Eating Disorders in Teen Athletes: What Are the Signs?
Olivia, a 16-year-old runner, was referred to me by her physical therapist after a stress fracture in her tibia. A standout athlete, she had just missed placing at the state meet as a sophomore and was determined to earn a medal in her junior year. She wanted to heal and recover to achieve her goal. Her PT noted that Olivia often spoke about food and wanted to ensure she was fueling her body properly for recovery and performance.
When Olivia arrived for our first session, she was friendly but somewhat reserved. I noticed from her profile that, despite getting her period at 15, she hadn’t had a cycle since. She was also 10 pounds lighter than she was at 14, despite being two years older and 3 inches taller. Olivia also reported ongoing gastrointestinal issues that caused daily discomfort.
Her food logs revealed a limited diet that wasn’t enough to support her intense training regimen of 30-40 miles per week. Olivia mentioned she was cutting out dairy, sugar, and processed foods to optimize her diet for running. She followed professional runners and "fitfluencers" on social media, even sharing her own healthy recipes online. I explained that she was underfueling and needed to increase the amount and variety of her food. When I suggested restoring weight, she became visibly anxious, admitting she felt heavier than a friend who had placed at state the previous year.
I spoke with Olivia’s parents at the end of our session, expressing concern that Olivia’s “healthy eating” was actually an eating disorder taking a physical toll. While they acknowledged something was wrong, they had difficulty accepting that their daughter might have an eating disorder. Her dad said, “She’s so driven—great grades, student council leader, never misses practice. She eats like a disciplined athlete and puts in more effort than anyone. She wouldn’t let an eating disorder distract her.” Her mom noted that Olivia's focus on running had caused her to drift from friends and lose interest in past hobbies. I referred Olivia and her family to a therapist, believing she needed more support.
While this story is fictional, it reflects many clients with whom I’ve worked. Adolescents and athletes are at higher risk for eating disorders, with prevalence rates up to 45% in female athletes and 19% in male athletes. Sports culture and the athlete mindset can contribute to this risk. As a parent of a teen athlete, it’s crucial to recognize potential signs of struggle.
5 Signs your teen athlete may be developing an eating disorder
A new interest in “healthy eating”
It’s common for teens to become more interested in their diet, influenced by health classes, peers, or social media. Incorporating nutrient-dense foods can help meet their nutritional needs and expand their tastes. Teen athletes may focus on nutrition to improve performance.
While being mindful of nutrition is fine, “healthy eating” can signal something more concerning. If your teen eliminates food groups, avoids calorie- and carbohydrate-rich foods in favor of fruits, vegetables, and proteins, or cuts out sugar, they may be at risk of underfueling and not getting enough of the nutrients needed for health and performance.
This is especially worrying if your teen stops eating foods they once enjoyed or avoids meals with others due to food preferences. An athlete who rigidly avoids fun or favorite foods may have taken “healthy eating” too far.
Rigidity with training and eating routines
Traits like discipline, perfectionism, and drive that make strong athletes can also increase the risk of an eating disorder. While following a coach’s recommendations and fueling properly are important, athletes with eating disorders may struggle with changes in routines.
Such athletes may develop an unhealthy relationship with exercise. They may overtrain by adding extra workouts, refuse to miss sessions (even when injured or ill), or adjust the amount or types of food they will eat based on exercise.
They might also rely on fitness trackers to determine how many calories they’ve burned and adjust their eating accordingly. For example, they may set calorie limits on rest days or only allow themselves dessert if they’ve trained a certain amount. If your teen athlete rigidly sticks to a movement or eating schedule, their behavior may go beyond “discipline.”
Frequent injuries
Athletes can be prone to injuries, but an underfueled or overtrained body is at a higher risk. Lack of proper nutrition can lead to nagging overuse injuries or prolonged soreness after workouts.
Bone stress injuries in teen athletes may be linked to poor nutrition. A common myth is that missing or irregular menstrual cycles are normal for female athletes, but this indicates underfueling that affects hormone production. These hormone imbalances can lead to low bone density when nutrition is inadequate. Male athletes can also experience hormone changes that impact bone health, despite the missing visual of a period.
