Norwegian School of Sport Sciences, Department of Sports ...€¦ · 2 4 6 8 10 12 14 Female Male...

transcript

Idrett og ungdom- vinnere og tapere

Jorunn Sundgot-Borgen, Professor PhD

Norwegian School of Sport Sciences,

Department of Sports Medicine

Hva vil jeg si?

• Status

• Utfordringer

• Risikoforhold

• Spiseforstyrrelser i idretten

• Take home…

Status

• For få er aktive

• Overvekt

• Mental helse

Vinnere og tapere

Utfordringer

• Ufaglærte trenere

• Utstyr

• Foreldre

• Uskrevne regler

• Helsepersonell?

Utfordringer

• Vekst og utvikling

• Tidlig spesialisering

• Flere idretter

• Flere roller

• 24-timers utøveren

• Borteboere

• Økt treningsmengde

• Miljø- og kulturskifte

• Sensitive, informasjonssvamper

Naughton et al, (2000). Bergeron. M.F, Mountjoy M, Armstrong N, et al. 2015

Utfordringer

• ↑ Treningsmengde

• Timeplaner

• Ungdomskulturen, Kroppsbilde

• Myter, markedsføring

NTG.NO

Desbrow B et al. (2014).Sundgot-Borgen, C. & Sundgot-Borgen, J. (2017).

High performance athletes

➢Natural ability

➢Optimal training

➢Optimal energy availability

➢Optimal body composition

➢ Motivation

Introduction of the IOC Consensus Statement

“Beyond the female athlete triad: RED-S”

IOC WORLD CONFERENCE

PREVENTION OF INJURY AND ILLNESS IN SPORT

The disordered eating continuum

Disordered eating Eating disordersOptimal

Energy availability

Sundgot-Borgen et al., 2015

Energy Availability

2800 kcal – 1500 kcal = 1300 kcal

Enough to maintain basic physiologic function and health?

ENERGY INTAKEEXERCISE ENERGY

EXPENDITURE

2800 kcal 1500 kcal

The DE/EA continuum

Eating disorders

(Sundgot-Borgen & Torstveit, 2010; Mountjoy et al., 2014; De Souza et al., 2014; APA, 2013; Loucks, 2004)

Anorexia nervosa (AN),bulimia nervosa (BN), binge eating disorder (BED) and other specified feeding or eating disorder (OSFED) (DSM-V; APA,

E.g. Abnormaleating behaviours, chronic dieting, fasting, use of pathological weight control methods, distorted body image, weight fluctuations

Appropriateeating and exercise behaviours, including healthy dieting

Low EA

Disordered eating

Reduced EABalanced EA

Healthy

≥45 kcal/kg FFM/day

30-45 kcal/kg

FFM/day

<30 kcal/kg FFM/day

- Altfor mange unge utøvere opplever at totalbelastningen blir for stor

• For ungdom som satser på idrett

er forekomsten av

spiseforstyrrelser langt høyere

enn hos ungdom flest

For ungdom som velger idrettslinje på videregående er forekomsten av spiseforstyrrelser høyere enn hos ungdom ellers. Foto: NTB Scanpix

Unge på ville veier: - Skremmende!

Unge langrennsutøvere får hetta før sesongstart i langrenn etter å ha kjent på slankepress. Mange lar det gå altfor langt

Dagbladet 19. desember 2019

Prevalence of ED in elite male and female athletes (n=962) and controls (n=924)

Estetic Weight

Endurance Ball game Technical Power Anti-g Control

female

(Sundgot-Borgen et al. 2004)

Athletes Controls Leanness

sports

leanness

sports

*p<0.001

Female Male Total

Athletes

Controls

Male, n = 390

Female, n = 221

Male, n = 199

Female, n = 156

*P≤0.01

ATHLETES

Female : 14 % *

Male : 3 %

Martinsen & Sundgot-Borgen, Med Sci Sports Exerc2012

And it is popular!

