The Athlete’s Plate: Eating Disorders, Underfueling, and Nutrition for Athletes
Fall is a big season for sports. Football fields are packed, soccer teams are traveling for tournaments, cross country runners are preparing for meets, and athletes in all kinds of sports are spending more time training, practicing, and competing.
Being an athlete can be an amazing experience. Sports can provide community, confidence, friendships, and a sense of accomplishment. But there can also be a lot of pressure surrounding food, exercise, body size, and performance. For some athletes, that pressure can contribute to disordered eating or an eating disorder, which can lead to further complications that harm both their athletic career and their body. This can be hard to identify, so continue to read on to understand what we are talking about.
As eating disorder dietitians, we want to talk about something that can easily get overlooked when we talk about athletes: athletes need to eat enough to support their sport and their individual body. Up to 19% of male athletes and up to 45% of female athletes have an eating disorder, according to a study by Bratland-Sand and Sundgot-Borgen (1).
This is where the Athlete’s Plate can be a helpful tool, along with awareness of signs and symptoms to look for.
What is the Athlete’s Plate?
The Athlete’s Plate is a visual approach to sports nutrition that helps athletes build meals based on their training demands. It was developed in collaboration with the U.S. Olympic Committee Food & Nutrition Services and the University of Colorado Sports Nutrition Graduate Program. Instead of giving someone a strict meal plan or asking them to count every calorie or gram of carbohydrate, it provides a general picture of what a balanced meal can look like. This provides room for flexibility, without the unnecessary overwhelm of numbers.
The Athlete’s Plate can change depending on the athlete's training day. An easier training day may look different from a hard training day or competition day. When training becomes more intense or lasts longer, athletes generally need more fuel, particularly carbohydrates.
This flexibility is important. Your body does not need exactly the same amount of food every day, and your nutrition should be able to change when your training changes.
Why Are Athletes at Risk for Eating Disorders?
Athletes can experience many of the same risk factors for eating disorders as anyone else, but sports can add another layer of pressure.
Certain sports, such as wrestling, gymnastics, dance place a greater emphasis on body weight, body composition, appearance, or making a particular weight class. Even in sports where weight is not officially part of the competition, athletes may receive messages about needing to be “leaner,” “faster,” or “stronger.”
An athlete may start by making what seems like a small change in pursuit of improving their performance. These small changes can spiral, and eventually, these behaviors can become increasingly rigid. Because these behaviors may initially be praised as dedication, discipline, or “healthy eating,” an eating disorder can be difficult to recognize in an athlete.
When Does Healthy Eating Become Disordered?
Eating well and taking care of your body are not inherently disordered. Athletes need nutrition that supports their training. Planning meals, eating before practice, bringing snacks to tournaments, and thinking about recovery nutrition can all be appropriate parts of sports nutrition.
The concern comes when food rules become rigid, fear-based, or increasingly restrictive.
Some warning signs may include:
Skipping meals because of concerns about body weight
Eliminating entire food groups without a medical reason
Becoming increasingly fearful of carbohydrates or fats
Feeling guilty after eating
Feeling like food needs to be earned through exercise
Exercising to compensate for eating
Avoiding team meals or social events because of food
Constantly thinking about food, weight, or body size
Becoming anxious when the normal eating routine changes
Feeling tired, dizzy, weak, or unable to recover from training
Heart rate abnormalities (read more about this in our blog on Florida’s Second Chance Act)
Intolerance to cold
An athlete does not have to be visibly underweight to have an eating disorder or to be underfueled. The Athletic Disordered Eating (ADE) Scale was developed to assess disordered eating and eating disorders specifically in current and former athletes using 17 questions about food, body, and eating.
Underfueling Can Affect Athletic Performance
It can be tempting to think that eating less will automatically make an athlete lighter, faster, or better at their sport. But athletes need enough energy to support their workouts as well as everything else their body does. In adolescents, their bodies are still growing, and extra care needs to be taken to ensure they are fueling both their growing body and their athletic pursuits.
