Athletes and Eating Disorders

By: Elissa Rosen, MD

Monday, June 6, 2016

300300p27278EDNmainMedical Monday Rosen 114From the ACUTE team: To offer our readers a more comprehensive look into the various aspects of eating disorders and treatment, Medical Mondays will periodically be penned by team physicians at the ACUTE Center for Eating Disorder.

This week’s Medical Monday is written by Elissa Rosen, MD.

Playing sports, whether on a recreational basis or professionally, can offer so many rewarding benefits both physically and psychologically – camaraderie; increased self-esteem; leadership skills; stress release – to name a few. Unfortunately, increasing numbers of athletes are also being diagnosed with eating disorders. From elite athletes to weekend warriors, nobody is immune.

Eating disorders occur in all sports. They can happen in both males and females, though are more common in female athletes. But what makes an athlete more likely to develop an eating disorder? First, there are sport related factors. Eating disorders are more common in sports that heavily focus on the individual athlete rather than a team. In sports such as endurance running, gymnastics, and triathlon, there is often an overvalued emphasis that thinness will increase sport performance. In these sports, many athletes believe they have to be thin to be their best. Certain sports also focus on appearance as a necessary part of the aesthetic of the sport. Ballerinas feel pressure to have their bodies look a certain way to make a dance more pleasing on the eye. Body builders feel they must be muscular, with little to no body fat to appeal to judges.

Second, psychological factors among the athlete can contribute to eating disorder development. Athletes with low self-esteem, performance anxiety, fear of failure, perfectionism, and history of chronic dieting are more predisposed to developing an eating disorder.

All athletes need fuel to perform at their best. Some athletes start following very strict diets that limit certain food groups based on the latest fads amongst fellow athletes or promoted by various media outlets (magazines, social media, etc.). Increasingly strict diets can be a slippery slope into a full-blown eating disorder. When nutritional intake is too low to meet the energy demands of a sport, weight loss occurs. For some, small amounts of weight loss may increase athletic performance in the short term. This positive feedback may lead to the misconception that further weight loss will continue to improve performance.

With continued weight loss and poor energy intake, the body starts to break down, and it becomes more difficult to perform at your best. You become more lethargic and fatigued all the time. Workouts that used to be manageable become increasingly more difficult. Muscles and bones break down, making you weaker and more prone to stress fractures and other injuries. An irregular or slow heartbeat can develop, especially if you throw up as part of your eating disorder. Dizziness may occur due to low blood pressure. Muscles can cramp due to dehydration. For females, periods become irregular or absent. These are all signs that an athlete is reaching a life-threateningly low weight, is not getting adequate nutrition, and needs an intervention.

The Female Athlete Triad is a medical term used to describe physically active women who have energy imbalance (i.e.: too few calories taken in for the amount they burn), irregular or absent periods, and abnormal bone health (often indicated by stress fractures). The presence of just one of the three components of the triad is indication for an athlete to seek help from a professional. The components of the triad are interconnected because decreased caloric intake can lead to irregular menstrual cycles which then can lead to poor bone health. The bone loss that occurs as part of the triad can be irreversible without recovery.

Athletes can fully recover from eating disorders, but they can be life threatening when unrecognized. The first step is to recognize that a problem exists, either by the athlete themselves, a coach, or other team members. For many athletes, it will be necessary to take time away from your sport in order to achieve a healthier weight and a healthier mindset about your body. A team approach involving a nutritionist, therapist, and medical doctor along with support from you coach is often the best approach. Many colleges already have such teams in place. With recovery you can learn to love your sport again, learn to love yourself, and learn to love your body no matter the size.

Remember: athletes come in all shapes and sizes. Being thin doesn’t mean you will perform better at your sport. Athletes need fuel to perform at their best. Limiting calories and weight loss negatively impacts performance over time and can lead to serious medical complications or death. If you or someone you know is an athlete struggling with an eating disorder, help is available. Don’t let an eating disorder pull you away from the sport that you love. Recovery is possible!

If you or a loved one is suffering from an eating disorder, do not delay seeking treatment. We at the ACUTE Center for Eating Disorders are here to help. For more information or to take a confidential assessment, please contact our admissions team at or by calling our admissions line at 1-877-ACUTE-4-U.