Athletes and eating disorders

Playing sports teaches valuable lessons in teamwork, perseverance, goal-setting and hard work. But a desire to be the best can also lead some athletes to develop unhealthy behaviors, including unstable dieting habits and eating disorders.

"Athletes can be at risk of developing eating disorders when they believe that their success in sports is tied to their size or shape," says Kimberly Williams, LCSW, Behavioral Health Care Manager with Children's Health℠ Andrews Institute for Orthopaedics & Sports Medicine. "They might start with simple calorie counting, which turns into dieting, which can lead to extreme unhealthy eating behaviors that need professional help."

While these athletes may think that losing weight will improve their athletic performance, an eating disorder can have serious, negative effects on their health and their career as an athlete. Learn which athletes are at highest risk for eating disorders and ways you can help encourage a healthy relationship with food.

What are the most common eating disorders in athletes?

The most common eating disorders in athletes are anorexia nervosa and bulimia nervosa. Athletes with anorexia typically eat very little and severely limit the types of food they eat. Athletes with bulimia tend to eat large amounts of food at once (called binge eating) and then do something to avoid weight gain, such as vomiting (purging).

Athletes may also be prone to orthorexia nervosa, which is when they are so focused on eating "clean" or healthy foods, that they feel serious anxiety or stress about mealtimes. This obsession with clean eating often contributes to existing eating disorders.

What are the effects of eating disorders in athletes?

The effects of eating disorders in athletes can vary, depending on the severity and type of eating disorder.

Common health issues related to eating disorders include:

• Impaired cardiovascular function, which may show up as a reduced heart rate or low blood pressure
• Gastrointestinal problems such as bloating, nausea, slowed digestion, constipation, bacterial infections and intestinal obstructions
• Changes in mood, including risk of heightened anxiety or depression
• Decreased energy or trouble focusing, fainting or dizziness
• Hormonal complications, including changes in or loss of menstrual cycles in females, reduced resting metabolic rates, insulin resistance and high cholesterol
• Bone density loss
• Dental problems
• Hair loss
• Decreased organ function (in severe cases)

Athletes with eating disorders can also experience sports performance effects, such as a loss of strength or power, increased risk of injuries (such as stress fractures), cramping, poor muscle recovery and delayed reaction times

"Athletes with eating disorders often say they believed that their athletic performance would improve by restricting food, purging or overexercising. But often, it is the opposite," says Andrew McGarrahan, Ph.D., a pediatric psychologist at Children's Health. "Typically, athletic performance decreases as an eating disorder gains strength. Athletes may have to leave their sport or seek medical attention due to issues and injuries connected to lack of nourishment."

Why do athletes develop eating disorders?

Athletes spend many hours in training and practice, which can lead them to become hyper-aware of how their bodies look and perform. Many athletes also tend to have perfectionistic, highly competitive tendencies, which help drive them to perform at a high level. But this striving for perfection can also drive the development of eating disorders.

"Athletes often compare themselves to teammates or competitors, and in doing so, they can get sucked into believing that they aren't winning because they aren't as lean or as skinny as others within their sport," says Williams.

Athletes may be at higher risk for developing an eating disorder if:

• Someone in their family has had an eating disorder.
• They have a mental health disorder, such as depression, anxiety or obsessive-compulsive disorder (OCD).
• They believe their weight is a determining factor of being successful in their sport.
• They have previously struggled with low self-esteem or lack of self-confidence.
• They have a coach who emphasizes winning rather than the well-being of an athlete.

Which athletes are at highest risk for eating disorders?

While athletes in any sport can develop eating disorders, athletes who participate in swimming and diving, gymnastics, running, competitive dance, wrestling and body building are at increased risk. Eating disorders are more common in female athletes, but male athletes can also develop eating disorders, especially those in wrestling, body building, rowing and running.

What are signs of eating disorders in athletes?

Signs of eating disorders in athletes can include:

• Significant weight loss
• Sudden restriction in caloric intake or an omission of entire food groups
• Changes in mood or behavior
• Obsessive or irrational thinking about eating or exercising
• Loss of energy
• Skipping social opportunities that involve eating
• Over-exercising
• Use of laxatives or other purging behaviors

Parents, coaches and teammates should watch for any of these warning signs, as acting quickly can help prevent serious health effects.

How can I help prevent eating disorders in athletes?

Be careful about how you speak about food, dieting and body image in front of young athletes. When parents or coaches place an over-emphasis on dieting or attaining a certain goal weight or body shape, it can negatively impact how young athletes perceive themselves and their bodies.

Weight is often seen as a significant factor in an athlete's performance, when in reality it is only a small piece of the performance puzzle. Coaches, trainers and other support staff should avoid suggesting diets, weight cutting or other weight-loss techniques with athletes. Instead, they should refer athletes to a sports dietitian if there are any concerns about an athlete's diet.

Encourage athletes to think of food as the "fuel" that propels their athletic power. Teach them to eat a well-balanced, healthy diet, but encourage flexibility.

By adopting a weight-neutral approach to performance – including avoiding body shaming and, on the other hand, not praising an athlete's weight-loss – coaches, trainers and parents can help athletes realize their athletic skill is not dependent on achieving a certain body size.

While this notion may seem counter to the current culture in sport, a shift has to be made if we expect athletes to begin facilitating healthier relationships with food and their bodies.

What should I do if I think an athlete might have an eating disorder?

If you are concerned that an athlete has an eating disorder, encourage them to seek professional help. Without treatment, eating disorders can lead to severe illness and even death.

Recovery is possible with careful intervention by specialists trained to treat eating disorders, including physicians, therapists, nurses, psychologists and dietitians. The most successful treatments include psychological and nutritional counseling and providing family-centered treatment and support, with medical monitoring of a patient's overall health.

The Center for Pediatric Eating Disorders at Children's Health can help young athletes get on a healthier nutritional path. Additionally, the National Eating Disorders Association (NEDA) offers local support groups, online forums and other assistance for people recovering from an eating disorder.

Learn more

Find out more about our services for children and teens with eating disorders.