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There are many benefits to being a college athlete. This group tends to report higher rates of physical, social, and community well-being than students who are non-athletes, both during and after college.1
However, stressors associated with the competitive atmosphere of sports, including the pressure to perform or maintain a particular body shape or weight, can increase the risk of developing eating disorders, maladaptive eating habits, and other harmful behaviors.
While it's impossible to know how many college athletes have an eating disorder, it's thought that this group can be at an exceptionally high risk.2 Learning about eating disorder dangers, signs, and symptoms in college athletes can help ensure people get the necessary treatment.
How common are eating disorders in college athletes?
Studies tend to use various definitions for "eating disorders" or "disordered eating behavior," which is just one reason why it's challenging to know exactly how many college athletes have eating disorders. But looking at the research as a whole can start to paint a picture. Generally, the group seems to be especially vulnerable to these conditions.
Up to 84% of college athletes have engaged in disordered patterns of eating or weight control behaviors.
By some measures, up to 84% of college athletes have engaged in disordered patterns of eating or weight control behaviors, such as:2
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 in college athletes falls between 1.1% and 49.2%, with one study determining that nearly 31% of all college athletes reported:2
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. College coaches, athletic trainers, and other members of an athlete’s support system need to be aware of the risk, as well as the signs of an eating disorder so that they can get student-athletes the support or eating disorder treatment they need.
Athletes and eating disorders: Risk factors
Athletes, as a whole, tend to experience pressure and stress associated with their performance, including high expectations and constant evaluation. But these thoughts can carry over into other areas of their life, including their body image, diet, and workout routine.
The risk factor for eating disorders in college athletes—including both male athletes and female athletes—may be particularly high for specific sports, including those that emphasize appearance, endurance, or weight requirements.
Specifically, the risks may be higher for those participating in:2,3,4
Gymnastics
Swimming
Diving
Cross-country
Wrestling
Rowing
Figure skating
Research also indicates that individual sports pose a higher risk than team sports. Other risk factors for athletes and eating disorders 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 from 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
Athletes and eating disorders: Impact on athletic performance
Ironically, even as many student-athletes work toward specific body shapes or weights, believing they will enhance their performance, the disordered eating behaviors used to achieve those shapes and weights can negatively affect their athletic abilities.2
Specifically, disordered eating behaviors can bring on: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 can indirectly impair their athletic performance. For example, college athletes with eating disorders may experience irritability, mood swings, sleep disturbances, social isolation, impaired concentration, and apathy, all of which can compromise sports performance.2
Though excessive and compulsive exercise is often found in patients with eating disorders from all walks of life, it is widespread 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 someone's daily life and functioning, occurs at inappropriate times, or continues despite medical issues or injury.5
However, excessive exercise is one of the most difficult-to-detect symptoms of eating disorders in college athletes, as this group often participates in a rigorous workout schedule connected to their training. Many also adopt philosophies like “no pain, no gain” to help power them through challenging workouts bordering on excessive behavior.
The female athlete triad
When it comes to athletes and eating disorders, female college athletes have some additional concerns. 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 sports involvement
Frequent weigh-ins
Participating in figure skating, ballet, distance running, diving, swimming, or gymnastics
Finding help for eating disorders in college 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 non-judgmentally and compassionately while validating their student-athletes' struggles and experiences.
It’s also essential 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 validate them as a person entirely separate from athletics.
With the proper support system or treatment, student-athletes can live healthy, active lives with the appropriate support system or treatment. 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 remote 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.
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.
How many college athletes have an eating disorder?
It's difficult, if not impossible, to calculate how many college athletes have an eating disorder. Studies use various definitions for eating disorders or disordered eating behaviors, and even if all studies were uniform and perfectly conducted, there will always be people struggling who don't speak up about their experiences.
Still, the research indicates that, overall, a large portion of college athletes struggle with eating disorders. One study in particular found a rate of eating disorders in college athletes as high as 49.2%, with others reporting lower, but still concerning, results.2
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