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Playing sports in high school can be a great way to build confidence, support physical health and fitness, and develop meaningful relationships with teammates and mentors. Yet despite the benefits associated with adolescent sports, research shows that for some teen athletes, the sports environment can increase the risk of developing disordered eating (DE) and eating disorders (ED) .
For example, one study found that the prevalence of EDs among high school athletes was approximately 7.0 percent compared to just 2.3 percent among non-athlete teens . Unfortunately, very few tools have been developed to identify eating disorders among teen athlete populations.
However, a recent study published in the Journal of Eating Disorders presents a six-question assessment tool designed specifically to detect DE/EDs among teen athletes. If approved and utilized, this tool may identify disordered eating in teen athletes at an earlier stage and help prevent health complications and future clinical eating disorder diagnosis.
Disordered Eating among Teen Athletes
One of the common precursors to a clinical eating disorder diagnosis is disordered eating, and as numerous studies report, disordered eating is an increasing problem among teen athletes . For example, one study found that 42 percent of female high school athletes in aesthetic sports reported disordered eating , while another study revealed 10.4 percent of male high school athletes exhibited disordered eating behaviors .
What Is Disordered Eating?
While disordered eating (DE) is not officially recognized as an eating disorder in the DSM-5, research shows that DE can cause a myriad of health complications (especially in teen athletes) and, if left untreated, can progress to a clinical eating disorder diagnosis. Disordered eating behaviors can be used by both males and females and are typically fueled by a desire to alter one’s body weight or shape (e.g., lose weight or gain muscle).
Behaviors associated with disordered eating include skipping meals, establishing rigid rules around food and exercise, restricting calories, using diet pills, fasting, purging to make up for “bad foods,” feeling guilty after eating, and being preoccupied with body image and food.
Unfortunately, disordered eating behaviors among teen athletes may appear harmless or even normal at first. In fact, some athletes may even be encouraged or praised by coaches, teammates, or parents for their dedication and commitment to improving their body or sports performance. However, if these unhealthy behaviors are left unchecked, they can lead to a full-blown eating disorder diagnosis and create long-lasting health problems and injury.
Some of the complications associated with disordered eating among teen athletes include :
- Electrolyte imbalances
- Gastrointestinal disorders
- Bone development problems
- Decreased bone mineral density (BMD)
- Higher incidence of stress fractures and other injuries
- Increased risk of osteoporosis
- Decreased estrogen levels (females)
- Vaginal atrophy (females)
- Amenorrhea (females)
- Suicidal thoughts
Screening for Disordered Eating in Teen Athletes
Due to the high prevalence of DE and EDs among teen athletes, and given the potential complications that can arise if DE/ED is left untreated, it is critical to regularly assess teen athletes for disordered eating and eating disorder behaviors. Unfortunately, few assessment tools have been developed to specifically identify risks for DE/EDs in teen athletes .
For example, tests like the AMDQ and the FAST have only been validated in female collegiate athletes but have not been legitimized for teens or male athletes. To remedy this problem, a recent study published in the Journal of Eating Disorders developed a new screening tool designed specifically with male and female teen athletes in mind .
Named the Disordered Eating Screen for Athletes (DESA-6), this screening tool quickly identifies adolescent female and male athletes who may be at risk for disordered eating. Using a simple, six-question survey, the DESA-6 effectively pinpoints specific aspects of disordered eating commonly found among teen athletes.
For instance, since disordered eating and eating disorders are commonly associated with increased injuries among teen athletes, the first question asks teens about the severity and frequency of their injuries.
Likewise, Question 5 deals with dieting (a major risk factor for EDs in athletes), while Question 6 evaluates whether the teen feels pressure from an authority figure (coach, parent, etc.) to lose weight for performance reasons (another big risk factor for the development of EDs) . Though further research is needed on the DESA-6 screening tool, the researchers conclude that it is “a promising tool for risk assessment of DE in adolescent athletes” .
They go on to say that thanks to its simple and easy-to-use format, the DESA-6 can be utilized by psychologists, physicians, registered dietitians, athletic trainers, and other sports/healthcare professionals to quickly screen student-athletes for DE behaviors, resulting in earlier detection of DE/EDs and greater treatment outcomes among teen athletes.
Resources: Kennedy, S.F., Kovan, J., Werner, E. et al. Initial validation of a screening tool for disordered eating in adolescent athletes. J Eat Disord 9, 21 (2021). https://doi.org/10.1186/s40337-020-00364-7  Martinsen, M., & Sundgot-Borgen, J. (2013). Higher prevalence of eating disorders among adolescent elite athletes than controls. Medicine and science in sports and exercise, 45(6), 1188–1197. https://doi.org/10.1249/MSS.0b013e318281a939.  Kennedy, S.F., Kovan, J., Werner, E. et al. Initial validation of a screening tool for disordered eating in adolescent athletes. J Eat Disord 9, 21 (2021). https://doi.org/10.1186/s40337-020-00364-7  Jankowski, C. (2012). Associations Between Disordered Eating, Menstrual Dysfunction, and Musculoskeletal Injury Among High School Athletes. Yearbook of Sports Medicine, 2012, 394-395. doi:10.1016/j.yspm.2011.08.003.  Rosendahl J, Bormann B, Aschenbrenner K, Aschenbrenner F, Strauss B. Dieting and disordered eating in German high school athletes and non-athletes. Scand J Med Sci Sports. 2009;19(5):731–9.  Mancine, R., Kennedy, S., Stephan, P., & Ley, A. (2020, January 30). Disordered Eating and Eating Disorders in Adolescent Athletes: Published in Spartan Medical Research Journal. Spartan Medical Research Journal. https://smrj.scholasticahq.com/article/11595-disordered-eating-and-eating-disorders-in-adolescent-athletes.  Kennedy, S.F., Kovan, J., Werner, E. et al. Initial validation of a screening tool for disordered eating in adolescent athletes. J Eat Disord 9, 21 (2021). https://doi.org/10.1186/s40337-020-00364-7  ibid.  ibid.  ibid.
About the Author:
Sarah Musick is a freelance writer who specializes in eating disorder awareness and education. After battling with a 4-years long eating disorder, she made it her mission to help others find hope and healing in recovery.
Her work has been featured on numerous eating disorder blogs and websites. When she’s not writing, Sarah is off traveling the world with her husband.
The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.
We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.
Published March 8, 2021, on EatingDisorderHope.com
Reviewed & Approved on March 8, 2021, by Jacquelyn Ekern MS, LPC