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By Columnist Eleni Psillakis – Eating Disorder Educator: 


Photo Credit: Dick Grayson, 2016, Athletes


A well-nourished body and rest are needed to develop the strength and endurance needed to perform at an optimum level. With eating disorders affecting about one in 20 Australians, studies show that female athletes are twice as likely to develop anorexia.

Both Sarah Coyte and Adriana Jones suffered from anorexia nervosa, yet their sports are not the ‘typical’ sports that you would associate a risk of an eating disorder. Sarah Coyte is an Australian International Cricketer and Adriana Jones plays football for Adelaide United.

Often being portrayed as body image issues, eating disorders are usually associated with sports like gymnastics, dancing, diving, figure skating and the many divisions of bodybuilding competitions, where body aesthetics or leanness are desired. Disordered eating and eating disorders (EDs) are also high risks for people involved in sports that require the athlete to make a certain weight class such as wrestlers, boxers, jockeys and rowers. People that participate in endurance sports like marathon, cycling, swimming and triathlons are also shown to be at greater risk.


Sarah Coyte
Photo Credit: Cricket Network, Sarah Coyte

What Research Found

Many studies have been conducted around the world on eating disorders amongst athletes. Some of the findings are:

  • The prevalence of eating disorders, having met diagnostic criteria for subclinical and clinical ED’s are higher amongst elite athletes (13.5%) than of control groups (4.6%). These are met more by female athletes (20%) than males (8%). 1.
  • 4%of male athletes in Australia have an eating disorder, however, this study did not include athletes in all weight class sports (only lightweight rowing)1.
  • In sports like gymnastics, figure skating, dance, aerobics, diving, jockeys and rowers, participants report experiencing pressure to reduce weight to perform well and this can increase the risk of developing an ED.1
  • The prevalence of ED’s of female athletes in ball sports increased from 11%in 1990 to 16% in 1997. 1
  • 24% of endurance athletes have an ED 1.
  • 18.3% of athlete’s reported binge eating at least once per week and 15.2% had done so for more than months. 1.
  • Female athletes reported exercising 2 hours per day on top of their sporting commitments purely to burn calories. 2.
  • 15.69% female athletes reported they fasted or went on strict diets at least 2 times in the past year. 2.
  • 3% vomited at least 2 – 3 times a month, and 1% use laxatives 1-2 times per week.2

However, some of these studies have only included female athletes and many involved self-reporting. The problem with this is that male athletes also suffer ED and not including them in studies increases the barriers for men to seek help.  Rates of muscle dysmorphia are increasing amongst some athletes, both male and female. Self-reporting may not deliver accurate results, especially in the area of ED, as disclosure is difficult or people that have ED may deny they have a problem.

Some Risk Factors

There are many reasons why the prevalence of ED is higher amongst athletes. Not every athlete develops an ED. All the risk factors need to be considered, including personality type, resilience, sense of worth, social and familial relationships and circumstances within a person’s life outside of their sport. A combination of these risk factors coupled with advances in technology for measuring body composition and pressure within the sport to reduce weight or body fat measures could be contributing factors. Ignoring any or all of the risk factors does not help to identify the mental illness that ED is, and so, for an athlete, they may use their dedication to the sport as a means of hiding the illness.

These things must be considered in combination if early detection and intervention are to be effective. The very nature of being a professional athlete may make it difficult to detect a growing problem with an eating disorder as many of the diet and exercise behaviours are often regarded as ‘dedication’ to the sport and being a ‘good athlete’. Purging and use of laxatives, combined with restricted eating and excessive exercise disturbs electrolyte balance and cardiac functioning, decreases bone density, increases the risk of dehydration and depression, all of which place an athlete who is focused on performance at medical risk.

There is an increased number of women in professional sport, which may account for the rise in eating disorder prevalence shown in studies. The question that needs to be asked here though, “Is do people engage in a sport to hide a developing problem or does training for the sport places a person who has other risk factors at greater risk of developing an ED?” There is also growing pressure experienced by athletes in tennis and volleyball in relation to their outward appearance. 1

Could this be due to the sexualisation of emerging images portrayed of these athletes?

Attitudes of Coaches and Support People Are Important

The attitudes of coaches and athlete support plays a big role in whether or not a person is identified as having a problem. It also plays a role in whether they receive professional help.

