Eating Disorders in Athletes: A Systematic Review

Authors

  • Aleksandra Kaźmierczyk 1st Military Clinical Hospital with the Outpatient Clinic, Lublin, Poland, al. Racławickie 23, 20-049 Lublin, Poland https://orcid.org/0009-0007-7283-2518
  • Jan Wojtas 4th Clinical University Hospital in Lublin, ul. Kazimierza Jaczewskiego 8, 20-954 Lublin, Poland https://orcid.org/0000-0003-1393-3689
  • Jędrzej Kęsik 1st Military Clinical Hospital with the Outpatient Clinic, Lublin, Poland, al. Racławickie 23, 20-049 Lublin, Poland https://orcid.org/0000-0001-8317-0213
  • Paulina Duda 1st Military Clinical Hospital with the Outpatient Clinic, Lublin, Poland, al. Racławickie 23, 20-049 Lublin, Poland https://orcid.org/0009-0005-7424-9735
  • Zbigniew Dębicki 1st Clinical University Hospital in Lublin, ul. Stanisława Staszica 16, 20-400 Lublin, Poland https://orcid.org/0009-0005-9489-4010
  • Julia Czerwik National Medical Institute of the Ministry of the Interior and Administration, ul. Wołoska 137, 02-507 Warszawa, Poland https://orcid.org/0000-0001-7241-194X
  • Karol Stępniak 1st Military Clinical Hospital with the Outpatient Clinic, Lublin, Poland, al. Racławickie 23, 20-049 Lublin, Poland https://orcid.org/0000-0002-8134-7967

DOI:

https://doi.org/10.12775/PPS.2026.30.69262

Keywords

Feeding and Eating Disorders, Athletes, Female Athlete Triad Syndrome, Relative Energy Deficiency in Sport, Energy Metabolism, Body Image, Health Promotion

Abstract

Eating disorders (EDs) represent a critical and complex issue in sports, particularly among athletes exposed to high-performance demands and appearance-related pressures. Athletic participation is generally associated with health and psychological benefits. However, certain environments increase the risk of developing disordered eating (DE) behaviors. This systematic review examines the epidemiology and risk factors associated with EDs in athletic populations. It focuses particularly on high-risk groups such as female athletes and participants in leanness-focused sports. It introduces a developing understanding of low energy availability, as conceptualized in the Female Athlete Triad and the broader Relative Energy Deficiency in Sport (RED-S) model. The review outlines the multi-system health consequences of RED-S, including effects on reproductive, cardiovascular, immune, and psychological function. Moreover, it highlights the diagnostic challenges in sports settings, where restrictive eating is often normalized or hidden. Finally, the review synthesizes current evidence on clinical management, treatment strategies, and the importance of educational and preventive interventions within sport environments to protect athlete health and performance. Comprehensive awareness and early multidisciplinary interventions are essential for addressing EDs and supporting sustainable athletic careers.

References

1. Bratland-Sanda S, Sundgot-Borgen J. Eating disorders in athletes: Overview of prevalence, risk factors and recommendations for prevention and treatment. European Journal of Sport Science. 2013;13(5):499-508. doi:10.1080/17461391.2012.740504

2. Mancine RP, Gusfa DW, Moshrefi A, Kennedy SF. Prevalence of disordered eating in athletes categorized by emphasis on leanness and activity type – a systematic review. Journal of Eating Disorders. 2020;8(1):47. doi:10.1186/s40337-020-00323-2

3. Diagnostic and Statistical Manual of Mental Disorders | Psychiatry Online. DSM Library. Accessed July 31, 2025. https://psychiatryonline.org/doi/book/10.1176/appi.books.9780890425596

4. International Statistical Classification of Diseases and Related Health Problems. 10th revision, 2010 ed. World Health Organization

5. An Umbrella Review of Body Image Concerns, Disordered Eating, and Eating Disorders in Elite Athletes. Accessed July 31, 2025. https://www.mdpi.com/2077-0383/13/14/4171

6. The Female Athlete Triad. Medicine & Science in Sports & Exercise. 2007;39(10):1867. doi:10.1249/mss.0b013e318149f111

7. Barrack MT, Ackerman KE, Gibbs JC. Update on the female athlete triad. Curr Rev Musculoskelet Med. 2013;6(2):195-204. doi:10.1007/s12178-013-9168-9

8. Gibbs JC, Williams NI, De Souza MJ. Prevalence of Individual and Combined Components of the Female Athlete Triad. Medicine & Science in Sports & Exercise. 2013;45(5):985. doi:10.1249/MSS.0b013e31827e1bdc

9. Vardardottir B, Gudmundsdottir SL, Olafsdottir AS. [Health and performance consequences of Relative Energy Deficiency in Sport (RED-s)]. Laeknabladid. 2020;106(9):406-413. doi:10.17992/lbl.2020.09.596

10. Mountjoy M, Sundgot-Borgen JK, Burke LM, et al. IOC consensus statement on relative energy deficiency in sport (RED-S): 2018 update. Br J Sports Med. 2018;52(11):687-697. doi:10.1136/bjsports-2018-099193

11. Sundgot-Borgen J, Torstveit MK. Prevalence of Eating Disorders in Elite Athletes Is Higher Than in the General Population. Clinical Journal of Sport Medicine. 2004;14(1):25.

