The Weight of Performance: Athletic Identity and Eating Disorders in Male Athletes

For decades, male athletes have been the dominant image associated with sport and competition—celebrated for their strength, speed, and idealized muscular physiques and often positioned as the benchmark of excellence. However, as societal pressures evolve, our understanding of what it means to be a male athlete is beginning to shift. Emerging evidence indicates that this population is often overlooked in the study of eating disorders, as most literature focuses predominantly on female athletes.

Consequently, many eating disorder screenings and assessments have traditionally been based on the assumption that the primary goal of an eating disorder is to become thin, often through weight loss and caloric restriction.¹ This narrow perspective overgeneralizes the presentation and purpose of eating disorders, applying it primarily to women while overlooking the diverse ways eating pathology manifests in men.

In Western society, the ideal male physique is typically defined by a lean, muscular build, emphasizing upper-body strength and low body fat percentages.² This image is reinforced throughout media, including movies, video games, advertising, fitness culture, and even children's toys, conditioning boys and men to aspire to a nearly unattainable body type. As a result, cultural definitions of masculinity have become increasingly tied to physical appearance, contributing to body dissatisfaction, disordered eating habits, and mental health concerns.

Importantly, the pursuit of muscularity may be a more salient concern for many male athletes than the pursuit of thinness. Unlike traditional eating disorder presentations characterized by weight loss, some male athletes engage in rigid dieting, excessive exercise, supplement misuse, or cycles of bulking and cutting in pursuit of a specific physique. These behaviors may not immediately raise clinical concern because they are often normalized within athletic and fitness environments.

So, what does a masculine man look like? This is a question that has been challenged on many fronts as societal definitions of masculinity continue to evolve. A UK data analysis showed that most men who experience or have experienced disordered eating habits found it difficult to reach out for help because they felt ashamed and in denial.³ Qualitative findings further highlighted this issue, with accounts describing that they were “living in fear of stigma” and that “admitting to eating disorders isn’t macho.”³ The ever-changing cultural pressures contribute to the under recognition and underreporting of eating disorders and disordered eating habits in men, particularly male athletes.

Major Concept 1: Athletic Identity

A key psychological construct related to this disparity is athletic identity. Athletic identity refers to the extent to which an individual defines themselves through their sport or role as an athlete. Males who strongly identify with the athlete role are associated with an increased risk of disordered eating.⁴ This includes men who currently play competitively, competed in sport previously, are consistent gym users, or participate in recreational endurance sports. This population remains particularly vulnerable to the influence of diet culture and appearance-based performance standards.

Athletes who are at particularly high risk for developing an eating disorder are those who compete in sports where leanness, weight categories, or appearance are emphasized. Wrestling, mixed martial arts, rowing, distance running, bodybuilding, gymnastics, and certain aesthetic sports have all been associated with elevated risk. A study conducted on 501 long-distance runners found a positive correlation between eating-related psychopathology and compulsive exercise patterns.⁵ Although no significant relationship was found directly linking athletic identity and eating disorder pathology, findings suggest that aspects commonly associated with athletic identity—such as performance pressure, discipline, and intense commitment to training—may contribute indirectly to disordered eating behaviors through compulsive exercise habits.

In addition, male athletes are especially vulnerable to the effects of “body talk,” or conversations centered around fat levels, muscularity, weight cutting, and physique comparisons.⁴ Research suggests that frequent exposure to and participation in these conversations increases body dissatisfaction and disordered eating behaviors among male athletes.⁴ Together, these findings demonstrate how identity, sport culture, and societal expectations intersect to shape eating behaviors.

Another emerging concern is muscle dysmorphia, a condition characterized by a persistent belief that one's body is insufficiently muscular despite evidence to the contrary. Although not classified as an eating disorder, muscle dysmorphia frequently overlaps with disordered eating behaviors, excessive exercise, and body image disturbance. In athletic environments where muscularity is rewarded, these symptoms may be minimized or even reinforced by peers and coaches.

Major Concept 2: Cognitive Dissonance

Cognitive dissonance is likely a significant factor in male athletes who experience eating disorders. Cognitive dissonance refers to the psychological discomfort that arises when beliefs, values, and behaviors conflict. In athletes, this may emerge when they understand the importance of proper nutrition and recovery while simultaneously engaging in restrictive eating practices to achieve a desired physique.

High-performing athletes are often educated on nutrition, recovery, and the physiological consequences of inadequate fueling. Yet many still feel pressure to pursue an idealized body image. As a result, athletes may justify restrictive eating, excessive exercise, or unhealthy weight-control behaviors as necessary sacrifices for success. Unfortunately, if these behaviors coincide with improved short-term performance outcomes, they may become further reinforced.

