Lorem ipsum dolor sit amet, consectetur adipiscing elit. Suspendisse varius enim in eros elementum tristique. Duis cursus, mi quis viverra ornare, eros dolor interdum nulla, ut commodo diam libero vitae erat. Aenean faucibus nibh et justo cursus id rutrum lorem imperdiet. Nunc ut sem vitae risus tristique posuere.
Learn more about the results we get at Within
Lorem ipsum dolor sit amet, consectetur adipiscing elit. Suspendisse varius enim in eros elementum tristique. Duis cursus, mi quis viverra ornare, eros dolor interdum nulla, ut commodo diam libero vitae erat. Aenean faucibus nibh et justo cursus id rutrum lorem imperdiet. Nunc ut sem vitae risus tristique posuere.
The sports world—both at the professional and amateur levels—is often accompanied by the pressure to perform. Sadly, this type of stress can manifest as a fixation on achieving certain body shapes, weights, or sizes, which may be thought to give athletes a competitive advantage. And those types of thoughts can bring on disordered eating behaviors.
In fact, while they represent a relatively small portion of the overall population, athletes are generally thought to be at a high risk of developing eating disorders for several reasons. Learning more about the signs and symptoms of eating disorders among athletes may help more people find the kind of treatment they need to recover from these conditions.
Eating disorders are often undetected in athletes because fitness and superior athletic performance are valued in competitive athletics.
Why are athletes more at risk of eating disorders?
It’s not uncommon for athletes to spend a lot of their time thinking about diet, exercise, and body image. For many athletes, a daily schedule revolves around different types of physical training, and many may utilize particular diets alongside their workouts to encourage certain physical results. Coaches and trainers may also push their players to “dig deep,” with mottos like “no pain, no gain.”
But research is consistently finding that this type of fixation on weight, eating, food, and fitness can actually have a detrimental effect on health and well-being. In fact, they may be among the first signs of eating disorder pathology or the distinct types of thoughts and behaviors involved in eating disorders.1
While all athletes may succumb to these types of conditions, research has shown that some types of athletes are at an especially high risk of developing eating disorders, including:3
Athletes participating in sports with weight classes
Women athletes in sports that emphasize appearance
Men athletes in endurance, technical, or power sports
All athletes with strong emotions related to appearance and weight
Competitive environment
Athletic competitions are, by their very nature, competitive events. This can create or drive a competitive mindset in athletes that can border on unhealthy fixation.
Athletes may look for any type of advantage they can create over competitors, including cultivating particular body shapes or maintaining a certain body weight or type of muscularity. Coaches and trainers may also contribute to this mindset, encouraging their players to take whatever advantages they can.
Type of sport
Certain types of sports may increase the likelihood of an athlete developing an eating disorder, as there is increased pressure to look a certain way or maintain weight to fit into a weight class.5
Aesthetic sports place an emphasis on being thin for appearance reasons, such as gymnastics, or dancing.
Weight-class sports that use someone’s weight to determine the division they compete in, such as wrestling and weightlifting.
Endurance sports, such as cycling, swimming, or running.
Individual sports, where athletes compete on their own, as opposed to part of a team, including diving and figure skating.
Being a woman
While all athletes are at risk for developing disordered eating behaviors, there are three factors thought to impact female athletes in particular, including:5
Performance anxiety
Negative self-appraisal of performance
Social influences that promote thinness
Other risk factors to athletes
There are a variety of other risk factors that can contribute to the onset of eating disorders in athletes, including:5
Being an elite athlete
Identity and self-esteem rely on being an athlete
Low self-esteem
Perfectionism
Family history of eating disorders
Family dysfunction, such as parents living vicariously through their child's success
History of physical, emotional, or sexual abuse
Family, cultural, or peer pressures to be thin
History of trauma
Warning signs of eating disorders in athletes
The warning signs of disordered eating in athletes can be difficult to determine, as they are often seen as a dedication to their sport. General signs that indicate an athlete may be having issues with their thoughts and beliefs about food and their bodies include:6,7,8,9
Longer recovery times needed
More frequent injuries, such as muscle strains or sprains
Decreased muscle function, coordination, and speed
Focusing on foods or eating habits that are “forbidden”
Difficulties with days off or tapering training
Prolonged or additional training beyond a set schedule
Bulimia nervosa is more common in athletes than anorexia nervosa, as athletes require larger intakes of energy to fuel their training efforts. Signs an athlete may be struggling with bulimia include:6,7,8,9
Binging episodes after practice
Compensatory behaviors following a binge, including fasting, excessive training, or purging via self-induced vomiting or laxative use
Eating in secret
Hiding food or food packaging, e.g., in their lockers, gym bags, etc.
