Eating Disorders and Nutritional Habits in Athletes: Risk Factors and Intervention Approaches

Sporcularda Yeme Bozuklukları ve Beslenme Alışkanlıkları: Risk Faktörleri ve Müdahale Yaklaşımları

Tuğba ÖZBAY

*Correspondence: Tuğba ÖZBAY tugba_pehlivanoglu@hotmail.com

¹Atatürk University, Winter Sports Institute, Department of Sports Health, Erzurum, Turkey,
Orcid id: 0009-0000-6999-8989

Doi: https://doi.org/10.5281/zenodo.20829683

https://www.ijoss.org/Archive/v3-i2/ijoss-Volume3-issue2-02.pdf

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Received / Gönderim: 21.04.2025 Accepted / Kabul: 13.06.2026 Published / Yayın: 23.06.2026

Abstract

This review comprehensively examines nutritional habits, psychological factors, and sport-specific risk factors involved in the development of eating disorders and disordered eating behaviors among athletes. Performance pressure is an important risk factor in athletic populations. Expectations regarding body composition may also influence eating behaviors. This risk is particularly evident in aesthetic, endurance, and weight-category sports. In these disciplines, weight control practices and low energy intake are commonly observed. This condition may lead to health problems associated with Relative Energy Deficiency in Sport (RED-S). RED-S may negatively affect endocrine, metabolic, skeletal, cardiovascular, and psychological functions. The reviewed findings indicate that anorexia nervosa, bulimia nervosa, binge eating disorder, and subclinical disordered eating behaviors constitute important concerns among athletes. In addition, perfectionism, body dissatisfaction, anxiety, and low self-esteem may increase the risk. Coaching practices, team culture, and social media influence may also contribute to this process. For early diagnosis, screening tools should be supported by clinical assessment, nutritional evaluation, psychological examination, physical examination, and laboratory findings. In conclusion, the prevention of eating disorders among athletes requires a multidisciplinary approach. Education, the promotion of healthy eating behaviors, and supportive sport environments are essential components of this process.

Keywords: Eating disorders, sports nutrition, disordered eating, relative energy deficiency in sport (RED-S).

Öz

Bu derleme, sporcularda yeme bozuklukları ve düzensiz yeme davranışlarının gelişiminde etkili olan beslenme alışkanlıkları, psikolojik etmenler ve spora özgü risk faktörlerini kapsamlı biçimde incelemektedir. Sporcularda performans baskısı önemli bir risk unsurudur. Beden kompozisyonuna yönelik beklentiler de yeme davranışlarını etkileyebilmektedir. Özellikle estetik, dayanıklılık ve sıklet temelli sporlarda bu risk daha belirgindir. Bu spor dallarında kilo kontrolü ve düşük enerji alımı sık görülmektedir. Bu durum, Sporda Göreceli Enerji Yetersizliği (RED-S) ile ilişkili sağlık sorunlarına yol açabilmektedir. RED-S; endokrin, metabolik, iskelet, kardiyovasküler ve psikolojik işlevleri olumsuz etkileyebilir. İncelenen bulgular, sporcularda anoreksiya nervoza, bulimiya nervoza, tıkınırcasına yeme bozukluğu ve subklinik düzensiz yeme davranışlarının önemli bir sorun olduğunu göstermektedir. Ayrıca mükemmeliyetçilik, beden memnuniyetsizliği, anksiyete ve düşük benlik saygısı riski artırabilmektedir. Antrenör tutumları, takım kültürü ve sosyal medya etkisi de bu süreci destekleyebilir. Erken tanı için tarama araçlarının klinik değerlendirme, beslenme analizi, psikolojik inceleme, fizik muayene ve laboratuvar bulgularıyla desteklenmesi gerekmektedir. Sonuç olarak, sporcularda yeme bozukluklarının önlenmesi multidisipliner bir yaklaşım gerektirmektedir. Eğitim, sağlıklı beslenme davranışları ve destekleyici spor ortamları bu süreçte temel unsurlardır.

Anahtar Kelimeler: yeme bozuklukları, sporcu beslenmesi, düzensiz yeme davranışları, sporda göreceli enerji yetersizliği (RED-S)

Anahtar Kelimeler: laktat eşiği, solunumsal kompanzasyon noktası, kalp atım hızı, egzersiz şiddeti alanları, artımlı egzersiz, rampa testi.

