Losing Your Balance: Understanding Disordered Eating and Body Image in High-Performance Athletes
In this blog post, Clinical Psychologist Scott Fatt discusses how disordered eating behaviours can be normalised in athlete culture, and how eating disorder interventions need to change to ensure better support of this cohort.
Since the first Olympic games in ancient Greece, athletes have awed and inspired us with incredible feats of speed, strength, flexibility, endurance, balance, and technical skill. In pursuit of these inspiring feats, many high-performance athletes’ training regimens have been characterised by rigorous control over diet and exercise behaviours, alongside intensive and meticulous observation and measurement of one’s body composition and form.
Outside of the sporting context, these behaviours may reflect a disordered relationship with eating, exercise, and body image – perhaps even a clinical eating disorder. But within the context of high-performance athleticism, they are often normalised or even heralded as an insignia of one’s discipline and determination. This begs the question: does the line become blurred between “normal” athlete experiences and disordered eating?
As a PhD student at Western Sydney University, I’ve spent over three years exploring this question. The first year of my research was dedicated to systematically reviewing the existing qualitative and quantitative research on disordered eating in high performance athletes. Based on these findings, I developed the ASPIRE project – a mixed-methods study which included a series of surveys and interviews with over 230 high performance athletes, conducted during the second and third years of my PhD.
To save you from reading a 200,000 word document, I’ve summarised the key takeaways here.
1. Understanding the Spectrum of Disordered Eating
Disordered eating includes a broad spectrum of problems in our relationships with eating, exercise, and how we view our bodies. Clinical eating disorders like anorexia nervosa or bulimia nervosa are the most recognised (and often most studied) but they represent just one part of this spectrum. In my systematic review of 38 qualitative studies, athletes often acknowledged clinical eating disorders as problematic, but they were far less likely to recognise the risks of the broader spectrum of disordered eating¹.Recognising disordered eating can be particularly tricky in high performance sport, where symptoms may fluctuate in severity and frequency over the course of the competitive season and/or be masked by “normal” training practices.
Unfortunately, by focusing only on clinical eating disorders, we risk missing a much larger group of athletes who are affected by disordered eating. In the ASPIRE project, over 20% of the high-performance athletes reported symptoms consistent with the most severe end of the disordered eating spectrum². However, an additional 58% reported moderate to high symptoms of disordered eating – many of whom may have been overlooked if we only considered clinical diagnoses. These athletes may not meet full diagnostic criteria for an eating disorder, but their symptoms still matter. Disordered eating (even at subclinical levels) can be impactful on an athlete’s physical health, mental wellbeing, and athletic performance.
The ASPIRE project included surveys and interviews with over 230 high performance athletes, exploring disordered eating behaviours.
2. Improving Interventions for Disordered Eating in High-Performance Athletes
There are several evidence-based interventions for disordered eating, but because they were developed for the general population, they don’t always account for the specific experiences and pressures that high-performance athletes face. A major aim of the ASPIRE project was improving our understanding of these athlete-specific factors, and how they can better be addressed in our interventions.
Weight Pressures in Sport
Athletes aren’t just influenced by societal beauty standards—they can also face additional pressures within the sporting environment around body weight and appearance. Comments from coaches, spectators, and teammates, public weigh-ins, skinfold assessments, and form-fitting uniforms all contribute to heightened scrutiny. These pressures need to be considered to help reduce the risk of disordered eating in athletes.
Dual Body Image
Many athletes describe experiencing dual-body image – where an athlete feels differently about their body image within the sporting context versus outside the sporting context. For example, a female athlete might value her powerful build in training but feel out of place and unhappy with her body image at social events. These contrasting experiences complicate our typical understanding of body image and should be considered in athlete-specific interventions.
The Importance of Performance
While disordered eating in the general population is primarily driven by appearance concerns, athletes also experience performance-based motivations. Many athletes hold strong beliefs that becoming leaner will help improve their performance, making disordered eating seem like a necessary sacrifice to reach their full potential. This mindset can sometimes lead athletes to prioritise leanness over actual performance outcomes. Critically, the ASPIRE project showed that disordered eating did not predict improvements in performance over time but instead increased an athletes’ risk of injury – leading to loss of time in training and competition. Both appearance and performance-based motivations for disordered eating need to be addressed in order to help protect high performance athletes from disordered eating.
Disordered eating in high performance sport is complex, often concealed beneath a culture of discipline and dedication. If we want to support athletes in achieving both success and wellbeing, we must broaden our understanding of what disordered eating looks like in sport, and design interventions that reflect the unique pressures athletes face. When high performance culture normalises harmful behaviours, athletes may lose the ability to recognise when they’ve crossed the line into something more dangerous. That’s why it’s crucial that we develop interventions that are not only evidence-based, but also athlete-informed. We need systems that help athletes perform at their best without sacrificing their health to get there.
References
- A systematic review and meta-synthesis of qualitative research investigating disordered eating and help-seeking in elite athletes https://doi.org/10.1002/eat.24205
- Comparing Population-General and Sport-Specific Correlates of Disordered Eating Amongst Elite Athletes: A Cross-Sectional Study https://link.springer.com/article/10.1186/s40798-024-00791-9
About the Author
Scott Fatt is a clinical psychologist and a PhD candidate at Western Sydney University. His research has focused on investigating disordered eating and body image concerns, particularly relating to athletes, males, and the impacts of social media.
