Eating disorders in athletes: The hidden paradox of health
Whether you’re an occasional attendee of a yoga class or an elite athlete with ambitions to go pro, every unique body needs enough nutritional support to go the distance.
But for some athletes, this might mean meticulously tracking numbers (calories), striving for their sport’s typical body type, or underfueling with the hope of overperforming, all of which are grounds for developing disordered eating behaviors.
Up to 45% of female athletes and up to 19% of male athletes present with symptoms of eating disorders.* Although participating in a sport doesn’t mean you’ll develop an eating disorder, an environment of high achievement, competition, and, sometimes, perfectionism can fuel disordered thoughts and behaviors around food and exercise.
In this post, I’ll look into:
why athletes are susceptible to developing eating disorders,
how a caloric imbalance can lead to something called RED-S,
the physical and mental effects of eating disorders in athletes, and
prevention and support strategies for athletes with eating disorders.
*The most recent data I could find was from 2013.
Athletes: The ‘pinnacle of health’
Before we dive into the risks and complications of disordered eating in athletes, let’s try to put ourselves in the mindset of these individuals.
The general public may view athletes as the pinnacle of health, but our beliefs in what health “looks” like can be challenged when it comes to athletes. For example, those of us who watched the 2024 Summer Olympics were shown all types of bodies, from shot-putters to distance runners to swimmers. (See U.S. rugby player Ilona Maher advocate for body image.)
The truth is, what a body can do doesn’t necessarily have a “look.” But young athletes might disagree. They may glance around at their competition and see bigger, stronger, leaner, or thinner and worry that they don’t measure up.
In this way, athletes can be susceptible to poor body image, which can have an effect on their nutrition, training, and performance. (But more on this later.)
Some sports like gymnastics or those that require athletes to belong to a certain weight class, like wrestling or bodybuilding, can be particularly dangerous environments. These sports almost set up their participants to engage in disordered eating by essentially forcing them to control their weight so they can compete with the best chance of succeeding.
Not only do these athletes feel pressure to perform, they also likely feel pressure to look a certain way or weigh a certain amount—two mounting pressures that can backfire when it comes to performing.
Individual athletes might feel an added pressure that team sport athletes might evade. Compared to team sports where everyone is working toward a similar goal, individual athletes have no one to rely on but themselves to achieve.
With this combination of pressure to perform, the idea that obtaining a certain body shape will improve performance, and external standards that need to be met to even participate, athletes face a host of opportunities that might lead them to body dysmorphia, disorder, and dysfunction.
The blurred line between healthy and unhealthy
Our views about athletes can complicate our own relationships with food and exercise. When U.S. swimmer Michael Phelps revealed the number of calories he consumes every day during training seasons, we let out a collective gasp. But elite athletes exert much more energy than the typical human being.
Complications can arise when striving for the highest levels of health. When we intentionally deprive ourselves of anything that doesn’t meet these standards, these behaviors can snowball into an eating disorder called orthorexia nervosa.
RED-S in athletes
Caloric imbalance in high-performing athletes can lead to something called “relative energy deficiency in sport,” or RED-S. This occurs when “an athlete’s nutritional fueling is insufficient to meet the demands of their training and daily activities.” In other words, the calories someone takes in are fewer than the calories they expend.
This low energy availability (LEA) means the body doesn’t have enough energy to support its functions and can have detrimental impacts on physical and mental health.
Such a caloric imbalance may be a result of the athlete’s innocuous determination to ramp up training without considering how to balance their nutritional needs to fuel this training.
However, some athletes might not make up for the energy burned during workouts. They may feel that the lighter they are (i.e., the less they weigh), the better they’ll perform.
Physical effects of eating disorders in athletes
When athletes are deprived of the nutrients they need to perform, there can be serious consequences for the body.
Inadequate protein can decrease muscle mass and slow muscle recovery post-training.
Low protein and fat intake can cause hormonal issues, like amenorrhea (absence of a menstrual period) in females and low testosterone in males.
Athletes may face a higher risk of injury and longer recovery times if injured.
Poor nutritional intake can put stress on bones, leading to fractures.
Undereating and/or overtraining can result in low energy and fatigue, which can affect performance.
