Sports & Eating Disorders: The Hidden Dangers in Competitive Environments

Sports can have an incredibly positive effect on people’s lives, promoting social connection, self-confidence, and skills in teamwork and leadership. However, athletes also grapple with unique challenges, particularly when it comes to their relationship with food and their bodies. Research has shown that participation in sports can trigger or exacerbate eating disorders in those who are susceptible.

Read on to learn why athletes are at special risk of developing eating disorders, the signs to watch out for, and how these disorders can affect athletic performance.

Eating Disorder Risk Factors for Athletes

Research has demonstrated that athletes are at a higher risk of developing eating disorders than their non-athlete counterparts. Rates of these illnesses among athletes seem to be on the rise as well, ranging from 6–45% in female athletes and 0–19% in male athletes (Glazer, 2008; Sundgot-Borgen & Torstveit, 2004). (It is important to note that there is extremely limited research on transgender athletes and athletes with diagnoses other than anorexia and bulimia.) One study found that eating disorder prevalence is 7% among elite high school students, whereas the prevalence for non-athletes is 2.3%. 

There is no question that athletes have an elevated risk of developing one of these illnesses. What is it about the sporting environment that can send someone down the path of disordered eating?

Overlapping Temperament Traits

Many athletes have personality traits that overlap with the traits common among those susceptible to eating disorders. This overlap of traits can also contribute to athletes’ elevated eating disorder risk. Such traits include: 

• Perfectionism
• High self-expectations
• Competitiveness
• The drive to continually improve performance
• The tenacity to push past discomfort

Highly competitive environment 

Eating disorders thrive on comparison, a fundamental aspect of the sports environment. Sports inherently have winners and losers, and athletes often compare their speed, strength, and skills to their competitors, teammates, or sports idols. Even if an athlete competes in an individualized sport, they likely compare themselves to their own best time or score. This competitive environment can drive athletes to push themselves past their limits in order to “outdo” themselves or their opponents. This drive to “be the best” may result in disordered behaviors like exercising even when sick, only eating foods considered “clean,” or using diuretics to “make up” for food eaten in a well-intentioned but ultimately destructive attempt to stay competitive. 

Pressure to perform

Athletes often face immense pressure to consistently deliver their best performance. Falling short of impossibly high standards can lead to mental health issues including eating disorders, depression, or anxiety. Added pressure from teammates, coaches, and/or parents can also impact an athlete’s mental state, increasing the risk of disordered behaviors such as overexercising, strict calorie counting, and binge eating. These behaviors may be (ineffective) attempts to improve performance and/or as a way to cope with stress. 

If an athlete is rewarded or praised for weight loss, winning, or setting a new record, this pressure to perform can intensify. Unfortunately, this pressure can potentially reinforce, trigger, normalize, or worsen eating disorder thoughts and behaviors, as ill athletes may mistakenly view these behaviors as key to their success.

Heightened attention to body size and shape

While all sports require some level of body awareness and optimization of the body’s performance, certain sports place an overwhelming emphasis on body size and shape. These sports can create immense pressure to have a specific muscle/fat ratio, meet a weight requirement, or fit a stereotypical body ideal. However, fitting a specific “aesthetic” does not mean that an athlete will actually perform better. This pressure to look a certain way can also be an eating disorder risk factor. Sports that tend to focus more on appearance and diet include:

• Gymnastics
• Figure skating
• Bodybuilding
• Dance
• Wrestling
• Swimming and diving
• Running
• Boxing

Signs of Eating Disorders in Athletes

Given the elevated likelihood of athletes experiencing eating disorders, it’s important for coaches, providers, teammates, and parents to know the warning signs. The sooner an eating disorder is identified, the sooner an athlete can get the help they need to begin healing. 

Weight loss is often understood as the biggest indicator of an eating disorder, but eating disorders come in all sizes. In fact, less than six percent of those with eating disorders are medically “underweight” (Flament, Henderson, Buchholz, et al., 2015). Below are some signs that an athlete may be struggling with an eating disorder:

• Decreased concentration, energy, muscle function, coordination, and speed
• Increased injuries
• Compulsive exercise patterns—never skipping a gym day, working out several times a day, or exercising to “make up” for food consumed
• Ritualistic eating (e.g. cutting food into small pieces, eating one food group at a time, choosing to eat alone, etc.) or avoidance of certain foods
• Negative self-talk and self-perception
• Preoccupation with food—their own or others
• Exercising when sick or injured
• Complaints of or reported medical complications, such as menstrual irregularity, dry skin, hair loss, dental problems, consistent fainting, dizziness, bruising, leg cramps, diarrhea, constipation, chest pain, heartburn, and shortness of breath

Checking in with the athlete and addressing any concerns you may have can open the door for a candid conversation. The athlete may not be forthcoming the first time you speak with them; eating disorders are illnesses often hidden in shame and secrecy. Keep communication open so they feel comfortable sharing what’s going on when they’re ready.  

Impact of Eating Disorders on Athletic Performance

As part of their eating disorder, ill athletes may hold on to the misguided belief that engaging in disordered behaviors will enhance their sports performance. For example, some may believe that compulsive exercise will make them stronger or that following extreme food rules will help them maintain a certain weight or body shape. However, the reality is that these and other disordered behaviors harm both health and athletic performance.

All eating disorder diagnoses—including anorexia, ARFID (Avoidant/Restrictive Food Intake Disorder) bulimia, binge eating disorder, and OSFED—have negative physical and psychological consequences. Physical impacts can result in reduced strength and endurance, leaving athletes feeling tired and weak. Everyone requires nourishment to fuel their body, and this need becomes even more essential during demanding physical activity. Disordered eating means the body doesn’t get the nutrients and energy it needs for physical activity, potentially leading to fatigue, dizziness, and even injuries. In fact, one study found that youth athletes with disordered eating are twice as likely to sustain a sports-related injury. 

The psychological impact of eating disorders can also affect sports performance.  Obsessive thoughts about food, weight, and body can impact motivation, self-esteem, and ability to focus during games or performances. 

Recovery is Possible

It is important for sports communities to recognize the dangers of disordered eating and eating disorders and prioritize each athlete’s health over their performance goals. Seeking professional help for an eating disorder is essential for recovery and can ultimately lead to improved physical and psychological well-being, as well as better athletic performance.

If you notice the signs of an eating disorder in an athlete you know, we can help. It is possible to find peace with movement and food. Give us a call at 855-875-5812, or if you prefer we call out to you, reach out via our online form. If you are a provider, you can refer your patient here.