Eating Disorders in Athletes: When Performance and Health Collide
Specialized Treatment for Athletes at Ezer Psychotherapy, PLLC
Athletes are often praised for discipline, commitment, and mental toughness.
But sometimes the very traits that make someone successful in sport—high standards, pain tolerance, competitiveness, and body awareness—can also increase vulnerability to disordered eating.
Eating disorders and disordered eating in athletes are often under-identified and can be normalized within sports culture. Athletes in aesthetic, endurance, leanness-focused, and weight-class sports appear to be at higher risk than athletes in sports without these pressures (Wells et al., 2020; Chapa et al., 2022).
If you’re an athlete struggling with food, weight, or performance anxiety, you are not “weak.” You may be dealing with something that deserves professional care.
At Ezer Psychotherapy, PLLC, we provide evidence-based outpatient eating disorder treatment tailored to adolescents, college athletes, and adult competitors across Minnesota, Wisconsin, Florida, and North Dakota through secure virtual therapy.
Why Athletes Are at Higher Risk
Certain sport environments increase risk, especially:
Endurance sports: cross country, track, cycling, swimming
Aesthetic sports: gymnastics, dance, figure skating
Weight-class sports: wrestling, rowing, martial arts
Sports emphasizing leanness or power-to-weight ratio
Risk factors include:
Pressure to “make weight”
Comments from coaches about body composition
Social comparison within teams
Belief that lighter always means faster
Perfectionism and high achievement orientation
Fear of losing a starting position
These pressures are clinically important because low energy availability, body-composition pressure, weight cycling, dieting, and critical comments about weight or eating are recognized risk factors in athlete eating concerns and RED-S/REDs frameworks (De Souza et al., 2014; Mountjoy et al., 2023; Wells et al., 2020).
What begins as “fueling for performance” can slowly shift into rigid restriction, binge/purge cycles, compulsive exercise, or obsessive body monitoring.
Warning Signs of an Eating Disorder in Athletes
Skipping meals or cutting out food groups
Anxiety when unable to train
Training through injury or illness
Frequent weight checks
Significant fatigue despite adequate sleep
Mood changes or irritability
Declining performance despite increased effort
Gastrointestinal issues
Loss of menstrual cycle in females
Recurrent injuries, especially stress fractures
Athletes often normalize these symptoms as part of training—but they are not. Disordered eating in athletes can include restrictive eating, compulsive exercise, bingeing, purging, body preoccupation, and rigid food rules, and these concerns can affect both health and performance (Wells et al., 2020).
What Is RED-S?
Relative Energy Deficiency in Sport
Relative Energy Deficiency in Sport, now commonly written as REDs, occurs when an athlete does not consume enough energy to support both training demands and basic physiological functioning. The underlying issue is low energy availability: not enough energy remains for normal body functions after exercise energy expenditure is accounted for (Mountjoy et al., 2018; Mountjoy et al., 2023).
This is not just about weight. It is about energy availability.
REDs can affect:
Metabolism
Hormonal function
Menstrual cycle
Bone health
Immunity
Cardiovascular function
Mood
Cognitive performance
Athletic performance
In females, this was previously described through the Female Athlete Triad: low energy availability, menstrual dysfunction, and low bone density. REDs expands this concept to include all genders and highlights broader systemic effects (De Souza et al., 2014; Mountjoy et al., 2023).
Common Signs of REDs
Chronic fatigue
Frequent illness
Stress fractures
Loss of period or irregular cycles
Low testosterone in males
Decreased performance
Depression or anxiety
Many athletes believe eating less improves performance. In reality, problematic low energy availability is associated with impaired health, increased injury risk, and decreased sport performance (Mountjoy et al., 2023; Gallant et al., 2024).
Proper nutrition is performance-enhancing.
The Culture Problem in Sport
One of the biggest barriers to treatment is normalization.
“Everyone cuts weight.”
“No days off.”
“Pain is weakness leaving the body.”
“If you want it bad enough, you’ll sacrifice.”
Eating disorders in athletes often hide behind dedication.
At Ezer Psychotherapy, we understand sport culture. Treatment does not mean giving up your identity as an athlete. It means protecting your longevity—both in sport and in life.
How Ezer Psychotherapy Treats Eating Disorders in Athletes
1. Evidence-Based Treatment: CBT-E and More
We use CBT-E, Enhanced Cognitive Behavioral Therapy, one of the evidence-supported outpatient treatments for eating disorders in adults and older adolescents (Atwood & Friedman, 2020; Öst et al., 2023).
Treatment focuses on:
Restoring adequate fueling
Reducing restriction, bingeing, and purging
Challenging performance-based body beliefs
Decreasing compulsive exercise behaviors
Building cognitive flexibility
Addressing perfectionism
We work collaboratively—not by shaming, but by aligning recovery with your long-term athletic and personal goals.