Frequent injuries may not always be related to nutrition, but when paired with other symptoms, malnutrition from an eating disorder could be a contributing factor.
“Falling off the growth curve:” Weight loss or lack of weight gain
Most teens tend to grow at a steady rate that is defined by their unique genetic blueprint. This growth can be plotted on the Center for Disease Control (CDC) growth charts to track progress. While deviations from a certain plotline are expected with the variability that is real life, many teen athletes will grow along or around a certain percentile, such as the 25th, 75th, or 90th percentile weight-for-age.
Source: Center for Disease Control
As you can see, these plotlines ae curves! Teens are expected to steadily gain weight as they mature. A sudden weight loss or dropping percentiles in a teen athlete is concerning. For younger athletes or those still growing, a lack of weight gain is also a red flag. Even if weight is stable, not gaining expected weight can indicate insufficient nutrition.
Athletes often face pressure to maintain a certain weight or appearance, especially in weight-class, endurance, or aesthetic sports like wrestling, dance, gymnastics, climbing, and running. This pressure increases the risk of eating disorders in these sports.
While weight loss or stalled growth can signal an eating disorder, research shows that some teens may experience growth deviations before showing physical or mental symptoms. Proper fueling for growth and development is crucial for any teen athlete.
Withdrawal from normal connections and activities
Is your typically bubbly and extroverted teen now isolating from her friends? Has your teen athlete seemed to lose all interest in activities outside of his sport/exercise? Is attending the team dinner suddenly a huge challenge for your teen? Eating disorders can cause alterations in mood and psychological function that can be debilitating.
Lack of nutrition can contribute to increased anxiety, depression, obsessive-compulsive behaviors, and poor social connections. If you notice that your teen athlete is not acting like themselves, they may need increased support.
You suspect your teen athlete is struggling: What do you do?
Talk to Your Teen
Seek to listen and understand if you notice your teen is struggling. Have a conversation that outlines the details of the concerning behaviors you have observed. Don’t approach your teen with judgement or condemnation – eating disorders can carry shame or stigma that make it difficult for those suffering to ask for help, especially if they are a high-achieving athlete.
Educate Yourself about Eating Disorders
There are many myths about eating disorders that lead many individuals to not receive a diagnosis or not feel they are “sick enough” to warrant treatment. A great starting point is Dr. Cynthia Bulik’s “9 Truths About Eating Disorders.”
Some common eating disorder myths that may show up in sports culture include:
Only underweight people have eating disorders
Eating disorders are a girl problem, boys don’t get them
It’s normal for an athlete to be rigid with their eating and workout routine
Only runners and ballerinas have to worry about eating disorders
It’s normal for athletes to be thinner than everyone else
The prevalence of these myths has contributed to families, providers, and athletes missing a diagnosis or delaying treatment. It is important to know the facts!
Build a Treatment Team – and Listen to Their Recommendations!
Eating disorders are best treated with a multidisciplinary team, including a registered dietitian, mental health therapist, and medical provider. Other professionals, such as a physical therapist, athletic trainer, or coach, may also be involved. Start with your teen's pediatrician for medical monitoring and referrals to other specialists. Keep in mind, many pediatricians may not have specific eating disorder training, so additional support may be needed. Some children's hospital networks have specialized eating disorder professionals.
Treatment teams may recommend actions that go against sports culture, such as rest or reducing training. Athletes may need to restore weight to a body type not considered "ideal" for their sport or eat foods that aren't seen as typical for athletes. While these recommendations can be challenging, trusting the team is crucial for your athlete's physical and mental health, as well as long-term food freedom.
Hopefully, you feel more educated and empowered on addressing an eating disorder in a teen athlete after reading this piece. Have additional questions or need support for your teen athlete in their recovery? Fill out a contact form on my website to see if my nutrition services are a good fit for your family!