Understanding Eating Disorders in Athletes
Eating disorders and disordered eating within the athletic population remain a consistent issue. We know that athletes have higher rates of eating disorder diagnoses and disordered eating behaviors than their non-athlete peers (Joy et al., 2016). Eating disorders are a category of mental health disorders recognized by the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). The most well-known eating disorders include Anorexia Nervosa, Bulimia Nervosa, and Binge-Eating Disorder (American Psychiatric Association, 2013; National Institute of Mental Health, 2021). For the purpose of this post, we use the definition of an eating disorder provided by the National Institute of Mental Health (NIMH) “...serious and often fatal illnesses that are associated with severe disturbances in people’s eating behaviors and related thoughts and emotions” (para 1). Disordered eating, on the other hand, typically encompasses irregular eating behaviors but does not always warrant a diagnosis of a specific eating disorder. These behaviors can be as simple as eating when bored, cutting out a main food group, or even a preoccupation with trying to lose weight (National Eating Disorders Association, n.d.). Disordered eating behaviors can put individuals at risk for an eating disorder diagnosis in the future. Often, it can be difficult to distinguish when an individual is struggling with disordered eating or an eating disorder.
In the context of elite athletics, disordered eating and eating disorders are the most common mental health diagnoses, with diagnostic rates higher than in the general population. Disordered eating behaviors and eating disorders can occur due to the desire to achieve a sport-specific body ideal (National Eating Disorders Association, n.d.). While sport-specific body ideals vary based on the type of sport, athletes who compete in lean sports (e.g., dance, gymnastics, wrestling, swimming, and running) are at the highest risk of eating disorders. This is due to the emphasis on achieving and maintaining a lower body weight due to the belief that lower body weight improves performance (Mancine et al., 2020). Furthermore, the ability to “hide” disordered eating behaviors as a component of one’s athletic training and performance (i.e., extra workouts, strict diets, etc.), is often reinforced by athletic trainers and coaches. Disordered eating behaviors are thus often indicative of, and reinforced by, overconformity to the sport ethic. This is because athletes are led to believe that they must engage in body surveillance behaviors to remain in their sport group and reconfirm their athletic identity (Hughes & Coakley, 1991). Recall from blog post #2 that the sport ethic is based on four primary assumptions of an athlete’s identity: (a) elite athletes make sacrifices for the game and are committed to the game; (b) athletes strive for distinction, domination, and greatness; (c) athletes adhere to the ‘no pain, no gain’ mindset’ (d) and athletes must overcome all obstacles to be successful (Coakley, 2009). Therefore, as disordered behaviors may be tied to athletic identity, it is imperative that coaches and other athletic staff are aware of both risk factors, as well as how their own actions might create a “culture of eating disorders” (Saxe et al., 2022).
It is imperative that coaches and other athletic staff prioritize a body-neutral environment for their athletes. A coach’s words highly influence athletes’ view of body image. Thus, not making any specific reference to body or weight in relation to athletic performance and not making observations on what athletes are eating or wearing is considered best practice. Furthermore, coaches and other staff should not weigh athletes in front of others (or at all outside of any needed medical appointments). Finally, it is important for all athletic staff to have contacts with mental health professionals and registered dietitians whom athletes could be referred to if needed. As a quick reference guide, below are some behaviors athletes may present with if they are struggling with disordered eating behaviors and/or an eating disorder and may need a referral:
Frequent dieting, anxiety associated with specific foods or meal skipping
Chronic weight fluctuations
Rigid rituals and routines surrounding food and exercise
Feelings of guilt and shame associated with eating
Preoccupation with food, weight, and body image that negatively impacts quality of life
A feeling of loss of control around food, including compulsive eating habits
Using exercise, food restriction, fasting, or purging to "make up for bad foods" consumed
Overall, it is essential to educate coaches and other athletic staff to better identify, intervene, and refer athletes to licensed professionals if they are demonstrating symptoms of eating disorders (Macpherson, et al., 2022; Saxe et al., 2022).
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Coakley, J. (2009). Sports in society (10th ed.). McGraw-Hill.
Hughes, R., & Coakley, J. (1991). Positive deviance among athletes: The implications of overconformity to the sport ethic. Sociology of Sport Journal, 8, 307-325. https://doi.org/10.1123/ssj.8.4.307.
Joy, E., Kussman, A., & Nattiv, A. (2016). 2016 update on eating disorders in athletes: A comprehensive narrative review with a focus on clinical assessment and management. British Journal of Sports Medicine, 50(3), 151-162. https://bjsm.bmj.com/content/50/3/154.info
Macpherson, M. C., Harrison, R., Marie, D., & Miles, L. K. (2022). Investigating coaches’ recognition of eating disorders in track athletes. BMJ Open Sport & Exercise Medicine, 8(3), http://dx.doi.org/10.1136/bmjsem-2022-001333
Mancine, R. P., Gusfa, D. W., Moshrefi, A., Kennedy, S. F. (2020). Prevalence of disordered eating in athletes categorized by emphasis on leanness and activity type: A systematic review. Journal of Eating Disorders, 8(47), 1–9. https://doi.org/https://doi.org/10.1186/s40337-020-00323-2
Saxe, K., Beasley, L., & Abdulhussein, R. (2022). Team environments influence student-athlete mental health through mesolevel interactions: An ecological systems perspective. Journal of Issues In Intercollegiate Athletics, 15, 558-584
National Eating Disorders Association. (n.d.). Eating disorders ver. Disordered eating: What’s the difference? National Eating Disorders Association. https://www.nationaleatingdisorders.org/blog/eating-disorders-versus-disordered-eating
National Eating Disorders Collaboration. (n.d.). Disordered eating & dieting. National Eating Disorders Collaboration. https://nedc.com.au/eating-disorders/eating-disorders-explained/disordered-eating-and-dieting/
National Institute of Mental Health. (2021, Dec.). Eating disorders. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/eating-disorders