"The emphasis is on a well-shaped, fit, healthy andattractive appearance, similar to that of models"

-International Federation of Body Building

2005 2013 2014 2015 2016

Norwegian Fitness categories

Body Fitness Bikini Fitness

2012 2013 2014 2015 2016

Norwegian Federation of Fitness & Bodybuilding

Total Fitness Categories Body Building

Health Consequencesof RED-S

(Mountjoy, Sundgot-Borgen, Burke, et al

Performance Consequencesof RED-S

(Mountjoy, Sundgot-Borgen, Burke, et al

BMD and risk factors; athletes (n=186)

Total body Total femur Lumbar spine

No EDs

Torstveit & Sundgot-Borgen, BJSM, 39: 282-287, 2005

Case – endurance athlete

➢ 21 years

➢ 171 cm, 42 kg, 8% fat

➢ Anorexia nervosa

➢ Amenorrhea

➢ Training 3 hrs/day

➢ Depressed

Bone mineral density

"RED-S og beinhelse"; Monica K. Torstveit

September 2016

Skjelettets respons til mekanisk belastning

Frosts Mechanostat theory

Over tid - HVA SÅ?

Risiko:• Oppnår ikke optimal

maksimal benmasse• For tidlig aldersrelatert

bentap• Stressfraktur/skjelett-

relaterte skader og forlenget skadetid

Mountjoy et al., 2018; Barrack et al., 2017; Rauch et al. 2010; Barrack et al., 2014; Manore et al. 2007

Diagnostiske kriteria for lav benmasse for utøvere (Nattiv et al., 2007;

Mountjoy et al., 2014)

Osteopeni: Z-score < -1 til -2

Osteoporose: Z-score < - 2.0 inkludert sekundære kliniske risikofaktorer

for brudd

DXA måling

Prevention and management of EDs

Athletes, coaches and

parents Health carepersonell

Sport organi-sations and

• Education• Knowledge• Communication• Encouragement• Support

Risk factors

General risk

factors

Sport specific

risk factors

”Genetics load the gun and environment pulls the trigger”

“I'm in a sport that praises lean body types. We know that all different sizes and builds can win on the World Cup, but still, lean is accepted. ”

http://www.espn.com/espnw/voices/article/26112613/olympic-gold-medalist-jessie-diggins-confronting-eating-disorder-recovery

”Experiences in skiing planted the seed”

As a junior she saw the skiers around her, cutting fat of their steaks, not having dessert, hot chocolate or other treats. By looking at others she believed that was the narrative to be successful in skiing

“I didn't know anything about ED or nutrition, and I convinced myself that I was doing what was best for my career”

EDs in high school in her strive for perfection

http://www.espn.com/espnw/voices/article/26112613/olympic-gold-medalist-jessie-diggins-confronting-eating-disorder-recovery

Dieting ……. Jenny Meadows:

the world 800m is mentoringBritish junior athletes, says;constantly I come across youngfemale athletes who have lostweight at the behest of theircoach.

Picture from: https://www.campaignlive.co.uk/article/spar-signs-first-athlete-endorsement-deal-jenny-meadows/1015886

https://www.telegraph.co.uk/athletics/2019/11/14/special-report-british-female-athletes-reveal-culture-fat-shaming/

Marilyn Okoro;

«the coach was like, ‘Well, you’re probablyready to have babies

Risk factors

Sport specific risk factors

Weightcycling and

dieting

Personality

Start of spes

Traumaticevents

Coachingbehavior

Rregulations in sports

Bratland-Sanda S, Sundgot-Borgen J. Eating disorders in athletes: overview of prevalence, risk factors and recommendations for prevention and treatment. Eur J Sport Sci 2013;13(5):499-508.

Bar RJ, Cassin SE, Dionne MM. Eating disorder prevention initiatives for athletes: A review. European Journal of Sport Science 2016;16(3):325-35.

