Athletes and disordered eating: Who is at risk and how to get help

Competitive athletes aim to perform at their peak, yet this drive to achieve can lead to unhealthy eating patterns, also known as disordered eating.

“Qualities that help athletes succeed — such as a focus on perfection, the ability to delay gratification and a willingness to endure physical discomfort to achieve a goal — also put them at risk for disordered eating,” says Lisa Lovejoy, MEd, RD, CSSD, CD, a sports dietitian at MultiCare Orthopedics & Sports Medicine.

Many athletes who struggle with disordered eating are teenagers, of all genders, and these behaviors can be harmful to their physical and mental health. Below Lovejoy shares tips about how to spot the signs of disordered eating, where to go for help and more.

What is disordered eating?

It’s important to note the difference between disordered eating and eating disorders.

According to the Academy of Nutrition and Dietetics, disordered eating refers to irregular behaviors related to food. Left unaddressed, these behaviors can lead to an eating disorder, which is a medical diagnosis with specific criteria.

“Not everyone who engages in disordered eating has an eating disorder,” Lovejoy says. “However, these habits can still have a negative impact on a person’s health, and many people who develop disordered eating in their youth struggle with it for years.”

So, what do we mean by disordered eating?

“Disordered eating for athletes often involves overly restrictive eating patterns,” Lovejoy says. “For example, a person might eliminate entire food groups from their diet or refuse to eat certain foods. They may skip social events where food is a focus or spend a disproportionate amount of time planning or preparing meals.”

Other signs of disordered eating may include:

• Skipping meals or making excuses not to eat
• Cooking individual meals rather than eating what the family eats
• Withdrawing from normal social activities
• Worrying persistently about losing weight
• Engaging in excessive exercise
• Using dietary supplements, laxatives or herbal products for weight loss
• Expressing depression, disgust, shame or guilt about eating habits
• Leaving during meals to use the toilet
• Eating in secret
• Having menstrual cycle abnormalities (when periods stop occurring regularly or stop altogether)
• Experiencing deviations in one’s growth curve
• Experiencing recurrent stress fractures

Sometimes dramatic weight loss can be a warning sign for disordered eating, but Lovejoy says that is not always the case.

“People of all body shapes, weights and sizes may struggle with disordered eating,” she says.

The dangers of disordered eating

While disordered eating may not always lead to the diagnosis of an eating disorder, these habits can be detrimental to both an athlete’s performance and health over time.

“Nutrition affects everything for an athlete, from their energy levels to their strength to their ability to make decisions quickly,” Lovejoy says. “Simply put, a body that is chronically under-fueled can’t perform at its best.”

From a health perspective, athletes who engage in disordered eating are at greater risk for injury and bone fractures, electrolyte abnormalities — which can lead to seizures, collapse or even death under some circumstances — hormone imbalances, and extensive muscle loss.

And there is also an emotional toll.

“It takes a tremendous amount of mental energy to constantly worry about what, when and how much you will eat,” Lovejoy says. “Some people who struggle with disordered eating say that it consumes all of their waking thoughts.”

Who is at risk?

Adolescence can be a tumultuous time, and teens who are competitive athletes face added pressures that put them at risk for disordered eating.

“Their bodies are changing and on top of that, they are highly susceptible to misinformation about nutrition, which is rampant in our diet-obsessed culture,” Lovejoy says. “Student athletes are very receptive to input from teammates and coaches who may not always be well-informed. They may give advice that just perpetuates disordered eating.”

Athletes who participate in sports that place an emphasis on a person’s appearance or weight tend to be at greater risk for disordered eating. Some of those sports include gymnastics, dance, weightlifting, wrestling, boxing, figure skating, diving, swimming, running, track and field, and crew, among others.

 “People of all body shapes, weights and sizes may struggle with disordered eating,” Lovejoy says.

What healthy eating looks like

Athletes can support their performance and health by consuming a wide variety of fresh, whole foods in quantities that meet the demands of their training schedules. This means a diet rich in vegetables, fruits, whole grains, lean proteins, low fat dairy and healthy fats.

“During intense periods of training or competition, sports nutrition items like carbohydrate/electrolyte drinks (also known as sports beverages) and protein powders can be a convenient way to fuel up,” Lovejoy says. “Plus, don’t forget the enjoyment factor in eating — sometimes food that is eaten simply for enjoyment is good for the body and the mind.”

How to get help for disordered eating

The sooner a person who is struggling with disordered eating can get help, the greater their chances for recovery.

“Anyone who feels like their relationship with food may be out of balance should speak up by going to a trusted family member, coach or medical provider,” Lovejoy says. “A registered dietitian who specializes in eating disorders can also be a good place to start.”

Lovejoy recommends the website eatright.org for finding a dietitian specializing in eating disorders.

If you suspect that your child or a loved one in your life may be engaging in disordered eating, it can be hard to know what to say or do. There is often a significant amount of secrecy and shame related to disordered eating. Lovejoy advises against making comments about a person’s body size, body shape or eating habits. Even the most well-intentioned comments can be triggering for someone with disordered eating.

“What is often most helpful is a gentle observation followed by an offer of nonjudgmental support. So, for example, ‘I’ve noticed that you seem a bit less energetic than usual. I’m here to listen if there’s anything that you’d like to talk to me about,’’ Lovejoy says.

Resources for disordered eating

Lovejoy works by referral with both adult and teen athletes who struggle with disordered eating. Contact her with questions.

Many local and national organizations offer free, confidential consultations with individuals trained to assess a person’s situation and the appropriate level of care. Some of those organizations include the Center for Discovery, The Emily Program, the Eating Recovery Center and Opal.

For general information about eating disorders, visit the National Eating Disorders Association.