Why Athletes Develop Eating Disorders

Everyday Health
September 2014

Eating disorders occur more frequently in athletes who participate in judged sports than refereed sports.

  • Athletes may be up to three times more likely to develop eating disorders than people who don’t play sports.
  • If you are an athlete at risk for an eating disorder, you need to watch for the warning signs and make sure to eat healthfully.

Competitive sports do wonderful things for participants — they can boost self-esteem, confidence, good health, and a positive outlook. But some sports put the athletes who play them at an increased risk for eating disorders.

A 2004 Norwegian study on the link between athletes and eating disorders concluded they are nearly three times more likely to have an eating disorder than the average person. The study found 14 percent of the 1,620 athletes evaluated had an eating disorder, compared with 5 percent of the general population.

James Greenblatt, MD, chief medical officer and vice president of medical services at Walden Behavioral Care in Waltham, Mass., says those statistics still hold true today.

The two main types of eating disorders in athletes, as well as the general population, are anorexia and bulimia. People with anorexia obsess about food and restrict the calories they eat, which causes them to become underweight. Those with bulimia binge on large amounts of food and then try to purge those calories by making themselves vomit or exercising excessively.

Both types of eating disorders in athletes and non-athletes can be very serious and lead to life-threatening complications.

Sports and Eating Disorders

“Eating disorders occur in all sports, but sports with the greatest risk for eating disorders include those referred to as ‘lean’ sports,” says Ron Thompson, PhD, a consultant psychologist to the Indiana University Athletic Department who specializes in the treatment of eating disorders. Lean sports are sports that have a weight-class requirement or for which a low body weight or lean body is believed to give a competitive advantage. Those include gymnastics, diving, rowing, ballet, running, cycling, jockeying, wrestling, and martial arts.

Eating disorders also tend to develop more in athletes who play judged sports than refereed sports. Thirteen percent of athletes in judged sports have eating disorders compared with 3 percent in refereed sports, according to the National Association of Anorexia Nervosa and Associated Disorders.

The personalities of high-performance athletes contribute as well. “The traits found in those with anorexia are also often found in high-performing athletes,” Dr. Greenblatt says. “These traits include high self-expectations, perfectionism, competiveness, hyperactivity, preoccupation with weight and dieting, and a tendency toward depression.”

A 2014 study published in the Journal of Sports Sciences found eating disorders in athletes predisposed them to depression.

Eating disorders develop in women and men, but women (both athletes and non-athletes) tend to be affected more. “And, in recent years, there has been a disturbing trend toward earlier onset of eating disorders, where disordered eating typically begins during adolescence and becomes more pronounced during the college years,” Greenblatt says. “Depending on the sport, athletes may be most vulnerable earlier in their professional career.”

How to Deal With Eating Disorders in Athletes

If you or a loved one who participates in a sport is at risk for an eating disorder, the first thing to do is watch out for warning signs. “These signs in athletes are similar to warning signs in non-athletes,” Greenblatt says. Potential signs of an eating disorder in an athlete include:

  • Preoccupation with body weight, size and shape
  • Obsessing over calorie intake
  • Over-exercising or training beyond the coach’s recommendations
  • Menstrual irregularity in female athletes
  • Decrease in sport performance

If you notice any of these symptoms in yourself or a loved one, the first thing you should do is seek medical attention. “If a physician suspects an eating disorder in an athlete, he or she may then refer the person to an eating disorder specialist to see if treatment is necessary,” Dr. Thompson says. “In some cases, withholding sports participation can motivate the athlete into treatment.”

The National Eating Disorders Association is a good online resource for athletes and coaches to understand how to prevent, recognize, and treat potential eating disorders.

It is also important to make sure the athlete eats healthfully. “The ideal diet for athletes doesn’t differ much from the diet for non-athletes,” says Nina Eng, RD, chief clinical dietitian at Plainview Hospital in New York. “You should include all food groups, adjusting the amounts you eat depending on your sport, the amount you train and the time you spend in each training session.”

Eng, who has worked with athletes and eating disorder patients, offers the following tips: Eat plenty of complex carbohydrates, like fruit, brown rice, cereal and whole wheat pasta and bread. Make sure to get enough lean protein to support muscle and body tissue repair. Good sources include lean meats, low fat dairy, and beans. Drink lots of water — 2 cups two hours before exercise, and one-half to 1 cup every 15 to 20 minutes during exercise.

When in doubt about what you should be eating, consult an expert.