‘Arthur-Cameselle JN, Baltzell A. Learning from collegiate athletes who have recovered from eating disorders: Advice to coaches, parents, and other athletes with eating disorders. J Appl Sport Psychol 2012;24(1):1-9.

IOC Clinical Practice ModelsRed light, Yellow light, Green light A model for risk assessment and return to play decision making

IOC Clinical Practice Models RED-S Clinical Assessment Tool

English, French, Italian, German, Norwegian, Japanese and Spanish

RED-S - Sport risk assessment model for sport participation

High Risk: No Start

RED LIGHT

Moderate Risk: Caution

YELLOW LIGHT

Low Risk

GREEN LIGHT

Anorexia Nervosa and other

serious EDs

Other serious medical

(psychological and

physiological) conditions related

to low energy availability

Extreme weight loss techniques

leading to dehydration induced

haemodynamic instability and

other life –threatening

conditions

Prolonged abnormally low % body fat or sum of

skinfolds

Substantial weight loss (5-10% BM in one month)

Attenuation of expected growth and development in

adolescent

Abnormal menstrual cycle: FHA amenorrhea > 6

months

Menarche > 16 years

Abnormal hormonal profile males

Reduced BMD (either from last measurement or Z-

score< -SD)

History of 1 or more stress fracture associated with

hormonal/menstrual dysfunction and or LEA

Athletes with physical/psychological complications

related to LEA/DE

- ECG abnormalities

- Laboratory abnormalities

Prolonged relative energy deficit

DE behaviour affecting other team members

negatively

Lack of progress in treatment/non compliance

Healthy eating habits with

appropriate energy availability

Normal hormonal and

metabolic function

Healthy BMD as expected for

sport, age and ethnicity

Healthy musculoskeletal

system

Modified from Skårderud et al, 2012

Sport risk assessment model

GREEN LIGHT

➢Full training and competition

➢With no stipulations

YELLOW LIGHT

➢Cleared to supervised training with a medical treatment plan

➢May compete once cleared under supervision

➢Re-evaluation at regular intervals (1-3 months)

➢Regular reassessments for compliance and progress

RED LIGHT

➢ Clearance to participate in

sport denied

➢ Athlete to receive treatment

➢ Use of a treatment contract

Is it possible to prevent ED and symptoms associated with ED among adolescent elite athletes?

Methods - Subjects

• 16 Elite Sport High Schools (private /state)

• Athletes, n = 677

• Coaches, n = 192

• 2 Ordinary High Schools• Controls (non-athletes), n = 421

• First-year pupils• Birth date in 1992

• 50 different sports

www.nrk.no

Prevalence of new ED cases among female athletes

Posttest 2 new cases

Intervention

Control

p< 0.001%

Monica K. TorstveitMartinsen et al., 2013

Recommendations: LEAHealth Care Professionals

➢ Se hele utøveren

➢ Hva vil han/hun?

➢ Vær konkret i forhold til

risikoforhold

➢ Gi tydelige anbefalinger

➢ Følg opp over tid

➢ Hold deg oppdatert

➢ Bruk eksisterende værktøy

Hvordan optimalisere?

• Praktisk kunnskap: hva, hvorfor, og hvordan

• Måltidsrytme

• Variasjon

• Planlegging• Tilrettelegge og ansvarliggjøring

• Foreldre• Trenere• Skolene

• Skeptisk til selvutnevnte "eksperter"

Sports Dietitians Australia Position Statement, 2014Sundgot-Borgen, C. & Sundgot-Borgen, J. (2017).

Enkle retningslinjer

• Start med frokost + tran/omega 3 kapsler

• Spis hver 3-4 time

• Planlegg for resten av dagen

• Alltid ha "nød proviant" i treningsbaggen

• Varier inntak i de ulike måltidene

• 1 håndfull frukt/grønnsak/bær per måltid

• 3 om dagen

• Vanlig mat fremfor barer, pulver og piller

• Vann fremfor energi/sportsdrikk

• Et perfekt kosthold er ikke nødvendig hele tiden!

