Amy Stephens


Licensed dietitian

specializing in sports nutrition

and eating disorders

Understanding Eating Disorders:
Insights for Coaches, Families and Friends

Eating disorders are complex conditions influenced by a combination of genetic, biological, environmental, psychological, and sociocultural factors. It’s important to note that these factors interact in complex ways, and not everyone with risk factors will develop an eating disorder. Additionally, eating disorders can affect individuals of any age, gender, socioeconomic status, or cultural background. An eating disorder is not visibly apparent. An individual may appear healthy but may be struggling. It’s important to note that eating disorders are a mental illness.

Addressing eating disorders early can improve the likelihood that individuals will be able to pursue their academic career and physical goals. A comprehensive approach to treatment that addresses physical, emotional, and psychological aspects is crucial for recovery


Among the general population, an estimated 9% of the U.S. population, or 28.8 million Americans, will have an eating disorder in their lifetime (Deloitte, 2020).

95% of people with an eating disorder are between the ages 12-25 years old (Bratland-Sanda, 2013).

Eating disorders are a mental illness with the highest death rate, higher than depression, bipolar or schizophrenia (Arcelus, 2011).

Among athletes, eating disorders may be particularly hard to detect due in part to secretiveness, stigma, and symptom presentation (Eichstadt, 2020).

Athletes may be less likely to seek treatment for an eating disorder due to stigma, accessibility, and sport‐specific barriers (Flatt, 2021).

13.5% of athletes have a diagnosable eating disorder (Goch, 2013). 

Up to 47% of female athletes, versus 19% of male athletes have an eating disorder (Brantland-Sanda, 2013). 


There is no single cause for eating disorders, but several factors may contribute to their development:

Genetic Factors:

  • Research suggests a genetic predisposition to eating disorders. Individuals with a family history of eating disorders may be more susceptible.

Biological Factors:

  • Abnormalities in brain chemistry and neurotransmitter imbalances, such as serotonin and dopamine may play a role in the development of eating disorders.

Psychological Factors:

  • Personality traits, such as perfectionism, low self-esteem, and high levels of anxiety or depression, are associated with an increased risk of developing eating disorders.

Environmental Factors:

  • Societal pressures, cultural ideals of beauty, and exposure to thinness-promoting media can contribute to body image dissatisfaction, leading to disordered eating behaviors.

Traumatic Experiences:

  • Traumatic events, such as childhood abuse, bullying, or other significant life stressors, may contribute to the development of eating disorders as a coping mechanism.

Dieting and Weight Concerns:

  • Strict dieting or extreme focus on weight loss can trigger disordered eating behaviors. Dieting may disrupt normal eating patterns and lead to the development of unhealthy relationships with food.

Athletics and Performance Pressure:

  • Athletes, especially those in sports that emphasize leanness or specific body types, may be at increased risk. The pressure to perform and meet certain body standards can contribute to the development of eating disorders.

Family Dynamics:

  • Family factors, such as dysfunctional family relationships, communication problems, or a history of parental eating disorders, can contribute to the development of disordered eating patterns.

Social Influences:

  • Peer pressure and the desire to fit in with a particular group may contribute to the adoption of unhealthy eating habits.

Signs and symptoms

Recognizing if someone has an eating disorder can be challenging, as individuals with these disorders often try to conceal their behaviors. However, there are signs and behaviors that may indicate the presence of an eating disorder. It’s essential to approach the situation with empathy and sensitivity, avoiding judgment. Here are some common signs that someone may have an eating disorder:

Changes in Eating Habits:

    • Frequent dieting or a sudden switch to restrictive eating patterns.
    • Excessive focus on calories, fat content, or specific food groups.
    • Eating alone or avoiding meals altogether.
    • Consuming an inadequate amount of food before or after a workout.
    • Denying or minimizing behaviors related to food, body image or weight.
    • Evidence of binge eating, like finding large amounts of food wrappers.

