Athletes and eating disorders: considerations for the sports nutrition practitioner

Sport is considered positive and good for the mind, body and soul. But it can also be a dangerous activity due to the competitive environment and resultant high expectations, that can place a great deal of pressure and anxiety onto athletes.

If not managed properly, this can lead to dysfunctional eating patterns and eating disorders.

“It’s not about food - it’s a way of control”, as Renee McGregor explained on Module 3 of our course. This control is a coping mechanism and provides a temporary release from all the anxiety and stress. But what athletes don’t realise is that their strict ‘food rules’ can actually heighten their anxiety in the long term and lead to a dysfunctional relationship with food.

Athletes with eating disorders are not seeking attention. In fact, due to the nature of these illnesses, an athlete with an eating disorder can often go to great lengths to hide or disguise their behaviour. In this case, the athlete’s eating disorder is harder to resolve and it becomes more difficult to restore energy balance because it’s an intentional behaviour. But athletes may also restrict energy intake involuntarily and not realise that what they are doing is harmful. This scenario is easier to resolve because these athletes often engage with nutritional interventions once they understand that they’re not fuelling their body properly for optimal health and performance.

No sports are exempt, although eating disorders are more frequent in aesthetic sports or sports that emphasise a low weight, because athletes believe the mantra: ‘being lighter means being faster’. But the personality traits of an athlete – high-achiever, determined, perfectionist, self-critical, obsessive, sensitive and compulsive – also put them at a higher risk of developing a dysfunctional relationship with food. And the more an athlete becomes unwell and lacks emotional resilience, the more pronounced these characteristics are likely to become. Renee showed us a staggering statistic, which is likely a result of an athlete’s mindset and personality traits: there is a 20 per cent higher prevalence of disordered eating in athlete populations than in non-athlete populations.

Although we can’t diagnose or treat an athlete with an eating disorder, by looking out for certain warning signs, as sports nutrition practitioners we can still do a lot to help them. Warning signs include:

  • - Poor performance, recovery and adaptations
  • - Excessive training and/or struggling to take rest days
  • - Stress fractures and recurrent injuries
  • - Digestive issues such as constipation and bloating
  • - A change in menstrual cycle/lack of three consecutive periods in female athletes and a decline in morning erectile function in male athletes
  • - Social isolation and severe anxiety
  • - Fear and worry about food
  • - Strict control of food intake
  • - Feeling cold all the time
  • - Lanugo; i.e. fine, soft, downy hair growth 

As sports nutrition practitioners, we need to educate athletes that, in theory, no food should be banned from their diet, but they need to be mindful of what they’re eating to achieve optimal health and performance. There may be certain times of their annual training/competition schedule when they need to be stricter. But they should never become restrictive to a point that it causes more anxiety and fuels irrational behaviours.

It’s hard for an athlete to break away from their own ‘food rules’. As practitioners, we need to challenge those rules so we can encourage more appropriate behaviours. For example; if an athlete is worried about eating fruit because it’s high in sugar and they believe that sugar is ‘unhealthy’, we should question this concern and ask whether there is any scientific evidence to support their ‘food rule’. As Renee explained, this can be a powerful exercise for the athlete so they realise how irrational their behaviour actually is.

If a number of these warning signs are observed and the athlete’s anxiety is heightened, if possible, we should refer the athlete to someone qualified in eating disorders, and who has experience of dealing with athletes. It is vital for the athlete to receive appropriate and timely support before this potentially ends their sporting career.