Disordered eating: an overlooked health crisis among young athletes

An estimated one-third of adolescent athletes suffer from disordered eating, a type of eating disorder that involves less severe or less frequent eating patterns typically associated with anorexia nervosa, bulimia nervosa, or binge eating disorder.

Last year, roughly 7.9 million students participated in high school sports in the U.S., meaning approximately 2.6 million student-athletes may be at risk.

“It’s essential to be on the lookout for disordered eating because it can progress to eating disorders, which have the highest mortality rate of all psychiatric illnesses,” Samantha Kennedy, DO, a child and adolescent psychiatrist at Michigan State University says. “This is due to medical complications and the higher rate of suicide among those with eating disorders.”

Patients with disordered eating exhibit irregular eating behaviors that may not meet diagnostic requirements for a clinical eating disorder.

Common warning signs associated with disordered eating include a preoccupation with body shape and weight, changes in weight, changes in bowel habits, and, in women, menstrual irregularity.

Nutrition and athletes

“The most common problem I see in younger athletes with nutrition is that many don’t understand how much fuel they need for their activity level,” says Dr. Kennedy. “This frequently happens when an athlete increases their competitive level, such as transitioning from a local team to a travel team or from high school to college. Often, the athlete was fueling enough previously, but now they are practicing and competing much more frequently while maintaining a similar level of intake.”

Certain types of athletes are at higher risk for developing disordered eating, Dr. Kennedy says. In particular, those competing in aesthetic sports, such as gymnastics and ice skating, which may be judged on appearance—often interpreted as needing a thin body type.

“Also, athletes competing in endurance sports, such as running and cycling, are at risk because of the common belief that being lighter always means being faster,” Dr. Kennedy notes. “Unfortunately, this is often initially true where an athlete can see an improvement in performance with a little weight loss, but continued weight loss results in poor nutritional status, which leads to increased injuries, low energy, and decreased performance,” she continued.

Identification, then education

If parents have concerns, they should speak with their family physician and the adolescent’s athletic trainer—along with others who see the athlete eat and train frequently, says Dr. Kennedy.  They are best-positioned to identify disordered eating.

Identification of disordered eating can make a difference. A study exploring the use of an intervention program designed to boost self-esteem and provide nutrition education for elite adolescent athletes found that while 13% of the control group developed an eating disorder, no one in the intervention group developed a new eating disorder.

If athletes are aware of disordered eating, progression can be prevented, Dr. Kennedy stresses. Once the behaviors are acknowledged, the likelihood of developing an eating disorder dramatically drops.