This article includes frank discussions of eating disorders and disordered eating. Take care of yourself, and reach out for immediate help from the National Eating Disorders Association if you feel you need additional support. 

Unhealthy eating patterns are pervasive in fitness culture. Whether it’s the latest “wellness” trend on TikTok, advice from elite athletes, or general messaging from an industry that thrives on athletes’ desire to perform optimally or meet an unattainable aesthetic standard, this messaging can lead to patterns of consumption or restriction that are disordered, and eventually, meet a diagnostic standard for an eating disorder. 

An eating disorder (ED) is a diagnosis, defined in The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, where a person’s disordered relationship with food meets specific diagnostic criteria determined by the American Psychiatric Association. There is an ongoing and robust debate about these criteria (which center the BMI, a notoriously fraught measurement that fails to capture the extent to which behaviors can negatively impact a person’s life), which many ED experts feel is imperfect and insufficient. 

Disordered eating is a descriptive term that encapsulates irregular or disrupted eating behaviors. Disordered eating often has many similar features of an eating disorder, but these are at a sub-clinical threshold that do not meet the diagnostic criteria for an eating disorder. 

Eating disorders are serious and have the highest mortality rates of any mental health diagnosis in the U.S., and will negatively impact athletic performance and well-being. Eating disorders can affect athletes of any age, gender identity, and body size. Appearances are not an accurate way of assessing an athlete’s mental, or physical well-being. 

“Although there is overlap between symptoms of disordered eating and an eating disorder, there are differences between these two presentations. As such, qualified providers need to assess further whether an eating disorder is also present in the context of disordered eating,” says Dr. Riley Nickols, Ph.D, a Counseling and Sports Psychologist who specializes in eating disorders among athletes.

Disordered eating is often normalized in running and endurance sports, and if left unchecked can lead to an eating disorder and severe mental and physical health issues. Dieting, and restricting foods at all, can put athletes at a higher risk of developing an eating disorder and requiring more serious intervention. Disordered eating and eating disorders might look similar in some athletes–and they might include the same thoughts or patterns of behavior–but the primary differentiator is the severity of the symptoms. 

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Not Normal

Many disordered behaviors are normalized or celebrated in society, exacerbated by a fitness culture that overemphasizes things like willpower, discipline (that might actually be symptomatic of mental illness), and restriction, to the detriment of focusing on food as a source of energy, connection, and joy. 

Just because behaviors are normalized doesn’t mean they’re safe, rooted in science, or appropriate for all athletes. Nickols strongly advises athletes to be critical consumers of the information they’re taking in and orienting their life and behaviors around. 

“It is important to discern who the source of such information is–are they qualified to give such advice and do they have the appropriate training and expertise to give guidance specific to nutrition and exercise?” says Nickols. 

Many positioning themselves on social media as experts lack specific training and certifications to be giving out nutritional information and advice, and they might have a vested interest in either selling supplements or their own “coaching.” It can be challenging to discern who actually is an expert, but a good place to start is by investigating where their training comes from (a verified academic institution vs. a non-validated certification program) or what their objectives are. 

Some specific behaviors that experts identify as being symptomatic of disordered eating, and leading to increased risk of an eating disorder:

• Not eating at certain times, especially if hungry
• “Clean eating” and hypervigilance about all food inputs, perceived purity, health value, and forgoing foods an individual enjoys
• Restricting calories on rest days
• Strict “food rules” like not eating before or after a certain time of day
• Not eating before a “short” run if you “don’t need it”
• Restricting “high-carb” or “high-fat” foods
• Skipping meals and snacks after exercise
• Underfueling during runs because sports nutrition “contains too much sugar” or “contains too many carbs”
• Counting calories, or aiming to stay under a certain number of calories per day 
• Eliminating foods and food groups without medical necessity (some plant-based diets can fall into this category for certain athletes)
• A dysregulated relationship with an exercise where runs and workouts are underfueled
• Rigidity in exercise: feeling guilt, shame, or anxiety about missing a run, not hitting certain paces, vert, or mileage is missed
• Inability to rest when tired/injured for fear of “not burning enough calories”
• Neglecting family, relationships, or other commitments to adhere to a training plan or eating behaviors
• Binge eating
• Compensatory behaviors (like exercise to “burn calories”, to ease feelings of distress or anxiety after eating
• Body dissatisfaction, hyper-focus on appearance and weight, fear of gaining weight

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“Athletes can learn to push against many of these behaviors when they come to a place of respecting their bodies and performance. For instance, to perform and recover adequately, athletes need to include adequate carbohydrates before and after exercise, and during longer endurance bouts,” says Sarah Schlichter, MPH, RDN, creator of Bucket List Tummy and Nutrition For Running, and co-host of the Nail Your Nutrition endurance running podcast. She also emphasizes understanding that an athlete’s weight is just one outcome among many (like performance), and is often dictated by things like genetics, resource availability, and other variables beyond an individual’s control. 

