Craig Pickering

Sports Science Monthly – October 2020

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Every month we take a deep dive into the latest research in sports science. In the October edition we start off looking at disordered eating in sport, including a look at prevalence, warning signs, and more. We then look at how training can be viewed in terms of creating synergies, monitoring training load in endurance athletes, integrated sports rehabilitation, game day priming, and more.

As always, the full Sports Science Monthly is available exclusively to HMMR Plus Members. You can browse the past topics on our archive page. The first topic below is free to everyone, but sign up now to read about all the latest research. To get an idea of what Sports Science Monthly is all about, the April 2016 edition is available in its entirety for free.

This Month’s Topics

Disordered eating in sport

» Quick summary: Disordered eating and eating disorders are increasingly prevalent. A recent position statement from the AIS explores what disorder eating is, what its signs are, and what to do if you spot it—crucial information for all involved in sport.

In the series I wrote on performance health, I explored the importance of relative energy availability, and discussed how, when athletes under-consume energy relative to their activity levels, they become at risk to a whole host of performance health related issues. Low energy availability is part of a bigger problem that affects athletes at all levels; disordered eating. Over the last couple of years, low energy availability and disordered eating have, quite rightly, been garnering more attention, both from a research perspective and from practitioners. As a result, the Australian Institute of Sport (AIS) recently collaborated with the Australian National Eating Disorders Collaboration (NEDC) on a position statement around disordered eating in high performance. Given nutrition’s role as a key pillar in athlete health, it is well worth taking a closer look, as it contains practical advice for athletes, coaches, parents, and administrators.

The authors define disordered eating as sitting on a spectrum between optimized nutrition (on the left, and being positive) and eating disorders (on the right, and very negative). Athletes with disordered eating may exhibit behaviors such as skipping meals, compulsive eating, using exercise as a means of controlling weight, and restricting their food intake, on a regular basis. As an easy rule of thumb, the authors define disordered eating as “problematic eating behavior that fails to meet the clinical diagnosis for an eating disorder”, and an eating disorder as “behavior that meets the DSM-5 diagnostic criteria for a feeding and eating disorder”. Furthermore, the relationship between disordered eating and low energy availability can also be complex; it is possible to have disordered eating and not low energy availability, and vice versa. As an example, athletes undertaking activities that have huge energy requirements—such as a stage of the Tour de France—may not be able to consume sufficient energy due to the sheer volume of food required; conversely, an athlete may consume insufficient energy due to poor meal planning, which can lead to low energy availability in the absence of disordered eating. However, outside of these examples, disordered eating is a common cause of low energy availability in athletes, and so being aware of it is crucial from both a health and performance standpoint.

Disordered eating is not uncommon in athletes, with estimates suggesting up to 19% of male and 45% of female athletes experience it, with overall rates higher in athletes than non-athletes. Athletes are increasingly vulnerable to eating disorders for a variety of reasons; those competing in aesthetic sports, such as gymnastics, appear to be at an increased risk, as are those in weight categorized sports (e.g. weightlifting) and sports where increased weight might be a performance-limiting factor (e.g. sprinting). Environments in which there is pressure to achieve and maintain a low body weight appear to further increase the prevalence of disordered eating in athletes. However, disordered eating can occur any time, and there are a variety of barriers that may prevent athletes seeking help. This can include a lack of knowledge around disordered eating—athlete, coach, and parent may not see anything wrong—along with the stigma often associated with such disorders. As a result, being aware of disordered eating, and its warning signs, can be crucial in optimizing athlete health by ensuring help can be provided when it is most needed.

These warning signs can be roughly put into two categories; behavioral changes and physical changes. Some of the behavioral changes associated with disordered eating (and eating disorders) in athletes include alternating periods of food restriction and binge eating, a lack of flexibility in approach to food, a preoccupation with food and body shape, and restrictive eating, including the elimination of entire food groups. From the physical side, relentless and excessive exercise is a big red flag, as are associated issues such as bone stress injuries, frequent illnesses, and hormonal dysfunction, including a loss of libido and altered menstrual cycles. If you’re concerned an athlete you’re working with has developed disordered eating, then the best course of action is to refer that athlete to either a sports doctor or dietician, where more in-depth assessment and support can be offered.

When it comes to disordered eating, prevention is better than cure, and so creating an environment that supports athletes and minimizes the risk is crucial. This includes an emphasis on overall athlete health and wellbeing, and de-emphasizing body weight, along with education around what disordered eating is. When attempting to manipulate body weight for performance, this should be done in conjunction with a sports dietician to ensure that disordered eating doesn’t develop. Forced weigh-ins in the training environment should be avoided, with athletes giving consent for their weight to be collected, and to have the option of not being aware of the results.

Overall, this article is a really important read, as it examines an increasingly common problem within sport, and provides some key take-homes for athletes, coaches, and parents to be aware of when it comes to disordered eating—the article itself is open access, so I would highly recommend reading it yourself. As with many things, awareness of the problem is crucial, and, as many of the behavioral changes associated with disordered eating are quite common in sport, it appears to be a problem that affects many athletes. In order to support both their performance and health, we need to support athletes and, hopefully, reduce the prevalence of disordered eating across all sports.


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