, power and performance and young people need to hear that from trusted adults. Keep the lines of communication with your daughter open about this subject.  She is likely to be getting many messages about weight loss.  You need to be willing to counter those with messages about accepting herself and valuing her health.  Those are the steps that I would take.

Ice Mom: A couple of my daughter’s friends are always on a diet, but they don’t need to be. Now my daughter’s talking about being on a diet, too. What should I do?

Dr. Bermudez: I think that you should put the situation in perspective and by that I mean that because eating disorders are genetically mediated illnesses where environmental illnesses also play a role, situations like this should not be ignored.  Another way of thinking about it is that “Genetics load the gun and the environment pulls the trigger.”  Some people get away with dieting when they don’t need to, but you don’t know who is genetically loaded or not. Your daughter may have the genetic vulnerability for the development of an eating disorder (especially if eating disorders have been present in her family history) that can be triggered by environmental influences such as dieting or weight loss. Dieting can be a gateway behavior to an eating disorder and should not be viewed as an innocent behavior or accept it because “everyone is doing it.”

As NEDA says, eating disorders are really serious mental illnesses not lifestyle choices, but the behaviors that often lead to eating disorders often begin as lifestyle choices.  My suggestion would be to put the situation into perspective for yourself and for your daughter.  If it was about smoking or underage drinking, the fact that others around her are doing it would not make it right for her.  That should be the right perspective.

I’d like to thank Dr. Bermudez for his time and answers to my questions and to the National Eating Disorders Association for helping me with the reader’s problem.

The NEDA offers several free toolkits to support parents, coaches, and trainers with their concerns about eating disorders. The toolkits are resources that answer common questions about eating disorders, myths about eating disorders, and ways to help someone who might have an eating disorder. Each toolkit also offers contact information for organizations and agencies that can offer more assistance. The Coach & Trainer Toolkit has 45 pages. The Parent Toolkit has 80 pages and also contains information about working with insurance companies.

Do you have a question about eating disorders? Do you have a concern about your figure skater’s eating or exercise habits? A representative from the NEDA will visit and answer reader questions, so feel free to ask anything. If you have words of encouragement for U.K. Reader and her daughter, you can include those, too.

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Do you have a question for Ice Mom or the Advisory Board? Do you have a suggestion for a blog post? I love e-mail. Really, I do! E-mail me at IceMom.Diane@gmail.com

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Photo credits:
The NEDA logo, the NEDA Coach & Trainer Toolkit, and the NEDA Parent Toolkit: National Eating Disorders Association
Belsay Mirrors: johndal / John Dalrymple on Flickr.com Creative Commons
Wall of mirrors More London: Steve Punter / Southbanksteve on Flickr.com Creative Commons
Mirrors 1.: Ashley R. Good / Ashley Good on Flickr.com Creative Commons
household object of desire, Gold bowed mirror, San Mateo, California, USA: Wonderlane on Flickr.com Creative Commons
Mirror mirror: Elsie esq./Les Chatfield on Flickr.com Creative Commons
wall o’ mirrors: Anosmia / Jennifer Boyer on Flickr.com Creative Commons
The gray mirror, random shopping, U Village, Seattle, Washington, USA: Wonderlane on Flickr.com Creative Commons