Eating Disorder Warning Signs in Elite Athletes

By Kristin Kaye

2002 United States Rhythmic Gymnastics Junior National Champion, 2009 United States Rhythmic Gymnastics World Championships Group Team Member

When I struggled with Anorexia Nervosa as an elite rhythmic gymnast over 15 years ago, my parents, coaches, teammates, and friends did not know what signs to look for when identifying my eating disorder. It was evident that something was changing in me for the worse; however, little knowledge about eating disorders left it difficult for these important people in my life to know what to do. Over time, my life was transformed in such a radical way through full recovery that it became my passion to help others understand the warning signs of eating disorders so those who are struggling can best be supported with the resources they need as early as possible. It is my hope that the following discussion on many of the major eating disorder warning signs in elite athletes, coupled with personal stories from my own struggle, will aid in a better understanding of how to identify these issues.

Elite athletes come in all different shapes and sizes. A national champion in rhythmic gymnastics may look strikingly different than a national champion in weightlifting at first glance, yet both athletes are at the top of their sport and share a similar desire to succeed and perform to their greatest potential. Both athletes may also be struggling with an eating disorder. Though male elite athletes are not exempt from developing eating disorders, female athletes in certain sports, such as gymnastics, diving, and figure skating, evidenced a higher risk for full-blown eating disorders (1). These aesthetic sports all share a similar element of pressure to look a particular way when executing a physical move, which often leads to a greater focus on one’s appearance. Sports that have weight classes, such as rowing or wrestling, also show a greater likelihood of athletes with eating disorders as some athletes find themselves harmfully trying to control their weight due to often strict regulations for “making weight” before a competition. Cycling is an example of a sport where low body-mass is seen as an advantage to performance, and therefore, also suggests an increased risk for eating disorders (2). Athletes from any sport, though, may be affected by an eating disorder or disordered eating due in part to their environment, which is why supporters, especially coaches, have an important role in creating an atmosphere that is one of understanding and support rather than one of harsh criticism and a win-at-all-cost attitude.

Many individuals who become elite athletes begin their sports at an early age and find themselves in the midst of various physical and mental changes associated with adolescence as they approach the height of their athletic careers. During these formative years, while athletes are spending long hours physically training, they are also mentally beginning to develop their personal views on body image and a sense of identity, or belonging. Constant self-criticism, low self-esteem, and poor and/or distorted body image are frequently displayed in those elite athletes with eating disorders. Key warning signs may also emerge when an athlete’s sole identity rests on their sport, and they become emotionally distraught when making errors, having a poor competition, or suffering from injury that prevents them from participating in the sport that gives them purpose. When one becomes so focused on being the “perfect” athlete, it is important to recognize that punishment may begin to cultivate in the form of an eating disorder as a result of perceived failure that keeps the athlete farther from reaching this unattainable level of perfection they desire. Though the individual must ultimately see him or herself as more than just an athlete, it is important for coaches, parents, friends, and other supporters to foster an environment that encourages the athlete to develop as a whole being – body, mind, and soul. Learning personal acceptance in the midst of these challenging and influential years is pivotal in nurturing a young athlete’s outlook on their identity, body image, and self-esteem, and may ultimately help to prevent the onset of an eating disorder.

Perhaps the most obvious warning sign in individuals and athletes alike who are struggling with anorexia is extreme weight loss. Weight fluctuations may be much more difficult to detect in other types of eating disorders, including Bulimia Nervosa. Especially observable in the athletic environment during training and competitions, exhaustion, prolonged fatigue, and decreased concentrationprovide warning signs, as well (3). Relating this to my experience, though once known as a persistently hard worker, I no longer had energy to get through my gymnastics routines at practice. It was physically apparent to my parents and parents of other gymnasts in the audience at competitions that I looked weak, which naturally resulted in poorer performances.

It is no secret that elite athletes spend a lot of time physically training. This is often required to reach a certain level, and when in a proper mindset, following a balanced training plan, and providing oneself with the nutrition that is needed, this is often not an issue. It may become a concern, however, when an athlete does not allow him or herself to take a rest daywhen their body needs a break, whether physically or mentally. For supporters of the athlete, it is important to be on alert for comments that suggest the athlete feels they do not deserve time off or that if they were to take time off, this rest period will automatically lead to weight gain.

