The Impact of Eating Disorders on Athletic Performance
The benefits of athletics are well-established. Participating in organized sports can help you build self-esteem, recognize the value of teamwork, set the foundation for a lifelong physical activity practice, improve mental health, promote social connections, open the doorway for scholarships or even a career, and teach important life skills, such as goal-setting and leadership.
However, these positive outcomes come with an important caveat. The pressures of athletic competition and the emphasis many sports place on body weight, shape, and size can contribute to psychological and physical stress. For individuals naturally predisposed to eating disorders, these stressors can be a tipping point into disordered territory.
Athletes frequently experience diminishing returns from disordered habits like restrictive dieting and over-training. Although it can be difficult for an athlete to step away from their sport, pursuing treatment increases their likelihood of safely returning—and can be lifesaving. Coaches, parents, teammates, and providers have a critical role in ensuring athletes are prioritized over the sport. Understanding the risks athletes face is key to providing preventative support.
Eating Disorders in Sports
While sports do not directly cause eating disorders, the athletic environment may increase the risk. As an athlete rises in their skill level and overall rank, they will naturally become more attuned to their nutrition and body in an effort to optimize their performance. When paired with specific genetics and neurobiological temperament traits (i.e., perfectionism, high attention to detail and errors, neuroticism, and impulsivity), this sort of microscopic self-evaluation can make an athlete particularly vulnerable to developing an eating disorder.
External pressure from coaches, peers, opponents, judges, or parents can further exacerbate body weight pressures and contribute to an athlete’s eating disorder risk. More broadly, this pressure can also come from social media and society’s perception of athletic body ideals. Sports emphasizing designated weight classes and/or aesthetics (e.g., bodybuilding, gymnastics, swimming and diving, rowing (crew), figure skating, wrestling, running, dancing, and volleyball) tend to have a higher risk of fueling eating disorders.
Identifying an eating disorder in an athlete can be difficult. An athlete’s symptoms may be wrongly considered “normal” behaviors due to their sport’s particular expectations or the type of athletic community they’re in. Unfortunately, it’s not uncommon for an athlete to report suffering for long periods of time before receiving an eating disorder diagnosis and treatment.
Eating Disorders and Athletes: Prevalence
The rates of athletes diagnosed with eating disorders are largely underreported. We know that secrecy and shame are hallmarks of an eating disorder, so it stands to reason that athletes may work hard to hide their struggles.
Existing studies reveal the following:
- When looking at athletics overall:
> Up to 19% of male athletes and 45% of female athletes struggle with disordered eating or eating disorders
- Eating disorder rates increase as competition level increases by sport type:
> 42% athletic sport
> 24% endurance sport
> 17% technical sport
> 15% ball game sport
- In male elite athletes:
> 8% had clinical or subclinical eating disorders
- In female elite athletes:
> 8% had eating disorders
> 7% were lean sport participants, and 19.8 % were non-lean sport participants
- In a sample of NCAA Division I and III female athletes:
> 2% (Division I) and 40.4% (Division III) were in the subclinical eating disorder range
> 7% of all athletes reported body dissatisfaction, weight preoccupation, and bulimia symptoms
- In female high school athletes in aesthetic sports:
> 42% reported disordered eating
> 8x more likely to have injuries than athletes without disordered eating
Wide-ranging rates of eating disorders and disordered behaviors in athletes call for future research, especially on normalized symptoms in the sports world, like compulsive exercise.
Effects of Eating Disorders on Athletic Performance
The impacts of an eating disorder on an athlete are vast and varied. The cumulative effects on both health and sport are overwhelmingly negative.
In aesthetic and weight-class sports, there is a pervasive myth that a lean physique enhances performance. Many athletes may attempt to achieve a low weight through disordered eating and compensatory behaviors. However, these methods often result in the opposite of their intended effects. Even a short period of restricting food and fluid intake can leave an athlete suffering a decline in strength, speed, or stamina.
It’s important to note that in some circumstances, at least initially, an athlete may perform well despite having a serious eating disorder. Inevitably, though, their performance will plateau or decline as the eating disorder begins to affect the athlete both physically and psychologically.