How to Cite This Article

APA 7

Özdenk, Ç., & Uğur, F. A. (2026). Eating disorders and nutritional habits in athletes: Risk factors and intervention approaches. International Journal of Health, Exercise, and Sport Sciences (IJOSS), 3(2), 430–447. https://www.ijoss.org/Archive/v3-i2/ijoss-Volume3-issue2-02.pdf

Vancouver

Özdenk Ç, Uğur FA. Eating disorders and nutritional habits in athletes: Risk factors and intervention approaches. Int J Health Exerc Sport Sci (IJOSS). 2026;3(2):430-447. Available from: https://www.ijoss.org/Archive/v3-i2/ijoss-Volume3-issue2-02.pdf

References / Kaynaklar

• Arghini, D. K. (2025). The Psychological Correlates of Perfectionism in Academic Settings. Advanced Journal of Management, Humanity and Social Science, 1(7), 459-472.
• Bailly, M., Thivel, D., Isacco, L., & Verney, J. (2025). Unique Energy Profile Associated with Persistent Thin Phenotype. Annual review of nutrition, 45.
• Beck, K. L., von Hurst, P. R., O’Brien, W. J., & Badenhorst, C. E. (2021). Micronutrients and athletic performance: A review. Food and Chemical Toxicology, 158, 112618.
• Benítez-Agudelo, J. C., Restrepo, D., Navarro-Jimenez, E., & Clemente-Suárez, V. J. (2025). Longitudinal effects of stress in an academic context on psychological well-being, physiological markers, health behaviors, and academic performance in university students. BMC psychology, 13(1), 753.
• Burgon, R. H., Beard, J., & Waller, G. (2023). Body image concerns across different sports and sporting levels: A systematic review and meta-analysis. Body image, 46, 9-31.
• Burke, L. M., Ackerman, K. E., Heikura, I. A., Hackney, A. C., & Stellingwerff, T. (2023). Mapping the complexities of Relative Energy Deficiency in Sport (REDs): development of a physiological model by a subgroup of the International Olympic Committee (IOC) Consensus on REDs. British journal of sports medicine, 57(17), 1098-1110.
• Cereda, F. (2023). Sporting bodies, societal norms in history: Examining body image and identity. Scientific Journal of Sport and Performance, 2(4), 572-589.
• Chang, C. J., Putukian, M., Aerni, G., Diamond, A. B., Hong, E. S., Ingram, Y. M., Reardon, C. L., & Wolanin, A. T. (2020). Mental health issues and psychological factors in athletes: detection, management, effect on performance, and prevention: American medical society for sports medicine position statement. Clinical Journal of Sport Medicine, 30(2), e61-e87.
• Coop, A., Clark, A., Morgan, J., Reid, F., & Lacey, J. H. (2024). The use and misuse of the SCOFF screening measure over two decades: a systematic literature review. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, 29(1), 29.
• Cunningham, M. L., Pinkus, R. T., Lavender, J. M., Rodgers, R. F., Mitchison, D., Trompeter, N., Ganson, K. T., Nagata, J. M., Szabo, M., & Murray, S. B. (2022). The ‘not-so-healthy’appearance pursuit? Disentangling unique associations of female drive for toned muscularity with disordered eating and compulsive exercise. Body image, 42, 276-286.
• Çakır, Z., & Coşkuntürk, O. S. (2022). Beden Eğitimi ve Spor Yüksekokulunda Öğrenim Gören Öğrencilerin Sporcu Beslenme Bilgi Düzeylerinin Bazı Değişkenler Açısından İncelenmesi. Ulusal Spor Bilimleri Dergisi, 6(2), 105-118. https://doi.org/10.30769/usbd.1210763
• DeJong Lempke, A. F., Reece, L. M., & Whitney, K. E. (2025). Nutrition educational interventions for athletes related to low energy availability: A systematic review. PloS one, 20(2), e0314506.
• Ebardo, G. J. M., Peralta, E., Ebardo, G. M., Ebardo, A. M. M., Fadare, M. C., Ebardo, G. J. M., Fadare, S. A., & Ebardo, G. M. (2025). Performance and health implications of feeding athletes with wrong diet during sports competition. Health Leadership and Quality of Life, 4, 730-730.
