Disordered eating: The overlooked, actionable public health crisis

Disordered eating, a subclinical spectrum of eating disorders, is more prevalent in athletes than the general population. Patients with disordered eating have atypical eating behaviors that may not meet the diagnostic requirements for a clinical eating disorder.

Last year, roughly 7.9 million students participated in high school sports in the U.S. As disordered eating has an estimated prevalence of up to 33% in adolescent athletes, that adds up to approximately 2.6 million students who may be at risk.

It’s also relatively common for female athletes to have what’s known as the female athlete triad—disordered eating, amenorrhea and bone loss.

Physicians should be aware of the signs and potential health consequences of disordered eating in student athletes and understand that early intervention can save lives.

Nutrition and athletes

“Nutrition plays a critical role in the health of all of our athletes,” says Jill Moschelli, MD, MBA, a sports medicine physician at Michigan State University Sports Medicine and team physician for MSU. “At the most basic level, it provides the energy source needed to perform an activity. The food consumed can impact an athlete’s strength, training, performance and recovery.”

The life of a student athlete is often from sunrise to sunset without much time for breaks, which can make finding the time for proper nutritional intake a challenge, Dr. Moschelli notes.

Certain types of athletes may be at higher risk for developing disordered eating, says Samantha Kennedy, DO, a child and adolescent psychiatrist at Michigan State University.

“The most common problem I see in younger athletes with nutrition is that many don’t understand how much fuel they need for their activity level,” she says. “This frequently happens when an athlete increases their competitive level, such as transitioning from a local team to a travel team or from high school to college. Often, the athlete was fueling enough previously, but now they are practicing and competing much more frequently while maintaining a similar level of intake.”

Progression to eating disorder

Disordered eating can progress to eating disorders, which have the highest mortality rate of all psychiatric illnesses, Dr. Kennedy says.

“The high mortality rate is due to the potential medical complications of eating disorders and the higher rate of suicide observed among individuals with eating disorders,” she says.

Dr. Kennedy is currently working on developing a screening tool to identify disordered eating behaviors in adolescents and adults of all sport types.

Family medicine physicians and athletic trainers—along with others who see athletes frequently—are best poised to identify disordered eating, says Dr. Moschelli. Common warning signs associated with disordered eating include a preoccupation with body shape and weight, changes in weight, changes in bowel habits and, in women, menstrual irregularity.

“I really rely on my athletic trainers when treating athletes because of how well they know each individual on the team,” she says. “They are in a unique position to identify any potential concerns of female athlete triad or disordered eating in the early stages.”

Dr. Kennedy agrees.

“Athletic trainers are in an excellent position to help identify female athlete triad and disordered eating behaviors,” she says. “Both can lead to increased injuries and increased length in recovery from injury, which means the athlete will likely come in contact with his or her athletic trainer. That is a great opportunity for the athletic trainers to identify potential problems and provide education on proper nutrition.”

Identification, then education

Identification of disordered eating is very, very important. A study exploring the use of an intervention program designed to boost self-esteem and provide nutrition education for elite adolescent athletes found that 13% of the control group developed an eating disorder while no one in the intervention group developed a new eating disorder.

Patient education is the primary method to prevent the progression of disordered eating.

By comparison, the treatment of an eating disorder is far more difficult, time-consuming and expensive. If athletes who are at risk are identified early, their likelihood of developing an eating disorder dramatically drops.

About the authors: Ryley Mancine, OMS II, Jacob Babb, OMS II, and Donald Gusfa, OMS II, attend Michigan State University College of Osteopathic Medicine.