Eating Disorders and Athletes

Tracy Narins Welchoff, Ph.D.

Licensed Psychologist

Although eating disorders are difficult to deal with no matter what the circumstances, athletes deal with some unique pressures that complicate the recovery process.  A thletes are vulnerable to developing eating disorders due to intense pressure of performance and competition combined with strenuous physical demands which require specific nutritional requirements to sustain.  However, participation in certain types of sports can contribute to the development of eating issues.  These include those that emphasize LEAN APPEARANCE such as swimming and diving, figure skating, and gymnastics.  Also, risk is greater in sports that emphasize on LEANNESS FOR PERFORMANCE, like cross country running and swimming.  Finally, there are those sports that include WEIGHT-CLASSIFICATION, such as boxing, wrestling, and crew.

Athletes require a high level of energy (i.e. calories) to fuel activity.  Energy deficits can be due to dieting or purging, but they can also be the result of increased activity without increased caloric intake.  Female athletes risk developing Female Athlete Triad, a constellation of symptoms including low energy availability, low bone mineral density (BMD), and menstrual dysfunction.   Although BMD usually higher in athletes due to protective effects of high-impact activities, the nutritional deficiencies of an eating disorder are prone can cause low estrogen levels which can lead to bone loss, osteopenia, and osteoporosis.  Male athletes with eating disorders are at risk for decreased testosterone levels (without which muscle development cannot occur).  

Psychological issues affecting athletes may be similar to non-athletes, such as rigid perfectionism, trauma, fear of growing up, anxiety, depression, family issues, or cultural pressures to be thin.  Driven, competitive personalities that lead to success in sports can cause problems if exercise or eating routines become rigid.  The “I’m an athlete” excuse often hides compulsive exercise as the athlete is praised for “being so dedicated” and “training so hard”.  To determine if exercise is compulsive, get details about exercise patterns to see if they are inflexible and do not change for illness, injury, or important life events.  If an athlete cannot deviate from the training plan without anxiety or excessive guilt accompanying a day off, exercise has become compulsive.  

When treating an athlete with an eating disorder, several treatment providers may be involved.  The more people that are supporting the athlete, the better the chance of recovery.  The Treatment Team may include a physician, psychologist, nutritionist, coach, trainer, family members, and of course, the athlete.  Treatment starts with recognition of the problem, accurate identification and treatment of psychosocial precipitants, stabilization of medical conditions, and re-establishment of healthy eating patterns.  Ideally, the athlete can be treated while continuing to participate in his or her sport, either fully or in a modified capacity. However, it may be necessary to pull the athlete from sports if health is compromised or if sports are used as excuse to avoid recovery behaviors.

If you suspect that an athlete you care about is suffering from an eating disorder, remember the following:  Talk privately with the athlete.  Focus on health rather than appearance.  Convey caring and concern, not criticism.  Discuss the need for an evaluation, but also express confidence that the athlete can recover and return to full sport participation.  The athlete should be considered “injured” until evaluated.  This can help preserve self-esteem and remind the athlete that eating disorders are medical conditions.   Emphasizing treatment as a way to improve enjoyment and performance outcome is helpful as well.