Frequency of Eating Disorders in Athletes

Eating disorders are complex mental health conditions that greatly affect the athletic community. In fact, 1 in 4 student athletes are said to have eating disorders such as anorexia nervosa and bulimia nervosa. From frequent injuries to anxiety, eating disorder behaviors create serious physical, psychological and medical consequences. It is very important not to ignore the red flags you may see in yourself or a loved one. Supportive treatment options can lead to a full and effective recovery for athletes and continuation in their chosen sport.

There are three types of sports that are more susceptible to eating disorders: aesthetic, endurance and weight class.

  • Aesthetic sports are focused on the look of the athlete and the shapes they create. These include dance, figure skating, synchronized swimming and diving, cheerleading and gymnastics.
  • Endurance sports are focused on prolonged exertion and cardiovascular endurance such as running, swimming, cycling, rowing and women’s beach volleyball.
  • Weight-class sports are divisions that match competitors against athletes of their size. These sports can include boxing, wrestling, mixed martial arts and bodybuilding. Football is also broken down by size and team position, which can also be classified as a weight-class sport.

Demographics Most Affected by Eating Disorders in Athletics

Athletes of every age, gender, class, ethnicity and sexual orientation can suffer from eating disorders. High school and college division sports, as well as worldwide competitions like the Olympics, are the most affected demographics. Adolescents competing in elite sports categories are more likely to struggle with eating disorders than their non-athletic counterparts.

Athletes in sports where there is a perceived competitive advantage to being “lean” – dance, synchronized swimming, figure skating and running – are more likely to succumb to behaviors of anorexia and bulimia to control their body weight, shape and size.

Comparing Eating Disorders in Male and Female Athletes

Unfortunately, up to 19% of male and 45% of female athletes struggle with disordered eating or eating disorders. According to Stanford Medicine Children’s Health, young male and female athletes tend to be at a greater risk for having an eating disorder if they play sports that focus on personal performance, appearance, diet and weight requirements.

Female NCAA Division athletes are especially vulnerable to disordered eating habits. In fact, in a study reported by The Sport Journal, 40% of female Division III athletes were in the subclinical eating disorder range. However, eating disorders are not limited to females in athletics. Roughly 33% of males in aesthetic and weight-class sports were reported to display eating disorder behaviors.

Risk Factors Contributing to Eating Disorders in Athletes

Athletes often feel extra pressure to maintain a certain body weight, shape and/or size which may lead them to engage in eating disorder behaviors. Rigorous overexercise, frequent weight checks and restrictive eating patterns are encouraged by peers, coaches and trainers. However, these habits are often overlooked by clinicians as part of the sport and as a result, athletes are underdiagnosed for clinical eating disorders in comparison to non-athletes.

Psychological Factors

People who are predisposed to mental health disorders due to genetics or familial influence are at a greater risk for developing eating disorders. Perfectionistic tendencies can cloud judgment and lead to unrealistic expectations of body weight and image. Underlying anxiety can lead to fear of performing in front of an audience due to worry over how their bodies will be perceived. Scrutinizing every detail of their bodies in the mirror and/or asking others for validation is common among those with anxiety and perfectionism in the athletic community.

Cultural Factors and Social Pressure

Adolescent females are dealing with the pressures of conforming to the requirements of their sports while going through puberty, which adds an extra layer of body dissatisfaction. They may desire to keep their bodies from changing shape and size, going back to the less curvy hips or smaller breasts they had before maturation. Comments from others may reinforce this mindset and encourage eating disorder behaviors in an attempt to cling to the past. Gymnasts, figure skaters and dancers are commonly criticized for their bodies and expected to maintain what is at times an unrealistically “lean” aesthetic in competitions.

In boys and men, having a muscular build may be strongly encouraged by coaches and trainers and reinforced by societal ideals of the male physique. The extra pressure to perform and look a certain way in sports can lead males to eating disorder behaviors including steroid and creatine use, binge eating, supplement and/or laxative abuse, excessive weightlifting, and overexercising to obtain a specific body weight, shape and/or size.

Physical Demands and Impact on Body Image

With required weight-class sports like boxing and wrestling, athletes must keep up with the physical demands of maintaining their body weight to stay in their competitive category (featherweight, heavyweight, etc.). Synchronized divers are expected to maintain a slim physique that looks as similar to their partner as possible. Male and female figure skaters and dancers are under constant pressure to perform at an extremely high level while maintaining a lean, toned body.

The physical demands of endurance competitions like triathlons are rarely met with the nutritional needs required to perform such high intensity sports because of the incorrect and perpetuated notion that the lighter you are the faster you will travel. These are examples of the damaging beliefs of negative body image and eating disorder behaviors that can develop in athletes.

Signs and Symptoms of Eating Disorders in Athletes

Recognizing the signs and symptoms of eating disorders in athletes is critical to understanding the condition and receiving appropriate treatment. Many athletes may not even realize certain behaviors are dangerous to their health, as they may seem to be the norm in athletic circles. Not only that, but eating disorders are mental health conditions that can alter brain activity. Here are the top eating disorder symptoms and signs to watch for in yourself or the athlete in your life.