2. REDs-Informed Care
If REDs is suspected, we:
Emphasize nutritional rehabilitation
Support medical monitoring
Coordinate with sports medicine providers when appropriate
Address fear of weight restoration
Reframe fueling as performance support
You cannot out-train under-fueling. REDs assessment and treatment are best handled through a multidisciplinary approach, often involving a physician, sports dietitian, therapist, and other athlete-support professionals (Mountjoy et al., 2023; Stellingwerff et al., 2023).
3. Collaboration With Your Team
With your consent, we can coordinate with:
Physicians
Dietitians, especially sports RD specialists
Athletic trainers
Parents, for adolescent athletes
Recovery often works best with aligned messaging from your support system.
4. Virtual Therapy for Busy Athletes
Training schedules are demanding. Our secure telehealth sessions allow you to:
Attend therapy around practice times
Continue treatment during travel
Maintain support during season transitions
Access specialized eating disorder care even if it is not available locally
What Recovery Means for Athletes
Recovery does not mean losing your competitive edge.
It often means:
Stronger endurance
Faster recovery times
Improved concentration
More stable mood
Fewer injuries
Longer athletic longevity
Greater freedom around food
Most importantly, it means your identity expands beyond your sport.
For Parents of Young Athletes
If your child is:
Losing weight during season
Missing menstrual cycles
Getting stress fractures
Overtraining despite fatigue
Becoming rigid around food
Early intervention matters. Adolescents and young athletes are especially vulnerable because nutrition supports not only sport performance, but also growth, puberty, bone development, and psychological health (De Souza et al., 2014; Mountjoy et al., 2023).
You Deserve to Be Strong—Not Depleted
Athletes are often told to push through.
But true strength includes knowing when to get support.
If you are struggling with food, body image, weight pressure, REDs symptoms, or performance-related eating concerns, Ezer Psychotherapy, PLLC offers specialized, compassionate, evidence-based outpatient care designed for athletes.
You can pursue excellence without sacrificing your health.
Contact Ezer Psychotherapy, PLLC today to schedule a consultation and begin eating disorder treatment that protects both your performance and your well-being.
Fueling your body is not a weakness.
It’s a strategy and is essential.
References
Atwood, M. E., & Friedman, A. (2020). A systematic review of enhanced cognitive behavioral therapy (CBT-E) for eating disorders. International Journal of Eating Disorders, 53(3), 311–330.
Chapa, D. A. N., et al. (2022). Eating-disorder psychopathology in female athletes and non-athletes: A meta-analysis. International Journal of Eating Disorders.
De Souza, M. J., Nattiv, A., Joy, E., Misra, M., Williams, N. I., Mallinson, R. J., Gibbs, J. C., Olmsted, M., Goolsby, M., Matheson, G., & Expert Panel. (2014). 2014 Female Athlete Triad Coalition Consensus Statement on treatment and return to play of the Female Athlete Triad. British Journal of Sports Medicine, 48(4), 289.
Gallant, T. L., et al. (2024). Low energy availability and Relative Energy Deficiency in Sport: A systematic review and meta-analysis. Sports Medicine.
Mountjoy, M., Sundgot-Borgen, J., Burke, L., Ackerman, K. E., Blauwet, C., Constantini, N., et al. (2018). IOC consensus statement on relative energy deficiency in sport: 2018 update. British Journal of Sports Medicine, 52(11), 687–697.
Mountjoy, M., Ackerman, K. E., Bailey, D. M., Burke, L. M., Constantini, N., Hackney, A. C., Heikura, I. A., Melin, A., Pensgaard, A. M., Stellingwerff, T., Sundgot-Borgen, J. K., Torstveit, M. K., Jacobsen, A. U., Verhagen, E., Budgett, R., Engebretsen, L., & Erdener, U. (2023). 2023 International Olympic Committee’s consensus statement on Relative Energy Deficiency in Sport. British Journal of Sports Medicine, 57, 1073–1098.
Öst, L.-G., et al. (2023). Cognitive behavior therapy for adult eating disorders in routine clinical care: A systematic review and meta-analysis. International Journal of Eating Disorders.
Stellingwerff, T., Mountjoy, M., McCluskey, W. T. P., Ackerman, K. E., Verhagen, E., & Heikura, I. A. (2023). Review of the scientific rationale, development and validation of the IOC Relative Energy Deficiency in Sport Clinical Assessment Tool: Version 2. British Journal of Sports Medicine, 57, 1109–1118.
Wells, K. R., et al. (2020). The Australian Institute of Sport and National Eating Disorders Collaboration position statement on disordered eating in high performance sport. British Journal of Sports Medicine, 54, 1247–1258.
