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Idrett og ungdom- vinnere og tapere Jorunn Sundgot-Borgen, Professor PhD Norwegian School of Sport Sciences, Department of Sports Medicine
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).
VS.
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
RED-S
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,
2013)
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)
0
5
10
15
20
25
30
35
40
45
50
%
Estetic Weight
class
Endurance Ball game Technical Power Anti-g Control
female
male
(Sundgot-Borgen et al. 2004)
0
5
10
15
20
25
30
35
40
45
50
%
Athletes Controls Leanness
sports
Non-
leanness
sports
*
*p<0.001
0
2
4
6
8
10
12
14
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
0
20
40
60
80
100
120
2005 2013 2014 2015 2016
Nu
mb
ers
of
par
tici
pan
ts
Norwegian Fitness categories
Body Fitness Bikini Fitness
0
50
100
150
200
250
2012 2013 2014 2015 2016
Nu
mb
er o
f p
arti
cip
ants
Year
Norwegian Federation of Fitness & Bodybuilding
Total Fitness Categories Body Building
IOC WORLD CONFERENCE
PREVENTION OF INJURY AND ILLNESS IN SPORT
Health Consequencesof RED-S
(Mountjoy, Sundgot-Borgen, Burke, et al
2015)
IOC WORLD CONFERENCE
PREVENTION OF INJURY AND ILLNESS IN SPORT
Performance Consequencesof RED-S
(Mountjoy, Sundgot-Borgen, Burke, et al
2015)
BMD and risk factors; athletes (n=186)
-6
-5
-4
-3
-2
-1
0
%
Total body Total femur Lumbar spine
EDs
No EDs
MD
No MD
*
*
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
"RED-S og beinhelse"; Monica K. Torstveit
Skjelettets respons til mekanisk belastning
Frosts Mechanostat theory
"RED-S og beinhelse"; Monica K. Torstveit
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
"RED-S og beinhelse"; Monica K. Torstveit
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
media
• 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
Early
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
Sport risk assessment model
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
Sport risk assessment model
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
0
2
4
6
8
10
12
14
Posttest 2 new cases
Intervention
Control
p< 0.001%
Monica K. TorstveitMartinsen et al., 2013
IOC WORLD CONFERENCE
PREVENTION OF INJURY AND ILLNESS IN SPORT
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
Angst
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
0%
10%
20%
30%
40%
50%
Spesialiserte Skoler Ordinære Skoler
1
2
Perfeksjonistiske trekk – relativ prosent
1
2
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)
