The Hidden Crisis: Eating Disorders Among Elite Athletes

Olympians – athletes at the top of their sport and in prime health – are idolized and often viewed as superhuman. These athletes spend their lives focusing on building physical strength through rigorous training and diets that are honed to provide the nutrients necessary to excel at their sport.

However, athletes are at considerable risk for eating disorders and having an unhealthy relationship with food and their bodies.

The distinctive lifestyle of elite athletes can create a hotbed for eating disorders and disordered eating, meaning restrictive, compulsive, irregular or inflexible eating patterns, all of which can occur on a spectrum.

In 2019, 19% of male and 45% of female athletes worldwide experienced disordered eating behaviors, according to the International Olympic Committee. For perspective, in the general population, about 9% to 10% of Americans will have an eating disorder in their lifetime.

Several Winter Olympians, including cross-country skier Jessie Diggins, Alpine skier Alice Merryweather and figure skaters Gracie Gold, Adam Rippon and Yulia Lipnitskaya, have spoken about their experience with an eating disorder and disordered eating. Lipnitskaya, one of the youngest Winter Olympic gold medalists, retired at age 19 due to her battle with anorexia, a few short years after winning her 2014 team gold medal in Sochi, Russia.

As a specialist in eating disorders and anxiety, I regularly work with athletes and clients who experience eating disorders and disordered relationships with food and exercise. Based on my clinical and personal experience, I believe that the public can learn to better support athletes with eating disorders by considering the unique risk factors they face.

One contributing factor for disordered eating is an athlete’s temperament, since certain traits also show up as risk factors for eating disorders.

For example, an athlete’s constant desire to improve and their intense attention to detail can border on perfectionism and obsessiveness. An unrelenting focus on achievement and competitiveness are all associated with heightened risks of developing an eating disorder. Personality traits such as mental toughness, discipline, high pain tolerance and persistence may also lead to worsened eating disorder risk and behaviors in athletes.

These traits are also common risk factors for nonathletes but are often viewed as positive traits in athletes since they lead to high achievement and attainment. For instance, an athlete might restrict food intake to find focus, or delay eating to achieve a specific goal that day. Or they might engage in compulsive exercise regardless of hunger or injury, chalking it up to discipline.

What’s more, in athletes, typical signs of an eating disorder, such as training for long hours without appropriate breaks for meals or obsessing about only consuming certain healthy foods, can be overlooked due to the normalization of these behaviors in high-level sports.

The primary sports where eating disorders traditionally surface are gymnastics, wrestling, dancing, bodybuilding and figure skating, since these are sports where weight and body image often come into play.

About 46% of athletes in so-called “leanness” sports have an eating disorder, compared with almost 20% of athletes in sports that are not weight-focused. That’s because athletes in weight-sensitive sports experience far more emphasis and demand on having a thin and muscular body, which often involves weight monitoring as part of their training or competition.

Athletes in these sports also experience high demands of constant competition, rigidity around their dieting and exercise schedule, high energy output and an incredibly high mental and physical strain on their bodies.

External factors can also put an athlete at risk for an eating disorder. For instance, in various sports like running, rock climbing and figure skating, there is a long-running belief that being at a lower weight will improve an athlete’s performance. This can lead to disordered behavior that may initially feel beneficial to performance; however, it can negatively affect performance and health over the long run. External pressure, such as weight stigma and pressure from coaches and family, media and societal standards of fitness and team culture around dieting and weight, also place athletes at high risk for eating disorders.

Another serious factor regarding eating disorders in high-level athletes is that a very small percentage of them seek treatment. A 2021 study found that among U.S. athletes who experienced disordered eating or had an official diagnosis, more than 95% were not in treatment and 75% had no intention of seeking it. For perspective, the help-seeking rate for those with disordered eating or eating disorders in the general population is between 32% and 40%., compared with around 5.4% in athletes.

In competitive sports, a “no pain, no gain” mentality can often directly and indirectly reward athletes who push themselves to the extreme. As a result, athletes may be less likely to seek treatment and to come forward with their issues for fear of not wanting to have restrictions on their practice and competition put in place, of being ostracized from their teammates or of losing sponsorship or scholarship opportunities.

Along with this comes a lack of awareness about eating disorders, stigma and unhealthy attitudes and assumptions toward mental health from coaches and other athletic personnel, all of which can impede an athlete’s likelihood of seeking care. Ultimately, seeking and receiving treatment can be difficult for athletes because athletes face sacrificing time away from their sport, which is often their livelihood.

Despite the stacked risk factors, athletes also have some protective factors against eating disorders working in their favor. For instance, exercising regularly and noncompulsively is associated with improved mental health. And participating in sports that emphasize body functionality over physical appearance can have a positive effect on athletes’ overall well-being.

Strong relationships between athletes and coaches who focus on creating a safe and supportive environment that prioritizes mental health – along with person-oriented coaching styles, rather than negative, performance-oriented coaching – can also be protective against disordered eating.

One preventive strategy that the International Olympic Committee has been working on is focusing on improving pre-competition assessment of health. This assessment will focus on an athlete’s body composition and other determinants of health, such as vital signs, to determine if they are fit to perform in the upcoming qualifiers and Olympic games. These guidelines may allow athletes to get much-needed help and support.

Despite the perception of superhuman qualities, athletes who experience eating disorders experience all of the same consequences of eating disorders as the general population. But athletes also have higher risk of injury, decreased strength and endurance, and worsened athletic performance over time due to low energy availability and fatigue, and are more likely to experience anxiety, depression and suicidal ideation in their lifetime.

Research shows that early detection of disordered behaviors, awareness of eating disorders in athletics, and education for athletes, families and coaches are all strong prevention strategies.

Athletes often require a multi-disciplinary team to support them. This may include a therapist, psychiatrist, sports psychologist, registered dietitian, medical doctor, physical therapist, occupational therapist or any combination of these. This team can assist the athlete in stabilizing medications, improving nutritional intake and recognizing differences between athletic dedication and disordered behavior.

It is also critically important for family to be involved and that the athletes’ entire support system – as well as the public – remember that athletes are humans, with real emotions and struggles, just like the rest of us.