Over time, disordered eating behaviors (i.e., restricted caloric intake, rigid eating, excessive and compulsive exercising, binge eating, purging, and significant loss of weight (or failure to achieve expected developmental weight gain) in the context of age, sex, developmental trajectory, and physical health) can affect an athlete’s whole body, potentially leading to:
- Electrolyte imbalances (including the loss of important minerals like potassium, magnesium, and sodium), that can lead to sudden death
- Decreased VO2 (the amount of oxygen the body uses while exercising)
- Increased fatigue and perceived exertion
- Longer recovery time needed after workouts and competitions
- Dizziness, light-headedness, and fainting spells
- Bradycardia (low heart rate) and/or Arrhythmia (irregular heartbeat)
- Orthostatic hypotension (low blood pressure) or Hypertension (high blood pressure)
- Increased risk for cardiac arrest
- Loss of lean muscle mass, provoking a reduction in muscle strength
- More frequent musculoskeletal strains, sprains, and/or fractures
- Increased risk for osteoporosis
- Irregular periods or absent periods (amenorrhea)
- Kidney stones and increased risk for kidney failure
- Gallbladder disease
- Peptic ulcers
- Pancreatitis (inflammation of the pancreas)
- Nausea, constipation, irregular bowel movements, abdominal cramping, bloating, and diarrhea
- Sleep disturbances, insomnia
- Social withdrawal
- Loss of endurance, coordination, and speed
- Overheating/heat stroke
- Changes in brain chemistry, increased risk for irreversible brain damage
- Psychiatric/psychological symptoms: depression, anxiety, irritability, poor memory, loss of concentration and the capacity to play with emotion (apathy)
- Preoccupation with thoughts about eating, food, bodily aesthetics, and weight
The Medical Complications of Relative Energy Deficiency in Sport (RED-S)
In addition, some athletes are at risk for Relative Energy Deficiency in Sport or RED-S. This often-unrecognized disorder encompasses the symptoms of poor health and declining athletic performance that occur when a person’s caloric intake is too low to support the energy demands of their daily lives and physical activity.
RED-S health risks include:
- Reproductive health: irregular or absent periods, low libido
- Poor bone health: low bone mineral density, early onset osteoporosis, stress fractures (and overuse injuries)
- Psychological health: anxiety, depression, moodiness, difficulty concentrating
- Reduced immune function: frequent colds, increased risk of infection
- Delayed growth/development: weight loss, falling off the growth curve
- Cardiovascular health: low heart rate, which can cause dizziness, fatigue, and the potential for long-term heart damage
- Gastrointestinal distress: slowed digestion, which can cause IBS symptoms
One of the key symptoms of RED-S in those who menstruate is amenorrhea, or the absence of menstruation. When the body perceives too large a gap between energy expenditure and caloric intake, estrogen levels in the body drop, and menstrual periods stop. Lower estrogen levels impact the calcium content in bones, causing bones to become progressively more porous. Over time, this results in osteopenia and, eventually, osteoporosis.
You do not need to be a competitive athlete to be at risk for developing RED-S. Any person engaging in regular exercise—regardless of gender, age, participation level, abilities, body shape, or weight—who is not eating enough to meet the demands of daily life and activity can suffer from RED-S. The lack of calories consumed in the context of RED-S can be intentional or non-intentional (i.e., due to poor eating habits, underestimating the energy requirements of exercise, a suppressed appetite during training, and/or as a function of too intense exercise). RED-S can exist with or without disordered eating.
Helping Athletes with Eating Disorders
The long-term impact of eating disorder behaviors on an athlete can be severe. The onset of eating disorder symptoms will inevitably compromise an athlete’s medical state and worsen their sports performance. The longer an eating disorder persists, the more difficult the recovery, and the more pervasive it can become across an athlete’s entire team.
Coaches, teammates, providers, and communities of support are responsible for fostering a balanced, flexible, and supportive sporting environment that focuses on the whole person, within and outside of the sport. An athlete should never have to endure an eating disorder or sideline their health because of the environment sports can create. Prioritize your athlete over the game or competition by:
- Educating athletes on the fueling demands of their sport and emphasizing adequate fueling before and after practice
- Encouraging trust in the body’s internal cues over any specific workout plan/metric
- Making workouts flexible and adjusting them in light of fatigue or injury
- Deemphasizing weight and appearance as performance enhancers
- Rejecting harmful diet culture beliefs surrounding food, body, and performance
- Integrating trainings that emphasize mental and emotional aspects of performance
- Discouraging dieting and body comparisons
- Encouraging athletes to build identities and sources of self-worth outside of sports
- Creating opportunities for athletes to discuss concerns around weight and performance
- Educating yourself and your athletes on the risk factors and warning signs of eating disorders
An eating disorder does not mean an athlete needs to give up their sport permanently. That said, effective eating disorder treatment takes time and commitment. Treat the eating disorder with as much gravity and empathy as you would any other injury or illness on the team. Support your athlete by suspending their participation in the sport until they can receive help to overcome their eating disorder and regain a stable level of health. Validate your athlete’s fears about leaving their sport and beginning treatment. Encourage your athlete to view their sport as a lifetime pursuit, which means caring for their bodies over a lifetime. With treatment, they can return to their sport when appropriate and will likely emerge a stronger, healthier athlete.
At The Emily Program, we’ve helped athletes from all walks of life heal from their eating disorders. We work collaboratively with families, coaches, and providers to bring balance and hope to an athlete’s relationships with food, body, and sport. If you’re concerned about an athlete in your life, please give us a call at 1-888-364-5977 or complete our online form. Lasting recovery is possible.