The prevalence of eating disorders among college athletes

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Participation in sports is often glamorized and thought of as being associated with plenty of benefits for student-athletes, but that is not always the case.

It can be true that both during college and after graduation, excelling at athletics may contribute to everything from self-confidence to fostering team-building and communication skills. College athletes also tend to report higher rates of physical, social, and community well-being than students who are non-athletes. (1) However, stressors associated with the competitive environment, such as the pressure to perform or maintain a certain body weight, can increase the risk of developing eating disorders, maladaptive eating habits, and other harmful consequences.

Further, student-athletes have very little free time or time to rest, often having to miss classes and other aspects of social life on campus, and lose autonomy over their own academic and personal schedules. Athletes participating in certain aesthetic or weight-dependent sports like wrestling, gymnastics, and track may be particularly vulnerable to disordered eating.

Last updated on 
November 26, 2021
In this article

How common are eating disorders in college athletes?

The rate of eating disorders among college athletes varies considerably from study to study. Some research has shown that up to 84% of college athletes have engaged in disordered patterns of eating or weight control behaviors, such as: (2)

  • Strict dieting
  • Fasting
  • Binge eating
  • Excessive exercise
  • Self-induced vomiting
  • Using weight loss supplements

However, engaging in unhealthy eating behaviors doesn’t necessarily indicate an eating disorder. Many student-athletes exhibit subclinical symptoms, which means their disordered eating behaviors aren’t severe enough to meet the full diagnostic criteria for an eating disorder, such as exercise addiction or orthorexia nervosa. That, of course, doesn’t mean that these symptoms aren’t extremely distressing as the symptoms are still likely to contribute to mental and physical health problems, as well as poor academic and athletic performance. 

Additional studies have found that the rate of eating disorders among collegiate athletes falls between 1.1% and 49.2%, with one study determining that nearly 31% of all college athletes reported: (2)

  • Bulimic tendencies
  • Weight preoccupation
  • Body dissatisfaction

Unfortunately, due to the pressure many student-athletes are under, these maladaptive eating behaviors and eating disorder symptoms may be normalized and possibly even encouraged. It’s essential for college coaches, athletic trainers, and other members of an athlete’s support system to be aware of the risk, as well as the signs of an eating disorder, so they can get student-athletes the support they need.

Which athletes are at risk of developing an eating disorder?

All college athletes, regardless of sport, feel the unique pressure and stress associated with performance, perfectionism, expectations, and constant evaluation, that can lead to disordered eating. However, some sports may carry a higher risk than others.

Athletes participating in sports that emphasize appearance, endurance, or weight requirements may have an increased risk of developing an eating disorder than athletes who play other sports. 

Examples of high-risk sports include: (2,3,4)

  • Gymnastics
  • Swimming
  • Diving
  • Cross-country
  • Wrestling
  • Rowing
  • Figure skating

It also appears that these individual sports put athletes at a higher risk than team sports, such as soccer or basketball. Other risk factors for eating disorders among college athletes include: (4)

  • A sense that the player may have friends, family, or loved ones who are over-invested in the player’s athletic performance. 
  • A family history of eating disorders
  • Sexual or physical abuse 
  • A belief that a reduced body weight will improve athletic performance
  • Training for a sport since a young age
  • Coaches who overemphasize the importance of success or even worse make comments about players weight or directives to lose weight 
  • Struggles with self-esteem
  • Establishing an identity based primarily or excessively on participation in sports
  • Performance anxiety

Effects of eating disorders on athletic performance

Due to the misguided idea that weighing less is “better” or “healthier” many student-athletes believe leanness will enhance their performance, however, the opposite is true—disordered eating can negatively affect their athletic abilities, as well as many other aspects of a person’s life and health. (2)

Here are some ways that disordered eating can harm athletic performance: (2,5)

  • Impaired muscular fitness and flexibility
  • Electrolyte imbalances
  • Dehydration and muscle cramps
  • A lack of estrogen production in female athletes
  • Musculoskeletal injuries
  • Decreased motivation to train or compete due to coexisting depression or anxiety
  • Reduced muscle strength
  • Decreased aerobic performance
  • Premature fatigue

Several other consequences of disordered eating affect an athlete’s mental and social health, which indirectly impair athletic performance. For example, athletes with eating disorders may experience irritability, mood swings which can include depression, severe anxiety sleep disturbances, social isolation, impaired concentration, and apathy, all of which can compromise sport performance. (2)

Excessive and compulsive exercising in athletes

Though excessive and compulsive exercise is often found in patients with eating disorders from all walks of life, it is particularly common in athletes.

