Eating Disorders In Swimmers: What You Need To Know

By Katherine Bell Hill, MD

Swimming has an eating disorder problem. 

If you follow the swimming news, you’re likely aware that a number of the best swimmers in history have publicly and bravely disclosed their eating disorders (and many, many more have struggled in silence). 

As a physician and former swimmer specializing in sports nutrition and eating disorders in athletes, I can attest to the fact that eating disorders don’t just affect the most elite swimmers. I have seen swimmers of all levels and ages struggle with eating disorders. When it comes to these common conditions, there are many myths that need busting. And before meaningful change can occur in our sport, the first step is raising awareness of eating disorders and how they uniquely impact swimmers.

Here are 6 key points that swimmers (and swim fans) should know about eating disorders. 

1.Eating disorders are rampant across our sport, and often left underrecognized and untreated 

A just-published meta-analysis found the rate of eating disorders in aquatic sports to be 27.6%. Another study found the prevalence of disordered eating behaviors to be as high as 45% in female aquatic athletes and 28% in male aquatic athletes, much higher than the background rate of around 5% of the general population.

Why are eating disorders so prevalent in swimmers? Many of the traits that may make someone an awesome athlete –like perfectionism or the ability to push through pain – also tend to be common personality traits in those predisposed to eating disorders. Combine these personality traits with:

• an image-focused sport and society (hello, social media)
• the fact that bodies naturally change over a swimming career
• small, revealing swimsuits
• the high nutritional needs of swimmers..

…and it’s no wonder our athletes are at risk. 

Unfortunately, swimmers with eating disorders are often not identified until the problem is more severe.  This occurs for a variety of reasons, including misconceptions about who gets eating disorders, a lack of awareness and education on the topic, and stigma of seeking treatment for a mental health condition. Many swimming careers have ended prematurely or have been negatively impacted by these conditions. 

The good news is that eating disorders are treatable, particularly when a struggling athlete is identified promptly and receives proper treatment with a multidisciplinary care team, typically involving a medical doctor, dietitian, and mental health professional. 

2. No one thing causes eating disorders…but we do know that commenting on athletes’ bodies can be harmful

Eating disorders are really nobody’s fault. They are thought to be caused by a complex mix of genetics and environmental factors, and are brain-based disorders with a strong biological component. But we do know that comments on an athlete’s body shape or size can, for certain individuals, be a triggering factor for an eating disorder, even if the comments are well-meaning. 

Therefore it’s a best practice, whether you’re a coach, parent, athlete, or an avid participant in the SwimSwam comment section, to have the topic of the shape and size of athlete bodies be off limits for discussion. I have not once seen comments like this be helpful for someone’s athletic career and on the contrary, have frequently seen devastating consequences to an athlete’s mental and physical health and athletic performance.

3. Male athletes are not immune

The stereotype is that female athletes are the ones struggling with eating disorders. However, about a third of patients with eating disorders are male. Males, however, may present a bit differently, often with a preoccupation of getting “ripped” or bulking up, with an unhealthy obsession with muscle shape or size. Some have termed this phenomenon “bigorexia” or “muscle dysphoria”. With the pressures of social media, more and more young males are presenting to eating disorder programs, often with medical complications like suppressed testosterone levels, which (unsurprisingly) negatively impacts performance. 

4. It’s not just the thinnest athletes at risk 

Another misconception about eating disorders is that they only show up in very thin people. We now know that eating disorders show up in all body types and sizes. In fact, athletes in larger bodies may in fact have elevated risk, often receive positive reinforcement with weight loss in the context of an eating disorder (which is not “healthy”), and can suffer from the exact same medical complications as their thinner counterparts. It’s also true that you can’t look at someone and accurately be able to tell whether or not they have an eating disorder. 

5. There are other very common eating disorders besides anorexia and bulimia 

Within the eating disorder umbrella, there are a number of conditions that all can lead to similar medical complications. Many have heard of anorexia nervosa or bulimia nervosa. But have you heard of ARFID, or Avoidant and Restrictive Food Intake Disorder? People with ARFID typically don’t have body image concerns or fear of weight gain, but they do have difficulty getting enough nutrients due to behaviors like extreme picky eating, fear of choking or vomiting, or extreme sensitivity to textures. ARFID is just as common as anorexia nervosa in adolescents, tends to be more common in males, and can be problematic in swimmers who tend to have high caloric needs.

Binge eating disorder is the most common eating disorder in the US. This sometimes shows up in swimmers who underfuel early in the day, and end up binging later on when hunger signals go into overdrive. 

And orthorexia, despite not being a “true” eating disorder, is an extreme preoccupation with healthy eating that can sometimes lead to an inadequate diet that is, ironically, unhealthy. 

6. Athletes who try to modify their body to look a certain way often end up behind. 

Sometimes, athletes may try to restrict their nutritional intake in order to achieve a certain “ideal”. And while it’s possible to see very short term benefits, underfueling will eventually catch up with them. 

Well-nourished swimmers tend to perform the best over time and have the most sustainable athletic careers. They tend to have the lowest risk of injury, the best ability to recover from intense workouts, and see the largest performance gains.

Have a question about eating disorders? Comment below or email Dr. Hill at [email protected]. 

This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. If you or someone you know is struggling with an eating disorder, please seek help from a qualified healthcare provider.

Resources:

• National Eating Disorders Association (NEDA)
• National Association of Anorexia Nervosa and Associated Disorders (ANAD)
• Lane 9 Project

Katherine Bell Hill, MD is a Stanford-trained physician, former Stanford swimmer, and Founder/Medical Director of AthleatMD. She was formerly the lead physician at Equip Health, the nation’s leading virtual eating disorder treatment program. She is passionate about educating anyone who will listen on health issues impacting athletes, especially eating disorders & REDs.