Behavioral Indicators of Eating Disorders in Athletes

  • Restricting food and calorie intake
  • Underperforming or running out of steam
  • Not eating with others; self-isolation during mealtimes
  • Showing signs of anxiety around food and/or refusing to eat
  • Showing concern and preoccupation with being overweight
  • Mood swings, irritability, sadness and/or lack of emotion and motivation
  • Frequent mirror-checking, focusing on appearance and perceived flaws
  • Observing and comparing their bodies to the bodies of other athletes
  • Exercising a noticeable amount more than others, even when injured, with the goal of burning calories to maintain or obtain a certain body size, shape and/or weight
  • Binging on food then attempting to purge the calories consumed with self-induced vomiting, laxatives, diuretics and/or overexercising
  • Obsessive or irrational thinking about eating and/or exercising

Physical Symptoms of Eating Disorders in Athletes

  • Weight loss and fluctuation
  • Pulled muscles and frequent injuries like sprains and strains
  • Stress fractures and decreased bone mass
  • Brittle hair and nails, dry skin, yellowing of the eyes and skin
  • Not feeling hungry or getting full quickly
  • Low energy, fatigue, weakness and insomnia
  • Headaches, dizziness, lightheadedness and fainting
  • Dehydration and malnutrition
  • Gastrointestinal issues such as constipation, acid reflux and stomach pain
  • Missed menstrual periods or low libido
  • Erosion of the teeth and calluses on the knuckles from self-induced vomiting

How to Differentiate Between Healthy Eating and Disordered Eating

Healthy eating is characterized by a well-balanced diet that nourishes the body by providing necessary micro- and macro- nutrients incorporating a variety of food groups such as fruit, vegetables, whole grains, lean protein and unsaturated fats. Healthy eating is flexible and varied without fully restricting entire food groups out of fear of weight gain and change in perceived body shape or size. Eating a balanced diet helps boost immunities and cognitive function, strengthen bones and muscles and provide daily necessary energy for performance.

Disordered eating in athletes is more about controlling the outcome of eating to control their body weight, shape and/or size with the misguided notion that it will improve sport performance. In addition to anorexia and bulimia, athletes can be susceptible to binge eating disorder, orthorexia nervosa, avoidant/restrictive food intake disorder (ARFID) and other specified feeding and eating disorders (OSFED) but it is less documented at this time.

Orthorexia is an eating disorder categorized by only eating “clean” foods people believe to be healthy and can be confused with healthy eating. Athletes with this disorder display severe anxiety when faced with unsafe foods and restrict or limit their food and caloric intake with the purpose of controlling their body weight, shape and/or size. Orthorexia differs from healthy eating because of the restrictions and intense fear athletes experience if clean foods are unavailable. They may refuse to eat anything they are uncomfortable with out of fear of weight gain and an immediate change in body perception.

Consequences of Eating Disorders on Athletic Performance

Eating disorders have long-term implications for athletic careers and are very dangerous to the physical and mental health of athletes. If left untreated, they can result in serious cardiac, neurological and musculoskeletal complications. The most concerning consequence is death due to starvation, dehydration or suicide.

Impact on Physical Health and Recovery

Eating disorders contribute to faster deterioration of muscles, tendons and bones due to a lack of vitamins, minerals and nutrients being delivered to the body. Overexercising and training too long and hard without fueling the body with daily caloric needs can cause injuries such as stress fractures, sprains and strains to be more common and even career-ending. Many months of physical therapy may be required to restore physical function, and even then, the athlete may not achieve a full recovery and return to the sport in the same way.

Effects on Mental Health and Cognitive Function in Athletes

A history of past trauma such as emotional, physical and/or sexual abuse can put athletes at a higher risk for co-occurring mental health and eating disorders. They are more likely to experience mental health disorders such as depression, anxiety and obsessive or intrusive thoughts and actions when they are actively practicing eating disorder behaviors. Memory is affected along with the ability to analyze and think clearly and concisely. Drastic shifts in mood can contribute to depression and suicidal ideations. Athletes may act in erratic ways that negatively affect sport performance and relationships with teammates, coaches and trainers.

Strategies for Preventing Eating Disorders in Athletes

The brains of adolescents are still forming, making them especially vulnerable to the words and actions of their role models. Great care should be taken by those involved in the careers of these athletes for the prevention of eating disorders. It is essential to ensure they understand their worth is not tied to their appearance.

The role of parents, teachers, coaches, trainers and doctors in supporting the well-being of the athletes in their lives cannot be denied. They must be educated in how to create a supportive environment for athletes. This may include deemphasizing weight and body image as being the major factors in sports success. Balance is necessary between training and fueling the body to do said training. The more rigorous the training, the more important it is for the right types of foods to be part of the athlete’s daily diet.

Sports medicine doctors are a crucial part of prevention and treatment of eating disorders in athletes. They are often a first step for screening and recommending diagnosis and treatment of eating disorder behaviors. A multidisciplinary team with a physician, dietician and mental health provider is the most effective support system for athletes with eating disorders.

Recovery and Treatment Options for Athletes with Eating Disorders

If you or an athlete in your life are experiencing symptoms of eating disorders that are affecting your daily life and sports performance, it may be time to seek supportive treatment options.

At Center for Discovery, we take a different approach to caring for our patients. Our unique CARE-CFD dietary program and nutritional support ensure you’re never alone on your journey to well-being.

We offer multiple levels of care to suit your individual needs including residential (RTC), partial hospitalization (PHP) and intensive outpatient (IOP). Our virtual programming (for PHP and IOP) offers flexibility from the comfort of your home.

Plus, Discovery365™ is our exclusive app that uses breakthrough AI technology to help in the first year post-treatment.

Please don’t hesitate to reach out to one of our caring representatives today for more information.

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