• Fatt, S. J., George, E., Hay, P., Jeacocke, N., Day, S., & Mitchison, D. (2024). A systematic review and meta‐synthesis of qualitative research investigating disordered eating and help‐seeking in elite athletes. International Journal of Eating Disorders, 57(8), 1621-1641.
• Fatt, S. J., George, E., Hay, P., Jeacocke, N., Gotkiewicz, E., & Mitchison, D. (2024). An umbrella review of body image concerns, disordered eating, and eating disorders in elite athletes. Journal of Clinical Medicine, 13(14), 4171.
• Fortuna, M., Hetnar, P., Kiper, S., Toczek, S., Tomala, M., Jastrowicz-Chęć, K., Koryszko, K., Pokrywka, N., Suwała, D., & Polak, M. (2025). Relative Energy Deficiency in Sport (RED-S): A Systematic Overview of Mechanisms, Effects, and Clinical Implications. Quality in Sport, 42, 60506-60506.
• Ghazzawi, H. A., Nimer, L. S., Haddad, A. J., Alhaj, O. A., Amawi, A. T., Pandi-Perumal, S. R., Trabelsi, K., Seeman, M. V., & Jahrami, H. (2024). A systematic review, meta-analysis, and meta-regression of the prevalence of self-reported disordered eating and associated factors among athletes worldwide. Journal of eating disorders, 12(1), 24.
• Gorrell, S., Sanzari, C. M., Ziegenhardt, P. S., Spell, J., Johnson, M. G., Whitlow, B., & Saigal, M. (2024). Preventing eating pathology among elite adolescent ballet dancers: a pilot trial of the Athlete Body Project. Eating Disorders, 32(6), 666-685.
• Grabia, M., Perkowski, J., Socha, K., & Markiewicz-Żukowska, R. (2024). Female athlete triad and relative energy deficiency in sport (REDs): nutritional management. Nutrients, 16(3), 359.
• Hänisch, T., Nieß, A. M., & Carlsohn, A. (2025). Effects of low energy availability on performance in male athletes: A scoping review. Journal of science and medicine in sport, 28(2), 110-117.
• Hauser, L.-L., Höner, O., O’Connor, D., & Wachsmuth, S. (2025). Exploring the interplay of functional and dysfunctional environmental features for holistic development: A case study in a German Olympic sport. Journal of Applied Sport Psychology, 1-26.
• Heather, A. K., Thorpe, H., Ogilvie, M., Sims, S. T., Beable, S., Milsom, S., Schofield, K. L., Coleman, L., & Hamilton, B. (2021). Biological and socio-cultural factors have the potential to influence the health and performance of elite female athletes: a cross sectional survey of 219 elite female athletes in Aotearoa New Zealand. Frontiers in sports and active living, 3, 601420.
• Hill Gallant, K. M., & Spiegel, D. M. (2017). Calcium balance in chronic kidney disease. Current osteoporosis reports, 15(3), 214-221.
• Hoogenboom, B. J., Capulong, Z., & Teeter, M. (2025). Examination of the Clinical Utility of Eating Disorder and Disordered Eating Screening Tools in Young Athletes: A Scoping Review. International journal of sports physical therapy, 20(1), 1.
• Ihalainen, J. K., Mikkonen, R. S., Ackerman, K. E., Heikura, I. A., Mjøsund, K., Valtonen, M., & Hackney, A. C. (2024). Beyond menstrual dysfunction: does altered endocrine function caused by problematic low energy availability impair health and sports performance in female athletes? Sports Medicine, 54(9), 2267-2289.
• Klimek, P., Murray, S. B., Brown, T., Gonzales IV, M., & Blashill, A. J. (2018). Thinness and muscularity internalization: Associations with disordered eating and muscle dysmorphia in men. International Journal of Eating Disorders, 51(4), 352-357.
• Knechtle, B., Jastrzębski, Z., Hill, L., & Nikolaidis, P. T. (2021). Vitamin D and stress fractures in sport: preventive and therapeutic measures—a narrative review. Medicina, 57(3), 223.
• Kussman, A., & Choo, H. J. (2024). Mental health and disordered eating in athletes. Clinics in sports medicine, 43(1), 71-91.
• Larrosa, M., Gil-Izquierdo, A., González-Rodríguez, L. G., Alférez, M. J. M., San Juan, A. F., Sánchez-Gómez, Á., Calvo-Ayuso, N., Ramos-Álvarez, J. J., Fernández-Lázaro, D., & Lopez-Grueso, R. (2025). Nutritional strategies for optimizing health, sports performance, and recovery for female athletes and other physically active women: A systematic review. Nutrition reviews, 83(3), e1068-e1089.
