Eating disorders in athletes: new studies map risks from RED-S to weight cutting

Eating disorders such as anorexia nervosa, bulimia nervosa and binge eating disorder, as defined in the Diagnostic and Statistical Manual of Mental Disorders-5, are increasingly observed among athletes, where they affect health, wellbeing and career longevity, according to a new editorial introducing a Research Topic in Frontiers in Nutrition. The editorial, authored by Heather Hower, Suzanne Dooley-Hash and Morteza Homayounnia Firouzjah and published on 20 October 2026, frames a collection of studies on the spectrum of eating behaviours in athletes and their consequences for both health and performance. Its central message is that these conditions are not marginal concerns for sport but a significant clinical and scientific problem that demands better prevention, earlier intervention and more tailored treatment.

The editorial notes that eating disorders are significantly more prevalent in the athletic community than in the general population, and links this elevated prevalence to the higher physical demands and aesthetic pressures that are prevalent in certain sports. In disciplines where weight control is crucial for performance or appearance, such as gymnastics, ballet, wrestling and long-distance running, athletes face heightened risks. Beyond the immediate danger to health, the editorial emphasizes that these conditions can potentially truncate athletes’ professional careers, underscoring the importance of effective preventative and intervention strategies for this population.

The Research Topic was designed with a broad set of aims. According to the editorial, it sought to explore how competitive sports contribute to eating disorder behaviours and nutritional issues among athletes, to delve into the root causes of eating disorders in these environments, and to propose actionable, evidence-based interventions. The intended analysis was meant to cover a wide spectrum of sports and demographics, with clinical implications for reducing both the prevalence and the impact of eating disorders. Contributions were welcomed across several critical aspects: studies examining the prevalence of eating disorders among diverse sports disciplines and athlete populations; comparative research detailing differences in nutritional health between elite athletes and their non-elite counterparts; investigations into the direct effects of specific eating disorders on physical performance and recovery; analysis of both risk and protective factors in athlete populations, with a focus on creating resilience strategies; research offering new perspectives or solutions for managing eating disorders in athletes; and guidelines for athletic and health professionals to foster healthier environments.

One of the highlighted studies, by Woronyczová and colleagues, examined the severity of Relative Energy Deficiency in Sport, known as RED-S, in relation to long-term low-calorie intake in athletes, a condition described in terms of low energy availability. Compared to healthy control participants, Czech female endurance athletes aged 15 to 30 demonstrated significant deficits in energy availability, lower serum concentrations of essential hormones, and greater menstrual irregularity, including amenorrhea. These findings illustrate how chronic under-fueling in endurance sport can manifest across multiple physiological systems at once, from energy balance to endocrine function to reproductive health, and they underscore why low energy availability is treated as a serious concern rather than a benign by-product of intensive training.

A different population was examined by Meng and colleagues, who studied Chinese male adolescent combat sport athletes. The editorial reports that the majority of participants engaged in intentional weight loss practices, such as increased exercise and wearing plastic suits to sweat in, for over two weeks before their weigh-in for the athletic event. Most participants reported that they believed their lighter weight would be beneficial for their athletic performance and would have no impact on health.

Adolescent experiences at the intersection of gender, sport and dietary identity were explored by Deslippe and colleagues, who interviewed a diverse cohort of high school athletes and non-athlete controls using an interpretive phenomenological approach. A prominent theme that emerged centered on eating behaviours as a demonstration of identities: boys eating protein to develop muscle, and girls taking smaller bites to remain thin. The adolescents also held conflicting views about masculinity, which they perceived as both toxic and useful in competition.

The editorial also draws attention to a specific pathology reported in elite athletes, anorexia athletica, in a contribution by Vasiliu. Using a narrative reviewing methodology, this work synthesized the available data on the condition. According to the editorial, while tentative diagnostic criteria and a self-administered questionnaire exist, further research on its pathophysiology is needed, particularly in subpopulations of elite athletes at high risk, such as those in aesthetic and individual sports with a prior history of an eating disorder.

On the intervention side, the editorial highlights a promising clinical study by Dunbar and colleagues, conducted in an athlete-focused eating disorder program at higher levels of care, comprising partial hospitalization and intensive outpatient programs. Participants included 182 adolescent and adult athlete patients, who were assessed for dysfunctional exercise symptoms, eating disorder symptoms, related impairment, depression and anxiety at admission, mid-treatment, discharge, and at 6- and 12-month follow-ups. Significant decreases were observed across all assessment measures, with outcomes showing stabilization through the 12-month follow-up.

Taken together, the editorial argues, the studies and reviews in the Research Topic represent a range of new perspectives on the spectrum of eating disorders in athletes and their implications for health and performance. The collection covers diverse sports disciplines, including aesthetic and non-aesthetic sports and elite and non-elite athletes, and athlete populations spanning adolescents and adults, all sexes and genders, and individuals residing in community settings through higher levels of care, drawn from five different countries. Each contribution, the editorial states, addressed the prevalence, risk factors and impact of eating disorders in populations of athletes, along with implications for further research and clinical intervention areas.

For clinicians, coaches and researchers, the editorial positions this body of work as a foundation for what comes next. Studies that provide potential new solutions for this unique population, it concludes, offer hope for prevention, early intervention and more tailored treatments.

Subject of Research: Eating disorder behaviours, nutritional health and performance consequences in athletes across sports, ages and competitive levels.

Article Title: Editorial: The spectrum of eating behaviours in athletes: health and performance consequences

Article References: Hower, H., Dooley-Hash, S., & Homayounnia Firouzjah, M. (2026). Editorial: The spectrum of eating behaviours in athletes: health and performance consequences. Frontiers in Nutrition, 13, Article 2021497. https://doi.org/10.3389/fnut.2026.2021497

Image Credits: AI Generated

DOI: 10.3389/fnut.2026.2021497

Keywords: eating disorders, athletes, RED-S, low energy availability, weight loss practices, anorexia athletica, adolescent athletes, endurance athletes, combat sports, higher levels of care, sport nutrition, body image