Disordered eating in athletes: key learnings

I recently completed a short online course, for coaches and sports professionals to learn how to identify, engage and support athletes with eating problems. Coaches and sport professionals work closely with athletes, so they are ideally positioned to detect the early warnings signs of potential eating issues.

It is estimated that up to 20 per cent of elite females and eight per cent of elite male athletes meet the criteria for a clinical eating disorder, such as anorexia, bulimia and binge eating disorder, compared to around one per cent in the general population.

But when it comes to disordered eating, it is not about whether or not you have an eating problem. Disordered eating lies on a spectrum and most people experience some body image concerns. As a result, they will have experimented with different diets, but this is worrying only when it starts to escalate to disordered eating behaviours that threaten their physical and mental health.

As a group, athletes tend to deviate from what we might see in the general population because they pay more attention to what they eat, but this alone is not considered disordered eating. However, their perfectionist personality traits do put them at a higher risk of slipping into disordered eating behaviour, with attitudes such as skipping meals, cutting out major food groups, occasional binge eating episodes, obsessing about constantly weighing themselves and over-exercising.

Athletes who compete in weight category sports (e.g. Judo, wrestling and boxing) and sports that accentuate leanness for performance gains and/or aesthetics (e.g. gymnastics, cycling and long-distance running), are at even greater risk. No wonder then, that the overall figure for athletes demonstrating signs of disordered eating is 40 per cent.

Clear warning signs that coaches and sports professionals should look out for include:

  • - Physical signs: change in weight, fatigue, poor recovery, an irregular menstrual cycle, feeling cold, gastrointestinal issues, injury, illness, electrolyte abnormalities and dental problems (common in those who vomit regularly), etc.
  • - Psychological and behavioural signs: avoiding eating with others, compulsive exercise, purging, fear and anxiety over food, secretive eating habits, frequently weighing themselves or distressed when weighing, etc.

Even so, identifying these warning signs in athletes is difficult because coaches and sports professionals face unique challenges. For example, we presume that well-performing athletes are in good health, and as a result, we may be less likely to look for an eating issue. But in the early stages of an eating problem, an athlete’s performance can actually improve due to the associated weight loss. This just shows that we shouldn’t use performance as a proxy for an athlete’s health.

We also expect athletes in certain sports to look a certain way (e.g. long-distance runners to be quite lean) and get concerned only when their body size and shape changes from the ‘norm'. But, disordered eating problems don’t discriminate – they come in all sizes and shapes.

There is also considerable overlap between the characteristics that we reinforce in a high-performance environment (e.g. commitment, mental toughness and enduring pain) and those commonly seen among eating disorder patients. And finally, athletes can be secretive and are more unlikely to admit they have a problem for fear they cannot train or compete anymore.

One key learning that stood out from this course is that there is no right way to engage with an athlete with a suspected eating problem as long as the coach or sports professional uses supportive language and demonstrates that they are concerned. However, there are a few key considerations:

  • - We shouldn’t let our own concern or feelings of frustration get in the way when we engage with the athlete.
  • - As athletes tend to respond better to a person they trust (e.g. parent), the coach or sport professional might not necessarily be the best person to engage with the athlete. If they do, it might help to involve someone else in the discussion.
  • - Early intervention is vital for the long-term recovery of the athlete.

The course went on to give some examples of conversation starters that I found really useful, and highlighted challenges to expect when we engage with an athlete with a suspected eating problem. It also provides guidance on how to continue to support the athlete throughout their recovery, and some strategies for good practice around athlete eating, shape and weight. For example, some coaches and sports professionals do make comments about weight and shape that can be unintentionally triggering for the athlete.

I highly recommend this short online course if you work closely with athletes (recreational to elite). Also check out Trainbrave, co-founded by Renee McGregor, who lectured on our course in 2018, about disordered eating in sport. There are some useful resources for coaches and sports professionals with information about the risks of disordered eating in athletes.

If you work with athletes, get informed. You can make the difference by detecting the early warning signs and starting the conversation, preventing them from potentially ruining their health and athletic careers.