Desbrow B et al. (2014).Sundgot-Borgen, C. & Sundgot-Borgen, J. (2017).

The sports dietitians of Australia 2017

Take-home message

➢The disordered continuum

➢High prevalence

➢Severe consequences

• Characteristics of individuals with ED & traits of «good athletes» may be similar

• Athletes rarely self-identify

➢When being faced with athleties (with six-pack, veins and muscular definition), promoting a healthy lifestyle be aware they might not be healthy! There is a need to reorientate their motivational focus and increase they knowledge related to training, nutrition and health.

➢Risk assessment tools exist

➢Need to convince the athlete (and coach). Talk about health as a performance variable

➢Preventive program are effective

PhD stipendiat Annett Victoria Stornæs

Så flink at en blir syk?

"Jeg synes det er veldig positivt å ha krav,

men hvis du setter kravet for høyt da, da kan

det hende at du, du pusher deg selv litte

grann for hardt. Og det er jo ikke bra. Da er

det mange andre ting som kanskje ikke funker

for deg lenger da, og at du blir veldig sliten

eller du kan få stressanfall eller veldig mye

da kan gå galt hvis du pusher deg selv for

hardt".

(Gutt 15 år, 9.trinn)

Tenåringers strev

PerfeksjonismeÅ sette ekstremt høye standarder for prestasjoner

etterfulgt av overdreven selvkritisk evaluering av egen atferd

(Ref. f.eks; Frost et al., 1990; Stoeber, 2018a; Hill & Curran, 2015)

▪ Få norske studier på ungdom mellom 13 og 18 år▪ Internasjonale studier

• Perfeksjonisme assosiert med bl.a. angst, depresjon, spiseforstyrrelser

Spiseforstyrrelser

Depresjon

Selvmordstanker

Burnout

Skader

Perfeksjonisme & Helse

(e.g., Stoeber & Otto, 2006; Gotwals et al., 2012)

(Flett et al, 2011 a; Stoeber et al, 2007; Shaunessy et al, 2011; Appleton et al, 2010; Madigan

et al, 2017; Luo et al, 2016; Damian et al, 2017; Jowett, et al 2013; Roxborough et al., 2012)

1) Sosialt/ytrestyrt P

2) Selvorientert PSelvfølelse

Tilfredshet med livet Skole-/idrettsengasjement

Autonom motivasjon

Spesialiserte Skoler Ordinære Skoler

Perfeksjonistiske trekk – relativ prosent

1-2. Dysfunksjonelle perfeksjonisme mønstre

- Moderat selvorientert – mindre ytrestyrt

- Lave-Ingen Perfeksjonistiske tendenser

8.trinn – 13årandeler med perfeksjonistiske tendenser

Jeg tror det var jeg som satte mine forventninger til meg selv, fordi

at jeg hadde ikke trengt å være så god, fordi at jeg bare

sammenlignet meg selv med andre, og jeg tror at det er egentlig det

verste man kan gjøre mot seg selv, å sammenlikne seg selv. Fordi

da, man vil alltid finne noen som er bedre enn seg selv. Man må bare

finne det man selv er god på. Ja, å ikke sammenlikne, eller, ja, å ikke

liksom bruke folk du vet er dårligere enn deg til noe som noe du kan

løfte deg selv opp med da.

Skjønte du hva jeg mente?

Og så er det viktig å ikke sette folk i bås, for det tror jeg også.. ja,

da kommer man liksom ingen steder da. Ja, det er litt det samme

som med forventninger da, altså hvis man setter folk i bås, så har

man forventet at de er sånn, selv om de kanskje ikke er sånn i det

hele tatt. (Jente, 14 år)

Norwegian School of Sport Sciences, Department of Sports ...€¦ · 2 4 6 8 10 12 14 Female Male...

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