Athletes and Eating Disorders: 5 Key Warning Signs

Athlete resting on bench in park at sunset after running with bottle of water (intentional sun glare and vintage color)

The recent Rio Olympics were a stark reminder that the fate of an athlete can change in seconds. While it was amazing to watch Michael Phelps, Katie Ledecky, Michelle Carter and the US women’s gymnastics team triumph, we can’t forget the two 5000-meter female runners who stumbled and then inspired us, the French gymnast who broke his leg on a vault and the hundreds of other athletes who finished fourth place in their respective events, falling just short of their dreams of attaining an Olympic medal.

These stories, and the cloud of uncertainty, represent athletes at all levels of competition. Hundreds of hours of training can seemingly be undone in an instant. Injuries and illnesses can derail seasons and sometimes end careers. Strength coaches, athletic trainers and physical therapists work on the front lines to prevent injuries and prepare athletes for competition. Yet one often hidden and overlooked threat to success in sport can carry devastating consequences: Eating disorders.

Did you know athletes are two to three times more likely than the average person to develop an eating disorder? Additionally, a recent report from the International Olympic Committee (IOC) found the prevalence of disordered eating to be 20 percent and 13 percent, respectively, among adult and adolescent female elite athletes, and eight percent and three percent in adult and adolescent male elite athletes.

Eating disorders happen in all sports, to athletes of all ages, competitive levels, body types and genders. Most worrisome, they can be difficult to detect, even by the most seasoned athletic trainer, coach or concerned parent. Attention to these early warning signs can make a difference in ensuring athletes receive the proper help.

1). Eating too little, exercising or training too hard – Fueling for sport is the cornerstone of peak performance, injury prevention and overall wellness. Yet attempts to “optimize” the athlete’s diet can easily become too rigid and result in disordered eating behaviors. Calorie counting, restricting specific foods or following strict diets can contribute to inadequate nutritional intake. Similarly, athletes are vulnerable to overtraining. Exercise places stress on the body. Excessive stress without rest and proper nourishment increases the risk for injury.

2). Increased focus on weight, shape, size and appearance – Discontent or focus on one’s weight, shape, size and appearance is typically followed by increased urges to eat less food, exercise more and gain control over appearance. Coupled with perfectionism, anxiety and persistent feelings of inadequacy, these patterns of behavior can frequently precipitate an eating disorder.

3). Underweight or notable weight loss – Slight shifts in body weight are expected when athletes move in and out of their competitive season. Rapid shifts in weight or prolonged periods of remaining underweight reflect inadequate food intake relative to energy needs for sport. Don’t buy into the “thin to win” mentality! An energy deficit for an athlete is extremely serious and could be another sign of an eating disorder. To maintain function without fuel, the body will rob from its internal systems. Over time, function and performance are reduced and eventually the body will operate at a fraction of its full capacity.

4). Abnormal sex hormone cycles – Abnormal sex hormone cycles often signal insufficient energy intake, a hallmark of an eating disorder. The body perceives the energy deficit as a threat to survival and will sacrifice vitality and reproduction for short term energy. For males, abnormal sex hormone cycles typically manifest in low testosterone. Symptoms include fatigue, lack of energy, reduced muscle mass and strength, decreased bone mass, mood changes, disrupted sleep, low sex drive and hair loss. For females, abnormal sex hormone cycles are further characterized by missed, irregular or shorter menstrual periods. Birth control pills can mask symptoms, so females are encouraged to talk with their doctor.

5). Stress fractures and overuse injuries – Although the age-old saying of “No pain, no gain,” frequently pervades the sports environment, injuries are not a sign of dedication to sport. In fact, stress fractures and overuse injuries can indicate that something is very wrong, like an undetected eating disorder. The combination of insufficient food and nutrient intake, high level training and low body weight reduces the strength of bones over time and naturally increases the risk for injuries. This risk is preventable with appropriate eating plans and exercise programming.

While not every case of energy deficiency or injury in athletics is the direct result of an eating disorder, exploration of early warning signs is essential, especially since eating disorders have the highest mortality rate of any psychiatric disorder.

If you know an athlete exhibiting any of these signs, it is best to seek help from a multidisciplinary team of specialized eating disorder therapists and dietitians who understand sport and who can help athletes build better relationships with their bodies and with food. Athletes who surround themselves with experts who understand the careful balance of nutrition in relation to training demands will be better equipped to avoid these pitfalls.

To learn more about resources for athletes and disordered eating, check out the Walden GOALS program.

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mattsMatthew Stranberg, MS, RDN, CSCS, LDN is a licensed registered dietitian nutritionist and certified strength and conditioning specialist. He is the lead nutritionist and exercise science advisor for the Walden GOALS program. Matt devoted the early part of his career to refining the art of training elite collegiate and professional athletes. In graduate school, he developed expertise in nutrition, behavior change and eating disorders. Matt now devotes his practice to translating nutrition and exercise science into practical solutions. As a lead member of the GOALS team, Matt is known for his dedication to educating and empowering athletes of all backgrounds to facilitate a full and meaningful recovery from disordered eating. Matt holds a B.S. degree in Kinesiology from the Honors College at The University of Massachusetts Amherst, a master’s degree in Applied Exercise Physiology and Nutrition from Columbia University and was a dietetic intern at Boston’s Brigham and Women’s Hospital.