Eating disorders show up in youth sport at higher rates than in the general adolescent population. The sports with documented elevated incidence: gymnastics, dance, wrestling, swimming, distance running, figure skating, lightweight rowing, cheerleading, and any program where body composition or weight is part of the explicit or implicit performance frame.
The kids most at risk often look like the kids doing the most “right” things. Disciplined, competitive, high-achieving, eager to please. The pattern that signals disordered eating is rarely overt at the start.
This piece is what to watch for, how to have the conversation, and where to go for help. It is sensitive content. If you or someone you know is in crisis, the National Alliance for Eating Disorders helpline at 1-866-662-1235 and the 988 Suicide & Crisis Lifeline are available.
The frameworks, briefly.
Anorexia nervosa. Restrictive eating, low body weight relative to expected, body-image distortion, intense fear of weight gain. Diagnosed clinically.
Bulimia nervosa. Episodes of binge eating followed by compensatory behaviors (vomiting, laxatives, excessive exercise). Body weight may be normal or above; the harm is internal.
Other Specified Feeding or Eating Disorders (OSFED). The most common diagnosis in adolescents. Disordered eating that does not meet full criteria for anorexia or bulimia but produces real harm.
Relative Energy Deficiency in Sport (RED-S). The International Olympic Committee (IOC) framework that captures the broader picture of inadequate energy availability in athletes. Includes the female athlete triad (low energy, menstrual disruption, low bone density) and recognizes male athletes are affected too. Relative Energy Deficiency in Sport (RED-S) effects span cardiovascular, gastrointestinal, immunological, hormonal, and psychological systems.
The shift from the older “female athlete triad” to RED-S reflects research showing the underfueling syndrome affects more than just the three classic triad components.
The signs to watch for.
Behavioral:
Skipping meals or snacks the kid used to eat. The kid who stops eating breakfast on their own. The kid who suddenly avoids team meals or family dinners.
New rigid food rules. “I don’t eat that anymore.” Foods reframed as “good” or “bad” beyond reasonable nutrition awareness.
Rituals around food. Cutting food into precise pieces, eating only at specific times, using only specific utensils, hiding food, eating alone.
Excessive checking — body weight, measurements, food-tracking apps with concerning detail.
Excessive exercise beyond team practice. Running before practice, working out after practice, weekend cardio sessions that the family did not initiate.
Social withdrawal. The kid who stops going to social events that involve food.
Wearing baggy clothes or layers in warm weather. Hiding the body.
Vomiting after meals (the bathroom door closing immediately after dinner).
Disposable hygiene items disappearing fast (laxative misuse).
Fingertip calluses (Russell’s sign — from self-induced vomiting).
Physical:
Rapid weight loss or significant weight changes.
Lightheadedness, dizziness, fainting.
For girls, missed or irregular periods (after menarche has been established for at least a year). This is the classic sign and often dismissed as “athletic amenorrhea.” It is a warning, not a benign training adaptation.
Stress fractures, especially repeated. RED-S produces low bone density.
Cold intolerance. Lanugo (fine body hair) in advanced anorexia.
Frequent illness. The immune system is one of the early systems affected.
Dental erosion in the back molars (sign of vomiting).
Persistent fatigue not explained by training load.
Performance:
Plateau or decline despite continued or increased training.
Loss of strength or power.
Increasing recovery time between workouts.
Loss of interest in sport that was previously the kid’s identity.
The conversation.
This is the hard part. Most kids in disordered eating do not want to talk about it and will deny patterns when asked directly. The framing matters.
What works:
Open, non-judgmental observation. “I’ve noticed you’ve been eating less at dinner. How are you feeling about food right now?”
Curiosity, not interrogation. “Tell me about your training. How is it going?”
Direct concern without panic. “I love you. I’m worried about some things I’m seeing. I want us to figure this out together.”
Frame the conversation around health, not weight. “I want you to be strong and to feel good. The way you’re eating concerns me because I’m not sure it’s getting you there.”
Avoid:
Specific weight, calorie, or body measurement comments. These can intensify disordered focus.
Praising weight loss or body changes. Comments that reward the disordered behavior.
Engaging in food-rule debates. The disordered logic is hard to argue with directly.
Forcing eating in the moment. Coercive feeding intensifies the disorder.
Promising not to tell anyone. You may need to involve professionals; the kid will need to trust that you act in their interest.
The escalation path.
Step one: pediatrician. The pediatrician does the initial screen, including weight history, vital signs, and lab work to assess medical complications.
Step two: referral to specialized care. Most pediatricians refer to:
A registered dietitian (RDN) with eating-disorder expertise.
A therapist with adolescent eating-disorder training (CBT-E, FBT, or similar evidence-based approaches).
A pediatric or adolescent medicine specialist for ongoing medical monitoring.
Step three: depending on severity, possibly higher levels of care: intensive outpatient program (IOP), partial hospitalization (PHP), residential, or inpatient. The clinical team makes these recommendations.
Step four: school and team coordination. With the kid’s permission, communicating with coaches and the school may be necessary. Reduced training volume, modified expectations, and informed adults at the venue all support recovery.
The role of the team.
Coaches. The first adults outside the family to often notice. SafeSport-aligned programs increasingly train coaches on RED-S and disordered-eating recognition. Coaches who comment on body composition, weight, or weight-cutting in any sport other than wrestling (where weight management is regulated) increase eating-disorder risk in their athletes.
Teammates. Sometimes the first to know. Most do not have the language for it. The team that has openly discussed mental health and eating-disorder recognition is more likely to surface concerns to coaches or trusted adults.
Sports environment. Programs that emphasize body composition, conduct weigh-ins, hold “before/after” photo sessions, or tolerate body-shape commentary produce higher rates of disordered eating. Programs that explicitly do not are protective.
The recovery timeline.
Eating-disorder recovery is not fast. The published research on adolescent recovery timelines suggests 1 to 5 years from initial treatment to stable recovery, with substantial variation.
Family-based treatment (FBT, the Maudsley method) is the most-studied approach for adolescent anorexia and shows strong outcomes when families are engaged. The family is part of the treatment, not just a support resource.
Returning to sport during recovery is a clinical decision, not a family or coach decision. The treatment team determines when training volume, competition, and identity-as-athlete are safe to resume.
The honest read. Eating disorders in youth sport are common, recoverable, and dangerous. The kids who recover most fully are usually the ones whose families noticed the pattern early, escalated to specialist care, and supported the recovery as long as it took. The kids whose recovery is delayed are usually the kids whose families thought it was a phase or whose programs reinforced the disordered behavior.
If this content is reaching a family or athlete in active crisis, the National Alliance for Eating Disorders (1-866-662-1235), the 988 Suicide & Crisis Lifeline, and the kid’s pediatrician are the right starting points. You are not alone, and the help is available.