How Eating Disorders Affect Sports Performance

Written by Ron A. Thompson, PhD, FAED, CEDS

When talking with athletes and coaches about eating disorders, the question I am often asked is how eating disorders affect sport performance. This is an important question because some athletes tell me that their performance actually improved when they began disordered eating behaviors (i.e., restricted eating, weight loss, increased training, etc.). This is sometimes a misperception athletes, but it can also be true. Due to individual differences and other factors that can affect sport performance, some athletes are able to perform well for extended periods of time while engaging in disordered eating and pathogenic weight control measures. However, the disorder will eventually result in poor performance due to dehydration, (early) glycogen depletion, muscle weakness, and a host of other physical/medical factors, not to mention the numerous psychological issues, such as depression, decreased concentration, and obsessive thought regarding eating, food, and weight.

As difficult as it is to convince athletes that eating disordered behaviors can affect sport performance negatively, it is even more difficult to convince female athletes that normal menstrual functioning is important for health and performance. Unfortunately, irregular menstrual functioning is often a consequence of eating disorders, if not simply from imbalanced sport training. In talking with female athletes regarding the importance of menstrual functioning with respect to reproductive and bone health, it is again difficult to get their attention. As we all know, to get the attention of athletes we must speak “performance.” Regarding menstrual health, many athletes tell me they don’t want a menstrual cycle because it makes them “feel fat,” it interferes with training, and that it must not be important because none of their teammates have a cycle. Some female athletes have suggested to me that they know when their menstrual periods stop, that they are training at the proper intensity level. We need research that suggests that menstrual functioning can affect sport performance, such as was provided recently in a study published in Medicine & Science in Sports & Exercise.

In the article, “Ovarian Suppression Impairs Sport Performance in Junior Elite Female Swimmers,” authors VanHeest, Rodgers, Mahoney, and De Souza (2014) compared two groups of junior national caliber female swimmers aged 15-17 during a 12-week competitive swim season. Swimmers were grouped based on ovarian status at baseline in either a cycle menstrual function group or an ovarian suppressed menstrual function group. Ovarian suppression was deemed to be secondary to an energy deficit based on several energy status measures. During the test period, athletes performed one maximal 400-m freestyle swim time trial at weeks 0, 2, 4, 6, 8, 10, and 12. During the 12-week test period, sport performance declined by 9.8% in the ovarian-suppressed group while it increased by 8.2% in the cyclic menstrual function group. The authors concluded that their data emphasize “the need for adequate fuel intake to maintain an optimal hormonal and metabolic environment to maximize sport performance outcomes.”

The full reference for this article is:

VanHeest, J.L., Rodgers, C.D., Mahoney, C.E., & De Souza, M.J. (2014). Ovarian suppression impairs sport
performance in junior elite female swimmers. Medicine & Science in Sports & Exercise, 46, 156-166.

Ron A. Thompson is a psychologist in Bloomington, Indiana, specializing in the treatment of eating disorders. He is also a consulting psychologist for the Athletic Department at Indiana University and has served as a consultant on eating disorders to the NCAA and on the Female Athlete Triad with the International Olympic Committee Medical Commission (IOCMC). He coauthored the Disordered Eating section of the IOC MC’s Position Stand on the Female Athlete Triad, the NCAA Coaches Handbook: Managing the Female Athlete Triad, and Managing Student-Athletes’ Mental Health Issues for the NCAA. Dr. Thompson recently became a member of the NCAA Mental Health Task Force as the eating disorder representative on the committee. Dr. Thompson also assisted in the development of the Healthy Body Image Project for the 2010 Youth Olympic Games. His publications include the books Bulimia: A Guide for Family and Friends, Helping Athletes with Eating Disorders, The Exercise Balance, and Eating Disorders in Sport. He has presented lectures and workshops at more than 110 regional, national, and international meetings, including presentations at the United States Olympic Training Center, the Dutch Olympic Training Center, and the Swedish Sports Federation. Dr. Thompson is a Fellow in the Academy for Eating Disorders (AED), where he cofounded the AED’s Special Interest Group on Athletes. Dr. Thompson and colleague Dr. Roberta Sherman jointly received the AED’s 2008 Leadership Award for Clinical, Administrative, and Educational Service.