• Li, Q., Li, H., Zhang, G., Cao, Y., & Li, Y. (2024). Athlete body image and eating disorders: A systematic review of their association and influencing factors. Nutrients, 16(16), 2686.
• Lindgreen, P., Willaing, I., Clausen, L., Ismail, K., Grønbæk, H. N., Andersen, C. H., Persson, F., & Cleal, B. (2024). “I Haven’t Told Anyone but You”: Experiences and Biopsychosocial Support Needs of People With Type 2 Diabetes and Binge Eating. Qualitative Health Research, 34(7), 621-634.
• Lis, D. M., & Strobel, N. (2026). UCI Sports Nutrition Project: Plate to Performance—Culinary Nutrition Support for Professional Road Cycling. International Journal of Sport Nutrition and Exercise Metabolism, 1(aop), 1-17.
• Lu, L., Zhou, Y., & Li, G. (2026). The paradoxical consequences of high performers: how and when subordinate performance drives paradoxical leader behaviors. Journal of Business Research, 207, 116018.
• McGee, S., Atkinson, M., & Stirling, A. (2025). Winning-at-all-costs: high-performance athletes learn to conform to the sport ethic. Sport, Education and Society, 1-15.
• Mountjoy, M., Ackerman, K. E., Bailey, D. M., Burke, L. M., Constantini, N., Hackney, A. C., Heikura, I. A., Melin, A., Pensgaard, A. M., & Stellingwerff, T. (2023). 2023 International Olympic Committee’s (IOC) consensus statement on relative energy deficiency in sport (REDs). British journal of sports medicine, 57(17), 1073-1098.
• Naderi, A., Rothschild, J. A., Santos, H. O., Hamidvand, A., Koozehchian, M. S., Ghazzagh, A., Berjisian, E., & Podlogar, T. (2025). Nutritional strategies to improve post-exercise recovery and subsequent exercise performance: A narrative review. Sports Medicine, 55(7), 1559-1577.
• Noakes, T. D., Prins, P. J., Buga, A., D’Agostino, D. P., Volek, J. S., & Koutnik, A. P. (2026). Carbohydrate ingestion on exercise metabolism and physical performance. Endocrine Reviews, bnaf038.
• Nolte, J., Kirmse, M., de Marées, M., & Platen, P. (2025). Effects of short-term low energy availability on metabolism and performance-related parameters in physically active adults. Nutrients, 17(2), 278.
• Nye, N. S., Kasper, K., Hoang, T. D., Gee, S., McClung, J. P., Crutchfield, A., Childress, M., Tenforde, A. S., & Boden, B. (2026). Metabolic Workup for Bone Stress Injury: A Practical Approach for Evaluating Bone Health in Athletes. Sports Health, 19417381251398501.
• Papini, N. M., Jung, M., Cook, A., Lopez, N. V., Ptomey, L. T., Herrmann, S. D., & Kang, M. (2022). Psychometric properties of the 26-item eating attitudes test (EAT-26): An application of rasch analysis. Journal of eating disorders, 10(1), 62.
• Pengelly, M., Pumpa, K., Pyne, D. B., & Etxebarria, N. (2025). Putting the Fe into female athletes: insights into heightened iron status and women’s Australian Football performance—a case study. Sports, 13(5), 136.
• Pineda, E., Atanasova, P., Wellappuli, N. T., Kusuma, D., Herath, H., Segal, A. B., Vandevijvere, S., Anjana, R. M., Shamim, A. A., & Afzal, S. (2024). Policy implementation and recommended actions to create healthy food environments using the Healthy Food Environment Policy Index (Food-EPI): a comparative analysis in South Asia. The Lancet Regional Health-Southeast Asia, 26.
• Power, K., & Power, M. D. (2024). Pushing Beyond the Limits: Disordered Eating, Compulsive Exercise, and Body Image Dissatisfaction in Collegiate Athletes. Journal of Sport Behavior, 47(4).
• Rinaldi, J. T., Patel, B. T., & Ackerman, R. S. (2025). Nutrition, Obesity, and Musculoskeletal Pain. In Musculoskeletal Pain: Evidence-Based Clinical Evaluation and Management (pp. 51-75). Springer.