Obsession with body weight, shape, and size
Overly negative body image
Shame and guilt surrounding food
Excessive fluid consumption
Scarring and abrasions on the knuckles from self-induced vomiting
Binge eating disorder can become a problem in athletes if they are engaging in restrictive behaviors and, therefore, not fueling their bodies enough for their energy output. Signs of binge eating disorder include:6,7,8,9
Weight fluctuations
The amount of food eaten in public is inappropriate for the amount of energy output in training
Eating at a fast pace
Hiding food and being secretive around food
Feelings of shame or guilt after eating
Restriction following binge episodes
Lack of purging behaviors
Reporting feelings of low self-worth and depression
Male athletes are more likely to experience muscle dysmorphia, a sub-type of body dysmorphic disorder in which a person believes they are not muscular or lean enough, regardless of their actual appearance. Behaviors that indicate that an athlete has muscle dysphoria include:6,7,8,9
Excessive training and working out
Preoccupation with body composition
Overuse of dietary and workout supplements
Use of anabolic steroids or other performance-enhancing drugs, which can risk their athletic career
Strict dietary rules
Skipping social events to maintain a strict workout regime
Wearing baggy clothes during training to hide their body
Athletes are at an elevated risk of exercise addiction. Almost 15% of endurance athletes, 10% of ball sports players, and 6.5% of power discipline participants show signs of the disorder, which include:9
Feelings of guilt or anxiety if they don’t exercise
Disrupting their usual routine of exercise
Withdrawal symptoms when they cannot exercise
Training even when injured or sick
Feeling like training is no fun anymore
Unsuccessful attempts to reduce training for a certain period
Needing to increase the amount of exercise for the same release of endorphins (feel-good hormones)
What is anorexia athletica?
Anorexia athletica (AA), or exercise anorexia, is not an officially recognized eating disorder diagnosis, but it describes a pattern of disordered eating that is common among athletes.
Those who have anorexia athletica tend to use excessive exercise not just as a way to achieve an athletic advantage but as a way to control body shape and weight. As with anorexia nervosa, this type of behavior is fueled by a distorted body image and a desire to lose weight and change body size.5 And as with AN, people struggling with AA tend to have a low body mass, despite a high level of physical performance.10
Risk factors, warning signs, and effects of anorexia athletica are similar to anorexia nervosa, though the condition can easily go undetected in athletes, as related behaviors can be rationalized as a drive for fitness and superior athletic performance. This is one reason why it’s essential to educate coaches and trainers about what red flags to look for in their athletes and the importance of adequate nourishment and rest between workouts.
Effects of eating disorders in athletes
An athlete requires proper nourishment and optimal body functioning to balance their energy output through training. If an eating disorder disrupts this balance long-term, an athlete may suffer the following consequences:6,7,8,9
Increased risk of injury
Decreased response to training and poor performance
Inability to compete, resulting in quitting or early retirement
Impaired coordination and judgment
Reduced aerobic functioning
Metabolic imbalances
Cardiovascular issues
Gastrointestinal complications
Loss of menstruation and fertility problems
Bone and muscle loss
Dental problems, including gum disease and tooth loss
Depression, anxiety, and suicide ideation
Increased risk of substance use
Death
Relative energy deficiency in sport (RED-S)
Athletes living with an eating disorder are at an elevated risk of developing a condition called relative energy deficiency in sport, or RED-S. This occurs when energy expenditure exceeds energy intake, which creates an energy deficiency that may compromise a number of internal processes and bodily systems, including psychological health, immune function, bone health, the menstrual cycle, metabolism, and cardiovascular health.11
The female athlete triad
Among female athletes with eating disorders, particularly those who are engaging in dietary restriction behaviors, a commonly recognized consequence is the female athlete triad.12 The condition describes three interrelated issues:13
Menstrual dysfunction or loss of periods
Low energy and extreme fatigue (with or without disordered eating)
Low mineral bone density
A lack of adequate nutrition and excessive energy expenditure through training can lead to reduced energy availability, which directly affects the menstrual cycle. This, in turn, directly influences bone health.14 Mineral loss within the bones puts the affected athlete at a significantly greater risk of stress fractures and the development of osteoporosis in later life.14
This dangerous combination presents in around 4.3% of female athletes.13 And while any female athlete can develop the triad, adolescent girls are the most at risk due to the active biological changes, social pressures, and rapidly changing circumstances that accompany the teenage years.
