The topic of disordered eating and eating disorders in athletes has been gaining increased attention in recent years. While it is something that more of us are aware of now than in the past, what puts athletes at risk for these types of struggles? And how can we recognize problems early on?

*Disclaimer: All information shared in this post is meant for educational and informational purposes only. This should not be taken as individual medical advice.*

Disordered Eating vs. Eating Disorders

The difference between “disordered eating” and clinical-level eating disorders is important to acknowledge.

“Disordered eating“ has been defined in many ways by various publications and thus there is no one exact definition. However, the term typically represents a spectrum of harmful eating behaviors that can vary in nature but stem from either a desire to control weight and body image or as a coping mechanism for other unresolved issues.

An eating disorder refers specifically to a clinical condition that has diagnostic criteria. The American Psychiatric Association’s currently recognizes several eating disorders including Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, Avoidant/Restrictive Food Intake Disorder (ARFID), and Other Specified Feeding or Eating Disorder (OSFED).¹

In short: the term “disordered eating” is a more broad way to capture harmful behaviors, while eating disorders involve a very specific diagnosis.

Signs and Symptoms

Signs of disordered eating can include:

• Eating differently to manipulate your body size
• Starting a specific diet or following a detox/cleanse
• Avoiding situations where you have to eat “unhealthy” food
• Focusing on calories or tracking your intake using an app or calculator
• “Saving calories” in the morning on days where you plan to eat or drink socially
• Cutting out food groups that you used to eat (other than foods you are truly allergic to)
• Adopting a vegetarian or vegan diet “just because” (ask yourself – is there more to this?)

Signs and symptoms of an eating disorder may include:

• Skipping meals or snacks frequently
• Difficulty concentrating or “brain fog”
• Extreme focus on weight or caloric intake
• Withdrawal from friends or social activities
• Extreme preoccupation with body size or shape
• Compensating for food eating with exercise or purging
• Trying to avoid eating when hungry using a variety of tactics
• Physical problems including:
  • Menstrual irregularities
  • New stomach/GI issues
  • Dizziness upon standing
  • Frequent injuries
  • Sleep problems

While none of these signs and symptom alone are cause to sound the alarms, if you or someone you love have begun exhibiting several of these behaviors, it is cause for concern.

Prevalence in Athletes

The research around prevalence of disordered eating and eating disorders in athletes is pretty variable. The National Eating Disorders Association has an entire portion of their website dedicated to athletes and eating disorders, due to the unique risk factors in this population. Included below are some statistics from NEDA.

In aesthetic and weight-class specific sports it is estimated that disordered eating affects 62% of female and 33% of male athletes. Athletes at the collegiate level have been found to have an elevated risk of developing anorexia and bulimia. Additionally, one study about high school athletes in aesthetic sports found that 42% of athletes reported disordered eating behaviors and those who reported these behaviors were 8 times more likely to become injured than athletes without disordered eating behaviors.

– National Eating Disorders Association²

Risk Factors in Athletes

The risk factors for developing an eating disorder range widely, and some are not related to athletics. However, for athletes some factors to consider include:

• Family history of eating disorders: Eating disorders do have a genetic component
• History of trauma: Such as physical or sexual abuse
• History of dieting: Especially if the first experience with dieting occurs at a very young age
• Dysfunctional family environment: For athletes specifically, a dynamic that emphasizes parents being expectant of their child’s success in athletics can be harmful
• Participation in:
  • Sports that emphasizes aesthetics or weight: Gymnastics, figure-skating, wrestling, dance, diving, equestrian, etc.
  • Endurance sports: Running, cycling, swimming, etc.
  • Individual sports as opposed to team sports
• Being exposed to a team culture where weight is believed to be a critical factor in performance: This belief may come from coaches, teammates, or other sport professionals
• Early sport specialization and elite-level athlete status

Why Disordered Eating Often Goes Unchallenged in Athletes

In my years as a sports dietitian, I have seen a wide range of disordered eating behaviors. I have also seen an incredible number of different reasons why athletes either (1) did not feel comfortable getting help or (2) were unable to recognize they even had a problem. The athletic culture is a unique place and, in my professional opinion, is a breeding ground for disordered eating.

Reason #1: Weight and Bodies are Frequently Discussed

Whether it’s team weigh-ins, regular body composition measurements or casual discussions about body size with teammates, weight is a frequent topic of conversation in athletic circles. Many coaches and other sport professionals place a great deal of emphasis on weight as an indicator of performance. When an athlete’s body goes through a period of change or for those who simply aren’t “built” like their teammates, this focus on weight and body size can cause them shame or worry.

McCallum Place is an eating disorder treatment facility that has an athlete-specific program, The Victory Program, housed in St. Louis, MO. The graphic below is an educational piece from the Victory Program that showcases numerous factors that impact performance other than weight.

Reason #2: Healthy Eating is Highlighted and Praised

“Healthy” eating looks different for everyone. There is no one “right way” to eat – for more on this, check out our Fueled & Well Nutrition Philosophy. However, because nutrition is known to impact athletic performance, athletes who are perceived to be eating “healthier” are often praised.

Coaches or other sport professionals may highlight athletes who are cutting out certain food groups, avoiding fast food, or “watching what they eat” in an effort to encourage their teammates to pay more attention to nutrition. Unfortunately, this can backfire in several ways. If an athlete with disordered eating behaviors is praised, that can enable and reinforce their disordered thoughts. This type of praise may also bring up feelings of shame or guilt for athletes who do not eat like their “healthier” teammates.

Reason #3: The Identity of “Being an Athlete” Changes

Many athletes have seen themselves as athletes from a very young age. As such, it is common for their identity to be, at least in part, tied to their status as an athlete. When that status is jeopardized or changes, some athletes shift their focus onto controlling something else: food.

Athletes who are “benched,” or injured are very often faced with feelings of desperation: they feel as though sacrificing anything is worth getting back on that field or court. That mentality, combined with the fear of not performing as well when they return, can cause athletes to try manipulating their food or weight. If individuals close to the athlete do not notice and take action, these thoughts can develop into disordered behaviors.

What Can Be Done?

This is a complex problem that requires awareness and change from many directions. It is important for coaches, athletic trainers, and team physicians to be able to spot the early signs of disordered eating in athletes. These professionals must also help create a sport culture that does not emphasize or value weight. To learn more, check out NEDA’s toolkit for coaches and athletic trainers.

Athletes who appear to be struggling with body image or harmful eating behaviors should be referred to a sports dietitian as soon as possible. Recovery has a much better prognosis when intervention begins early.

If you find yourself struggling with disordered eating thoughts or suspect you may have an eating disorder, I work with athletes with these concerns on a daily basis. Please consider sending me an email so that we can talk about how I may be able to support you.

Be well,

References
1. https://www.mccallumplace.com/admissions/dsm-5-diagnostic-criteria/
2. https://www.nationaleatingdisorders.org/athletes-eating-disorders
3. Greenleaf, C., Petrie, T. A., Carter, J., & Reel, J. J. (2009). Female Collegiate Athletes: Prevalence of Eating Disorders and Disordered Eating Behaviors. Journal of American College Health, 57(5), 489-496. doi:10.3200/jach.57.5.489-496