Your heart, brain, and bones need energy. Your entire body needs energy to repair muscles and recover from training.When an athlete consistently does not eat enough to support their activity, they can develop low energy availability. This can contribute to Relative Energy Deficiency in Sport, commonly called RED-S. In 2023, the International Olympic Committee revised the definition of RED-S, which replaced what was formerly called the “Female Athlete Triad.” The new definition is, “A syndrome of impaired physiological and/or psychological functioning experienced by female and male athletes that is caused by exposure to problematic (prolonged and/or severe) LEA. The detrimental outcomes include, but are not limited to, decreases in energy metabolism, reproductive function, musculoskeletal health, immunity, glycogen synthesis and cardiovascular and haematological health, which can all individually and synergistically lead to impaired well-being, increased injury risk and decreased sports performance.”
RED-S can affect both male and female athletes and may impact bone health, hormones, immune function, mood, metabolism, and athletic performance. Approximately 20-605 of athletes may experience RED-S to some degree. A key term in RED-S is “low energy availability,” or LEA, which is the mismatch between caloric intake and the energy expended during exercise in addition to health metabolic function. More training is not always better, and more training without enough recovery and fuel can work against the goals an athlete is trying to achieve.
Additionally, athletes often have 5-15% higher bone density than non-athletes. If an athlete is restricting food or underfueling, or when a female athlete loses her period, a DEXA scan can be a helpful tool in determining whether there is damage to the athletes bones.
Eating Disorders Can Look Like Dedication
This is one reason eating disorders can be particularly difficult to identify in athletes.
A coach may see an athlete who never misses a workout and think they are incredibly committed. A teammate may see someone who is extremely strict about what they eat and assume they are simply disciplined. A parent may be proud that their athlete is “eating so healthy.”
But sometimes what looks like dedication on the outside is actually an athlete struggling with food and exercise.This does not mean every disciplined athlete has an eating disorder. It means we need to look at the bigger picture.
Can the athlete take a rest day without feeling guilty? Can they eat foods that are not considered “perfect”? Can they adjust their meals when practice changes? Can they take time off when they are injured? Can they eat enough before and after training?
These questions can tell us much more than simply looking at how “healthy” someone's diet appears.
Using the Athlete’s Plate Without Turning It Into Another Set of Rules
The Athlete’s Plate can be a useful tool for helping athletes understand what their bodies need. However, for someone struggling with an eating disorder or significant food anxiety, even a helpful nutrition guide can sometimes become another set of rules.
The goal is not for every meal to look exactly like a picture. Sometimes the most important nutrition goal is not creating the “perfect” plate. It is simply helping an athlete eat consistently and enough, and for athletes who do not have an eating disorder, but need guidance around meals and snacks. Athletes who have an eating disorder should work with a dietitian on a specific plan for supporting their recovery and their athletic pursuits.
You Can Be an Athlete and Still Have a Healthy Relationship With Food
Being committed to your sport does not mean you have to be afraid of food. As Bill Bowerman, the co-founder of Nike said, “If you have a body you are an athlete.”
You do not have to earn your meals, train through every injury, or change your body in order to deserve a place on your team.
Your body is what allows you to participate in the sport you love. Taking care of it means giving it enough food, rest, recovery, and support.
At Namaste Nourished, our dietitians work with athletes who want to fuel properly, are struggling with eating disorders, disordered eating, body image concerns, and the pressure that can come with sports. We believe nutrition should support both athletic performance and a healthy relationship with food. If you or an athlete you love is struggling with food, exercise, or body image, you do not have to wait until things become severe to ask for help. Reach out to Namaste Nourished to learn more about working with an eating disorder dietitian.
Resources
Bratland-Sanda, S., & Sundgot-Borgen, J. (2013). Eating disorders in athletes: overview of prevalence, risk factors and recommendations for prevention and treatment. European journal of sport science, 13(5), 499–508. https://doi.org/10.1080/17461391.2012.740504
International Olympic Committee. Relative Energy Deficiency in Sport.
Mountjoy, M., Sundgot-Borgen, J., Burke, L., et al. (2018). IOC consensus statement on relative energy deficiency in sport (RED-S): 2018 update. British Journal of Sports Medicine, 52(11), 687–697.
National Eating Disorders Association. Eating Disorders and Athletes.
University of Colorado Colorado Springs Sport Nutrition Graduate Program. The Athlete’s Plate.