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Eating disorders among athletes

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.
 minute read
Last updated on 
March 1, 2024
Eating disorders among athletes
In this article

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

Eating disorders in athletes
Athletes with a high risk of developing an eating disorder

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.

Runners lined up at a start line for a race

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 

  1. Performance anxiety
  2. Negative self-appraisal of performance
  3. Social influences that promote thinness
Women in a locker room

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
Anorexia nervosa in athletes
Bulimia nervosa in athletes
Binge eating disorder in athletes
Muscle dysmorphia in athletes
Exercise addiction in athletes

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

Woman running across the finish line

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

  1. Menstrual dysfunction or loss of periods
  2. Low energy and extreme fatigue (with or without disordered eating)
  3. 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
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Learn about nutrition

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.

Tips for coaches to prevent eating disorders in athletes

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 goals of eating disorder treatment include:14

  • Addressing, reducing, and preventing disordered eating behaviors
  • Improving emotional identification, expression, and regulation
  • Improving body image
  • Restoring normalized patterns of eating
  • Implementing a balanced diet
  • Restoring an appropriate body weight
  • Resolving co-occurring conditions and team-related stressors

Levels of care for eating disorders

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.

Medical hospitalization
Residential treatment
Partial hospitalization program (PHP)
Intensive outpatient program (IOP)

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.

Get help today

Final thoughts

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.

Further reading for athletes

Further reading for parents and coaches

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.


  1. Eating Disorders: About More Than Food. (n.d.). National Institute of Mental Health. Accessed January 2024. 
  2. Statistics & Research on Eating Disorders. (n.d.). National Eating Disorders Association. Accessed January 2024. 
  3. 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.
  4. Types of Treatment. (2020, November 16). National Eating Disorders Association. Accessed January 2024.
  5. Nickols, R. (2018, April 27). Eating Disorders & Athletes. National Eating Disorders Association. Accessed January 2024.
  6. Currie, A. (2010). Sport and eating disorders - understanding and managing the risks. Asian journal of sports medicine, 1(2), 63–68.
  7. Thompson, R. (n.d.). Mind, Body and Sport: Eating disorders. National Collegiate Athletic Association. Accessed January 2024. 
  8. Freimuth, M., Moniz, S., & Kim, S. R. (2011). Clarifying exercise addiction: differential diagnosis, co-occurring disorders, and phases of addiction. International journal of environmental research and public health, 8(10), 4069–4081.
  9. Di Lodovico, L., Poulnais, S., & Gorwood, P. (2019). Which sports are more at risk of physical exercise addiction: A systematic review. Addictive Behaviors, 93, 257–262. 
  10. Vasiliu, O. (2023). Current trends and perspectives in the exploration of anorexia athletica-clinical challenges and therapeutic considerations. Frontiers in Nutrition, 10, 1214398.
  11. Conviser, J. H., Schlitzer Tierney, A., Nickols, R. (2018). Assessment of Athletes with eating disorders: essentials for best practice. Journal of Clinical Sports Psychology, 12(4), 480-494. 
  12. Joy, E., Kussman, A., Nattiv, A. (2016). 2016 update on eating disorders in athletes: A comprehensive narrative review with a focus on clinical assessment and management. British Journal of Sports Medicine, 50, 154-162. 
  13. El Ghoch, M., Soave, F., Calugi, S., & Dalle Grave, R. (2013). Eating disorders, physical fitness and sport performance: a systematic review. Nutrients, 5(12): 5140–5160.
  14. De Souza, M.J., Nattiv, A., Joy, E., et al. (2014). Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad: 1st International Conference held in San Francisco, California, May 2012 and 2nd International Conference held in Indianapolis, Indiana, May 2013. British Journal of Sports Medicine, 48, 289. 
  15. Coaches and Trainers. (2018, February 22). National Eating Disorders Association.
  16. Conviser, J. H., Schlitzer Tierney, A., Nickols, R. (2018). Essentials for Best Practice: Treatment Approaches for Athletes With Eating Disorders. Journal of Clinical Sport Psychology, 12, 495-507.
  17. Levels of Care. (n.d.). University of California San Diego. 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.

Further reading

Eating disorders among athletes

The sports world—both at the professional and amateur levels—is often accompanied by the pressure to perform.

What is anorexia athletica?

Many people have heard of eating disorders like bulimia nervosa (BN) or anorexia nervosa (AN), but these...

Eating disorder treatment programs for athletes

Many people think of athletes as some of the healthiest individuals, thanks to their regular exercise...

The prevalence of eating disorders among college athletes

There are many benefits to being a college athlete. This group tends to report higher rates of physical...

Further reading

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