Cognitive dissonance in other areas of an athlete’s life may also contribute to the maintenance of disordered eating. The higher the dissonance arousal a person experiences, the more likely they are to experience psychological discomfort related to exercise behaviors.⁶ This highlights the importance of evaluating the athlete as a whole person rather than focusing solely on performance metrics. Left unresolved, chronic dissonance can contribute to anxiety, depression, burnout, and worsening eating pathology.

Major Concept 3: Underdiagnosis

Another important psychological consideration is the underdiagnosis of eating disorders among male athletes. Clinical presentations in males often differ from those observed in females, making assessment particularly challenging. Eating disorder symptoms in males may present as an excessive focus on muscularity, compulsive exercise, rigid dietary rules, or performance-enhancing behaviors rather than an explicit desire to lose weight.

Typically, eating disorder symptoms emerge during adolescence or young adulthood and frequently co-occur with other psychiatric symptoms.⁷ Among these, substance use deserves particular attention because it can obscure underlying eating pathology and contribute to delayed diagnosis or misdiagnosis.

One relevant diagnostic criterion for anorexia nervosa is the presence of behaviors that offset caloric intake or increase energy expenditure.⁸ While these behaviors are often more readily identified in female patients, they may be overlooked in male athletes because intensive exercise is viewed as a normative component of training. The challenge for clinicians lies in distinguishing sport-specific behaviors from behaviors driven by body image disturbance and psychopathology.

Clinicians should also be aware of Relative Energy Deficiency in Sport (RED-S), a syndrome resulting from insufficient energy availability to support physiological functioning. RED-S can affect athletes of any gender and may present with fatigue, impaired recovery, decreased performance, hormonal disruption, mood changes, and increased injury risk. Because symptoms often emerge gradually, RED-S may be mistaken for overtraining or burnout rather than recognized as a consequence of inadequate nutritional intake.

Clinical Implications

The under recognition of eating disorders in male athletes has significant clinical implications. Screening tools historically developed using predominantly female samples may fail to identify male-specific symptom presentations. Clinicians working with athletes should assess not only eating behaviors but also body image concerns, compulsive exercise, supplement use, weight-cycling practices, and attitudes toward muscularity.

Given the stigma surrounding help-seeking among men, clinicians may need to approach these conversations indirectly and within the context of performance, recovery, and overall wellbeing. Collaboration among psychiatrists, primary care physicians, sports medicine providers, athletic trainers, dietitians, and coaches can improve early identification and intervention.

Concluding Thoughts

The evolving understanding of eating disorders among male athletes remains incomplete, yet increasingly urgent. Unique pressures shaped by cultural ideals of masculinity, athletic identity, and performance expectations contribute not only to the development of disordered eating behaviors but also complicate their recognition and diagnosis. As awareness grows, clinicians must broaden traditional assumptions about how eating disorders present in men and athletes. Creating environments where male athletes feel supported in discussing body image concerns, nutrition, and mental health may ultimately improve both psychological wellbeing and athletic performance. Earlier recognition, more nuanced screening approaches, and multidisciplinary treatment models will be essential in addressing this often-overlooked population.

Ms Jackson is a graduate student at Louisiana State University with a strong interest in sport psychology and counseling.

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. Bryant E, Spielman K, Le A, et al. Screening, assessment and diagnosis in the eating disorders: findings from a rapid review. J Eat Disord. 2022;10(1):78.

2. Nagata JM, Brown TA, Lavender JM, Murray SB. Emerging trends in eating disorders among adolescent boys: muscles, macronutrients, and biohacking. Lancet Child Adolesc Health. 2019;3(7):444-445.

3. MacLean A, Sweeting H, Walker L, et al. “It’s not healthy and it’s decidedly not masculine”: a media analysis of UK newspaper representations of eating disorders in males. BMJ Open. 2015;5:e007468.

4. Ahlich E, Choquette EM, Rancourt D. Body talk, athletic identity, and eating disorder symptoms in men. Psychology of Men & Masculinities. 2019;20(3):347-355.

5. Turton R, Goodwin H, Meyer C. Athletic identity, compulsive exercise and eating psychopathology in long-distance runners. Eat Behav. 2017;26:129-132.

6. Harmon-Jones E, Harmon-Jones C. Individual differences in dissonance arousal/reduction relate to physical exercise: testing the action-based model. PLoS One. 2022;17(10):e0275990.

7. Murray SB, Nagata JM, Griffiths S, et al. The enigma of male eating disorders: a critical review and synthesis. Clin Psychol Rev. 2017;57:1-11.

8. Diagnostic and statistical manual of mental disorders. 5th ed. American Psychiatric Association; 2013.