NEDA TOOLKIT for Educators
Tips and information for coaches
Disordered eating and full blown eating disorders
are common among athletes. For example, a study
of Division 1 NCAA athletes found that more than
one-third of female athletes reported attitudes and
symptoms placing them at risk for anorexia nervosa.
Though most athletes with eating disorders are
female, male athletes are also at risk — especially
those competing in sports that tend to emphasize diet,
appearance, size, and weight.
The benefits of sport are well-recognized: building
self-esteem, staying in good physical condition, and
setting a foundation for lifelong physical activity.
Athletic competition, however, can also cause severe
psychological and physical stresses. When the
pressures of athletic competition are added to societal
norms that emphasize thinness or a certain body type,
the risks increase for athletes to develop disordered
eating. Listed below are some recognized risk factors
for developing an eating disorder as an athlete.
Although increased risk of eating disorders in specific
sports like gymnastics, running, swimming, diving,
dancing, rowing, bodybuilding, and wrestling that
require athletes “make weight” or maintain a certain
body size to stay competitive has been documented,
the fact is that any athlete in any sport can develop an
eating disorder. No one is immune.
Personal factors that may create risk for an
athlete • Inaccurate belief that lower body weight will
improve performance. In fact, under-eating
can lead the athlete to lose too much muscle,
resulting in impaired performance.
• Imbalance between energy input and output
resulting in weight loss. This is especially a risk
for athletes who burn high levels of energy in
their sport, such as distance runners.
• Family history of eating disorders, addiction,
and other mental health disorders.
• Personal history of anxiety and perfectionism.
• Coaches who focus only on success and
performance rather than on the athlete as a
whole person.
• Performance anxiety, fear of failure. Athletes
who feel they are not performing at their
peak capability may increase training and/or
decrease food intake to bridge the gap. If no
improvement in performance results, they may
believe they didn’t lose enough weight or body
fat they may step up their efforts even more.
• Social influences, including family and
peer pressure about athletic ability and
performance. Concerns specific to female athletes
The Female Athlete Triad (the Triad), a term coined
in 1993 by the American College of Sports Medicine,
refers to a syndrome commonly seen in athletic
women. It involves the interrelated symptoms of
disordered eating, menstrual irregularity and low
bone mass. Although the exact prevalence of the Triad
is unknown, studies have found that nearly three-
quarters of female athletes have at least one sign of the
Triad, according to a 2009 study in the Clinical Journal
of Sports Medicine.
How do you detect the Triad?
The signs and symptoms of the Triad are very broad,
and they involve all of its three components: eating
and exercise habits, menstrual irregularity and poor
bone health.
• Disordered eating
• Menstrual irregularity is not usually detectable
by a coach, but it is important to let your
athletes know that missing menstrual cycles is
not normal and they should feel comfortable
going to student health or a specialist to have
this addressed. Missed cycles in athletes are
not always an indication of the Triad, so it
is important to have the athlete evaluated
by a doctor for other medical problems
that may cause amenorrhea (e.g., polycystic
ovarian syndrome or a pituitary tumor). This
evaluation involves various laboratory tests
and sometimes imaging. Once other causes are
ruled out, treatment can proceed with dietary
and exercise adjustments.
Female athletes taking oral
contraceptive pills (OCP) may be
unaware of menstrual irregularities
or think the artificial period created
by the pills will protect her from
decreased bone density. More recent
studies show that this is not the case.
Only natural menstruation produces
the right hormones at the right levels
to build bone mass.
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