Getting Back in the Game of Life

Eating disorders are an epidemic in the United States today. One population increasingly at risk for developing anorexia or bulimia is athletes. Athletes are far more prone to eating disorders than non-athletes, especially for females. The risk increases significantly for those involved in sports that necessitate a certain body type or weight, when success tends to be more appearance-based than performance-based, and when the athlete is competing at an elite level.  This includes sports such as ice skating, gymnastics, wrestling, diving, rowing, distance running, ballet, and other forms of dance.

Those taking part in judged sports are particularly at risk. Research indicates that female athletes in judged sports have a 13 percent prevalence of eating disorders, compared to just 3 percent in the general population. Factors that contribute to risk for developing an eating disorder include: endurance sports, sports with weight categories, individual sports and “lean” sports. Sports with revealing clothing are rapidly moving to the top of this list, as sports attire continues to shrink. With every passing year, players on the tennis circuit or professional volleyball teams are revealing far more skin than ever before.

Athletes struggling with eating disorders are not unlike non-athletes dealing with similar issues. Highly competitive, they rarely admit to having a problem, for fear of losing playing time or displeasing coaches, teammates or family members.  They may incur more injuries and have declining health, as they restrict food intake and engage in rigorous exercise schedules. Often times, these dangerous behaviors go unrecognized by coaches, parents and teammates. In fact, these very behaviors are frequently encouraged by coaches and/or parents who believe that weight loss and extreme training will give their athlete a competitive edge. Tragically, the cost may be the young person’s life, since anorexia and bulimia are potentially fatal illnesses.

What is important for parents, trainers and coaches to remember is that an athlete who develops an eating disorder doesn’t have to permanently relinquish his or her involvement in sport. Effective eating disorders treatment is available and recovery is possible, especially if the individual is young and the eating disorder is relatively new. However, though weight may be restored and health regained, serious thought must be given to when or if the athlete will return to training or competition.

Attention must be paid to what is motivating the person to return.  Is it internal or external? Does the athlete want to return to competition due to a genuine love of the sport, or is pressure to return being applied by a coach, teammates or even family?  Just because an individual is highly skilled in a particular area in no way means he/she must continue to participate, especially when first entering recovery.

If a comeback is decided upon, it is imperative for an outpatient team of eating disorder professionals to be in place. At the very least, this team should include a primary care physician, a psychiatrist, an individual therapist, a family therapist and a dietitian. A representative from the team should also be included in the treatment plan. This support network will ensure the athlete is maintaining recovery as a top priority. Recovery behaviors need to be clearly identified: taking in sufficient nutrition according to a meal plan prescribed by a sports nutritionist; sustaining a healthy weight and not exercising to excess; participating in individual, group and family therapy sessions; and attending 12 step or other community support groups. Parameters around weight ranges and recovery behaviors necessary for healthy participation in sport need to be developed and explicitly communicated to the athlete, parents and coaches. All parties involved need to support the treatment plan in order for it to work.

There are some instances where return to sport would be contraindicated. For instance, if an athlete has unstable vital signs, abnormal electrolyte levels, significant weight loss, or engages regularly in eating disorder behaviors, he/she should not return to sport. If an athlete has relapsed with eating disorder behaviors several times in the past upon returning to sport, that person may need to consider not returning until at least 1-2 years of recovery are achieved, if ever. It can be a devastating loss for the athlete and family to let go of the sport as well as the identity, meaning, and accolades that go with it. Grief work for the athlete and family can be an important piece of facilitating life-long recovery for those who cannot safely return to their sport. As tough as grief work is, it is much easier to help a patient and family work through the loss of sport, rather than the loss of their child,s life.

The good news is many of the same characteristics that make an athlete great make for a successful recovery from an eating disorder. Athletes tend to have better treatment prognosis because they are used to being coached and taking direction. They also have a built-in support system to help monitor signs of improvement and slip-ups: coaches, trainers, teammates and family.  Finally, because of their love of the sport, many athletes have a unique motivation for recovery. They know they need to get healthy to get back in the game, thus giving them the internal motivation needed to succeed in a healthy and long-lasting recovery.

Published Date: March 1, 2011
Last Reviewed By: Jacquelyn Ekern, MS, LPC on August 22, 2011

Page last updated: June 12, 2012
Published on, Eating Disorders Information