Physical Signs and Symptoms:

      • Significant weight loss or fluctuations in weight.
      • Noticeable changes in appearance, such as a pale complexion or brittle nails.
      • Fatigue, weakness, or dizziness.
      • Frequent fluctuations in energy levels.
      • Evidence of self-induced vomiting, laxative use, or excessive exercise.

Emotional and Behavioral Changes:

    • Preoccupation with body image, weight, or food.
    • Avoidance of social events that involve food.
    • Anxiety or distress around mealtime.
    • Frequent comments about feeling fat or expressing dissatisfaction with one’s body.

Social Withdrawal:

    • Isolation from friends and social activities.
    • Desire to be alone.
    • Changes in relationships, especially if they involve food-related activities.

Mood Changes:

    • Increased irritability, mood swings, or signs of depression.
    • Emotional distress before, during, or after eating.

Denial of the Problem:

    • Dismissing concerns about weight loss or changes in eating habits.

Physical Health Issues:

    • Menstrual irregularities or the absence of menstrual periods in females.
    • Digestive problems, such as constipation or bloating.
    • Frequent complaints of feeling cold or wearing layered clothing to hide weight loss.

The presence of one or more of these signs does not necessarily confirm an eating disorder. However, if you notice several of these behaviors persisting over time, it may be an indication that further evaluation is needed.

How to help

Early intervention has been shown to improve outcomes. Treatment provides an opportunity for individuals to learn and adopt healthy eating habits, coping mechanisms, and stress management skills. If you suspect an individual has an eating disorder, express your concern in a nonjudgmental and caring manner. Encourage them to seek help from a healthcare professional, therapist, or dietitian who specializes in eating disorders. Remember that though eating disorders share commonalities, everyone is unique. You might need to bring up this issue several times before the person is willing to seek help. 


Arcelus J, Mitchell AJ, Wales J, Nielsen S. Mortality Rates in Patients With Anorexia Nervosa and Other Eating Disorders: A Meta-analysis of 36 Studies. Arch Gen Psychiatry. 2011;68(7):724–731. doi:10.1001/archgenpsychiatry.2011.74

Bratland-Sanda S, Sundgot-Borgen J. Eating disorders in athletes: overview of prevalence, risk factors and recommendations for prevention and treatment. Eur J Sport Sci. 2013;13(5):499-508. doi: 10.1080/17461391.2012.740504. Epub 2012 Nov 13. PMID: 24050467.

Deloitte Access Economics. The Social and Economic Cost of Eating Disorders in the United States of America: A Report for the Strategic Training Initiative for the Prevention of Eating Disorders and the Academy for Eating Disorders.June 2020. Available at:

Eichstadt, M., Luzier, J., Cho, D., & Weisenmuller, C. (2020). Eating disorders in male athletes. Sports Health: A Multidisciplinary Approach, 12(4), 327–333. 

Flatt, R., Thornton, L., Fitzsimmons‐Craft, E., Balantekin, K., Smolar, L., Mysko, C., Wilfley, D. E., Taylor, C. B., DeFreese, J. D., Bardone‐Cone, A. M., & Bulik, C. M. (2021). Comparing eating disorder characteristics and treatment in self‐identified competitive athletes and non‐athletes from the National Eating Disorders Association Online Screening Tool. International Journal of Eating Disorders, 54(3), 365–375. 

Ghoch M, et al. Eating disorders, physical fitness and sport performance: a systematic review. Nutrients. 2013 Dec 16;5(12):5140-60. doi: 10.3390/nu5125140. PMID: 24352092; PMCID: PMC3875919.

Paul A. Krebs, Christopher R. Dennison, Lisa Kellar, Jeff Lucas, “Gender Differences in Eating Disorder Risk among NCAA Division I Cross Country and Track Student-Athletes”, Journal of Sports Medicine, vol. 2019, Article ID 5035871, 5 pages, 2019.

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