Along this note is another warning sign that shows up when an athlete has already completed a hard training session and then feels compelled to exercise even more without sensing an ability to control the session. Therefore, it is important to be able to differentiate between long training hours or multiple training sessions a day that are required for a sport with that of compulsive exercisingbecause of more deeply-rooted body image issues. In my case, the mentality of the exercise that I required of myself after a long day of training was not to enhance myself as a gymnast. I was not thinking about how this exercise could help improve my performance as an athlete, but rather, it was a direct attempt to rid myself of negative feelings. This exercise became a compulsive behavior beyond training, often after meals and done in secret, so no one could observe how I was punishing myself for the shame I felt about how I looked. If I was not allowed to do this exercise or was interrupted during this time, I often became agitated and short-tempered, which was a strikingly different attitude in comparison to my usual personality during a regular gymnastics practice.

Additionally, it is not uncommon for athletes to be highly focused on nutrition, as this can be an essential component to enhanced physical performance (1). Though eating disorders are about much more than just food, there are certain warning signs to look for around food behaviors in elite athletes. Although unnoticed at the time, as I have looked back on my gymnastics career over the years, it is clear to see that there were some very apparent warning signs that I was not developing a healthy relationship with food. For example, even before I had reached elite status, I was fearful to eat around my coaches. Unfortunately, the lack of education around proper nutrition for optimal performance in sports like gymnastics can result in food being presented in a negative way. Rather than being seen as a source of energy that can enhance training and recovery, many times food becomes exclusively linked to one’s body weight, which in aesthetic sports, sometimes can dishearteningly be used by coaches as a reason against why an athlete cannot perform an element to the ideal standard. In young athletes especially, these mixed messages about food as related to personal judgment rather than fuel the body requires can lead to disordered eating behaviors, such as hiding orrestricting food for fear of consequences to their athletic performance. Coupled with issues such as identity and body image, these behaviors may develop into a full-blown eating disorder.

Hydration for an athlete can be crucial to enhanced performance and recovery, and water intake, whether restrictive or excessive,may also indicate eating disorder behaviors. Furthermore, when the body begins breaking down due to improper nutritional intake, an athlete may become more prone toinjuriessuch as bone fractures or muscle strains (3). Another common symptom of anorexia is low heart rate, which for athletes can sometimes be misinterpreted in terms of fitness levels rather than a reason for cardiac concern (4). In addition, for female elite athletes, irregular menstrual cyclesmay be a warning sign of further eating disorder complications, such as the Female Athlete Triad, which consists of energy deficiency, amenorrhea, and osteoporosis (5).

Most athletes go through periods of training that are mentally challenging. It is not always fun for a rower to wake up at dawn to row on a chilly November morning; however, many times short- and long-term goals can keep athletes moving forward through these brief phases of wavering motivation. Though interests can change over time, when an elite athlete no longer finds enjoyment from participating in their sport, this may be yet another warning sign of an eating disorder, especially when an athlete does not acknowledge their unhappiness and continues going through the motions of training so as not to disappoint themselves, their coaches, or their families. Moreover, when an athlete begins to show signs of isolation from teammates, family, and friends during meals or declines to participate in social and team bonding activities, this may also be an indication of deeper issues.

On a final note, quite often various qualities that are praised in the athletic world are similar to the characteristics that are seen in those struggling with an eating disorder, but can also be used to aid in recovery when it is understood how to use these traits in a positive way. There is no doubt my determination, discipline, and the perfectionist tendencies that I used to reach success in my gymnastics career also helped in my journey of recovery from anorexia. Ultimately, when I learned recovery did not mean changing who I was, but rather enhancing who I already am by learning about what my body individually requires nutritionally and how to constructively cope with life’s challenges, I overcame my eating disorder. I am grateful to be able to share that after three years completely away from gymnastics due to treatment, I returned to the sport I truly loved with the support of my family and coaches, and two years later achieved the goal I had set as a young gymnast to one day represent the United States at the World Championships.