Teenage girls have a higher risk of developing the female athlete triad.
Preventing disordered eating behaviors and eating disorders in athletes
As an athlete, there are things you can do to maintain a healthy mindset when training and reduce your risk of developing disordered eating behaviors.
Find the right coach and team
Whether you're an individual athlete or part of a team, your coach should encourage a healthy and balanced perspective on training, diet, and physical appearance. This means understanding that winning is not the end-all, be-all and that other priorities, such as mental health, should take precedence.
It’s also important to be around coaches, trainers, and peers you can feel comfortable approaching if you’re struggling with body image, self-confidence, or eating behaviors. These connections can serve you well throughout your athletic career.
If you’re not in an environment where this is the case or this is possible, it’s important to seek out support elsewhere. A parent, teacher, mentor, or even a therapist can be a good outlet for your concerns. And, if you feel that the coaches you’re working with are actively harming your mental or physical health, you may want to ultimately consider stepping away from the situation.
Pay attention to your body
If you’re experiencing physical pain or noticing major changes in your mood or energy levels, your current training regime may be doing more harm than good. These changes to body and mind not only put you at greater risk of physical injury but also of the onset of eating disorder symptoms.
If you’re suffering from intrusive thoughts about your weight, diet, and training schedule, reach out to your coaches and peers or another resource you can count on, so they can help support you while you find the help you need before the problem escalates.
Learn how remote treatment can help you recover from an eating disorder
Ask your coach to connect you with a nutrition counselor. They will be able to teach you what nutrients and energy your body needs to function and support you through your training.
Through nutrition counseling, you’ll learn about the basic food groups, how to cook meals that support active athletes, and how proper nutrition is essential for your body to function properly.
Get out of the gym
While training is an important part of an athlete’s life, when it becomes the sole focus of your day, that can be a problem and cause significant damage to your body, mind, and overall well-being.
It’s important to spend time out of the gym doing social and leisure activities in a more relaxed environment. Doing so with your training mates can help strengthen your relationships, as opposed to encouraging competition. This can also help alleviate levels of stress and feelings of pressure, which can lower your risk of developing disordered eating behaviors.
Eating disorder treatment for athletes
Early intervention is key for recovery from any eating disorder, prioritizing the athlete over the sport. Eating disorder treatment takes time, and it’s usually not possible for an athlete to work on their recovery and participate in their sport simultaneously.
This means that an athlete may need to take a break from their sport to focus solely on treatment. While this may be distressing for the athlete, it increases their chances of a full recovery and fewer health complications later in life, as well as returning to the sport they love.
Athletes with eating disorders should undergo assessment and treatment by a multidisciplinary team that typically includes nutritionists, therapists, and medical doctors. The team physicians will also play a critical role in determining when an athlete can return to their sport.11
Although eating disorders may present slightly differently in athletes, some of the same evidence-based treatments are typically recommended. They include:
The level of care an athlete needs will depend on the severity of their eating disorder symptoms, the mental well-being of the athlete, and their overall physical health.
The highest level of care, medical hospitalization, is for people whose disordered eating behaviors have left them medically and psychologically unstable and are, therefore, at risk of severe health consequences. Emphasis is placed on treating symptoms that pose an immediate threat to someone’s life or well-being.17
Athletes undergoing residential treatment will need to take a break from training, as they will be temporarily living in a facility. People in residential treatment are medically stable but still require constant monitoring due to poor motivation and/or a lack of control over their eating behaviors.
Patients in a partial hospitalization program commute to treatment sessions while living and sleeping at home. But programs are often still vigorous, lasting as long as 10 hours a day, up to 5 days per week or more.17 This means athletes may still be unable to train, as they still require structure and support to engage in treatment, as well as supervision during meals.
Once an athlete has the motivation to engage in and cooperate with treatment fully, they can move on to an intensive outpatient program, or IOP. Support and structure are still provided, but most meals are eaten at home. As they attend the treatment facility just a few days a week for a couple of hours, an athlete may be able to start training again if approved by their treatment team.
The lowest level of care is outpatient, requiring only regular appointments with a therapist or dietitian and occasional check-ins with physicians or psychiatrists. At this level of care, a person should have a good amount of control over their disordered behaviors, and, for athletes, it’s most likely that this is the stage where they can resume training in a healthy way, though the approval of a physician will likely be needed.
