Eating Disorder Risk in Elite Athletes

by Rachael Flatt, UNC Clinical Psychology PhD Student

As a former elite figure skater, I had the honor of competing internationally for Team USA, culminating in my performances at the 2010 Olympic Games in Vancouver. Throughout my travels, I fully embraced each culture and had the opportunity to connect with other athletes, coaches, staff, and officials over our shared experiences in the sport. But when it came time for the competition, all attention was centered on the athletes and our performances. The intense focus was not just on technical skills and artistry, but also on the aesthetics of our performances. From our costumes to the way we moved on the ice, we were expected to exude perfection, particularly when it came to our physiques.

Ina Bauer Pic from Leah[1]

Rachael Flatt                                                                               Photo Credit: Leah Adams

From decades of research, we understand that our bodies gravitate toward natural weight setpoints and our body composition (shape, size, proportions) reflect a host of genetic, physiological, and environmental factors. Athletes from all over the world also have different natural setpoints for their healthy weight and body composition, depending on their ancestral background and type of sport in which they compete. Interestingly, athletes at the top of any particular sport tend to exhibit similar physiques, whereas physiques vary widely across sports (e.g., compare the bodies of high jumpers versus shot putters). In aesthetic sports like figure skating where there is a judging component, a preference is often given to one type of physique over another, without the consideration that each athlete has a unique body type and can bring different aesthetics to the sport.

Revealing costumes, media attention on an athlete’s “competitive weight,” and comments from coaches, peers, officials, and fans only add to the pressure on an athlete to conform to the stereotypically “ideal” physique for that sport. In fact, I had a judge once tell me that in order to achieve better scores, I needed to drop 20 pounds right before a Grand Prix event despite me being the highest ranked U.S. skater and consistently delivering clean performances. I’ve even been told that my routines would be easier to get through without “that sack of potatoes on my body,” referring to my body going through puberty!

As a result of these types of comments and pressures, many athletes begin to equate weight and body shape with success. Unfortunately, the pressure to achieve the ideal body type combined with other biological, social, and psychological risk factors may lead to poor body esteem, disordered eating habits, and in some cases, a frank eating disorder. Unsurprisingly, elite athletes competing in aesthetic sports like figure skating, gymnastics, and diving have a higher prevalence of eating disorders than athletes competing in other sports (Sundgot-Borgen & Torstveit, 2004; Thompson & Sherman, 2010) and than non-athletes (Joy, Kussman, & Nattiv, 2016; Torstveit, Rosenvinge, & Sundgot-Borgen, 2007).

Sports can be an incredibly positive experience, as many athletes have the opportunity to develop lifelong skills and friendships, travel, and build a strong personal identity. But as more athletes step forward to share their experiences with an eating disorder, their stories highlight the importance of raising awareness, improving education, and changing the sport culture to promote body positivity and health over athletic success at all costs. Moving forward, the global sports community has an opportunity to be the model for celebrating the strength of all bodies and prioritizing both the physical and mental well-being of each athlete. By doing doing research in the area and serving as an athlete representative on U.S. Figure Skating’s Athlete Advisory and Sports Sciences & Medicine Committees and on the National Center of Excellence for Eating Disorders, I hope to bring positive changes to the sports community.

To hear Rachael talk about her plans at Carolina click here.


Joy, E., Kussman, A., & Nattiv, A. (2016). 2016 update on eating disorders in athletes: A comprehensive narrative review with a focus on clinical assessment and management. British Journal of Sports Medicine, 50(3), 154–162.

Sundgot-Borgen, J., & Torstveit, M. K. (2004). Prevalence of eating disorders in elite athletes is higher than in the general population. Clinical Journal of Sport Medicine: Official Journal of the Canadian Academy of Sport Medicine, 14(1), 25–32.

Thompson, R.A., & Sherman, R.T. (2010). Eating Disorders in Sport. New York, NY: Routledge.

Torstveit, M. K., Rosenvinge, J. H., & Sundgot-Borgen, J. (2007). Prevalence of eating disorders and the predictive power of risk models in female elite athletes: a controlled study. Scandinavian Journal of Medicine & Science in Sports, 18(1), 108–118.