Eating Disorders and Athletes

Eating Disorders
Written By Allison Tucker, RD

Happy August! We are back today with another post from Allison Tucker, RD. With the Olympics in full swing, this post is quite timely. Learn the prevalence rate of eating disorders in athletes, what it can look like, and the impact on performance! Take it away, Allison!

Eating Disorders and Athletes

Athletes are not immune from the impact of diet culture. In fact, athletes are 2-3 times more likely to develop an eating disorder compared to non-athletes. Up to 45% of female athletes and 19% of male athletes struggle with disordered eating. Additionally, 84% of female college athletes report having disordered patterns of eating or have engaged in unhealthy weight control practices at one time.

What’s more concerning?

Cases are likely underreported due to the stigma and secrecy surrounding eating disorders.

It’s important to remember that commonality does not equal normality. Eating disorders have serious consequences, especially for athletes, and are unfortunately more common among this population due to a combination of psychological, physical, and sociocultural factors.

Can Any Athlete Develop an Eating Disorder?

Athletes in sports emphasizing appearance, like ballet, gymnastics, cheerleading, and figure skating have a higher prevalence of eating disorders, ranging from 20% to 45%. Additionally, sports that group athletes by weight, like boxing, wrestling, and rowing may lead to heightened body awareness due to frequent measuring, weighing, and monitoring.

However, eating disorders don’t discriminate by sport or body size and shape. It’s not uncommon for athletes to assume, or even be told that a lighter body is a faster body. Let’s say an athlete is in a sport that promotes a lean physique for optimal performance, like cycling, long-distance running, or swimming. This invites opportunities for under-eating and excessive training - both of which may be mistaken for a performance-enhancing strategy.

The Culture

What does it mean to “look like an athlete”?

Society assumes athletes have a specific body type, which doesn’t leave much room for body diversity. Individuals in larger bodies may be discriminated against for their weight, increasing the likelihood of developing an eating disorder. Let’s not forget: more than 90% of individuals struggling with eating disorders are not in visibly emaciated bodies, which means not only are individuals in larger bodies more likely to develop eating disorders, but also less likely to reach out for help or receive treatment. 

Athletes tend to have more muscle mass compared to the general population, sometimes resulting in a higher body weight. Because we still use the same simple formula to label individuals as “normal, overweight, or ob*se”, and because that formula only takes into consideration a person’s height and weight, it is common for athletes to be labeled as overw3!ght or ob*se. While some may be able to rationalize their muscle mass or the naïve simplicity of this formula, this could be a detrimental label to others.

(Allison has an upcoming post covering the BMI - the simple formula she references above.)

Larger-bodied athletes are more susceptible to unsolicited comments about their bodies, along with advice about their diet and exercise habits. This may come from peers, parents, coaches, or trainers. Diet culture affects most of us, and therefore, coaches and trainers are also not immune, meaning some warning signs of disordered eating might even receive praise. Remember: coaches are not the ones putting in the hours of practice and requiring the same fuel, which can sometimes mean is coach making a recommendation that might be appropriate for themselves, but not their athletes.

While coaches and trainers have specific expertise in their field, in most cases, they are not experts on nutrition.

Athletes: The Picture of Health?

Eating disorders tend to take advantage of perfectionism, a trait that is often observed among athletes as well. Athletes typically have a competitive drive and may feel pressure to do their absolute best, all of the time. They’re taught to push their limits and to constantly strive for excellence.

Athletes are encouraged to make sacrifices to prioritize their sport. Some sacrifices may have a positive impact on performance and well-being. For example, taking time to attend physical therapy appointments after practice to rehab an injury, or trading a weekend of going out with friends to prioritize sleep.  Learning discipline and willpower can be helpful to their sport, but if that strict mentality spills over into other areas like food and movement, it could potentially become harmful. Sacrificing plans with friends because you worry about sticking to your meal plan, for example, could be a sign of disordered eating that may also negatively impact social well-being.

Because athletes are looked up to as healthy beings, they may feel pressure to follow a diet that reflects that. However, an obsession with only eating “healthy” foods is the trademark of an eating disorder called orthorexia.