Common therapies for athletes with eating disorders
A combination of therapies are used to treat eating disorders. Which ones are implemented will depend on the patient. Common therapies include:2,11
Cognitive behavioral therapy (CBT): CBT is a form of talking therapy that focuses on changing the beliefs and values that fuel disordered eating behaviors. A CBT therapist will also work with an individual to determine the underlying causes of these maladaptive thought processes.
Dialectical behavior therapy (DBT): DBT is a very effective therapy when it comes to changing eating disorder behaviors by focusing on developing skills to replace them in times of emotional distress. These skills include emotional regulation, distress tolerance, and mindfulness.
Acceptance and commitment therapy (ACT): During ACT, an individual learns to identify core values and form a list of goals that meet these values. ACT also encourages patients to accept that anxiety and pain are a normal part of life.
Family therapy: In family therapy, all family members (and coaching staff, in the case of athletes) are considered an essential part of treatment. During family therapy, those close to the athlete learn about the restoration of healthy eating, disrupting compensatory behaviors, and restoring weight, so they can support an individual throughout their treatment.
Nutrition counseling: In nutrition counseling, a person learns the nutritional values of foods and what their diet needs to contain for their body to function effectively and for their overall well-being. This can prove really useful to athletes, learning how much fuel their body requires to maintain their training schedule safely. Meal planning will help ensure they are getting the balanced diet they require.
Medication: Co-occurring disorders, such as obsessive-compulsive disorder, anxiety, and depression, can be treated with medications, such as selective serotonin reuptake inhibitors (SSRIs).
Remote treatment can help
Eating disorder treatment doesn't need to happen in person. At Within, we offer personalized care from the comfort of your own home or wherever you are. Submit vitals remotely, attend therapy sessions from your phone, and have meals delivered right to your door.
Call us today to learn more about our fully remote program.
There are so many benefits to participating in sports. They’re fun and build self-esteem, improve fitness, and foster a good teamwork ethic. However, it can become dangerous for an athlete when the pressures of maintaining a high level of performance combine with an obsessive focus on body image or weight.
The training environment should shift the focus away from weight and onto expanding the entire team’s knowledge of what healthy eating habits and balanced nutrition really entail and how they work to support performance and well-being.
Unfortunately, our fitness-fixated, fatphobic, diet-crazy culture too often leads too many people down the wrong path toward self-destructive patterns and eating disorders, which can have serious, sometimes fatal mental health and medical complications. That’s why it’s critical to know when so-called “healthy” behaviors can spiral into very harmful mental health conditions.
Efforts to prevent eating disorders should not only be aimed at athletes but also at coaches, parents, and administrators of sports programs, so all involved can be aware of the warning signs. Swift intervention and treatment greatly improve the chances of a full recovery and of an athlete successfully returning to the sport they love.
Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.
Disclaimer about weight loss drugs: Within does not endorse the use of any weight loss drug or behavior and seeks to provide education on the insidious nature of diet culture. We understand the complex nature of disordered eating and eating disorders and strongly encourage anyone engaging in these behaviors to reach out for help as soon as possible. No statement should be taken as healthcare advice. All healthcare decisions should be made with your individual healthcare provider.
Giel, K. E., Hermann-Werner, A., Mayer, J., Diehl, K., Schneider, S., Thiel, A., Zipfel, S., & GOAL study group. (2016). Eating disorder pathology in elite adolescent athletes. The International Journal of Eating Disorders, 49(6), 553–562.
Types of Treatment. (2020, November 16). National Eating Disorders Association. Accessed January 2024.
Nickols, R. (2018, April 27). Eating Disorders & Athletes. National Eating Disorders Association. Accessed January 2024.
Why are athletes at a high risk for eating disorders?
Most athletes already have a strong focus on issues like exercise, diet, and physical appearance. But it can become easy for these thoughts to become fixations. Paired with a drive to compete, the issues can become problematic.
What types of athletes are at higher risk for eating disorders?
Anyone can develop an eating disorder, but among athletes, the conditions are generally more prevalent in athletes participating in:5
Endurance sports, like running or swimming
Sports with an emphasis on appearance, like gymnastics or dancing
Individual sports, like diving or figure skating
How can you tell an athlete has an eating disorder?
It can be very difficult to tell the difference between a dedicated athlete and someone struggling with disordered behaviors, especially in a culture that generally pushes the idea of athletic excellence above all else.
In general, someone’s behavior tends to become problematic once it starts disrupting someone’s daily life, routine, or well-being. If someone can’t seem to stop themselves from working out, continue to work out longer than their training requires, fixates on which foods they “can’t” eat, or restricts calories to a significant degree on a regular basis, it may be the sign of a deeper problem.
