Risk Factors For Eating Disorders In Sports

Athletes often face pressure to optimize their sports performance, which can lead to an intense focus on body composition and nutrition. This focus may sometimes result in disordered eating behaviors.

Eating disorders in sports affect athletes across various disciplines and levels of competition, impacting physical health, mental health, and athletic performance. Addressing an eating disorder requires an understanding of the pressures and challenges athletes face and aiming to develop more supportive environments that consider overall health too, not just performance metrics.

Common eating disorders: Anorexia nervosa and bulimia nervosa

The spectrum of eating disorders in sports includes but extends beyond anorexia nervosa. Sports athletes may also be at higher risk of bulimia nervosa, binge eating disorder, other specified feeding or eating disorders (OSFED), and others. These eating disorders can manifest differently in athletic populations, often interacting with performance anxiety and body image concerns specific to their sport.

Eating disorder occurrence among athletes differs according to sport type, competitive intensity, and individual factors, but these conditions can affect athletes of any gender—including female athletes, male athletes, and all others—competing in any sport at any level. That said, athletes involved in aesthetic or weight-sensitive sports may be more susceptible to disordered eating behaviors. These sports, such as gymnastics, figure skating, and bodybuilding, often emphasize leanness and appearance in judging criteria, especially at high levels.

Eating disorders in athletes

Identifying eating disorders in athletes can be particularly challenging, as behaviors associated with these conditions may be mistaken for dedication to training and performance. Bulimia nervosa, characterized by cycles of binge eating followed by compensatory behaviors, can be particularly difficult to detect in athletic settings. 

That said, athletes with eating disorders may exhibit symptoms like:

• Weight fluctuations
• Preoccupation with food and body image
• Avoidance of team meals or social events that involve food
• Exercise beyond scheduled training sessions

Not all athletes with disordered eating behaviors meet the full diagnostic criteria for a specific eating disorder, but they may still experience health complications and reduced performance. For example, relative energy deficiency in sport (RED-S) results from low energy availability due to insufficient nutritional intake. RED-S may lead to hormonal disruptions, reduced bone mass, and weakened immune responses.

Symptoms of anorexia nervosa and bulimia nervosa

Eating disorders can manifest in diverse ways, influenced by the particular condition and its intensity. Athletes with anorexia nervosa often exhibit weight loss, exhaustion, dizziness, and sensitivity to cold. In addition, amenorrhea—a common occurrence in athletes assigned female at birth who have disordered eating behaviors—may also affect bone strength over extended periods. This can lead to an increased likelihood of fractures and is part of the female athlete triad.

Bulimia nervosa may present with less obvious physical signs, as individuals often maintain a weight within their normal range. However, frequent self-induced vomiting typically results in dental decay, acid reflux, and electrolyte imbalances. Cardiac difficulties, gastrointestinal issues, and suppressed immune function may develop with both conditions.

Sports culture and body image

Many sports place emphasis on body shape, size, and composition. This focus can influence body image and attitudes towards weight among athletes. In some disciplines, there's a belief that a specific body type is optimal for performance, which may lead athletes to pursue certain body ideals.

Pressure to maintain a certain weight or body composition can come from various sources within the sports environment, including coaches, teammates, judges, and spectators. Additionally, revealing uniforms in certain sports can increase body consciousness among athletes.

Body image concerns

Athletes in competitive settings are frequently compared to their teammates and athletes on other teams. This environment can affect body image and contribute to a sense of perfectionism, which is common in many sports. Developing strategies to navigate these challenges may help athletes maintain more realistic standards and a stronger sense of self-compassion—which can be important considering that the trait of perfectionism is a risk factor for eating disorders.

Recognizing body diversity and the range of body types that can excel in different sports may help counteract narrow standards. Focusing on performance metrics and skill development rather than appearance may help shift attention away from body-centric thinking.

Food and body weight

The relationship between athletes, food, and body weight is often influenced by performance pressures and sport-specific demands. Many athletes view food primarily as fuel for training and competition, which can affect their relationship with eating. This functional approach to nutrition, while sometimes necessary for peak performance, can contribute to disordered eating patterns if taken to extremes.

Body weight in sports is often viewed as a performance variable. However, this view often fails to consider the physical and psychological aspects determining an individual's typical weight range. Efforts to sustain an unnatural body weight may lead to health concerns and can influence sport performance as well.

Unhealthy behaviors around food and body weight

Identifying potentially dangerous behaviors related to food and body weight is a step that may help prevent the development of eating disorders. Examples of these “red flag” behaviors may include restrictive eating, binge eating, purging, or excessive exercise beyond scheduled training sessions.

