Eating Disorders in Athletes: Spotting Unhealthy Behaviors

Teen athlete gets support from coachThe body is an athlete’s most important tool. Many athletes learn to constantly monitor this tool, treating it as something to be perpetually tweaked and improved. For some athletes, this means staying in good health, eating nourishing food, and adopting a body positive approach to dieting and weight loss. For others, a fixation on the body can lead to eating disorders. A 2004 study of eating disorders in female elite athletes found that 20% had clinically significant signs of at least one eating disorder.

Eating disorders can destroy an athlete’s body and even claim their life. Anorexia nervosa has the highest death rate of any mental health diagnosis, killing an estimated 10% of the people it afflicts. Treatment can save lives and athletic careers while helping an athlete develop a more positive relationship with their body.

Signs an Athlete May Have an Eating Disorder

Athletes tend to fixate on exercise and nutrition more than the average person. As such, it can be difficult to tell the difference between typical athlete behavior and symptoms of an eating disorder.

Some signs of eating disorders for athletes include:

  • Unusual or unhealthy attitudes about food. An athlete may be very fixated on the calories they consume or might not want to eat around others.
  • An extremely strict exercise regimen. An athlete may train without rest, even in inappropriate weather or after an injury.
  • A fixation on appearance or the body that is out of proportion to or disconnected from the demands of the sport. For example, a runner might focus on getting thin instead of getting faster or more limber.
  • Dressing in a way that conceals the body, even in warm weather. An athlete may have a distorted perception of their body, believing themself to be bigger or smaller than they actually are.
  • Frequent or excessive trips to the bathroom. This sign is especially noteworthy if the athlete also has damaged teeth, as bulimia-related vomiting can affect dental health.
  • Health complaints related to malnourishment, such as constipation, dizziness, exhaustion, or frequently feeling cold.
  • Unexplained or unhealthy weight loss. An athlete may lose weight rapidly without any apparent change in exercise or diet.

No single behavior is proof of an eating disorder, but seeing many red flags at once may be cause for concern. If you are concerned about a loved one, consider getting professional help.

Who is at Risk?

In the general population, eating disorder rates are significantly higher among cisgender women than men. This is likely due to the immense pressure women face to conform to an unrealistically thin beauty “ideal”. A 2008 study found 75% of American women endorse at least some unhealthy thoughts or behaviors related to food and body image. More specifically, female athletes tend to face more appearance pressure than male athletes, as women’s sports often focus on thinness as a sign of strength.

However, male athletes can and do get eating disorders. Some studies suggest that eating disorders may be underdiagnosed and undertreated in men. Additionally, some men—including gay and bisexual men—may be more vulnerable to eating disorders than others.

Gender is not the only risk factor for eating disorders. Sports-specific risk factors include:

  • Participating in a sport that emphasizes thinness or conforming to a narrow physical ideal. Athletes in ballet, dance, and similar sports are at a higher risk.
  • Participating in a sport that has weight classes. For example, boxers and wrestlers may engage in disordered eating to meet the weight requirements for a competition.
  • Participating in an endurance sport such as long-distance running.
  • Playing for a team or coach that heavily emphasizes weight or appearance.
  • Parents who heavily emphasize the importance of athletic achievement.
  • Believing that weight is the most significant predictor of athletic performance.

Personal risk factors for developing an eating disorder include:

  • Perfectionism.
  • Negative attitudes about fat or weight, either in oneself or others. A person at a high risk of eating disorders may express fatphobic comments or negative views about people who are not thin.
  • Low self-esteem.
  • A family history of eating disorders.
  • A history of trauma.

Female Athlete Triad

Female athlete triad refers to three dangerous health consequences some female athletes experience. The triad includes:

  1. Disordered eating. This may involve not eating enough food, eating only from certain food groups, purging, or yo-yo dieting.
  2. Menstrual irregularities. When a cisgender woman’s body fat percentage drops too low, she no longer ovulates, which prevents her from getting her period. Some female athletes stop getting their period altogether (amenorrhea), while others experience irregular periods. Amenorrhea and other menstrual irregularities can cause infertility. According to a 2012 analysis, the prevalence of amenorrhea among female athletes involved in sports that emphasize thinness is as high as 69%.
  3. Osteoporosis. Estrogen levels fall in female athletes with unhealthy eating habits and very low body fat. This, coupled with inadequate intake of calcium and vitamin D, can cause osteoporosis—a bone mineral density deficiency that increases the risk of broken bones. The risk of broken bones is already higher among athletes than the general public.

Athletes with this triad may feel chronically fatigued. They may also get more injuries and suffer declines in their athletic performance. For athletes who believe their performance is tied to thinness, these effects may prompt even more unhealthy eating.

Getting Help for Athletes

Many athletes with disordered eating struggle with shame and low self-esteem, so it is important for loved ones not to shame or guilt them about their condition. Insulting an athlete’s body or calling their thinness unattractive may also backfire. Instead, loved ones should emphasize the harms of disordered eating and reassure the athlete that treatment can and does work.

Eating disorders are highly treatable. Treatment often focuses on improving self-esteem. It can also address underlying mental health issues such as perfectionism, trauma, and depression. In treatment, an athlete can learn how to manage painful emotions and change their relationship with food. They may also identify unhealthy attitudes about body image, appearance, and performance, discussing the way cultural messages reinforce those attitudes.

Some athletes may worry about how treating disordered eating will affect their athletic performance. A dietitian can help athletes regain the weight they have lost and construct an eating plan that improves their athletic performance. Many athletes also need help managing the emotional challenges of competitive athletics, such as negative comments about their appearance or constant pressure to be thin. A therapist who specializes in treating athletes or a sports psychologist can help manage these concerns.


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