The Impact of Eating Disorders on Athletic Performance
By: Dana Baker
The benefits of athletics are well-established. Participating in organized sports can help 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 warning. 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 predisposed to eating disorders, these stressors can be a tipping point into disordered territory.
Athletes often experience temporary results from disordered behaviors like restrictive dieting and over-training/exercising. 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 adjusted to their nutrition and body to optimize their performance. When paired with specific genetics, psychological, sociocultural, and environmental factors can make an athlete particularly vulnerable to developing an eating disorder.
External pressure from coaches, peers, opponents, judges, or parents can further increase body weight pressures and contribute to an athlete’s eating disorder risk. This pressure can also come from social media and society’s perception of athletic body ideals. Sports emphasizing designated weight classes and/or aesthetics (ex: bodybuilding, gymnastics, swimming and diving, rowing, 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 Disorder Risk Factors for Athletes
Research has demonstrated that athletes are at a higher risk of developing eating disorders than non-athletes. Rates of these illnesses among athletes seem to be on the rise as well, ranging from 6–45% in female athletes and 0–19% in male athletes (Glazer, 2008; Sundgot-Borgen & Torstveit, 2004). (It is important to note that there is extremely limited research on transgender athletes and athletes with diagnoses other than anorexia and bulimia.) One study found that eating disorder prevalence is 7% among elite high school students, whereas the prevalence for non-athletes is 2.3%.
Overlapping Personality Traits
Many athletes have personality traits that overlap with the traits common among those susceptible to eating disorders. This overlap of traits can also contribute to athletes’ elevated eating disorder risk. Such traits include:
Perfectionism
High self-expectations
Competitiveness
The drive to continually improve performance
The tenacity to push past discomfort
Highly competitive environment
Eating disorders thrive on comparison, a fundamental aspect of the sports environment. Sports have winners and losers, and athletes often compare their speed, strength, and skills to their competitors, teammates, or sports idols. Even if an athlete competes in an individualized sport, they likely compare themselves to their own best time or score. This competitive environment can drive athletes to push themselves past their limits to “outdo” themselves or their opponents. This drive to “be the best” may result in disordered behaviors like exercising even when sick, only eating foods considered “clean,” or using laxatives to “make up” for food eaten in a well-intentioned but ultimately destructive attempt to stay competitive.
Pressure to perform
Athletes often face a lot of pressure to consistently deliver their best performance. Falling short of impossibly high standards can lead to mental health issues including eating disorders, depression, or anxiety. Added pressure from teammates, coaches, and/or parents can also impact an athlete’s mental state, increasing the risk of disordered behaviors such as overexercising, strict calorie counting, and binge eating. These behaviors may be (ineffective) attempts to improve performance and/or to cope with stress.
If an athlete is rewarded or praised for weight loss, winning, or setting a record, this pressure to perform can intensify. Unfortunately, this pressure can potentially reinforce, trigger, normalize, or worsen eating disorder thoughts and behaviors, as ill athletes may mistakenly view these behaviors as key to their success.
Heightened attention to body size and shape
While all sports require some level of body awareness and optimization of the body’s performance, certain sports place an overwhelming emphasis on body size and shape. These sports can create a lot of pressure to have a specific muscle/fat ratio, meet a weight requirement, or fit a stereotypical body ideal. However, fitting a specific look or body type does not mean that an athlete will perform better. This pressure to look a certain way can also be an eating disorder risk factor.
Signs of Eating Disorders in Athletes
Given the higher risk of athletes experiencing eating disorders, it’s important for coaches, providers, teammates, and parents to know the warning signs. The sooner an eating disorder is identified, the sooner an athlete can get the help they need to begin healing.
Weight loss is often seen as the biggest indicator of an eating disorder, but eating disorders come in all sizes. In fact, less than six percent of those with eating disorders are medically “underweight” (Flament, Henderson, Buchholz, et al., 2015). Below are some signs that an athlete may be struggling with an eating disorder:
Decreased concentration, energy, muscle function, coordination, and speed
Increased injuries
Compulsive exercise patterns—never skipping a gym day, working out several times a day, or exercising to “make up” for food consumed
Ritualistic eating (e.g. cutting food into small pieces, eating one food group at a time, choosing to eat alone, etc.) or avoidance of certain foods
Negative self-talk and self-perception
Preoccupation with food—their own or others
Exercising when sick or injured
Complaints of or reported medical complications, such as menstrual irregularity, dry skin, hair loss, dental problems, consistent fainting, dizziness, bruising, leg cramps, diarrhea, constipation, chest pain, heartburn, and shortness of breath
Checking in with the athlete and addressing any concerns you may have can open the door for a candid conversation. The athlete may not be forthcoming the first time you speak with them; eating disorders are illnesses often hidden in shame and secrecy. Keep communication open so they feel comfortable sharing what’s going on when they’re ready.
Impact of Eating Disorders on Athletic Performance
All eating disorder diagnoses—including anorexia, ARFID (Avoidant/Restrictive Food Intake Disorder) bulimia, binge eating disorder, and OSFED—have negative physical and psychological consequences. Physical impacts can result in reduced strength and endurance, leaving athletes feeling tired and weak. Everyone requires nourishment to fuel their body, and this need becomes even more essential during demanding physical activity. Disordered eating means the body doesn’t get the nutrients and energy it needs for physical activity, potentially leading to fatigue, dizziness, and even injuries. In fact, one study found that youth athletes with disordered eating are twice as likely to sustain a sports-related injury.
In aesthetic and weight-class sports, like wrestling, body building, or ice skating, there is a myth that a smaller body enhances performance. Which can cause athletes to have disordered eating patterns in order to achieve this result. These methods often actually result in poorer performance. 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 at first, an athlete may perform well despite having a serious eating disorder. Inevitably, their performance will decline as the eating disorder begins to affect the athlete both physically and mentally.
The psychological impact of eating disorders can also affect sports performance. Obsessive thoughts about food, weight, and body can impact motivation, self-esteem, and ability to focus during games or performances.
Recovery for Athletes
In general, when athletes are being treated for an eating disorder, they should stop significant physical activity. As they get further into recovery, athletics can be reintroduced. This should be done under appropriate medical supervision and treatment team.
Athletes should be monitored at first to make sure their health and mental health continues to be solid and intact going forward. Individuals will work with a team about when and how to reintroduce movement in a safe and balanced way.
Recovery is Possible
It is important for sports communities to recognize the dangers of disordered eating and eating disorders and prioritize each athlete’s health over their performance goals. Seeking professional help for an eating disorder is essential for recovery and can ultimately lead to improved physical and psychological well-being, as well as better athletic performance.
Are you struggling with disorder eating? Are you feeling like you need someone to talk to? Interested in giving therapy a try? Worried about the New Year and creating new goals/resolutions? Give us a call today at 217-203-2008 or send an email to schedule an appointment.
Resources to learn more:
https://www.nationaleatingdisorders.org/eating-disorders-and-athletes-2/
https://emilyprogram.com/blog/muscle-dysmorphia-sports-and-eating-disorders-in-males/
https://emilyprogram.com/blog/how-can-gyms-and-coaches-recognize-an-eating-disorder/
Eating Disorders in Sports by Ron A. Thompson $ Roberta Trattner Sherman
Running in Silence: My Drive for Perfection and Eating Disorder that Fed It by Rachael Rose Steil