Florida’s Second Chance Act
This school year, along with new teachers, new pencils, and new classes, there is also something new in high schools across the state of Florida. Florida’s Second Chance Act, passed by the Senate in 2025, goes into effect for the 2026-2027 school year. The law is inspired by Chance Gainer, an 18- year old wide receiver and defensive back at Port St. Joe High School. He collapsed to the ground during an away game at Liberty County High School, and later died at the hospital from an undiagnosed heart condition.
Florida’s Second Chance Act mandates that all high school students who are playing an FHSAA sport must have at least one EKG screening completed and kept on file. If a student has an abnormal EKG result, they are prohibited from participating until they receive written medical clearance from a doctor. Florida is the first state to mandate EKG screenings for high school student-athletes. While all high school athletes are required to complete a sports physical prior to participation, the majority of heart conditions can be missed by the standard sports physical.
As dietitians who specialize in the treatment of eating disorders, it is our hope that this change will not only help identify cardiac abnormalities and keep young athletes safe, but also encourage earlier recognition of athletes who may be struggling with inadequate fueling or an eating disorder and connect them with the support they need in order to continuing enjoying the sport they love.
Heart Conditions and Athletes
As medical providers, we are thrilled that Florida is taking such an important step towards protecting our athletes. Discovering undiagnosed heart conditions allows for management and prevention, rather than tragedy. It’s especially important for student athletes, whose hearts undergo additional stress from practices and games/competitions. Awareness of underlying conditions means that athletes and coaches can make a plan.
We’re especially excited about this new law as eating disorder dietitians. While athletes typically have a lower resting heart rate than their peers, a starved heart also has a low resting heart rate. Bradycardia is an abnormally slow resting heart rate, usually below 60 beats per minute. It is a common and incredibly dangerous complication of starvation. As the body adapts to not consuming enough calories, it compensates by slowing down the heart rate in order to conserve energy for necessary daily functions. Screening for latent heart conditions means that they can be treated. If an athlete is found to be bradycardic, working with a Registered Dietitian Nutritionist for support with increasing caloric intake can help the body to slowly return to normal.
Eating Disorders and Athletes
In our diet culture focused society, eating disorders are often underestimated. We discussed why this is in our blogs, Disordered Eating Versus Eating Disorders as well as Latent Eating Disorders: When Disordered Eating Hides in Plain Sight, but amongst the athletic population, the rates are likely even higher than statistics bear. This is due to the shame and secrecy of eating disorders, as well as the belief that reporting any sort of diagnosis might lead to sidelining or removal from competition.
Current available studies show that up to 19% of male athletes and up to 45% of female athletes have an eating disorder(1). A study of NCAA athletes found that around 35% of female athletes and 9.5% of male athletes are at risk for anorexia nervosa, and both female and male athletes carry a 38% risk for bulimia nervosa(5). This doesn’t include those athletes with subclinical presentation of disordered eating behaviors. Certain sports carry a higher risk of eating disorders, especially sports that focus on body shape, size, and/or weight. These include endurance (cross country, swimming), aesthetic (dance, gymnastics, figure skating), or weight-class sports (wrestling, karate). Individual sports rather than team sports also carry a higher risk, as the focus is on the individual rather than the whole team.
Eating disorders can occur in athletes more frequently than the general population due to the pressure to perform, believing that a lower body weight or specific physique will lead to better performance. As eating disorder dietitians, we know that health can’t be determined by a person’s weight or what they look like, and when an athlete pursues disordered eating to alter their appearance, it can have negative physical and mental impacts that can last longer than the sports season, and take hard work to unravel and undo.
In athletes, we often see Low energy availability, or LEA, which is a mismatch between caloric intake and the energy expenditure during exercise in addition to healthy metabolic function. LEA is a spectrum, ranging from accidental inadequate nutrition on one end, and eating disorder on the other. The definition of LEA was revised by the International Olympic Committee (IOC) in 2023 and reads, “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.”