Some level of dietary control and regimented exercise is often part of an athlete's routine, which can make it challenging to distinguish between appropriate training practices and potentially harmful behaviors. Regular check-ins with sports nutrition experts and mental health specialists may be a way to frequently assess athletes' attitudes towards food and body image. These professionals can provide guidance on nutrition strategies that support both performance and overall health.

Identifying athletes at risk

Several factors can influence an athlete's likelihood of developing an eating disorder. These may include participation in sports that emphasize leanness or weight categories, personality traits such as perfectionism and high achievement orientation, and environmental factors like coaching styles and team dynamics. 

Early identification of athletes who may be at risk is relevant to prevention and may correlate with reduced long-term effects. Early intervention typically leads to better clinical outcomes, highlighting the importance of recognizing warning signs and implementing preventive measures in athletic environments.

Risk in different sports

The prevalence of eating disorders varies across different sports and disciplines. Aesthetic sports such as gymnastics, figure skating, and diving, which place emphasis on appearance and body shape, may be associated with higher rates of disordered eating. Weight-class sports like wrestling and rowing also present unique considerations, as athletes may engage in rapid weight-loss or weight-gain practices to compete in specific categories.

Endurance sports like long-distance running and cycling can also be associated with eating disorders, particularly when there's an emphasis on maintaining a low body weight for performance advantages. While certain sports may have higher overall rates of eating disorders, athletes in any discipline can be affected.

Open dialogue about eating behaviors

Creating an environment where athletes feel comfortable discussing concerns about eating behaviors and body image may contribute to early identification of and intervention for disordered eating. This approach involves reducing the stigma surrounding mental health challenges and promoting open communication between athletes, coaches, and support staff.

Educational initiatives may also support more transparent conversations. Offering athletes, coaches, and support teams information regarding eating habits, disordered eating symptoms, and the effects of eating disorders may lead to increased understanding in sports environments.

Healthy eating in team settings

Team meals and shared eating experiences provide opportunities to model positive eating behaviors. Creating a food environment that emphasizes nourishment and social connection may help counteract some of the restrictive or disordered eating patterns that can develop in competitive sports settings.

Coaches and team leaders can do their part by avoiding negative comments about weight or eating habits and emphasizing the role of nutrition in supporting performance and overall health. Encouraging athletes to respond to their bodies' hunger and fullness cues rather than adhering to strict dietary rules can help support an intuitive approach to eating.

Integrating mental health in sports eating disorder discussions

Recognizing the connection between mental and physical health is relevant to addressing eating disorders in sports. Integrating mental health professionals into sports medicine teams can help provide a comprehensive approach to athlete care and well-being.

Regular mental health checkups and routine medical checkups may enable early detection of emerging concerns. This approach supports a broader perspective on an athlete's well-being and may allow for coordinated care initiatives when necessary.

Multidisciplinary care for athletes

Athletes who are experiencing or are especially vulnerable to eating disorders will likely benefit from diverse care approaches. Multidisciplinary care may involve collaboration between sports medicine physicians, mental health professionals, nutritionists, and physiologists to address the interplay of physical, psychological, and nutritional factors involved in eating disorders.

Navigating recovery and sport performance

Recovery from an eating disorder while continuing to train and compete as an athlete presents unique challenges. Balancing the nutritional needs for recovery with the physical demands of sport requires careful planning and ongoing support.

Nutritional needs and body image

Addressing nutritional needs during recovery usually involves working with a sports nutritionist specializing in eating disorders. They may be able to help athletes develop meal plans that support both recovery and athletic performance. Note that in some cases, athletes may need to take time off from training or competing in order to recover.

In addition, a licensed therapist can apply cognitive behavioral strategies to address body image concerns and anxiety around food or weight gain. These techniques may help athletes develop a more balanced attitude towards their bodies and eating habits. 

Seeking support

Meeting with a therapist regularly is typically a key part of eating disorder recovery, as this type of condition generally won’t resolve without professional support. For athletes managing an eating disorder, online therapy in particular presents several potential benefits. First, the flexibility in scheduling allows athletes to fit sessions around their rigorous training and competition schedules. Additionally, the affordability of many online therapy options may make it easier for athletes to maintain long-term treatment, which is often necessary for addressing eating disorders.

Empirical evidence generally supports the use of online therapy in addressing eating disorders. Studies suggest that online therapeutic interventions may be as effective as conventional in-person treatment methods in many cases. More specifically, research has documented significant improvements in core eating disorder symptomatology, functional capacity, and associated depressive symptoms among individuals receiving online therapy. Follow-up assessments conducted three months post-treatment revealed that these improvements were sustained over time.