12. Satapathy P, Sahu SS, Khatib MN, et al. Prevalence of eating disorders in aquatic athletes: a systematic review and meta-analysis. Annals of General Psychiatry. 2025;24(1):33. doi:10.1186/s12991-025-00564-y

13. Krebs PA, Dennison CR, Kellar L, Lucas J. Gender Differences in Eating Disorder Risk among NCAA Division I Cross Country and Track Student-Athletes. J Sports Med (Hindawi Publ Corp). 2019;2019:5035871. doi:10.1155/2019/5035871

14. Keczeli V, Kisbenedek AG, Verzár Z, et al. Prevalence of Eating Disorders among Competitive Rowers. Sports (Basel). 2024;12(10):264. doi:10.3390/sports12100264

15. Sundgot‐Borgen J, Torstveit MK. Aspects of disordered eating continuum in elite high‐intensity sports. Scandinavian Med Sci Sports. 2010;20(s2):112-121. doi:10.1111/j.1600-0838.2010.01190.x

16. Mountjoy M, Sundgot-Borgen J, Burke L, et al. The IOC consensus statement: beyond the Female Athlete Triad—Relative Energy Deficiency in Sport (RED-S). Br J Sports Med. 2014;48(7):491-497. doi:10.1136/bjsports-2014-093502

17. Hopkinson RA, Lock J. Athletics, perfectionism, and disordered eating. Eat Weight Disord. 2004;9(2):99-106. doi:10.1007/BF03325052

18. Holland G, Tiggemann M. A systematic review of the impact of the use of social networking sites on body image and disordered eating outcomes. Body Image. 2016;17:100-110. doi:10.1016/j.bodyim.2016.02.008

19. Fardouly J, Diedrichs PC, Vartanian LR, Halliwell E. Social comparisons on social media: The impact of Facebook on young women’s body image concerns and mood. Body Image. 2015;13:38-45. doi:10.1016/j.bodyim.2014.12.002

20. Krentz EM, Warschburger P. A longitudinal investigation of sports-related risk factors for disordered eating in aesthetic sports. Scandinavian Journal of Medicine & Science in Sports. 2013;23(3):303-310. doi:10.1111/j.1600-0838.2011.01380.x

21. Garner DM, Olmsted MP, Bohr Y, Garfinkel PE. The eating attitudes test: psychometric features and clinical correlates. Psychol Med. 1982;12(4):871-878. doi:10.1017/s0033291700049163

22. Morgan JF, Reid F, Lacey JH. The SCOFF questionnaire: assessment of a new screening tool for eating disorders. BMJ. 1999;319(7223):1467-1468. doi:10.1136/bmj.319.7223.1467

23. Melin A, Tornberg ÅB, Skouby S, et al. Energy availability and the female athlete triad in elite endurance athletes. Scand J Med Sci Sports. 2015;25(5):610-622. doi:10.1111/sms.12261

24. Carson TL, Tournat T, Sonneville K, Zernicke RF, Karvonen-Gutierrez C. Cultural and environmental associations with body image, diet and well-being in NCAA DI female distance runners: a qualitative analysis. Br J Sports Med. 2021;55(8):433-437. doi:10.1136/bjsports-2020-102559

25. National Collegiate Athletic Association (NCAA). Mind, Body and Sport: Understanding and Supporting Student-Athlete Mental Wellness. Published online 2015. https://www.ncaa.org

26. Fédération Internationale de Football Association (FIFA). FIFA Medical Network: Health and Performance. Published online 2020. https://www.fifamedicalnetwork.com

27. Conviser JH, Tierney AS, Nickols R. Essentials for Best Practice: Treatment Approaches for Athletes With Eating Disorders. Published online December 1, 2018. doi:10.1123/jcsp.2018-0013

28. Jacobson CM, Luik CC. Epidemiology and Sociocultural Aspects of Non-suicidal Self-Injury and Eating Disorders. In: Claes L, Muehlenkamp JJ, eds. Non-Suicidal Self-Injury in Eating Disorders: Advancements in Etiology and Treatment. Springer; 2014:19-34. doi:10.1007/978-3-642-40107-7_2

29. Petrie T, Galli N, Greenleaf C, Reel J, Carter J. Psychosocial correlates of bulimic symptomatology among male athletes. Psychology of Sport and Exercise. 2014;15(6):680-687. doi:10.1016/j.psychsport.2013.09.002

30. Souza MJD, Nattiv A, Joy E, et al. 2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad: 1st International Conference held in San Francisco, California, May 2012 and 2nd International Conference held in Indianapolis, Indiana, May 2013. Published online February 1, 2014. doi:10.1136/bjsports-2013-093218

Pedagogy and Psychology of Sport

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Published

2026-03-12

How to Cite

1.
KAŹMIERCZYK, Aleksandra, WOJTAS, Jan, KĘSIK, Jędrzej, DUDA, Paulina, DĘBICKI, Zbigniew, CZERWIK, Julia and STĘPNIAK, Karol. Eating Disorders in Athletes: A Systematic Review. Pedagogy and Psychology of Sport. Online. 12 March 2026. Vol. 30, p. 69262. [Accessed 26 March 2026]. DOI 10.12775/PPS.2026.30.69262.

Issue

Vol. 30 (2026)

Section

Physical Culture Sciences

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Copyright (c) 2026 Aleksandra Kaźmierczyk, Jan Wojtas, Jędrzej Kęsik, Paulina Duda, Zbigniew Dębicki, Julia Czerwik, Karol Stępniak

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