Eating Disorders and Athletics: Why is There a Link?
By Jenna Donnelly, Dietetic Intern
July 5th, 2024
Participating in a sport offers a host of benefits, from physical benefits such as improved cardiovascular and muscular fitness, to mental and emotional benefits like improving self-esteem, confidence, and cognitive abilities. However, the sports environment can bring extra external pressures that make athletes more likely to develop eating disorders than their non-athlete peers (3). Pressures to adhere to a certain body shape, high body image dissatisfaction, and high internal pressures can all increase risk for athletes (1).
The prevalence of eating disorders in athletics varies across surveys and studies. A large study of collegiate athletes found that 19.6% of participants reported pathogenic behaviors to control weight and 67.9% were at risk for orthorexia (8). Another 2012 study found that disordered eating and eating disorders combined is as high as 19% in male athletes and 45% in female athletes (7).
Why athletes?
Perfectionist personality type: A perfectionist mindset or personality may increase internal pressures and result in more dissatisfaction with body image and sports performance (1,2)
Weight control sports: Sports like wrestling, bodybuilding, and rowing all emphasize weight requirements which can increase the risk for compensatory behaviors for losing weight (2,4,5)
Pressure to adhere to a lean body type: sports such as diving, gymnastics, and dancing where scores are assessed by a judge place a high emphasis on body aesthetics. This places higher pressure to lower body weight (3,5)
Normalization of low body weight in higher levels of competition: endurance sports such as running, rowing, cycling, and swimming have higher rates of disordered eating because of emphasis on body leanness (1,3,5)
Coaches who do not value the athlete as a whole person: extra criticism of body image from a coach can also contribute to ED behaviors (5)
Higher levels of body dissatisfaction than non-athletes (3)
Disordered eating and eating disorders are related but exist on a continuum. Someone who has an eating disorder will engage in disordered eating, but disordered eating is not always diagnosed as an eating disorder depending on the severity. Disordered eating can describe any dysfunctional eating pattern such as over-eating, binging, fasting, dieting, purging, or use of laxatives or diet pills. For more information on the classification and signs of eating disorders, see our series on the blog from National Eating Disorder Awareness Week earlier this year.
Relative Energy Deficiency in Sport (REDs) (6)
Relative Energy Deficiency in Sport or REDs was a term coined by the International Olympic Committee in 2014. It’s described as a syndrome of detrimental health and performance outcomes experienced by male and female athletes exposed to low energy availability (LEA). In the simplest definition, LEA occurs when there is a mismatch between dietary intake and the amount of energy expended during exercise, leaving the body’s total energy needs unmet. Some physical health issues from LEA are impaired energy metabolism, gastrointestinal function, reproductive function, reduced skeletal muscle function, neurocognitive function, and impaired bone health. Athletes engaging in disordered eating behaviors may fall into a pattern of under-fueling and increase their risk of developing REDs.
It is important as friends, family, coaches, teammates, or healthcare providers of athletes to look for signs of disordered eating. An athlete may be fearful of losing their scholarship or spot on their team if they ask for help. An athlete struggling with an eating disorder should get help as soon as possible with a multidisciplinary team to improve their chances of recovery.
To learn more about eating disorder treatment
References:
Mancine RP, Gusfa DW, Moshrefi A, Kennedy SF. Prevalence of disordered eating in athletes categorized by emphasis on leanness and activity type – a systematic review. J Eat Disord. 2020;8:47. doi:10.1186/s40337-020-00323-2
Godoy-Izquierdo D, Ramírez MJ, Díaz I, López-Mora C. A Systematic Review on Exercise Addiction and the Disordered Eating-Eating Disorders Continuum in the Competitive Sport Context. Int J Ment Health Addiction. 2023;21(1):529-561. doi:10.1007/s11469-021-00610-2
Chapa DAN, Johnson SN, Richson BN, et al. Eating-disorder psychopathology in female athletes and non-athletes: A meta-analysis. International Journal of Eating Disorders. 2022;55(7):861-885. doi:10.1002/eat.23748
Arthur-Cameselle J, Sossin K, Quatromoni P. A qualitative analysis of factors related to eating disorder onset in female collegiate athletes and non-athletes. Eating Disorders. 2017;25(3):199-215. doi:10.1080/10640266.2016.1258940
Currie A. Sport and Eating Disorders - Understanding and Managing the Risks. Asian J Sports Med. 2010;1(2):63-68.Mountjoy M, Ackerman K, Bailey D, et al. 2023 International Olympic Committee’s (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs). British Journal of Sports Medicine. 2023;57:1073-1097. doi:10.1136/bjsports-2023-106994
Eating disorders in athletes: Overview of prevalence, risk factors and recommendations for prevention and treatment - Bratland‐Sanda - 2013 - European Journal of Sport Science - Wiley Online Library. Accessed May 2, 2024. https://onlinelibrary.wiley.com/doi/10.1080/17461391.2012.740504
Uriegas NA, Winkelmann ZK, Pritchett K, Torres-McGehee TM. Examining Eating Attitudes and Behaviors in Collegiate Athletes, the Association Between Orthorexia Nervosa and Eating Disorders. Front Nutr. 2021;8:763838. doi:10.3389/fnut.2021.763838