Exercise becomes compulsive when someone:

  • Feels compelled to exercise
  • Prioritizes exercise over important activities or hobbies
  • Feels extreme anxiety or guilt when they don’t exercise

Meanwhile, exercise can be defined as excessive when it interferes with an athlete’s daily life and functioning, occurs at inappropriate times, or continues despite medical issues or injury. (5)

Excessive exercising may be difficult to detect in student-athletes, especially because of the highly competitive environment associated with collegiate sports and the pressure to continually push their athletic abilities.

Further, athletes are indoctrinated with a “no pain no gain” mentality and may feel it is unacceptable or weak to rest or let their team and/or coaches down, by tending to the needs of their own body. 

College athletes who engage in compulsive exercising may train several times per day, beyond their scheduled practices and workout sessions, and in some settings, this may even be encouraged or viewed as necessary to win or achieve greatness. Over-exercising may only become detectable once a student-athlete’s athletic performance begins to deteriorate or they lose a noticeable amount of weight. (5)

The female athlete triad

The female athlete triad is a syndrome comprised of three conditions, including: (6)

  • Disordered eating
  • Osteoporosis
  • Amenorrhea (the absence of menstruation)

Note that “the female triad” is an outdated term, as the more inclusive terminology refers to those who were assigned female at birth, which includes nonbinary and trans athletes who still menstruate. 

Disordered eating behaviors, such as restrictive eating, excessive and compulsive exercising, and purging can lead to poor nutrition, which can cause menstruating athletes to miss several consecutive periods. The absence of menstruation can cause significant bone and calcium loss, increasing the risk of stress fractures. All three of these conditions are dangerous on their own, but together, they are even more concerning. (4,6)

Risk factors for this syndrome include: (6)

  • Poor self-image
  • Pressure to win no matter what
  • Overly controlling parent or coach
  • Social isolation caused by sport involvement
  • Frequent weigh-ins
  • Participating in figure skating, ballet, distance running, diving, swimming, or gymnastics

Eating disorder support for student-athletes

Although professional treatment is necessary to help student-athletes recover from eating disorders, there are some things that coaches can do to reduce the risk of their student-athletes developing eating disorders in the first place. These include:

  • Educating their student-athletes on the risk of eating disorders
  • Providing student-athletes with on-campus resources for counselors
  • Using a person-centered coaching style as opposed to a performance-focused coaching style
  • Employing a nutritional counselor who has experience working with college athletes
  • Encouraging a healthy attitude toward diverse bodies
  • Emphasizing factors that contribute to athletic success, such as enthusiasm, motivation, and enjoyment
  • Keep an open-door policy in which student-athletes feel comfortable coming to their coach to discuss their athletic stressors 

Coaches of student-athletes should have the appropriate resources on hand should any of their athletes approach them with concerns. They should listen with a nonjudgmental and compassionate attitude while validating their student-athlete’s struggles and experiences.

It’s also very important that the coach expresses how much they value their student-athlete beyond how they perform in their sport—this can reduce pressure to return to their sport prematurely and validates them as a person that is entirely separate from athletics.

With the proper support system, or treatment, student-athletes can live healthy, active lives. If you know a student-athlete who needs help with disordered eating, or are a student-athlete concerned with your own eating patterns, Within Health is here to help. Our virtual treatment and care is revolutionizing the way eating disorders are thought about, approached, and treated. Contact our clinical care team today to learn about the first steps in our inclusive treatment modalities for student-athletes.

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.

Resources

  1. Gallup. (2020). A Study of NCAA Student-Athletes: Undergraduate Experiences and Post-College Outcomes.
  2. Power, K., Kovacs, S., Butcher-Poffley, L., Wu, Jingwei, and Sarwer, D. (n.d.). Disordered Eating and Compulsive Exercise in College Athletes: Applications for Sport and Research. The Sport Journal 22
  3. Mancine, R.P., Gusfa, D.W., Moshrefi, A. et al. (2020). Prevalence of disordered eating in athletes categorized by emphasis on leanness and activity type – a systematic review. Journal of Eating Disorders 8(47). 
  4. National Eating Disorder Association. (n.d.). Eating Disorders & Athletes.
  5. 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. 
  6. Hobart, J.A., and Smucker, D.R. (2000). The Female Athlete Triad. American Family Physician 61(11), 3,357-3,364.

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