Kara Bazzi, Co-founder and Exercise and Sport Program Director of Opal Food and Body in Seattle, WA, recommends athletes fortify themselves with culturally sensitive, science-based information, and hold the diet industry accountable for misinformation. “The diet culture industry (which has grown to be a $71 billion industry) predicates itself upon people wanting to change the way they look to fit a narrow definition of beauty, aesthetic, or health (buying into the belief that they are not “good enough”). Instead of being complicit with diet culture, there is an invitation to not buy into the messages to change our bodies, but rather hold the diet industry accountable for the problem.”

Bazzi recommends that people play “diet culture detective,” and start being more attentive to the daily messaging they get from diet culture so that athletes can start to identify harmful and misleading messaging, and set a boundary around it. That way, athletes are less likely to internalize harmful messaging on social media, from coaches, and in magazines and exercise classes. Athletes can start to assess where their beliefs are coming from, and how that internalized messaging might be shaping their eating behaviors, and ultimately, running performance. 

RELATED: 5 Red Flags That Someone May Have An Eating Disorder

When Should Athletes Get Additional Help and Support?

Dieting is pervasive and normalized, especially in athletic spaces and among women. Many athletes struggle with their relationship to food and exercise and learning to listen to internal cues and tune out cultural chatter that distorts those signs can take a lot of work. 

It can be especially difficult for athletes of additionally marginalized identities, like queer, gender-nonconforming, and BIPOC athletes, says Bazzi. It’s a complex issue that won’t be untangled overnight and will require individuals reaching out for help in addition to some societal soul-searching and cultural shifts. 

“Eating disorders are complex and professionals can help unpack the ‘why’ behind the function the eating disorder serves to help unlock motivation for change,” says Bazzi. “Once someone has an eating disorder, it’s really hard to change on your own without the help and support of trained professionals.” 

Athletes should reach out for help if symptoms like stress and anxiety around food and exercise persist and or intensify over time. If your relationship to food is affecting your quality of life, and interfering with your athletic performance, or relationships, it could be time to reach out, says Nickols. 

“When disordered eating/an eating disorder is present, there are frequently adverse health implications, for example, cardiovascular, bone health, hormonal dysfunction, immune, growth and development, hematological, gastrointestinal, and metabolic functioning) in addition to psychological consequences (i.e., depression, anxiety) can either precede disordered eating/an eating disorder or be exacerbated by disordered eating/an eating disorder,” says Nickols.   “Interpersonal relationships and sport performance are frequently negatively impacted in the context of these struggles.”

“Interpersonal relationships and sport performance are frequently negatively impacted in the context of these struggles.”

Experts agree that time is of the essence, and if an athlete’s relationship with food becomes problematic, it’s better to reach out sooner rather than later. 

“If you feel like you’re always on a diet or trying to manipulate your weight, you need support,” says Leslie Schilling, a Sport Dietitian and Nutrition Therapist who specializes in eating disorders. “If someone is struggling to feed themselves consistently and adequately, I’d recommend speaking to an ED-informed health practitioner (like a dietitian, therapist, or physician). We far too often dismiss or don’t notice typical disordered eating behaviors because they’re considered normal, or even “healthy” in our culture. They’re even celebrated,” 

Bazzi acknowledges that athletes might struggle in asking for help out of concern that professionals will “take away” their exercise, and she encourages looking for a treatment option that understands each athlete’s specific context and will support healing around movement as part of the ED care process. 

“Our weight-centric ‘health’ model praises disordered eating practices in those who are at a higher weight, while cautioning restrictive behaviors in those at lower weights,” says Schilling. “Yet only a very small percentage (less than 6 percent) of those suffering from eating disorders are medically underweight.” 

Disordered eating and eating disorders are highly interconnected and can have severe negative health, emotional, and interpersonal implications that can, and will, deteriorate an athlete’s health and quality of life.