Body, food and sport: when weight becomes part of the result

“You’ve filled out a bit over the summer, haven’t you?”

The coach said it in passing, on the way out of the changing room, with a smile. He had probably forgotten the sentence five minutes later. She never forgot it. Even years afterwards, long after she had stopped competing, the sentence came back every time she looked in the mirror or sat down to lunch.

In sport, the body is a tool. It is measured, weighed, compared, improved. And in some sports the body is not just a means to a result — it is part of the result. Judges assess how it looks on the mat, how much it weighs at the weigh-in, how light it is on the ski jump or on the climb. That is where the line between caring for your body and a dangerous relationship with food quickly blurs. In this post I will write about why athletes are more vulnerable to eating disorders, what relative energy deficiency in sport is, how much power a single sentence about the body can have, and when it is time to see a doctor. I am writing as a therapist in training in marriage and family therapy: what interests me is the person and their relationships, not a meal plan or a training programme.

Why athletes are more vulnerable

For a long time, it was assumed that sport protects against eating disorders: exercise is healthy, athletes are disciplined, their bodies serve them well. Research has shaken that picture considerably. In 2004, the Norwegian researchers Jorunn Sundgot-Borgen and Monica Torstveit compared elite athletes with the general population and found that 13.5 per cent of athletes met the criteria for a clinical or subclinical eating disorder, compared with 4.6 per cent of people in the control group. The proportion was higher among women than men, and highest in sports where appearance or low body weight matter.

There are several reasons, and they reinforce one another. Sport rewards exactly the qualities that are common in people with eating disorders: perseverance, self-discipline, high standards, the ability to ignore pain and tiredness. The body is constantly being watched — by coaches, judges, teammates, cameras. And in some sports, reducing body weight looks like a logical way to get better.

But it is important to know something I also stressed in Eating disorders are not about food: what is really underneath. Food is only the surface. Underneath there is often control, fear, shame, the need to be good enough, and relationships in which love and recognition could not be taken for granted. Sport does not create these vulnerabilities out of nothing — but it can give them a shape, a vocabulary and an excuse. You will find a short explanation of the term in the knowledge base under eating disorders.

Where the body is part of the result

Researchers usually distinguish a few groups of sports in which the risk is higher:

• Aesthetic sports, where appearance is also judged: rhythmic and artistic gymnastics, figure skating, dance, artistic swimming. Here the body has a double role — it has to perform and it has to please.
• Weight-category sports, where you step on the scales before competing: judo, wrestling, boxing, lightweight rowing. Rapid weight cutting before the weigh-in is still part of the culture in many clubs.
• Sports where lightness is an advantage: long-distance running, cycling, sport climbing, ski jumping. In ski jumping, around two decades ago the International Ski Federation tied the length of the skis to the ratio between a jumper’s weight and height — precisely because lightness had become an advantage that some were paying for with their health.

This does not mean that everyone in these sports is at risk and no one in others. An eating disorder can develop in a footballer, a handball player or a recreational runner. The risk lies not only in the rules of the sport, but also in the culture woven around them: in how the club talks about bodies, whether weigh-ins are public, whether weight is commented on in front of the team, and whether there is anyone who notices when something is changing.

When the body doesn’t have enough: relative energy deficiency

In 2014, the International Olympic Committee published an expert consensus that changed how this area is viewed. Until then, the talk had mainly been of the so-called female athlete triad: eating disorders, loss of periods and weaker bones. A group led by Margo Mountjoy proposed a broader concept — relative energy deficiency in sport (RED-S, renamed REDs in the updated 2023 consensus).

The core idea is simple, even though it is hard to spot in practice: the body gets too little energy for training, recovery and everyday functioning. When this goes on for a long time, it starts to economise — and the consequences are not limited to performance. Hormones and the menstrual cycle, bones, the immune system, mood and, in young people, growth and development can all be affected. Importantly, the consensus explicitly includes men, not only women.

One more thing is crucial: relative energy deficiency is not necessarily an eating disorder. It can arise unintentionally — because training load has increased and appetite has not kept up, because an athlete does not know how much they need, or because between school, training and travel there is simply no time to eat. But it can also be part of an eating disorder or develop into one. That is why it must be assessed by a doctor, ideally a sports doctor who knows this field, and not judged by eye by a coach, a parent or a psychotherapist.

One sentence that stays for years

Let us go back to the coach’s sentence from the beginning. As early as the 1990s, Jorunn Sundgot-Borgen asked elite female athletes with eating disorders what they thought had triggered their difficulties. Among the common answers were prolonged dieting, a change of coach, injury — and a casual comment about their body or weight. Not deliberate humiliation, not shouting. A sentence said in passing.

Why does a sentence like that carry so much power? Because it is spoken by someone who carries enormous weight in a young athlete’s life. The coach decides on places in the team, on selection, on recognition. Often the athlete sees the coach more than their parents. Their gaze is not that of a passer-by, but that of an authority on whom almost everything depends. When such a person comments on a body, a young person does not just hear “lose weight”. They hear: “The way you are, you are not all right.”

In relational family therapy, in which I am training, we know that important relationships become written into our inner world. A voice that was once outside eventually becomes an inner one. An athlete who heard at fourteen that she was “too heavy for this sport” may no longer have a coach at thirty — but she has a voice that tells her the same thing at every meal. I wrote about how this way of seeing the body takes root in Body image and the mirror: why you see something that isn’t there, and you will find a short explanation under the term body image.

This does not mean coaches must not talk about nutrition or the body. It means that how matters. A conversation about what the body needs for training and recovery is something different from a comment on how it looks. The first builds; the second often wounds.

