Eating Disorders and Athletes: Why Awareness Matters

COMMENTARY

Among all mental health concerns in sports and mental health, none have a higher potential to take a life than eating disorders. Anorexia nervosa in particular can have rates of mortality up to 20% within 20 years of developing the condition.^1-3 Research shows that athletes are at higher risk of developing an eating disorder compared with nonathletes.⁴ Among female athletes, rates can be as high as 45%, and among male athletes, around 19% report disordered eating behaviors.⁵ The pressure to perform, achieve a certain body type, or meet strict weight expectations in sports like gymnastics, wrestling, swimming, and running increases this risk even more.⁵

As a physician and as someone who has witnessed the impact of eating disorders up close, this topic feels personal and hits close to home (KP). In medical school, I had a friend who developed an eating disorder. She once told me she wanted something in her life that she could control, as everything else felt out of her control and was happening without her. I will never forget the quiet determination in her voice, as well as the pain behind it. When my sister was in the dancing world, I have also known dancers who struggled with the same illness, caught in the delicate balance between artistic expression, perfectionism, and comparison to others. And I still think about the young woman in medical school who did not survive her eating disorder. I never got a chance to know her. Her story still haunts me. The human cost is devastating, and it reminds me every day that awareness is not only optional, but essential.

The Impact Beyond Food

Eating disorders are not only about food. They affect nearly every system of the body:

• Heart: Dangerous changes in heart rate and function and increased risk of cardiac complications^1,6
• Bones: Higher rates of fractures due to low bone density¹
• Hormones: Disruption of reproductive and growth hormones^5,7
• Mind: Increased anxiety, depression, and isolation^1,4,6,7

Left untreated, eating disorders can be life-threatening. Studies estimate that eating disorders have the highest mortality rate of any mental health condition, with some research suggesting that up to 20% of individuals may die as a result of the illness.^1,3

Why Awareness Matters

Talking openly about eating disorders can save lives. Awareness helps reduce the stigma and encourages athletes to reach out for support. Coaches, teammates, and entire communities play a crucial role in noticing the signs and stepping in with care.

This section of the Athlete Mental Health Center of Excellence provides:

• Information on how eating disorders affect health and performance
• Guidance on recognizing early warning signs
• Resources for athletes, coaches, and teams to find help and support

Eating disorders are more common in sports than many realize, but awareness and support can make recovery possible. Sharing these resources can help protect both the health and future of athlete well-being.

Ambassador Spotlight: Alice Merryweather

Professional alpine skier Alice Merryweather has spoken openly about her journey through recovery, helping to shed light on how perfectionism, performance pressure, and data tracking can become intertwined with disordered eating.

“My whole team had OURA [health-tracking] rings and used to compare sleep data. It could be fun, but it also fostered a weird comparison environment. My heart rate was low during my eating disorder days, and I thought this meant that I was really fit and I was really healthy. But hindsight is 20/20 and that was not a healthy spot for me to be at. Overanalyzing or getting too much data (Strava, heart rate monitors, etc) can be fun. But when mixed with societal norms like a low resting heart rate, it can be easy for that data to become negative and really overwhelming.”

Alice’s reflection reminds us how easily health can be misread as performance. Numbers that seem to show fitness, such as a low heart rate, a perfect sleep score, etc, can sometimes mask silent suffering.

She also captures a simple yet powerful truth about food and self-worth:

“Just because I worked harder, doesn’t mean that I deserve certain food. Delicious food should not be linked to needing to work out harder. I went on this long run so now I get to eat X.”

Food is not a currency to be earned. It is a birthright. Everyone deserves food and needs it to live.

A Call for Compassionate Change

Athletes are often celebrated for their discipline, drive, resilience, and strength. Yet these same traits can make it harder to ask for help. In psychiatry, we see this often, the internalized belief that struggle equals weakness. It does not. Struggle means you are human, and it takes even greater strength to reach out for help.

By creating spaces where athletes can speak freely and receive care without shame, we protect more than their performance—we protect their life. If we can begin to treat nourishment as part of strength, rest as a necessary part of discipline and training, and openness as part of resilience, we can begin to rewrite the culture that quietly harms so many. Recovery is possible, and it begins with awareness, understanding, and compassionate support.

Dr Paraskevas is a physician, research fellow for Athletes for Hope, andowner and CEO of Epitome Translations Inc.

Dr Mirhom is past president of the New York County Psychiatric Society, an assistant professor of Psychiatry at Columbia University, a Forbes contributor, and Chief Wellbeing Officer at Athletes for Hope.

References

1. Anorexia nervosa- highest mortality rate of any mental disorder: why? Eating Disorder Hope. March 13, 2022. Accessed January 15, 2026. https://www.eatingdisorderhope.com/information/anorexia/anorexia-death-rate

2. 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.

3. Eating disorder statistics. Montana Public Health & Safety. March 27, 2019. Accessed January 15, 2026. https://archive.legmt.gov/bills/2019/Minutes/Senate/Exhibits/phs63a01.pdf

4. Joy E, Kussman A, Nattiv A. 2016 update on eating disorders in athletes: a comprehensive narrative review with a focus on clinical assessment and management. Br J Sports Med. 2016;50(3):154-162.

5. Ghazzawi HA, Nimer LS, Haddad AJ, et al. A systematic review, meta-analysis, and meta-regression of the prevalence of self-reported disordered eating and associated factors among athletes worldwide. J Eat Disord. 2024;12(1):24.

6. Carlson JL, Lemly DC. Medical considerations and consequences of eating disorders. Focus (Am Psychiatr Publ). 2024;22(3):301-306.

7. Misra M, Klibanski A. Endocrine consequences of anorexia nervosa. Lancet Diabetes Endocrinol. 2014;2(7):581-592.