A study by Siobhain et al, revealed that Athlete Support Personnel (ASP) in sport and exercise science professional bodies and associations in Ireland, and the United Kingdom, found communication with an athlete suffering anorexia nervosa  ‘more difficult’. They also felt the athlete was more likely to be using the disorder to gain attention, less likely to recover and only had themselves to blame for their mental health condition’. 3

ASP felt that they were more able to communicate with athletes suffering depression and had less stigmatizing attitudes towards these athletes. This kind of attitude shows lack of understanding of EDs as serious mental health issues and actually places more barriers on a person to receive help. These athletes are crying out for assistance and have a real need – they are not attention seeking.  This attitude also means that signs are ignored, hoping the athlete will attend to the illness when they leave the sport or that the illness will cause the person to drop out of the sport. 3


Photo Credit: Laura Maitem, 2004, Support


Screening and Education is Imperative

Screening processes must be in place to determine all risk factors that need to be considered, so coaches and support staff have the knowledge to detect a problem early. Education on the signs and symptoms as well as how to communicate with athletes who are experiencing ED and engaging in risk behaviours is necessary. Having a knowledge of the next steps to take the athlete receives appropriate professional support. This support is crucial as it helps them to take that step. Communicating the hope of recovery underpins all these practices.

Being a ‘good dedicated athlete’ may be a sign that the suffering athlete does not believe they are ‘good enough’ – that healthy attitude of supportive nutrition to nourish the body to perform well, may be compromised when unhealthy behaviours are used to feel a sense of worth.


  1. Prevalence of Eating Disorders in Elite Athletes Is Higher Than in the General Population, Sundgot-Borgen, Jorunn PhD*†; Torstveit, Monica Klungland MS*, Clinical Journal of Sport Medicine:  January 2004 – Volume 14 – Issue 1 – pp 25-32.
  2. Christy Greenleaf PhD , Trent A. Petrie PhD , Jennifer Carter PhD & Justine J. Reel PhD (2009) Female Collegiate Athletes: Prevalence of Eating Disorders and Disordered Eating Behaviors, Journal of American College Health, 57:5, 489-496, DOI: 10.3200/ JACH.57.5.489-496.
  3. Service Providers’ Attitudes Toward Athletes With Eating Disorders, Siobhain McArdle, PhD, CPsychol,* Mary M. Meade, PhD,† and Emma Burrows, BSc*.


Workshops & Events

Identifying & Managing Eating Disorders in the Fitness Industry

Event #1

Where: Northern Beaches Community College, Level 1 14 William Street; BROOKVALE, NSW.

When: Feb 2nd, 2018

Time: 12 noon – 6pm

Event #2

Where: QUEST WODONGA, 46 Reid St Wodonga, VIC

When: Feb 9th, 2018

Time: 12 noon – 6pm

The link to register is https://www.brazengrowth.com.au/services/identifying-and-managing-eating-disorders-in-the-fitness-industry

About Our Eating Disorder News and Review Columnist – Eleni Psillakis


Combining over 27-years experience in the fitness industry, education and a lived experience, Eleni Psillakis is raising awareness of eating disorders as serious mental illnesses. In her time as a group fitness instructor, personal trainer, secondary and tertiary educator, Eleni wasn’t aware of the fine-line that crossed from healthy to unhealthy diet and exercise habits.

How Eleni Used Resistance Training

Using resistance training to gain weight to her 39kg frame at age 19, Eleni physically recovered and went on to compete in women’s bodybuilding. However the underlying emotional issues and thought patterns resurfaced 25-years later when her marriage broke down and a diagnosis of clinical depression resulted. Antidepressants and 8-years of psychological counselling, assisted with unlearning of negative thought processes that Eleni had of herself for most of her life. These were nothing to do with body image, but self-worth.

Resistance training again helped the process of stopping her thoughts racing during this time of depression and she stepped back onto the competition stage gaining a top 3 place in her division for each of the 5 competitions since. It was the psychological help that has made the difference this time around.

An Insight to Anorexia and Other Eating Disorders for Fitness Professionals”, a seminar that Eleni has written, has been approved by Fitness Australia for continuing education.

Eleni Logo


Disclaimer: The information published in this column are based on the author’s own professional and personal knowledge, and opinion. This information is not a substitute for professional medical advice, diagnosis or treatment of any manner. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding any medical condition and consult a qualified medical professional before beginning any nutritional program or exercise program. Never disregard professional medical advice or delay in seeking it because of something you have read on InShape News.


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