• Schulz, J. M., White, J., Edwards, C., Liu, S., & Thornton, J. S. (2025). Responding to Relative Energy Deficiency in Sport (REDs): a multidisciplinary care pathway for safe return to sport. Sports Psychiatry.
• Solberg, A., & Reikvam, H. (2023). Iron status and physical performance in athletes. Life, 13(10), 2007.
• Stoyel, H., Delderfield, R., Shanmuganathan-Felton, V., Stoyel, A., & Serpell, L. (2021). A qualitative exploration of sport and social pressures on elite athletes in relation to disordered eating. Frontiers in Psychology, 12, 633490.
• Sundgot-Borgen, C., Sundgot-Borgen, J., Sølvberg, N., Torstveit, M. K., Mountjoy, M., & Mathisen, T. F. (2025). Factors predicting disordered eating and the prevalence of eating disorders in adolescent elite athletes, trained athletes and a reference group: a prospective controlled two-step study. British journal of sports medicine, 59(15), 1043-1054.
• Svenaeus, F. (2014). Diagnosing mental disorders and saving the normal: American Psychiatric Association, 2013. Diagnostic and statistical manual of mental disorders, American Psychiatric Publishing: Washington, DC. 991 pp., ISBN: 978-0890425558. Price: $122.70. Medicine, Health Care and Philosophy, 17(2), 241-244.
• Talbot, K. (2025). Perfectionism and body image among young women athletes: a preventative intervention Laurentian University Library & Archives].
• Tarocchi, M., Pellegrino, A., Skroce, K., Zignoli, A., Cavadini, L. C., Bodini, C., Pagliai, G., Toncelli, L., Stefani, L., & Vanni, S. (2024). Assessing Energy Availability and Glucose Dynamics in Adolescent Cyclists: Implications for Nutritional Interventions During the Competitive Season. Nutrients, 16(22), 3824.
• Torstveit, M. K., Ackerman, K. E., Constantini, N., Holtzman, B., Koehler, K., Mountjoy, M. L., Sundgot-Borgen, J., & Melin, A. (2023). Primary, secondary and tertiary prevention of Relative Energy Deficiency in Sport (REDs): a narrative review by a subgroup of the IOC consensus on REDs. British journal of sports medicine, 57(17), 1119-1128.
• Turner, V. J. (2025). The CBT Therapist’s Described Experiences in Addressing Perfectionism, Body Image, and Eating Disorders Grand Canyon University].
• Veniamakis, E., Kaplanis, G., Voulgaris, P., & Nikolaidis, P. T. (2022). Effects of sodium intake on health and performance in endurance and ultra-endurance sports. International Journal of Environmental Research and Public Health, 19(6), 3651.
• Voelker, D. K., Visek, A. J., Learner, J. L., & DiBiasio, M. (2022). Toward understanding of coaches’ role in athletes’ eating pathology: A systematic review and ecological application to advance research. Psychology of Sport and Exercise, 58, 102059.
• Walter, N., Heinen, T., & Elbe, A.-M. (2022). Factors associated with disordered eating and eating disorder symptoms in adolescent elite athletes. Sports Psychiatry.
• Wyatt, P. B., Reiter, C. R., Satalich, J. R., O’Neill, C. N., Edge, C., Cyrus, J. W., O’Connell, R. S., & Vap, A. R. (2024). Effects of vitamin D supplementation in elite athletes: A systematic review. Orthopaedic journal of sports medicine, 12(1), 23259671231220371.
• Xiong, J., Wang, J.-T., Lin, S., & Xie, B.-Y. (2025). Advances in hemiplegia rehabilitation: modern therapeutic interventions to enhance activities of daily living. Frontiers in Neurology, 16, 1555990.
• Yel, K., & Gönülateş, S., & Kurcan, K. (2025). Sporcu gelişiminde beslenme eğitimi ve erken yaşta kazanılan beslenme alışkanlıklarının rolü. International Journal of Sport, Health, Exercise and Recreation Research (IJSHER), 1(1), 26–37. http://ijsher.com/Archive/volume1-issue1/ijsher-Volume1-issue1-04.pdf
• Yel, K., Şencan, D., Güzel, S., & Erkılıç, A. O. (2024). Physical activity, nutrition, and healthy living. International Journal of Health, Exercise, and Sport Sciences (IJOSS), 1(3), 15-28. https://www.ijoss.org/Archive/ijoss-Volume1-issue3-02.pdf