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Eating Disorders in Athletes: The Good News

There is good news about eating disorders. As a friend, parent, or coach, you can help prevent them in young athletes!

The ugly stuff: eating disorders are harmful!

But before we get to that good news, let's take a look at the ugly stuff.  Too many athletes (of all ages) struggle with food. Some have disordered eating patterns; others have outright eating disorders. A Norwegian study found that 14% of elite female teen athletes develop an eating disorder by the ages of 15/16, as compared to only 3% of their non-athletic peers. Gymnast doing backflip

Among older athletes, most report having started dieting and developing an eating disorder during puberty or adolescence. (You know, when, at age 12, your parent suggested you go to Weight Watchers...) While the prevalence of eating disorders is higher among elite athletes than non-athletes, and higher in females than in males, the runners, dancers, gymnasts and others who compete in weight-sensitive sports are the most vulnerable.

An eating disorder is a psychological diagnosis (not a nutritional diagnosis, even if the symptoms show up in food-related issues).  Eating disorders often start at the time of puberty, when the body is changing and maturing. The skinny little runner who starts to mature and lay down some body fat (a normal part of puberty) can feel out of control, imperfect, and scared that she'll get fatter and fatter and fatter. Add in a critical comment from a parent, coach, or teammate ("Maybe you should lose a little weight...) and the kid believes she is not good enough. The "simple" solution is to eat less and exercise more-but that can become a vicious cycle of restricting (anorexia), restricting/bingeing (bulimia), or other variations of obsessive dieting.

Weight issues tend to be "I'm not good enough" issues. Feeling imperfect or out of control is an unhappy place to live, so an athlete might distract himself from feeling that discomfort by keeping himself busy tracking calories, exercising to burn fat, and obsessing about what, when and how much to eat. Food-thoughts can occupy 99% of the day, leaving little time or energy to deal with the real issue: poor self-esteem and why he doesn't feel good about himself.

To every athlete's detriment, dieting/restricting food can hurt the body's ability to function normally (as commonly noted by feeling cold and tired all the time, and in women, ceasing to have regular menstrual periods). Bones become weakened, stress fractures occur, and osteoporosis appears too young. Future infertility can be a sad consequence.

The good news: Eating disorders can be prevented

Preventing eating disorders is certainly preferable to dealing with them. Marianne Martinsen and colleagues at the Norwegian School of Sports Sciences have researched how to prevent eating disorders from starting in the first place (Med Sci Sports Exerc, March 2014).

They created a one-year program to try to prevent the development of new cases of eating disorders among first-year students representing 50 different sports/disciplines attending all 16 Elite Sport High Schools in Norway. The researchers randomized the different schools into the intervention group (received the program) and the control group (no input). In total, they followed 465 male and female first-year students during three years of high school. To create supportive environments also the athletes coaches at the schools were included in the intervention.

The primary focus of the eating disorders prevention program was to enhance self-esteem by strengthening the students' self-efficacy (belief in themselves and their abilities to meet performance goals). Over the course of the year, the intervention students attended lectures, performed teamwork exercises, and completed homework assignments. On a closed Facebook page, they read posts by renowned athletes who shared their experiences related to self-esteem, self-efficacy, and mental training. Every day, for several weeks, each student recorded three positive events that were not related to their sports performance, as a way to develop a strong sense of themselves that was not contingent on performance or approval from significant others

The students learned the following information:

  • physiological changes that occur during puberty.
  • the role of nutrition with enhancing performance.
  • the need for proper fueling throughout the 24-hour day.
  • ways to evaluate the latest nutrition supplements, diets.
  • the importance of rest days; the dangers of overtraining
  • causes of stress in competitive athletics; how to manage it.
  • how to set reasonable and achievable goals.
  • visualization techniques to build a positive mindset.
  • skills to create positive self-talk.
  • how to show concern for teammates with eating issues.

As a result of the one-year intervention program, the female athletes significantly reduced their dieting behaviors by 90%. Not one of the athletes developed an eating disorder during that year or the one-year followup-a contrast to 13% of the female athletes in the control schools. Of the thirteen athletes who started the educational program with an eating disorder, 12 recovered. In comparison, only 4 of the 13 with eating disorders in the control group recovered.

So what does this mean for your child?

As an athlete, your child is undoubtedly self-critical. But the possibility exists that she (and her body) are indeed good enough the way she is. With counseling (as opposed to dieting), she can address those "I'm not good enough" demons that dominate her thoughts and lead her to believe she is not smart enough, strong enough, thin enough, or good enough. Fortunately, with the help of a therapist and a sports dietitian, she can find a more peaceful way to live and to care for herself, including proper fueling. (I use the feminine pronoun here for convenience, not because male athletes don't have eating disorders too, because they do).

If you are a parent of an athlete who is struggling, express your concern about how tired, unhappy, or withdrawn they seem. Repeatedly ask "Are you OK?"  For more tips, check out the Disordered Eating Center on MomsTEAM and additional resources at www.nationaleatingdisorders.org and books at www.edcatalogue.com.

Boston-area sports nutritionist Nancy Clark, MS, RD is a MomsTEAM nutrition expert and counsels both casual and competitive athletes, including many who struggle with food. Her office is in Newton, MA (617-795-1875). For information about her Sports Nutrition Guidebook (new 5th edition) and food guides for runners, see www.nancyclarkrd.com. For online education, also see www.sportsnutritionworkshop.com.


Martinsen M, Bahr R, Borrensen R, Holme I,  Pensgaard A, Sundgot-Borgen J. Preventing Eating Disorders among Young Elite Athletes: A Randomized Control Trial. Med Sci Sports Exerc 2014; 46(3):435-447

Martinsen M, Sundgot-Borgen J.  Higher prevalence of eating disorder among adolescent elite athletes than controls. Med Sci Sports Exerc 2013;45 (6):1188-1197

Sundgot-Borgen J, Torstveit, MK Prevalence of Eating Disorders in Elite Athletes is Higher Than in the General Population. Clin J  Sport Med 2004;14(1), 25-32.

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