From Silence to Support: A Coach's Guide to Eating Disorders
Ashley Bastron
Wake Forest University
Message
Navigating eating disorders/disordered eating with athletes is difficult and complex. I hope this presentation creates space for questions & conversation.
Before we get started…
Eating disorders have the 2nd HIGHEST risk of death of any mental illness.
Anxiety & Depression
Opioid Use Disorder
Bipolar Disorder
PTSD/OCD
Clinical Eating Disorders (ED)
Anorexia nervosa - Persistent energy intake restriction, intense fear of gaining weight or persistent behavior that interferes with weight gain, with a disturbance in self-perceived weight or shape.
Bulimia Nervosa - Recurrent episodes of binge eating and recurrent inappropriate compensatory behaviors with the goal of preventing weight gain.
ARFID (Avoidant/Restrictive Food Intake Disorder - An eating disturbance as manifested by persistent failure to meet appropriate nutritional and/or energy needs.
Binge Eating Disorder - Involves recurrent episodes of binge eating, defined as eating an amount of food in one sitting that is definitely larger than what most people would eat in a similar period of time coupled with a lack of control.
(What is) Disordered Eating (DE)
Disordered eating
Is a spectrum of problematic eating behaviors and distorted attitudes towards food, weight, shape, and appearance.
EDs and DE behaviors are often accompanied by some level of denial/secrecy and can therefore be tricky to detect, either in yourself or others.
Orthorexia
An obsession with proper or ‘healthful’ eating. Incredibly common with athletes and often reinforced by coaches.
Why Athletes?
Athletes are 2-3x more likely to experience an ED/DE than the general population
Up to 85% of collegiate athletes in the NCAA reported engaging in maladaptive eating and weight control behaviors.
Athletes are a unique population
Sport specific pressures and harmful stereotypes are promoted as key indicators of performance.
An athlete’s natural psychological makeup increases their chances of developing unhealthy eating behaviors.
Warning Signs
Behavioral
Physical
Indications
Experiencing a compulsive need to exercise every day or eating less on off days
Viewing foods as ‘good’ or ‘bad’
Having unrealistic expectations of your appearance/body
Demonstrating an immense fear of weight gain. Ex. dieting frequently, choosing low calorie, low fat and sugar free options to ‘save calories’
Demonstrating highly restrictive eating or refusal to eat
Athletic Consequences of Unhealthy Eating Behaviors
Those with ED or DE are more prone to endure bone stress injuries (stress fractures/reactions).
Athletes who demonstrate DE behaviors take longer to heal from injuries and get sick more often.
Injured athletes are then unable to train which can increase risk of eating disorders and other psychological illnesses such as anxiety & depression.
Ever find yourself thinking, isn’t this normal?
*Debunking Common Myths*
Myth - Successful athletes should diet/have rigid food rules (ex. avoids sugar).
Myth - You can tell an athlete has an eating disorder by looking at them.
Myth - They are setting personal records, they can’t possibly be struggling/sick.
Myth - Anxiety around food, especially on days off from exercise or sport, is normal.
Fact - Any amount of restriction can quickly spiral out of control. Athletes should be more concerned about underfueling.
Fact - The perceived performance “boost” is often a temporary result of weight loss and will soon be replaced by fatigue, impaired functioning, and long term consequences.
Fact - Fueling on a rest day is necessary for recovery & health. Athletes don’t need to ‘earn’ their food.
Fact - Eating disorders don’t have a physical ‘look’, someone in a larger body could have an ED or be struggling with DE.
Relative Energy Deficiency in Sport (REDs)
Check out Project RED-S at https://red-s.com/
Suppressed appetite or gastrointestinal issues. This can be both a cause and consequence of REDs.
What does REDs look like?
Female Athletes
Of female high school and college athletes were identified with DE.
60%
Of female high school and college athletes were diagnosed with clinical EDs
25%
Female athletes face both athletic & societal pressures
88%
57%
of adolescent girls were dissatisfied with at least 1 aspect of their body
of adolescent girls experimented with disordered eating behaviors
up to
Pay Attention to Your Cycle
Losing your menstrual cycle is typically a warning sign that your body needs more fuel!
Women!
The body is trying to conserve energy and redirects resources away from non-essential bodily functions, such as reproduction. Insufficient caloric intake can also cause a decrease in females’ estrogen levels. Despite being common, this is NOT normal or healthy!
