Written by Teresa Rufin with contributions by Marika Chrisanthopoulos.
When I was in college, spring semesters were a time when my friends and I would obsessively count calories on fitness apps, exercise for several hours a day, and sometimes eat fairly restrictive meals. As a research assistant at the Columbia Center for Eating Disorders, I can now appreciate that to an outsider, it would seem as though we were all suffering from an eating disorder. Yet, we were simply making the required effort to be at a competitive weight for our sport: women’s lightweight rowing.
We weren’t the only athletes who engaged in behaviors that would be considered disordered outside of the context of our sport. Many athletes who participate in endurance sports (i.e. running, swimming, cycling) or aesthetic-based sports such as ballet or figure skating maintain rigid diets and exercise for hours on end to be in peak physical shape. Although there is no evidence that participating in a sport can cause an eating disorder, rates of eating disorders among athletes are higher than the national average and can have severe physical consequences.
Aesthetic-based sports such as ballet, gymnastics, and figure skating are notorious for celebrating athletes with small, lean frames. Famous figure skaters such as Adam Rippon have openly discussed the intense dieting they endured in order to be light enough to land difficult jumps and look good in front of judges. On top of the pressure that many of these athletes face to be as slender as possible, aesthetic-based sports often require that training begins at a young age in order to be competitive- as young as 5 or 6 years old for figure skaters, ballerinas, and gymnasts. Research has shown that starting a sport at a young age can increase the risk of developing an eating disorder. Competing during adolescence can also be tricky as this is when we are expected to experience rapid body changes and are already at a higher risk for developing eating disorders.
Other sports that see higher-than-average rates of eating disorders include endurance-based sports such as:
- swimming, and
and weight-based sports such as rowing and wrestling. Athletes who specialize in long-distance sports are often encouraged to have extremely low body fat percentages to maximize their speed. Many endurance athletes also burn thousands of calories a day from their workouts and run a risk of becoming severely underweight if they are not properly refueling.
Athletes who have to make a minimum weight in order to compete (such as rowers and wrestlers) may feel encouraged to engage in dangerous weight-cutting behaviors and weightlifters may engage in similarly unhealthy behaviors to achieve the desired muscularity and strength for their sport.
Hypotheses about the Connection
One theory for the high rate of eating disorders among athletes proposes that individuals who are more predisposed to developing eating disorders are more likely to participate in a competitive sport. Personality traits such as competitiveness, perfectionism, and concerns about performance and body shape are seen both among athletes and individuals with eating disorders. Participation in highly competitive sports that focus on body shape can further drive individuals with these traits into patterns of maladaptive behaviors in order to fulfill desires for perfection and leanness.
Or, competing in a sport at an elite level may be a risk factor for developing an eating disorder. Several professional athletes have discussed how having their bodies, diets, and performance constantly under scrutiny lead them to develop obsessive and unhealthy exercise and eating patterns.
Implications for Physical Health
Although eating disorders exert severe physical and psychological consequences on individuals who suffer from one, the consequences can be especially severe among athletes who are engaging in extreme exercise on top of disordered eating.
The term “female athlete triad” was coined to describe a common occurrence among female athletes characterized by
- menstrual dysfunction,
- low energy availability, and
- decreased bone mineral density.
The triad can lead to health consequences including malnutrition and increased risk of stress fractures. Weight-class athletes who engage in unhealthy weight-cutting methods are at increased risk of long-term health effects such as increased risk for heart attacks and kidney failure.
Male athletes who suffer from muscle dysmorphia may abuse steroids and other performance-enhancing drugs to achieve extreme muscularity, putting their bodies at severe risk.
Signs of a Problem
For athletes who are dieting and exercising frequently as part of their sport, it can be incredibly difficult to determine who is at risk for developing an eating disorder and who isn’t. However, when either of the following behaviors is present, this is a sign of a problem worth addressing:
- Exercise beyond the demands of a sport. Many individuals with eating disorders will exercise with the same intensity despite illness or injury, exercise more than their teammates, and experience severe anxiety if unable to meet their exercise quota for the day. More tips on how to recognize excessive exercise can be found here.
- Disordered eating. While most athletes follow diets to ensure that they are meeting their nutritional needs for their workouts, the diets should still be well-balanced and proportional to the calories that they are expending. A healthy weight should be maintained, as well as some practical and psychological flexibility about eating. Adopting an extremely strict diet (i.e. cutting out entire food groups such as dairy or carbs or eating very low-calorie meals) can be a warning sign. To learn more about the spectrum of eating behavior, from normal to disordered to eating disordered, read here.
Despite the prevalence of eating disorders among athletes, research has also shown that participating in a sport, especially a team sport, can have a number of positive effects on the mind and body. Additionally, many coaches, physical therapists, and other professionals who work closely with athletes are now trained to recognize symptoms of eating disorders and ensure that athletes maintain a healthy weight and a healthy relationship with food.
If you are an athlete, here are some tips to support a teammate who may be suffering from an eating disorder.