This is by no means an exhaustive list. For a full list of how eating disorders affect athletic performance, click here.
Mental effects of eating disorders in athletes
Engaging in disordered eating behaviors while pushing your body to its physical limits can have crippling mental effects, as well.
Obsessive thoughts about food and body image. Athletes who aren’t well-nourished might find themselves fixating on food, worrying about when their next meal will come, and seeing a distorted image of themselves when they look in a mirror.
Depression and anxiety. These two co-occurring symptoms are extremely common with eating disorders. An individual might feel helpless, worried that no one understands what they’re going through, or anxious about eating.
Low self-esteem. If the physical effects mentioned above start to take a toll on an individual’s performance, they may feel like they’re not good enough, which may set off a series of self-fulfilling beliefs and behaviors.
How to detect disordered behaviors in athletes
If you’re worried about your or a loved one’s relationship with training, food, and body image, here are a few signs and symptoms to look out for.
Physical symptoms
Physical symptoms of eating disorders in athletes can include (but are not limited to):
rapid weight loss
low energy
absence of menstrual periods (in females)
frequent injuries or illness
poor or declining performance
Psychological symptoms
Mentally and psychologically, athletes with eating disorders might present with the following:
a change in mood or behavior
withdrawal from activities they used to love or social interactions
an insatiable drive to be perfect and an over-commitment to training
a new or growing dissatisfaction with appearance
Eating disorder support for athletes
Despite the prevalence of eating disorders in athletes, there are ample ways to help prevent problems from arising in the first place as well as addressing them if they do.
Education and awareness
The fact that you’re reading this blog post means you now know that eating disorders in athletes are possible. Educating yourself is the first step to awareness!
Nutritional support
Athletes have unique nutritional needs and therefore can find nutritionists who specialize in sports nutrition. Athletes can benefit from one-to-one consultations where they review meal plans with training schedules in mind, and help ensure they’re getting the right nutrition for their energy needs.
Mental health support
The roots of eating disorders extend beyond the body’s appearance. In fact, some eating disorders have very little to do with appearance.
Since they usually develop from other issues, mental health support is an imperative piece of any recovery effort. Counselors, sports psychologists, and group therapy can be especially beneficial here to remind athletes that they’re not alone.
From a prevention mindset, routine screenings or check-ins with medical professionals can help spot the symptoms mentioned in the previous section.
Coach and trainer support
Athletes need to feel like they’re supported, not just when it comes to their athletic abilities. Coaches and trainers have a responsibility to create a safe environment in which athletes feel comfortable asking for support and expressing concerns.
Additionally, coaches and trainers should work to make sure the feedback they give to their athletes is focused on performance, not on their image.
Are you a coach or a trainer who is responsible for training athletes? See below for a toolkit designed by the National Eating Disorders Association to help you navigate tough discussions with your athletes.
Personal story
I consider myself an “ex”-elite athlete. For years, hardly a day passed when I wasn’t training for or playing on at least one soccer team, plus a team for an additional sport. I was once told by a coach that because of the amount of exercise I was putting my body through, I could “eat whatever I wanted.” I ran with this statement and did just that.
But my attitude toward food and its effect on my body flipped the moment I started developing muscle in my legs. Women’s legs were supposed to be long, svelte, and slender, not bulky and manly. At least, that’s what the media showed me. Rather than taking pride in the abilities of my strong legs, I was embarrassed to be seen as “less feminine.”
Now, decades later, I love my strong legs. During a recent run around the National Mall, I passed a group of high school students touring Washington, D.C. As I ran past, one of them shouted, “Dang, her legs are bigger than mine!” I heard him loud and clear, turned to look in his direction, and smiled. That’s right, and I can probably run faster than you, too, I thought.
We can’t control what other people think or say about our bodies. But we can learn to reframe how we see our bodies. They can be our strengths, pieces that make up our uniqueness, and—if we work really hard at how we see ourselves—something to be proud of.
Pause & Prompt
Think about a body part you may have been at odds with in the past. Write a letter to this body part explaining your relationship with it now. How do you feel about it? What does it do for you? How can you improve your relationship?
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