Information for coaches and trainers

Disordered eating and full-blown eating disorders are somewhat common among athletes. For example, a study of Division 1 NCAA athletes found that more than one-third of female athletes reported attitudes and symptoms placing them at risk for anorexia nervosa. Both female and male athletes are at risk—especially those competing in sports that tend to emphasize diet, appearance, size, and weight.

The benefits of sports are well-recognized: building self-esteem, staying in good physical condition, and setting a foundation for lifelong physical activity. Athletic competition, however, can cause severe psychological and physical stress. When the pressures of athletic competition are added to societal norms that emphasize thinness, “making weight,” or a certain body type, the risks of developing disordered eating increase for athletes.

Sports that can create risk for developing an eating disorder

A recent comprehensive review on eating disorders in athletes noted that particular classes of sports place both male and female athletes at greater risk for developing an eating disorder due to the sport’s requirements or expectations sport (Joy et al., 2016):

    • Making or keeping a certain weight to maintain eligibility (wrestling, gymnastics, rowing, some track and field events)
    • Maintaining a certain body size or body fat percentage to stay competitive (bodybuilding, figure skating, dance, swimming/diving, gymnastics)

Some of these sports tend to place greater emphasis on individual athlete performance, in contrast to sports such as football, basketball, or baseball, which rely on overall team performance as a measure of success. Combined with any number of personal factors such as personality traits, life experiences, or other mental health conditions, the risk for developing an eating disorder becomes even greater.

Personal factors that could create risk for an athlete

    • Inaccurate belief that lower body weight will improve performance
    • Training for a sport since childhood or being an elite athlete
    • Low self-esteem or self-appraisal
    • Family dysfunction
    • A tendency toward perfectionism and rigidity
    • Strong need to control or fear of losing control
    • Family history of eating disorders
    • Chronic dieting
    • History of physical or sexual abuse
    • Cultural pressures to be thin
    • Other traumatic life experiences
    • Over-competitive personality, tends to compare self to others excessively
    • Coaches who focus only on success and performance rather than on the athlete as a whole person
    • Performance anxiety
    • Social influences, including family and peer pressure about athletic ability and performance
    • Substance dependence or abuse
    • History of impulsive behaviors
    • The presence of other mental health issues such as depression, anxiety, or obsessive-compulsive disorder

Factors that protect athletes from developing eating disorders

    • Positive, person-oriented coaching style rather than negative, performance-oriented coaching style
    • Social influence and support from teammates with healthy attitudes toward body image, size, strength, and shape
    • Coaches who emphasize factors that contribute to personal success such as motivation, strength, and enthusiasm rather than body weight or shape

Concerns specific to female athletes

Female athletes may be at risk for a specific group of harmful consequences, known as the Female Athlete Triad:

    • Reduced or low energy availability (with or without disordered eating)
    • Menstrual dysfunction or complete loss of menstrual periods
    • Low bone mineral density

Low energy availability can result from insufficient calorie intake caused by restricting food or exercising excessively and burning many more calories than the athlete is consuming. This lack of adequate nutrition can cause the loss of several or more consecutive periods. This in turn leads to calcium and bone loss, placing the athlete at greatly increased risk for bone stress fractures and the development of osteoporosis. These conditions are a medical concern and, taken together, create serious, potentially life-threatening health risks. While any female athlete can develop this triad, adolescent girls are most at risk because of the active biologic changes and growth spurts, peer and social pressures, and rapidly changing life circumstances that accompany the teenage and early college years. Male athletes may develop similar syndromes and are also at risk for hormone imbalances and stress fractures and other sports injuries.

10 Tips for Coaches and Trainers

Coaches and trainers should explore and understand their own values and attitudes about weight, dieting, and body image. Recognizing how one’s values and attitudes is important to realizing how they could inadvertently affect athletes. An important part of a coach’s role is to promote positive self-image and self-esteem in athletes. These tips, developed for and by coaches in consultation with eating disorder experts, can help raise knowledge about eating disorder warning signs, preventive measures, and behaviors that may suggest disordered eating in an athlete.



Obtain, basic education on recognizing signs and symptoms of eating disorders to understand and implement prevention strategies—or help athletes who have them. People with eating problems are highly secretive about their eating habits. They develop coping skills to mask symptoms and to make believable excuses when their behavior is noticed or questioned. They are often ashamed, though they may be aware that the behavior is abnormal.


Pay attention to the warning signs, and take disordered eating behaviors seriously! Cardiac arrest and suicide are leading causes of death for people with eating disorders.


Chronic dieting or slightly odd eating habits are important signals of a potential problem. Coaches should refer concerns to the school’s student assistance program, responsible family member of the student, or a health professional with eating disorder expertise. Early detection increases the likelihood of successful treatment; left untreated, a problem that begins as disordered eating may progress to an eating disorder.


Athletes need accurate information about healthy weight, weight loss, body composition, good nutrition, sports performance, and the impact of bad nutrition. When discussing these subjects, include the common myths about eating disorders and challenge unhealthy practices. Seek assistance from local health professionals with expertise in eating disorders and athletics who can help educate athletes, including a board-certified, registered dietician who specializes in working with athletes, to educate athletes on appropriate nutrition for optimal sport performance.


Understand why weight is such a sensitive and personal issue for both male and female athletes. Eliminate derogatory comments or behaviors about weight no matter how subtle, slight, or “in good fun” they seem.


Deemphasize weight. Whenever possible, avoid weighing athletes. Eliminate comments about weight. Focus on other areas that athletes can control to improve performance, such as strength and physical conditioning, and mental and emotional aspects of performance. Improving mental and emotional coping skills carries no risk.


Don’t assume that reducing body fat or weight will enhance performance. Weight loss or lower body fat may improve performance in some cases, but studies show this does not apply to all athletes. Performance should not come at the expense of the athlete’s health.


Emphasize the health risks of low weight, especially for female athletes with menstrual irregularities or total cessation of menses. Remember that males also suffer health risks from weight concerns. Refer athletes for medical assessments in these cases.


If an athlete has an eating disorder, don’t automatically curtail participation in the sport unless advised by a physician who has evaluated the individual.


Always consider the whole person (emotional, physical, and psychological health), not just the athletic aspect of the person, when making decisions about an athlete’s level of participation in sports.