Not Just Women…
Men also experience pressure to conform to an “ideal” body shape for athletic performance
Drive for Muscularity
Muscle Dysmorphia
Pre-Participation Screening
Screening Tools:
Red Flags 🚩🚩
Returning to Sport
Returning to sport and competition is often a key motivation for athletes recovering from their ED, however re-entering training or competition too early has been associated with increased risk of relapse!
Positive signs your athlete is ready: weight restoration, menstrual restoration, lab values within normal ranges, improvements in sex hormones, and psychological stability.
Creating a healthy team culture
Language Matters:
It’s easy to make comments or jokes about food and bodies, we’ve grown up in a culture that normalized this. But for many people, these comments are not harmless.
A struggling athlete may internalize comments and turn to maladaptive coping strategies to lose weight. You never know who is battling intrusive thoughts, and hearing those comments out loud, from someone they trust (coach/teammate), can make that battle even harder.
As a coach, it’s crucial to model healthy conversations about food and bodies while being mindful of your own unconscious biases. Your words carry power! Use them to support your athletes, your team, and yourself.
Takeaways to reinforce:
All foods fit!
What you permit you promote - avoid competing unhealthy athletes!
Body Talk Free Zone - a commitment between teammates to create a space where athletes avoid engaging
in body talk and challenge this behavior when it occurs.
Establish zero-tolerance policies towards body shaming.
Create safe spaces to discuss body image concerns and normalize conversations around body image.
Focus on body functionality and overall well-being, rather than appearance and avoid comparing athletes to each other or to other athletes.
What questions do you have ?
Resources
Check out this informative resource list put together by Hannah Chappell-Dick, the Head XC/T&F coach at Amherst College.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596.
Anorexia Nervosa. (2024, May 13). https://www.hopkinsmedicine.org/health/conditions-and-diseases/eating-disorders/anorexia-nervosa
Bratland-Sanda, S., & Sundgot-Borgen, J. (n.d.). Eating disorders in athletes: Overview of prevalence, risk factors and recommendations for prevention and treatment: European Journal of Sport Science: Vol 13, No 5. Retrieved July 9, 2025, from https://www.tandfonline.com/doi/abs/10.1080/17461391.2012.740504
Byrne, S., & McLean, N. (2001). Eating disorders in athletes: A review of the literature. Journal of Science and Medicine in Sport, 4(2), 145–159. https://doi.org/10.1016/S1440-2440(01)80025-6
Forsberg, S., & Lock, J. (2007). The relationship between perfectionism, eating disorders, and athletes: A review. Minerva Pediatrica, 58, 525–536.
Kerian, E. (2024). Eating Disorders in Female High School Athletes: Educating Coaching Staff on Prevention, Recognition, and Intervention Strategies. Carver College of Medicine.
Kolnes, L.-J., & Rodriguez-Morales, L. (2016). The meaning of compulsive exercise in women with anorexia nervosa: An interpretative phenomenological analysis. Mental Health and Physical Activity, 10, 48–61. https://doi.org/10.1016/j.mhpa.2015.12.002
Mancine R, Kennedy S, Stephan P, Ley A. Disordered Eating and Eating Disorders in Adolescent Athletes. Spartan Med Res J. 2020 Jan 30;4(2):11595. doi: 10.51894/001c.11595.
Sundgot-Borgen, J., Meyer, N. L., Lohman, T. G., Ackland, T. R., Maughan, R. J., Stewart, A. D., & Müller, W. (2013). How to minimise the health risks to athletes who compete in weight-sensitive sports review and position statement on behalf of the Ad Hoc Research Working Group on Body Composition, Health and Performance, under the auspices of the IOC Medical Commission. British Journal of Sports Medicine, 47(16), 1012–1022. https://doi.org/10.1136/bjsports-2013-092966
Sundgot-Borgen, J., & Torstveit, M. K. (2004). Prevalence of Eating Disorders in Elite Athletes Is Higher Than in the General Population. Clinical Journal of Sport Medicine, 14(1), 25.
Ruggiero, G. M., Levi, D., Ciuna, A., & Sassaroli, S. (2003). Stress situation reveals an association between perfectionism and drive for thinness. International Journal of Eating Disorders, 34(2), 220–226. https://doi.org/10.1002/eat.10191
Quesnel, D.A., Cooper, M., Dobinson, A. Safe exercise at every stage: Athlete. SEES-A.