A Unique Challenge: Increased Energy Demands

Let’s pretend none of the sociocultural pressure exists. Fueling yourself without the element of being involved in a sport several months out of the year can be challenging enough. Increased energy demands make getting proper nutrition even more difficult. Have you ever trained for an endurance event, like a half marathon, and realized how much more you needed to eat to support your training? It can feel like a part-time job! 

It may seem like no big deal, but when an athlete is getting even a little bit less than what they need, a decline in performance can be observed within a matter of days.

Intuitive Eating is a framework we focus on at Collaborative Counseling & Nutrition, but it’s important to highlight that simply listening to your body’s cues might not lead to adequate fueling for an athlete. If you or an athlete you know is struggling, the dietitians and therapists at Collaborative Counseling & Nutrition can help!

Impact on Health & Performance

Relative Energy Deficiency in Sport or RED-S refers to a set of conditions in which an athlete isn’t able to consume enough energy (calories) to meet the demands of their training regimen.

When athletes don’t refuel themselves after demanding practices or events, an energy deficit occurs. This means there’s less energy available for the athlete to use. An energy deficit can occur when an athlete is eating too little or training too much. In the short term, performance declines, and injury risk increases (athletes with eating disorders are 8x more likely to be injured in sports).  Over time, other issues could present including decreased training response, gastrointestinal problems, ulcers, decreased coordination, bone and muscle loss, loss of menstrual cycle and fertility issues, and increased risk for depression, anxiety, substance abuse, cardiovascular complications, heart failure, and death.

Another huge issue: It’s more common for an athlete to avoid seeking help, because they fear appearing weak or jeopardizing their career, meaning they may stay stuck in this cycle of overtraining and undereating for far too long.

Moving Forward

Athletes should be able to focus on their sport without the pressure to maintain a specific body size or shape. The combination of intense training regimens, societal pressure to perform and look a certain way, and the discipline it requires to be an athlete may create the perfect storm for disordered eating.  It’s important that coaches, parents, and trainers are aware of the warning signs of eating disorders in athletes and even more imperative that they do not contribute to the problem.

Athletes should be in supportive environments where they feel safe to seek help without fear or judgment. Eating disorders have negative effects on an athlete’s physical, mental, and social well-being and can have long-lasting effects on individuals. Performance should never come at the cost of health. Let’s cultivate an environment where athletes can thrive without sacrificing their relationship with food and their bodies.

If you are an athlete or if you know an athlete who is struggling with their relationship to food or body, the dietitians and therapists at Collaborative Counseling & Nutrition are here to help!

Resources Used:

  • Cabre, H E et al. “Relative Energy Deficiency in Sport (RED-S): Scientific, Clinical, and Practical Implications for the Female Athlete.” Deutsche Zeitschrift fur Sportmedizin vol. 73,7 (2022). Retrieved on July 1, 2024 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9724109/

  • Borowiec, Joanna et al. “Eating disorder risk in adolescent and adult female athletes: the role of body satisfaction, sport type, BMI, level of competition, and training background.” BMC sports science, medicine & rehabilitation vol. 15,1 91. 25 Jul. 2023. Retrieved on June 18, 2024 from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10369723/

Collaborative Counseling & Nutrition is an outpatient nutrition and body image counseling center, with locations in Indianapolis and Carmel, that provides compassionate, holistic eating disorder treatment. Through practicing mindfulness, intuition, and Health At Every Size, we are on a mission to help you find a true state of well-being! We take an anti-diet, weight-inclusive approach with all our clients and work to help guide you towards a way of healthy living designed by you, just for you! This post is for education purposes only and should not be used as a substitute for treatment for an eating disorder. If you are looking for a registered dietitian or therapist to assist you on your recovery journey, please reach out today!

Allison Tucker, RD

Allison is a Registered Dietitian with a Masters in Nutrition. Learn more about Allison by visiting her profile on the team page

Previous

6 Practical Tips for Your Intuitive Eating Journey
Next

5 Ways to Shift Rigid Thinking