Eating disorders in athletes: The pressure to perform

Athletes are often perceived as the epitome of health and fitness. Their toned bodies, rigorous training regimens and almost superhuman performances can lead us to believe that they embody the peak of physical well-being. However, behind the curtain of their remarkable feats, there lurks a less-talked-about issue: eating disorders. The sporting world, despite its emphasis on fitness, is not immune to the clutches of these deeply harmful conditions and even some of the highest-profile athletes are suffering under the surface.

The pressure to perform, maintain certain body standards or achieve specific weight goals can all significantly intensify the risk of developing eating disorders and so understanding their effects on athletes is crucial to recovery.

What causes eating disorders in athletes?

Athletes can develop eating disorders for the same reasons as the general public, such as underlying mental health issues, unresolved trauma and societal factors. However, there are also unique causes that stem from the specific demands of their sport. Understanding these factors is crucial not just for the athletes themselves but also for their support systems.

Here are some of the reasons why athletes can be particularly susceptible to eating disorders:

Performance pressure

For many athletes, a slight weight change could mean the difference between winning and losing. Whether it’s a runner aiming for lightness or a bodybuilder seeking bulk, the constant scrutiny of weight and physique can be mentally exhausting and lead to unhealthy eating habits.

Aesthetic sports

Athletes in sports such as gymnastics, ballet, figure skating and diving are judged not only on their performance but also on their appearance. This dual pressure can lead to a heightened awareness of body image, particularly as many athletes in these sports start young, laying the foundation for long-term mental health challenges and eating disorders.

Weight-class sports

Athletes in sports like wrestling, boxing and martial arts have to maintain a specific weight to compete in their category. This pressure to “make weight” can lead to extreme dieting, bingeing and purging behaviours. While these practices might offer short-term solutions for meeting weight requirements, they can be detrimental to the athlete’s health in the long run, affecting metabolism, cardiovascular health and mental well-being.

Injury and recovery

An injury can be an athlete’s worst nightmare as they are unable to train or compete. The fear of weight gain during the recovery period can lead to restrictive eating, further hampering the healing process.

Cultural and social factors

Societal beauty standards, peer pressure and even comments from coaches, teammates or family can contribute to an athlete’s preoccupation with weight and shape.
Personality traits
Athletes, particularly those at elite levels, tend to be perfectionists. This trait, while advantageous in pursuing sporting excellence, can also make them more prone to the rigidity and obsessive behaviours associated with eating disorders.

Training demands

Intense training schedules might lead to missed meals or reduced appetite due to fatigue, paving the way for unintentional weight loss and potential disordered eating patterns later.

The spectrum of eating disorders in athletes

Just as the sporting world is vast and varied, so too are the types of eating disorders that can afflict athletes. Some common forms and symptoms of eating disorders in athletes include:

Anorexia nervosa

Characterised by an intense fear of gaining weight, leading to severe food restriction. Athletes may feel the need to maintain a lean physique for aesthetic or performance reasons, which can amplify these fears. Athletes with anorexia may push themselves harder in training, believing that extreme thinness will enhance performance while it can actually degrade it. They may reject team meals, weigh themselves obsessively or wear baggy clothes to hide their thinness.

Bulimia nervosa

Bulimia involves frequent episodes of eating large amounts of food followed by purging. This may manifest in athletes due to pressures to maintain a particular weight or to combat feelings of loss of control. Bulimia can lead athletes to cycles of bingeing and purging as well as intense, unplanned workouts to “burn off” extra calories.

Binge eating disorder

This is regular episodes of overeating, but unlike bulimia, binge eating disorder does not involve regular purging or excessive exercise. All top athletes need more calories than regular people due to the energy spent training and competing. However, some may overconsume calories as a response to real or perceived energy deficits or to cope with performance pressures.

Orthorexia

Orthorexia is an unhealthy obsession with consuming only ‘clean’ or ‘perfect’ foods. Athletes, in their quest for peak performance, may fall into the trap of eliminating entire food groups, believing it will enhance their capabilities.

Avoidant/Restrictive food intake disorder (ARFID)

Unlike anorexia, ARFID involves avoiding specific colours, textures or types of food without concern for weight or body shape. It can arise in athletes who, for example, may only want to consume foods they believe enhance performance.

