Eating Disorders and Athletes: What You Need to Know, by Katie Elliott, MS, RD

Sports are a playground for dreams, hopes, and aspirations. Yet athletic careers are also fragile, easily derailed, and often abbreviated. Fro m injury to burnout, there are many reasons dreams never become a reality. But of all the reasons hopes are dashed, I have found eating disorders to be one of the most dangerous and hidden culprits.

In her powerful Milesplit USA article, Lauren Fleshman aptly referred to eating disorders as “The Number 1 Destroyer of Dreams.” I think she is exactly right, and in my experience, such destruction extends far beyond lost medals, accolades, and records. Eating disorders slowly, silently and deliberately chip away at one’s overall quality of life. They not only wreak havoc on athletic performance, but also erode self-confidence, happiness, relationships, health, longevity, and much, much more.

Athletics, Disordered Eating and Eating Disorders

Athletics present a unique challenge to maintaining a healthy relationship with food because physical characteristics impact performance. The culture of sports is also a weight-conscious one, adding additional fuel to the fire. The qualities inherent in successful athletes such as mental toughness, pursuit of excellence, perfectionism, performance despite pain, coachability, and selfless commitment may also contribute to the development of eating disorders. Furthermore, the association of competitive athletics with health frequently allows eating disorders among athletes to go unnoticed and untreated.

Research has found disordered eating or a subclinical eating disorder (simply put, an unhealthy relationship with food) to be as high as 45% in female athletes and 19% in male athletes. [1] Such statistics are higher in weight-class sports (wrestling, rowing, horse racing) and aesthetic sports (bodybuilding, gymnastics, diving), where up to 33% of males and up to 62% of females are affected by disordered eating. Prevalence estimates of clinical eating disorders among athletes tend to be less than the prevalence of subclinical, disordered eating.  However, disordered eating can have serious health consequences and also places individuals at higher risk for a full-blown eating disorder.[2]

Performance & Health Consequences

Many of you might be thinking that you have seen athletes lose weight and experience immediate performance gains. You may have seen calculations about how running speed or VO2 max increases with weight loss or talked about power to weight ratios. In some cases, disordered eating behaviors do lead to short-term performance increases. The key word here is short-term. Such performance increases quickly disappear as the body breaks down due to nutrient deficiencies, anemia, fatigue, reduced heart function, and frequent infection, illness, or injuries. In short, the fastest way to stop your athletic progress dead in its tracks is to start down a disordered eating path.

Talking about performance declines is likely to catch an athlete’s attention in the disordered eating discussion. However, I would be remiss if I didn’t address potential, associated health consequences. The aftermath of disordered eating and clinical eating disorders is lengthy (too lengthy in fact to cover completely in this article).

In addition to the consequences I listed above, the following are just some of the problems associated with various eating disorders:

  • Heart damage and dysfunction
  • Heart failure
  • Gastrointestinal distress and complications
  • Bone loss (often premature osteoporosis/osteopenia)
  • Growth stunting and structural brain abnormalities in children and teens
  • Reproductive dysfunction
  • Hormone dysfunction
  • Fertility issues, and even death.

In addition, disordered eating has a way of consuming an athletes’ thoughts and overworking the will power muscle.

I attended a powerful lecture by Dr. Riley Nickols, Counseling and Sports Psychologist. Riley is also the Director of the Victory Program, a treatment facility that works specifically with athletes with eating disorders.

In his presentation, Dr. Nickols explained that there are 40 behaviors and traits that improve athletic performance (listed below):

Genetics, training, practice, coaching, physical health, balance, body composition, coordination, courage, endurance, nutrition, quickness, reaction time, rest/sleep, speed, strength, VO2 max, weight, mental health, mental preparation, mental toughness, anticipation, coachability, competitiveness, commitment, concentration, confidence, desire, “heart,” intelligence, motivation, perfectionism, “playing with pain,” poise, pursuit of excellence, mood, resilience, relationship between athlete and coach, relationship between/among teammates, respect, sacrifice, teamwork, and hard work.

He pointed out that if an athlete’s thoughts are consumed with weight, that leaves little room to address the other behaviors and traits that contribute to athletic performance. Furthermore, disordered eating will hinder most of the other 39 determinants in one way or another. This point is a good one and aptly describes my view that weight is only one determinant of performance out of 40.[3] Dr. Nickols’ message was aimed at coaches and athletes. Bottom line, narrowly focusing on one thing out of 40– one that is not even the most important and can negatively affect others, is clearly harmful to an athlete’s goals.

Taking Inventory of Your Relationship with Food

If you find yourself thinking mostly about your weight, it might be time to reflect on your relationship with food. The National Eating Disorders Association has an online screening tool that might help you to better evaluate this relationship and its place in your life. Click here to access this evaluation. If you already know that your relationship with food could improve, make an appointment with a healthcare professional (e.g., your doctor, a counselor or a Registered Dietitian). This type of professional can help you to determine the right steps to take to move toward better food practices (and better quality of life).

You may be an athlete who has seen a lot of conflicting information in the media that left you confused about how to best approach food. You may be wondering what your ideal race weight is or how to fuel your training effectively. In this case, make an appointment with a Registered Dietitian to ensure that you understand your fueling needs and what a healthy relationship with food looks like for an athlete.

In Conclusion

I said it above and will restate it here: disordered eating and eating disorders will not allow you to reach your full potential as an athlete. Such practices will not only hinder your performance but will also limit your energy and focus to one variable (weight). Your tunnel vision around a number will limit your ability to address other aspects of your performance like competitiveness, reaction time, strength, and even being a good teammate.

Beyond that, disordered eating has a sneaky way of replacing the good in your personal life with constant thoughts of food. And then there’s your health, which will take a hit if you continue down a road driven by a singular focus on weight. Take a different road. Get the help you need. First educate yourself about sports nutrition. Then preserve or repair your relationship with food. After all, you deserve to give yourself the best chance to succeed at sports and life.

[1] Karpinski, C. and Rosenbloom, C. (2017). Sports Nutrition: A Handbook for Professionals, 6th Edition. Chicago: Academy of Nutrition and Dietetics.
[2] National Eating Disorders Association. (2016). Coach and Trainer Toolkit. Retrieved from:
[3] Nickols, R. (2015). “Athletes and Eating Disorders: What Treatment Teams Need to Know.” McCallum Place, The Victory Program (Boston, MA).


Katie Elliott is a Registered Dietitian Nutritionist. She is the founder of Elliott Performance and Nutrition, based in Aspen, Colorado. Katie works with clients nationwide via tele-health and provides counseling and exercise testing at Achieve Health and Performance.

Katie’s specialties include sports nutrition, nutrition for the prevention and treatment of disease, weight loss, and worksite wellness. She has coached athletes to several podium finishes as a Triathlon Coach.

In addition, Katie attended IMG Academies as a junior tennis player. She played Division I tennis at Davidson College.  She has competed on numerous amateur world triathlon teams. Since 2004, Katie has won numerous overall amateur titles. She has been on 6 World Championship teams and has finished 2nd at two National Championships. Furthermore, Katie achieved a 6th place finish at the World Championship in her age group.

Contact her here: Katie Elliott, MS, RD.

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