20-60% of female athletes may experience RED-S (Relative Energy Deficiency in Sport), which is a combination of disordered eating, amenorrhea in females (loss of menstrual cycle), and osteoporosis. RED-S can lead to cardiovascular, hormone, skeletal, endocrine, gastrointestinal, psychological and metabolic complications, and can severely impact growth and development in growing athletes. RED-S expanded upon the concept of the Female Athlete Triad, which because its name inherently disregards athletes of all sexes.
Eating Disorders and the Heart
It’s important to determine whether the malnourishment in the athlete is from not eating enough to compensate for the training, or an eating disorder. The physiological consequences of either can be the same, but the treatment will vary greatly if there is a mental health component. The pressure on athletes to maintain a certain physique, look, or body type can lead to extreme measures.
While athletes typically have a lower heart rate than their peers due to their training, bradycardia can also be a symptom of a body in starvation.The body doesn’t know that the starvation is from an eating disorder, and slows the heart rate. Bradycardia is defined as an abnormally slow resting heart rate (below 60 bpm), and is one of the most common and dangerous complications of an eating disorder.
Another cardiac complication seen in eating disorders is hypotension, which is chronically low blood pressure. An athlete’s heart may have lower blood pressure, but a malnourished heart will maintain low blood pressure regardless of the tasks it undergoes. Having someone stand and walk across the room is a simple test to determine why the blood pressure is low. If the blood pressure remains the same while the pulse changes due to the action of walking, it is indicative of starvation, not of athletic achievement. Low blood pressure can lead to dizziness and fainting.
The most concerning cardiac complication in eating disorders is that of cardiac arrest. Cardiac arrest is different from a heart attack, in that cardiac arrest is an electrical malfunction where the heart stops beating, and a heart attack is a circulation problem where blood flow is blocked to the heart. Cardiac arrest can occur from an undiagnosed arrhythmia or an electrolyte abnormality. Electrolyte abnormalities can occur in someone with an eating disorder or someone not properly fueling regularly. Arrhythmias, or abnormal heart rhythms, can be undetected without an EKG.
Undetected arrhythmias are one of the many reasons why Florida’s Second Chance Act is so impactful. Early detection allows doctors to help manage symptoms and prevent severe complications. Our hope with this law is that athletes will be able to get the care they need for life, but that athletes with disordered eating or eating disorders will be able to get the support they need to heal. If athletic achievement is important, managing an eating disorder is necessary. Eating disorders worsen under stress, and the constant pressure to perform can only add to the stress and behaviors of an eating disorder. Our team works with many athletes, from novice to professional, and we can help you to fuel your athletic goals and feel your best. If you have concerns about yourself or a child, please reach out to us today.
References
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
Cohen, R., Kottke, J. (2024, September 7). Florida high school football player dies after collapsing on field during game. NBC News. https://www.nbcnews.com/news/us-news/florida-high-school-football-player-dies-collapsing-field-rcna170070
Cost, J. (2025). Identifying And Treating Eating Disorders in Athletes. ACUTE Center for Eating Disorders & Severe Malnutrition. https://www.acute.org/resources/treating-eating-disorders-athletes
Gaudiani, Jennifer L. Sick Enough: A Guide to the Medical Complications of Eating Disorders and Undernutrition. Routledge, 2025.
Johnson, C., Powers, P. S., & Dick, R. (1999). Athletes and eating disorders: the National Collegiate Athletic Association study. The International journal of eating disorders, 26(2), 179–188. https://doi.org/10.1002/(sici)1098-108x(199909)26:2<179::aid-eat7>3.0.co;2-z
Krantz M.J., Mehler P.S. (2004). Resting tachycardia, a warning sign in anorexia nervosa: case report. BMC Cardiovascular Disorders, Vol. 4(10). https://doi.org/10.1186/1471-2261-4-10