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.