Eating Disorders

Since nutrition is one of the final frontiers for legal performance enhancement, it is not surprising that athletes are at a greater risk for eating disorders and disordered eating than their sedentary counterparts. Endurance sports and sports that ‘prize’ lean physiques have the highest eating disorder risks. Athletes in general are known to have eating patterns and practices that may vary from the sedentary population. It is, however, the athlete’s lifestyle that sometimes allows justification of nontraditional eating practices that can mask a very serious condition.

Eating disorders and disordered eating are two terms used interchangeably, but they are very different. Eating disorders are clinically diagnosed conditions that include anorexia nervosa, bulimia nervosa and eating disorders not otherwise specified (including anorexia athletica). Disordered eating is used to describe various abnormal and harmful eating behaviors that may be used as a misguided attempt to lose weight or maintain an abnormally low body weight. An example may be excluding one or more food groups as a means to control weight.

Anorexia nervosa is a condition associated with very low energy intake. Characteristics of an anorexic athlete are less than 85% of a normal weight for the athlete’s height, intense fear of gaining weight, severe body dissatisfaction, and amenorrhea (absence of three or more consecutive menstrual cycles).

Bulimia nervosa is a condition associated with episodes of controlled eating (binge eating) followed by a purge behavior. The purge behavior, such as vomiting, use of laxatives or excessive training, is an attempt to rid the body of the calories consumed. bulimics are usually normal to slightly overweight.

Anorexia athletica is a subclinical disorder that is displayed by an intense fear of gaining weight or becoming fat even though the athlete is normal to underweight (5% below normal weight for the athlete’s height). Other features of the disorder are delayed menarche (no menstrual period by age 16), menstrual dysfunction (erratic menstrual periods), gastrointestinal complaints, absence of a medical illness to explain the weight loss, distorted body image, fear of weight gain, restricted energy intake, periodic binge and purge behaviors, and compulsive exercise.

The impact of eating disorders and disordered eating may not negatively impact performance for some time. In some cases, performance may initially improve secondary to a drop in body weight and an improved strength to weight ratio. The impact of the disorder on short-term and long-term performance and health depends on the length and severity of the condition. The effects on an athlete’s health include depression, anxiety, irritability, stunted growth and maturation in adolescent athletes, altered reproductive function, and osteoporosis.

Eating disorders or disordered eating, amenorrhea and osteoporosis together form a serious syndrome known as the female Athlete Triad. Any female athlete is at risk for this syndrome, but those who participate in sports where low body fat is required or seen as an advantage are at the highest risk. Each component of this triad increases the chances of suboptimal health, poor performance and even death.

About the Author

Jennifer Hutchison, RD, CSSD, LDN is a registered/licensed dietitian with a Board Certification as a Specialist in Sports Dietetics as well as a USAT level iii Coach. Jennifer has been involved with the USAT coaching certification program since 2001, educating coaches on advances in sports nutrition. She is a USAT All American triathlete with experience racing all distances as well as being a three-time qualifier/finisher of the Ironman® World Championship. Jennifer uses her academic training, certifications and experiences as an athlete and coach to help coaches and athletes apply the art and science of performance nutrition. Jennifer can be reached with questions at

References/Recommended Readings

American Academy of Pediatrics. Pediatrics. 106 (2000):158−59.

Beals, Katherine. Eating Disorders Among Athletes: A Comprehensive Guide for Health Professionals. Champaign, IL: Human Kinetics, 2004.

Driskell, Judy A., and Ira Wolinsky, eds. Nutritional Assessment of Athletes. Boca Raton, FL: CRC Press, 2002.

Jeukendrup, Asker, and Michael Gleeson. Sports Nutrition: An Introduction to Energy Production and Performance. Champaign, IL: Human Kinetics, 2004.

Maughan, R. J. L. M. Burke, E. F. Coyle. Food, Nutrition and Sports Performance II. The International Committee Consensus on Sports Nutrition. New York: Routledge Press, 2004.

McArdle, WD, F.I Katch, V.L. Katch. Sports and Exercise Nutrition. 3rd ed. Baltimore, MD: Lippincott Williams & Wilkens. 2009.

Ryan, Monique. Sports Nutrition for Endurance Athletes. 2nd ed. Boulder, CO: VeloPress, 2007.

Williams, Melvin. Nutrition for Health, Fitness, and Sport. 7th ed. New York: McGraw-Hill, 2005.