Experts Explain Anorexia Athletica And Why It’s Easy To Miss

For many children and teens, sports are a core part of their lives. According to the Aspen Institute’s Project Play initiative, 55.4% of kids between the ages of 6 and 17 play organized sports. There are many benefits linked to team sports, including higher self-esteem and lower rates of depression and anxiety.

In general, participating in team sports is associated with better mental and physical health, but it is possible to become overly fixated on athletic performance, which is spawning a disorder known as anorexia athletica.

“Though not an official diagnosis, anorexia athletica is a term used to describe athletes who become preoccupied with weight control or body composition to better perform as an athlete,” Alli Spotts-De Lazzer, a psychotherapist, eating disorders specialist and author of “My Child Has an Eating Disorder: An Essential Guide for Parents of Kids, Teens, and Adults,” told HuffPost.

Dr. Jessica Lin, a pediatrician at Cincinnati Children’s, added to this, explaining that the focus on weight control specifically for athletic performance is what sets anorexia athletica apart from anorexia nervosa, though their symptoms often overlap.

“With anorexia nervosa, the focus is on body image and thinness, while with anorexia athletica, it is more about athletic performance, though body image is still a component,” Lin said.

Since anorexia athletica isn’t a diagnosable condition, data around it is sparse. However, existing evidence shows that young athletes are at increased risk. According to scientific research that took into account 21 different studies, elite youth athletes were more likely to engage in disordered eating (a symptom of anorexia athletica) than non-athletes. And according to a 2023 study, a full 77% of youth athletes surveyed presented a risk of developing an eating disorder, with 22% at high risk. Student athletes between the ages of 14 and 16 were at the highest risk, and it impacted both boys and girls almost equally.

HuffPost talked to pediatricians and eating disorder specialists about what is fueling anorexia athletica, how to spot it, and what to do about it.

“Young athletes are up to three times more likely to struggle with an eating disorder than kids who don’t play sports. When you look at the environment they’re in, it makes a lot of sense: It’s a perfect storm of personal drive and intense sports culture,” said Barbara Kessel, a child and adolescent psychiatrist specializing in eating disorders at Equip.

Kessel explained that athletes are naturally driven and high-performing, and that perfectionism can easily slide into obsessively tracking calories, macros and weight — all cornerstones of anorexia athletica.

Health tracking wearables can fuel this obsession. Considering that the first Apple Watches and Fitbits came out about 10 years ago, kids today have grown up always having health data at their fingertips. With so many metrics that exist to track health, unfortunately, it isn’t surprising that anorexia athletica may be becoming more prevalent among youth, Lin said. These tools aren’t inherently bad, but they can fuel an existing obsession with sports performance.

In addition to health tracking apps, Spotts-De Lazzer shared that social media can be a contributing factor, a theory that is backed up by scientific research. Users’ feeds are filled with content related to their personal interests (such as excelling in a specific sport or physical activity), including tips on how to achieve certain levels of fitness that may or may not actually be healthy. Lin pointed out that these tips are often geared toward adults and may not be safe or effective.

“The tricky part is that coaches and teammates usually praise dedication, missing the fact that it’s turning into an obsession,” Kessel said.

With that in mind, how can parents and coaches spot anorexia athletica in youth? Dr. Lorna Richards, a psychiatrist specializing in eating disorders at Central Health London, told HuffPost that changes such as restrictive eating, increased exercise, weighing regularly, weight loss or dropping on percentile growth charts, low energy, recurrent injuries, loss of periods, mood changes, irritability, and anxiety are all signs to keep an eye out for.

Lin and Spotts-De Lazzer both emphasized that children or teens with anorexia athletica may not even realize that their thinking or actions are problematic.

“Don’t expect them to tell you — they may or may not even realize something has gone out of whack,” Spotts-De Lazzer said. That’s why it’s up to parents to be aware of the above warning signs.

If a child develops rigid thinking about training schedules and food, Kessel said, that is a red flag. Lin similarly said if a child or teen doesn’t want to go to a team pizza party because they don’t want to be around pizza, that’s an example of a behavior consistent with anorexia athletica.

It bears repeating that a child or teen could have anorexia athletica and not even realize it. That means it’s up to the parent to broach the subject. How do you do this? Very carefully.

Lin recommends not starting the conversation at mealtime or other situations that may be stressful for the child. Instead, bring it up in a more relaxed setting, such as in the car. Not having to maintain eye contact can make the conversation easier for them, Lin said.

Kessel offered up some examples of how to start the conversation around any worrisome behaviors, such as “I’ve noticed that you aren’t recovering from practice as you used to” or “It seems like you’re more fatigued lately. I’m wondering if it has anything to do with your nutrition?”

“Once the door is open, guide them toward a professional evaluation by an eating disorder specialist,” Kessel said, adding that parents should approach their child with supportive, nonjudgmental observation rather than accusation.

According to Lin, it can be helpful for parents to educate their kids on how food is important for fueling activity. For example, telling them that it’s important they have an extra snack on days they have sports practice.

“It’s also really important to always encourage eating all the food groups, including sugar, carbs and fat. It’s important for kids to know that everything is OK in moderation. This prevents kids from labeling something as ‘good’ or ‘bad,’ which can fuel unhealthy eating behaviors,” Lin said.

If anorexia athletica is caught early, the experts said treatment often involves the child working with a registered dietitian as well as a therapist trained in disordered eating, who can help correct any harmful thought patterns.

If anorexia athletica is more progressed and has led to physical symptoms, that’s when it’s time to work with a pediatrician in addition to a registered dietitian and therapist. “It is important that there is a unified and coherent approach to support the young person both psychologically and physically,” Richards said.

All of the experts said treatment, including whether the child can remain physically active, varies based on the individual.

“If their heart rate is dangerously low or their body is under too much stress, they have to hit the pause button on sports until they are physically safe and cleared by their medical team,” Kessel said. Richards added to this, saying that planning a safe return to sports with the involvement of coaches is very important after a period of treatment.

To ensure your child’s interest in sports remains healthy and not obsessive, Lin said to make sure the sport remains fun for them. If it stops being fun and starts making them feel bad about themself or not good enough, it might be time for them to take a break from that particular sport or activity.

Spotts-De Lazzer said that it can also be helpful to share with a child what you love about them as a person that has nothing to do with their athletic performance. This, she said, can help create balance and prevent all their self-worth from being tied to their sports performance.

When you do want to comment on their sports performance, Kessel recommends focusing on their effort, how they support their teammates, and whether they’re actually having fun.

Lin and Kessel both reiterated the importance of teaching kids that food is the fuel they need for strength, recovery and staying healthy. “It’s never a reward they have to earn, and it’s definitely not something they need to ‘burn off’ with extra workouts,” Kessel said.

If a child or teen is getting health advice from social media, Lin said it’s important to remind them that the advice is geared toward adults and that they have different nutrient needs. It can be helpful to arrange a meeting with a dietitian who specializes in adolescent health so they can get advice tailored to their individual needs.

With these tips in mind, you can help foster an interest in sports and physical activity that’s healthy, not punishing. Staying active should be fun for kids, not something to obsess over — pretty good advice for adults to live by too.