How it shows

Eating disorders in athletes are harder to spot than elsewhere. Much of what would cause concern in someone else looks like dedication in sport: extra training, carefully planned meals, avoiding sweets, leaving celebrations early. A few signs worth paying attention to:

• food and weight take up more and more of a person’s thoughts and conversations;
• training becomes a punishment, or a condition for being allowed to enjoy something;
• extra, hidden training, even when injured or ill;
• avoiding shared meals, excuses around food, hiding food;
• loss of periods, which those around explain away as “normal for female athletes”;
• frequent injuries, especially stress fractures;
• irritability, withdrawal, anxiety before weigh-ins or before meals.

In men the signs are often different and even easier to overlook — more on this in Men and Eating Disorders: Bigorexia and the Invisible Group. And with teenagers, it is crucial that parents notice early. I describe what to look out for in Early signs of an eating disorder in a teenager, and I will write about the pressure that parents of young athletes often do not see in Young athletes and their parents: the pressure we don’t see.

What it sounds like up close

This is how a conversation with a former competitor might sound (composed, not a real person):

“I don’t eat badly. I just know what I’m allowed.”
“Who told you that — what you’re allowed?”
“No one in particular. That’s just how it was at the club. Anyone who had dessert was lazy.”
“And now that the club is gone?”
“Now I’m my own coach. An even stricter one.”

The club disappeared from her life, but the rules stayed. More than that: they became hers. This is often the heart of the work in therapy — not that someone gives her a new meal plan, but that she can look at whose rules she is living by and whether she still needs them.

Exercise: how you talk about your body

This exercise is not meant to find out whether you have an eating disorder. It helps you notice how you talk and think about your body. It takes a few minutes a day, for one week.

1. Write down three sentences about your body that you have said out loud or in your head in recent days — or heard from others.
2. Next to each one, mark what it is about: appearance, weight, or what the body can do. Notice the balance; don’t judge it.
3. Rephrase one sentence into a sentence about what your body does. Instead of “my thighs are too big”, for example, “my legs carried me through the whole training session today”.
4. For one day, notice when you experience food as a reward or a punishment. Just write it down; don’t change anything.
5. Check three warning signs. If in recent months you have noticed missed periods, frequent injuries, or that thoughts about food take up a large part of your day, book an appointment with a doctor. That is not overreacting; it is care.

Where this story does not apply

Because this is a sensitive topic, I want to be precise about what I am not claiming:

• Not every lean athlete is ill. In many sports, build is a matter of genetics and years of training. Inferring an eating disorder from appearance is unreliable and can hurt.
• Planned nutrition is not a disorder. Athletes need to think about what and when they eat. The right person for that is a sports nutritionist or dietitian, not a psychotherapist. Care becomes a problem when it is driven by fear and shame rather than by the body’s needs. I also wrote about this fine line in Orthorexia: when healthy eating becomes an illness.
• Psychotherapy alone is not enough. Eating disorders are serious conditions with physical consequences. Treatment usually happens in a team: a doctor who monitors the body, a psychiatrist when needed, a dietitian and a psychotherapist. If physical health is at risk, treating the body comes first.
• It is not all the fault of the coach or the parents. Eating disorders arise from an interplay of biological, personal, family and social factors. Looking for a single culprit does not help — understanding the whole picture does.

When to see a doctor straight away: fainting, dizziness, an irregular or very slow pulse, vomiting after meals, missed periods, repeated fractures or rapid weight loss. For teenagers, the first port of call in Slovenia is their paediatrician or school doctor; for adults, their GP, who can refer them on. If thoughts of death join in, call the Klic v duševni stiski helpline on 01 520 99 00 in Slovenia (7 pm to 7 am), the Samarijan helpline on 116 123 in Slovenia (24 hours), or in an emergency 112.

What psychotherapy can offer

In psychotherapy we do not count meals or set a target weight — that is the work of a doctor and a dietitian. Psychotherapy turns to what lies beneath the food: what control over your body means to you, whose voice you hear when you eat, what love and recognition were like at home, who you are when you are not the best. It often turns out that sport was only one of the places where the story played out — it began earlier.

Because I am training in marriage and family therapy, I am also interested in what is happening in the family. Parents of a young athlete are often torn between fear, guilt and helplessness — and they can be the strongest support in recovery. That is why family therapy sometimes makes sense, so that everyone together can find a new way of talking about bodies and food. I also work with English-speaking clients. You may also find it helpful to read How to talk to your child about bodies, weight and food without doing harm.

Recovery is possible, even after years. But it is not always a straight path, and it does not necessarily mean returning to sport. I wrote about what recovery actually means in Recovery from an Eating Disorder: What Being “Well” Actually Means. When exhaustion and loss of enjoyment are tangled up with the relationship with food, read also Burnout in athletes: when the love of sport fades. And for a basic sense of self-worth that does not depend on the scales, a good starting point is the term self-image.

What to remember

• Athletes are more vulnerable to eating disorders than the general population, especially in aesthetic and weight-category sports and where lightness is an advantage.
• Relative energy deficiency in sport affects hormones, bones, immunity and mood — in women and men. It can occur without an eating disorder, so a doctor should assess it.
• A single comment about the body from someone important can echo for years. Talking about what the body needs is different from commenting on how it looks.
• Planned nutrition is not a disorder. For nutrition, see a dietitian; for the body, a doctor; for severe distress, a psychiatrist.
• Psychotherapy turns to what lies beneath the food: control, shame, relationships and a sense of your own worth.