Eating Disorders in Sport: Risk, Recognition, and Care

Eating disorders affect athletes at every level of competition, at rates that exceed the general population, and they are treatable. Yet they remain among the most underidentified and underaddressed conditions in sport. 

Athletes have always represented something larger than themselves. Soviet ballet dancers carried their country's cultural identity in their bodies; defection was a geopolitical event as much as a personal one. Olympic competition has stood in for national superiority since the ancient games, and the modern spectacle of professional sport — the Super Bowl, the World Cup, the NCAA tournament — extends that dynamic across billions of people and trillions of dollars.

The bodies at the center of all of it have always been subject to a level of scrutiny that most people will never experience, and that scrutiny has always carried consequences that rarely make the highlight reel. Eating disorders are among them, and they are far more prevalent in athletic populations than the sports world has historically been willing to acknowledge.

The Scope of the Problem

Eating disorders occur in athletes at rates meaningfully higher than in the general population. Among female athletes, prevalence estimates range from 6 to 45 percent, compared to approximately 8 percent in non-athlete women. It’s a broad range. The variation reflects genuine differences across sport types, but it also reflects inconsistent research methodology and varying degrees of athlete willingness to disclose symptoms. 

Male athletes are underrepresented in this research and underdiagnosed in clinical practice. Prevalence estimates reach up to 19 percent in male athletes versus approximately 2 percent in the general male population, yet help-seeking remains extraordinarily rare. Patrick Devenny, a former University of Colorado and Seattle Seahawks football player who has spent years advocating for eating disorder awareness in male athletes, described his experience in sport as one where the behaviors associated with his bulimia were consistently read as signs of dedication. His coaches, he has said, were almost in denial when his struggles were eventually raised, because to them, it was a “woman's problem”.

That is a structural feature of how eating disorders are understood, screened for, and treated in athletic contexts, and it is a significant reason why the male athlete numbers are almost certainly an undercount. (Fatt et al., 2024)

Is Sport a Risk Environment?

Sport-specific pressures explain additional variance in disordered eating among elite athletes beyond what is seen in the general population. The environment itself is a risk factor, independently of whatever an athlete brings into it.

That risk concentrates most visibly in sports where body composition is treated as a competitive variable. Examples include:

• Gymnastics
• Figure skating
• Ballet
• Swimming
• Diving
• Distance running
• Rowing 

Weight monitoring and body composition targets are also common practice well outside those disciplines, embedded in strength and conditioning programs, contract negotiations, and recruiting processes across professional and collegiate sport.

Relative Energy Deficiency in Sport, known as REDs, is a physiological consequence particular to athletic contexts. It occurs when energy expenditure chronically outpaces intake, with effects that can include hormonal disruption, bone loss, and cognitive decline. Because REDs can develop in athletes who are still competing at a high level and maintaining what looks like adequate nutrition, it often goes undetected until the damage is significant. REDs frequently co-occurs with eating disorders, and the athletic environment creates specific conditions for both to develop simultaneously.

The drive that makes someone exceptional at sport and the psychological conditions that sustain an eating disorder overlap in ways that sport culture has not historically examined honestly. Screening for eating disorders is not standard practice in most athletic programs, and the professionals closest to athletes often lack the training to recognize the difference between disordered eating and dedicated athletic preparation. 

Getting Help and Getting Better

Only 1.5% of elite collegiate athletes sought help for disordered eating in one study, despite 27.7% screening positive for clinical-level symptoms. Stigma and the fear that seeking help could cost an athlete their position or scholarship are documented barriers to treatment, and they help explain why prevalence numbers almost certainly underrepresent the reality.

Effective treatment requires a team that understands both the demands of sport and the complexity of eating disorder recovery. A mental health professional with experience in both areas is central to that team, given that athletes presenting with disordered eating almost universally carry significant psychological burden alongside the physical consequences. A registered dietitian with eating disorder experience brings an equally essential perspective, focused on rebuilding a functional relationship with food and fuel in a way that serves long-term health.

Metabolic testing and body composition analysis offer objective data about how the body is actually functioning internally, providing a clinical picture that standard assessment often misses. Resting metabolic rate and energy availability reveal the physiological impact of disordered eating in athletes who may appear healthy by conventional measures, including those in larger bodies or those whose performance has remained intact despite significant internal compromise. At the Kahm Center, these tools are integrated into eating disorder assessment and treatment as part of a weight-neutral, science-backed approach to understanding nutritional status.

Structural change within sport matters alongside individual treatment. Coaches and athletic trainers are often the first to observe behavioral changes in athletes, yet most programs have no formal screening protocols and no requirement that staff receive training in recognition. Eating disorder screening deserves the same institutional investment as injury prevention, and mental health access should be built into athletic programs at every competitive level.

The Price of Performance Culture

The athletes, like Devenny, who have spoken publicly about their eating disorders describe years of performing at the highest level while something was quietly destroying them from the inside. The culture that produced their excellence also made it nearly impossible to ask for help. That is the cost the highlight reel doesn't show, and it is the cost that better recognition, more honest sport culture, and accessible specialized care can actually change.