Helping Runners with Eating Disorders

by Nancy Clark, MS, RD, CSSD

An estimated 30% to 60% of female athletes struggle with food, as do 10% to 33% of male athletes. Many of these athletes believe they are not “sick enough” to seek treatment. Others are too ashamed to ask for help. Some believe getting treatment will hinder them from reaching their athletic goals. They fear:

  1. they will gain weight, and any added weight will impair their performance.
  2. they will not be able to participate in training or competitions during treatment, hence lose fitness and status with the team; and
  3. they might displease their coaches and teammates.

But the questions they need to ponder are:
What do you think your future will look like with the eating disorder?
Are you currently satisfied with your quality of life?

At the October 2022 Food and Nutrition Expo and Conference of the Academy of Nutrition and Dietetics (the nation’s largest group of nutrition professionals), sports nutritionist Page Love MS RD CSSD ( of Atlanta and psychologist Ron Thompson PhD of Bloomington IN ( addressed the topic of Athletes with Eating Disorders. They shared insights from their years of professional experience.

This article passes along some of their insights and words of wisdom that might help not only runners who struggle with food, body image, and weight issues, but also their teammates, friends, family, and loved ones—and nudge them to encourage ED athletes to seek help.

• When dieting goes awry and eating disorders (ED) take hold, relationships and quality of life suffer, to say nothing of longevity as an athlete. Runners with EDs can easily believe they have more reasons to keep the eating disorder than they do to give it up. Eating disorders serve a purpose. They can distract a runner from feeling difficult emotions; offer a source of power and control; give a sense of security; provide an excuse for anything and everything; sustain an identity; offer a way to be angry, self-abusive, special, rebellious, and competitive both inside and outside of sport.

• Given many runners and other athletes with EDs deny the seriousness of this mental health disease, Dr. Thompson has asked his clients, “Do you realize that people with your disorder sometimes die?” Indeed, athletes can—and have—died from eating disorders, often via suicide. Looking from the inside out, life can feel very grim, despite a runner appearing happy, bubbly, and “just fine” on the outside.

• Ideally, food should be one of life’s pleasures, as well as an enjoyable source of energizing fuel that enhances performance. If you stop eating at mealtimes just because you think you should, or because your allotted portion of food is all gone (but you are still hungry), you might want to ask yourself a few probing questions:

– What are your food rules and nutrition beliefs that restrict your food intake?

For example, do you forbid yourself to eat refined sugar, snacks, birthday cake, white flour…?

– What percent of your time do you spend thinking about food and weight? 

Thinking about food includes shopping for food, preparing food for yourself and others, reading cookbooks or other food- and diet-related publications, binge-eating, purging, and thinking about how much you ate at your last meal. If you spend way too much time thinking about food, you likely have a problematic relationship with food and are living in a state of hunger. That’s no fun — and also limits your ability to recover, heal, and perform optimally. “Normal eaters” think about food as they start to get hungry at appropriate times — before meals and snacks.

– Do you enjoy eating socially with friends and  teammates?

Or do you avoid such situations?

– Are your food allergies and intolerances real?

Or are they convenient excuses to avoid certain foods? 

– Ladies, do you currently have regular menstrual periods?

Amenorrhea—loss of menses—can be a sign of under-eating, to the point of disrupting normal body functions.

– Gentlemen, do you no longer have morning erections?

Another sign of under-eating, to the point of disrupting normal body functions.

– Does your family have a history of eating issues, dieting practices, and/or mental health concerns?

If yes, how have those issues influenced your food habits?

• Chronically underfed bodies can end up “hibernating,” with slowed metabolic processes. Symptoms related to inadequate fueling include fatigue, lack of energy, dehydration,  anemia, frequent injuries, amenorrhea, stress fractures, and “weird” eating habits. These are all good reasons to seek help from a registered dietitian who specializes in sports nutrition (RD CSSD). The referral network at can help you find a local RD CSSD.

• Most of my clients report, “I know what I should eat. I just don’t do it.” Given today’s confusing food environment, any runner with nutrition questions and weight concerns would be wise to meet with a sports RD to learn how to overcome barriers that limit optimal fueling. Don’t let (self-imposed) shame or embarrassment stop you. Eating “right” is not as simple as it once used to be.

• All food can fit into a balanced sports diet—even fatty foods. Runners should consume at least half of their calories from (preferably nutrient-rich) carbohydrate, and at least 20% of calories from (preferably health-promoting) fat. A fat intake less than that increases the risk of inadequate energy intake.

• If you live in Food Jail and consume a very repetitive—but “safe”—diet, a sports RD can help you expand your menu so you can consume a wider variety of nutrients. If you want to try to do this on your own, start by making a list of your fear-foods (foods you are afraid to eat because they lack nutrient-density or because you deem them to be “fattening”). Challenge yourself to includw at least one food each day into your meals or snacks, starting with the easiest and ending with the hardest foods. With time, you’ll be able to enjoy social eating with your teammates.

• Notice that other runners look forward to, let’s say, a special holiday gathering like a New Year’s Brunch—but you don’t because the foods will be way too fattening or you’re afraid you’ll end up eating way too much. Other runners can eat holiday treats; why can’t you? Your body is not different from anyone else’s and it will not “get fat on you.” The problem isn’t the food or your body, but more likely your self-imposed food rules.

• Few runners will ever achieve a perfect body. Please don’t measure your self-worth as an athlete by your body weight or size. You are more than just a person who runs; you are a valuable human, like the rest of us, and are good enough the way you are.


Sports Nutritionist Nancy Clark, MS, RD counsels both casual and competitive athletes in Newton MA (617-795-1875). Her best-selling Sports Nutrition Guidebook is a popular resource, as is her online workshop and books. For more information visit

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