Eating disorders in elite female athletes are more common than many people realize—and often far more difficult to detect.
In a recent feature with Women’s Soccer Coaching, Dr. Riley Nickols, a sport psychologist specializing in eating disorders, shares key insights into why female athletes are uniquely vulnerable and how coaches and support systems can better recognize and respond.
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Eating Disorders and Elite Female Athletes
Why Elite Female Athletes Are at Higher Risk
One of the most important takeaways from Dr. Nickols’ interview is that eating disorders in athletes are not caused by a single factor—but rather a combination of biological, psychological, and environmental influences.
As he explains, eating disorders have biopsychosocial underpinnings, meaning genetics, personality traits, and sport culture all interact to increase risk.
For female athletes specifically, several factors heighten vulnerability:
- Pressure to perform at a high level
- Expectations around body composition or appearance
- Perfectionistic tendencies
- Strong identity tied to sport
In fact, research suggests that eating disorder rates may be as high as one in three among elite female athletes.
The Culture of Sport Can Mask the Problem
A central theme highlighted by Dr. Nickols is that sport environments can unintentionally normalize behaviors that, outside of sport, would raise concern.
For example:
- Restrictive eating may be framed as “discipline”
- Excessive training may be praised as “commitment”
- Weight loss may be interpreted as “performance optimization”
This creates a dangerous gray area where disordered behaviors can go unnoticed—or even reinforced.
Even in team sports like soccer, which are not traditionally considered “lean sports,” research shows that athletes still experience disordered eating and body image pressures.
Why Eating Disorders Are Often Missed in Athletes
Dr. Nickols emphasizes that athletes are often less likely to be identified early, despite being at higher risk.
Several dynamics contribute to this:
- Athletes may continue performing well despite symptoms
- Teammates may normalize similar behaviors
- Coaches and sport staff may lack training in recognizing warning signs
- Athletes themselves may not perceive a problem
In some cases, even serious health consequences—such as menstrual dysfunction or stress fractures—can occur alongside relatively “normal” outward appearances.
What Coaches and Support Systems Should Watch For
Because early detection is critical, Dr. Nickols highlights the importance of awareness across the athlete’s environment.
Potential warning signs include:
- Increased rigidity around food or eating patterns
- Avoidance of team meals or social eating
- Excessive or compulsive training beyond expectations
- Mood changes, irritability, or heightened anxiety
- Preoccupation with weight, body, or performance metrics
Importantly, these signs are often subtle—making education and proactive conversations essential.
Moving Toward a Healthier Sport Culture
Beyond identifying individual cases, Dr. Nickols underscores the need for a broader cultural shift in sport.
This includes:
- Shifting focus from weight to overall health and performance
- Encouraging flexible, sustainable nutrition practices
- Promoting identity development beyond sport
- Creating environments where athletes feel safe discussing mental health
Research also highlights the role of coach-athlete dynamics and body ideals in shaping risk, reinforcing the importance of informed and supportive coaching practices.
Final Thoughts
Eating disorders in elite female athletes are complex, challenging to identify early, and deeply influenced by sport culture.
Dr. Riley Nickols’ insights serve as an important reminder that what is often rewarded in sport—discipline, control, and sacrifice—can sometimes mask significant psychological and physiological distress.
With increased awareness, earlier detection, and a shift in how we define “healthy performance,” athletes can be supported not just in achieving success—but in sustaining long-term well-being. Reach out today for more information about psychology for athletes.