These days, when someone mentions the benefits of sports or athletics, the conversation almost always hits the same few points: of course, athletics are good for physical health, but the benefits for social, mental, and emotional wellness bring the benefits of athletics to the next level. And while there’s plenty of anecdotal truth (and scientific data) to back up these claims, they don’t account for the entire intersection of mental health and athletics. Here, we take a closer look at the intersection of athletics and eating disorders. Athletes are often at a higher risk of eating disorders compared to the general population. We will take a look at some of the factors that may contribute to this trend, note some of the risks that athletes with eating disorders face, and emphasize the importance of finding support.

Eating Disorders Disproportionately Affect Athletes

Eating disorders (ED) are complex mental health conditions that impact both mental and physical health. These disorders can impact one’s relationship with food, eating, exercise, and/or their body. We’ll touch more on this in a later section, but eating disorders develop due to a multifaceted combination of genetic, environmental, temperamental, and socioemotional conditions. The current culture of athletics poses a risk of exacerbating the intensity of these factors. As a result, eating disorders affect athletes at a disproportionate rate.

For example,

• Approximately 13.5% of athletes grapple with eating disorders
• Up to 45% of female athletes suffer from an eating disorder, compared to an average of 8.4% of women in the general population.
• Up to 19% of male athletes have EDs, compared to an average of 2.2% of men in the general population.

This binary reporting also doesn’t account for the increased risk that transgender and non-binary individuals have for developing an eating disorder (a study found that 18% of trans individuals suffer from an ED diagnosis). While there haven’t been studies done on the rates of eating disorders in transgender athletes, this piece on trans athletes in the Current Sports Medicine Reports notes the higher rates of EDs in the trans community.

When reading any statistics about eating disorders, it’s important to recognize that they are often underreported. Many of the studies cited here used self-reporting methods to assess the prevalence of EDs among athletes. Along with the complex factors affecting the development of these disorders, EDs have been highly stigmatized. Because of this added shame, it can add an additional challenge to effectively assess the impact that eating disorders have on athletes, or the population in general. 

Types of Eating Disorders

The five more-commonly recognized eating disorder diagnoses include Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder (BED), Avoidant/Restrictive Food Intake Disorder (ARFID), and Other Specified Feeding and Eating Disorders (OSFED). Though body weight is historically used as a diagnostic criterion for EDs, people may struggle with disordered eating or an eating disorder at any weight or size. Here, we provide an overview of the diagnoses that can affect athletes and mention a couple of sub-diagnoses that may show up in the sports arena.

1. Anorexia Nervosa: Anorexia nervosa is a disorder characterized by an intense fear of gaining weight, a preoccupation with body image, and restriction of food/caloric intake. 
2. Bulimia Nervosa: Bulimia nervosa is characterized by a cycle of binge eating followed by purging behaviors, such as self-induced vomiting, laxatives, or excessive exercise. 
3. Binge Eating Disorder (BED): Characterized by episodic overeating within a short time frame without any compensatory behaviors, BED is the most common eating disorder among U.S. adults. 
4. Other Specified Feeding or Eating Disorder (OSFED): These disorders include abnormal thoughts and behaviors related to food, eating, and a person’s body image, but do not fully meet the criteria for other diagnoses. However, this does not mean that these disorders are any less harmful for the people who experience them
   

Additionally, Orthorexia Nervosa and Anorexia Athletica (also known as hypergymnasia) are two disordered eating conditions that may show up in athletes. While not officially recognized as a clinical diagnosis, orthorexia nervosa involves an obsessive fixation on “healthy” or “clean” eating to the detriment of overall well-being. Hypergymnasia, or Anorexia Athletica, is characterized by an unhealthy and compulsive relationship with physical activity.

Increased Pressure on the Body’s Performance

Why do eating disorders disproportionately affect athletes? These complex, biopsychosocial conditions affect an individual’s relationship with food, body image, and exercise, and often coexist alongside other mental illnesses, like anxiety and depression. While sports and athletics themselves may not be direct catalysts for eating disorders, they can escalate the risk. 