Notable examples of athletes with eating disorders

Over the years, the sporting world has seen a series of courageous athletes stepping forward, shedding light on the dark corners of eating disorders in professional sports. Their stories offer insights into the internal battles they have faced, often behind the gloss of medals and championships.

Tom Daley

The acclaimed British diver Tom Daley has candidly discussed his battles with bulimia and the mental pressures he faced in the world of competitive diving. Daley says that his bulimia was triggered ahead of the 2016 Rio Olympic Games by comments from his trainer regarding his weight:

Kathleen Baker

The Olympic swimmer has candidly spoken about her struggles with Crohn’s disease, a condition that complicated her relationship with food. The necessity to control her weight and manage her symptoms pushed her towards patterns resembling disordered eating and greatly affected her mental health.

Yulia Lipnitskaya

A Russian figure skater and Olympic gold medalist, Lipnitskaya revealed her fight with anorexia following her rapid ascent to global fame. The immense pressure to maintain a specific body weight and silhouette for her sport took a toll on her mental and physical health. Speaking about her condition, Lipnitskaya explained:

How are eating disorders treated?

Addressing an eating disorder, especially within the high-pressure realm of sports, requires a multifaceted approach that considers both the physical and psychological dimensions of the disorder. Recognising the issue is the first step, but active intervention and treatment are vital for holistic recovery. Here is an overview of the treatment modalities that treatment specialists, including UKAT, provide:

• Medical care: This is the immediate priority if an individual’s health is at risk. This phase includes monitoring and addressing potential complications, ensuring nutrition and treating related conditions such as osteoporosis or heart issues.

• Individual therapy: Cognitive-behavioural therapy (CBT)  is often a first-line treatment for eating disorders, helping athletes identify negative thought patterns and behaviours and develop coping strategies. Other therapy types include dialectical behaviour therapy and interpersonal psychotherapy, depending on the specific disorder and individual needs.

• Nutritional counselling: This involves working with a dietitian to develop a balanced diet plan, understand healthy versus disordered eating patterns and learn the nutritional needs specific to their sport and body.

• Medication: Some individuals benefit from medications, such as antidepressants, to treat co-occurring mental health issues like depression or anxiety.

• Group therapy: Joining a group can help athletes realise they are not alone in their struggles, providing a platform for mutual support and shared experiences.

• Family-based Therapy: Especially for younger athletes, involving the family can be crucial as it equips loved ones with the tools to support recovery.

• Aftercare and relapse prevention: Recovery is an ongoing process so regular check-ups, continued therapy and support group attendance can be integral in maintaining progress and preventing relapses.

• Addressing sports-specific triggers: This includes working with coaches and trainers to ensure the athlete’s environment is supportive of their recovery and potentially making adjustments in training regimens or competition schedules.

• Holistic practices: Incorporating practices like meditation, yoga, and mindfulness exercises can help athletes cope with pressure, reducing the risk of resorting to disordered eating as a coping mechanism.

The pivotal role of trainers and sporting bodies

The sports ecosystem – from coaches to sporting bodies – plays an essential role in either reinforcing or challenging the unhealthy pressures athletes face. Their responsibilities include:

• Awareness and education: Trainers should be well-educated about eating disorders, enabling them to spot warning signs early.

• Open communication channels: Athletes should feel comfortable discussing their struggles without fear of judgement or repercussions.

• Mental health resources: Sporting organisations should provide resources dedicated to mental health.

• Nutritional guidance: Access to nutritionists who understand the unique demands of sports can help athletes maintain a healthy relationship with food.

• Policy changes: Sporting bodies may also need to reconsider policies that inadvertently encourage unhealthy behaviours, like rapid weight loss in weight-category sports.

Get help today

In the high-stakes arena of sports, where performance is paramount, it is crucial for everyone involved – from the athletes themselves to their support systems – to recognise the signs and understand the treatments available for eating disorders. Early intervention can make all the difference, ensuring that athletes can continue to pursue their passion in a healthy, balanced manner.

Eating disorders are not a sign of weakness; they are complex conditions that require understanding, compassion and professional intervention. Everyone deserves a chance to heal and thrive, whether on the sporting field or the battlefield of personal health.

If you or someone you know is struggling with an eating disorder, reach out to UKAT today. Our dedicated team of professionals is trained to provide holistic care tailored to each individual’s needs, ensuring the best possible path to recovery.