This starts in society at large. Diet culture upholds the “thin ideal,” propagating the myth that smaller bodies equate to better health or superior performance. Within the realm of sports, this ideal gains even more fervor. Athletes endure heightened scrutiny of their bodies, especially in fiercely competitive arenas. Additionally, though eating disorders can infiltrate any sporting discipline, sports with a heightened focus on aesthetics (like gymnastics or figure skating) or weight classifications (like wrestling) harbor an elevated risk. This relentless pursuit of excellence places immense strain on athletes’ relationships with their bodies, paving the way for disordered eating and eating disorders. Next, we’ll take a look at some of the factors that contribute to the higher prevalence of eating disorders among athletes.

Risk Factors Impacting the Prevalence of Eating Disorders in Athletes

This list is far from comprehensive, as the factors contributing to the development of eating disorders can include everything from genetics to societal pressures. However, these four factors commonly show up in athletic spaces and may contribute to the prevalence of eating disorders in athletes.

1. The Thinness Performance Fallacy: This is the “thin ideal” wearing a jersey. It’s the belief that a leaner physique correlates with enhanced athletic performance. Whether it’s the pursuit of a lower weight class or the quest for a more streamlined figure, this fallacy perpetuates the cycle of body scrutiny among athletes.
2. Coach and Authority Figures’ Influence: Coaches and authority figures within the athletic sphere wield considerable power over athletes’ trajectories. When success is narrowly defined by performance metrics without consideration for holistic health, athletes may resort to extreme measures to meet unrealistic expectations.
3. Abuse and Neglect: Instances of emotional, physical, or sexual abuse within sports environments can exacerbate vulnerability to eating disorders. Traumatic experiences coupled with the intense pressure to perform can trigger maladaptive coping mechanisms.
4. Underlying Self-Esteem Issues: Low self-esteem, often exacerbated by societal pressures and perfectionism, is a risk factor for someone developing an eating disorder. 

Long-Term Effects of Eating Disorders on Athletes

With the second highest mortality rate among all mental illnesses, eating disorders take a devastating toll on both the mind and body. The intensity of an athletic lifestyle means that the consequences of eating disorders may not only disrupt one’s athletic career, but can also cause long-term health issues.

Decreased Sport Performance 

Chronic malnutrition and dehydration wreak havoc on the body’s ability to sustain peak performance, often leading to fatigue, weakness, and diminished athletic capacity. The resulting low energy availability means that athletes with eating disorders may experience a decline in aerobic functioning, along with a decreased responsiveness to training. Additionally, because insufficient nutrition compromises bone mineral density, athletes suffering from EDs have an increased risk of athletic injuries due to the effects on their musculoskeletal system

Overall Health Risks

Along with affecting body systems that are explicitly tied to athletic performance, the effects of EDs can be life-threatening.

• Reproductive Health: Reproductive systems are impacted by disruptions to the hormonal balance potentially affecting fertility.  
• Cardiovascular Health: Electrolyte imbalances due to disordered eating behaviors can increase the risk of heart failure and other cardiovascular functioning.
• Gastrointestinal Tract: The stress on the GI tract can lead to complications with nutrient absorption along with more severe digestive issues.

To learn more about the effects of eating disorders, check out our in-depth blog here.  

The Importance of Finding Treatment

Some athletes may walk a fine line between optimal performance and potentially harmful habits when it comes to their relationship with food and exercise. While heightened awareness of nutrition and training regimens is often important for athletic success, it can also obscure the warning signs of eating disorders.

Eating disorders are often overlooked, or even subliminally encouraged, among athletes. Part of the problem is the signs of eating disorders can be glorified as signs of “effective training”. Obsessing over “healthy” eating or training long hours may be considered “normal” behaviors for an athlete. This can contribute to the unfortunate reality that many athletes may suffer for a long time before their eating disorder is recognized, diagnosed, and treated.

Additionally, getting treatment can be tricky for athletes. They face an additional barrier of not wanting to sacrifice time away from their sport. But, in the long-term, pursuing treatment can allow them to continue their athletic endeavors safely.

Recognizing the differences between athletic dedication and disordered eating is critical for athletes and their supportive communities. The Alliance offers a range of resources to aid in identifying the signs and symptoms of eating disorders. If you or someone you know is struggling with eating disorders or disordered eating, please call The Alliance’s therapist-staffed helpline to connect with healthcare providers in your area who can support you or your loved one on the road to recovery.