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Resources for Athletes with Eating Disorders

Most eating disorder treatment options do not cater to the specific needs of athletes. We understand the that the eating disorders in athletes are unique and require specialized help.

Located in beautiful Denver, Colorado, our intensive program offers treatment up to 10 hours per day, 7 days a week for elite athletes and performers. We offer affordable housing options with overnight support.

In this setting, you will receive excellent, evidence-based care from professionals who understand eating disorders AND the athletic experience.

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Signs of Eating Disorders in Athletes

· Decrease in physical and/or  psychological performance

· Change in weight or body shape

· Changes or isolation around mealtime

· Shifts in mood or irritability

· Conflict with teammates and coaches

· Change in behavior around teammates and coaches

· Inability to concentrate during performance or practice

· Peer reports of concern to coach

· Amenorrhea

· Chronic or overuse injuries

· Obsession, rituals, or rigidity around food or exercise

· Training beyond prescribed routine

· Training when injured or tired

· Obsessing about training details or feeling distressed when training routine is interrupted

Research and Statistics:

Eating disorders are one of the most common mental illnesses in elite athletes. The prevalence varies from 0-39% in male athletes and 6-45% in female athletes (Bratland-Sanda & Sundgot-Borgen, 2013; Karrer et al., 2020; Mountjoy et al., 2014).

In adult female elite athletes, eating disorder prevalence rates up to 45% have been found.

The prevalence of DE/ED in elite female athletes is high in:

  • Aesthetic sports (42%)
  • Endurance sports (24%)
  • Technical (17%)
  • Ball game sports (16%)

(Sundgot-Borgen J, Torstveit, 2004)

In adult male elite athletes, eating disorder prevalence rates up to 32.5% have been found. Gender-specific risk factors are the drive for muscularity, anabolic androgenic steroid use, and homosexuality.

The prevalence of DE/ED in elite male athletes is high in:

  • Cycling (50%)
  • Gravitational sports (24%)
  • Weight class sports (18%)
  • DE/EDs in male jockeys are associated with low BMD

(Bratland-Sanda & Sundgot-Borgen, 2013; Karrer et al., 2020; Mountjoy et al., 2014)

Among female college athletes, in a wide range of sports, 25.5% of them displayed subclinical symptoms of eating disorders (Bratland-Sanda & Sundgot-Borgen, 2013; Karrer et al., 2020; Mountjoy et al., 2014). 

Aesthetic sports, weight-dependent/class sports, and endurance sports together carry the highest risk for the use of pathological weight management behaviors.

Some studies have estimated as many as 94% of athletes in weight-dependent sports engage in extreme weight control methods prior to competition.

38.2% of male lean sport athletes in their sample engaged in dysfunctional exercise, whereas only 13.8% of non-lean male athletes did so (Dimitrova & Vanlyan, 2019). Lean sports emphasize achieving and maintaining a lower body weight due to the belief that lower body weight improves performance. These often include aesthetic, weight-dependent, and endurance sports such as dancing, long-distance running, wrestling, diving, judo, swimming, etc. (Mancine, Gusfa, Moshrefi, Kennedy, 2020).

Athletes in non-weight class sports lose an average of 3-6% of total body weight; athletes in weight class sports lose on average 13% of body weight during their season (Sundgot-borgen & Garthe, 2011).

Some studies have estimated as many as 94% of athletes in weight-dependent sports engage in extreme weight control methods prior to competition (Sundgot-Borgen & Garthe, 2011), putting athletes competing in these sports at high risk of developing an ED (Rosendahl et al., 2009).

Research has indicated that 30-35% of females, and 17-18% in male’s weight class sport athletes meet diagnostic criteria for an ED, compared to 5% and 16% in ball/game sports or 4% and 17% for technical sports in males and females respectively (Sundgot-Borgen & Torstveit, 2010).

Athletes with an eating disorder are more likely to experience injuries than non-athletes with eating disorders, with up to 40% of athletes reporting a stress fracture (Snyder, Koester, & Dunn, 2006).

However, eating disorders augment the risk of adverse cardiac events due to the impact of malnutrition in athletes engaging in inappropriate levels of activity (Casiero & Frishman, 2006).

For example, Thomas and colleagues support DellaValle’s recommendation (2013) that all female athletes are likely to require an additional 70% of the recommended iron intake due to the additional and varied physiologic demands placed on the female athlete.

Frequently Asked Questions

In the context of personal and professional eating disorder treatment, patients in the Athlete EDGE™ at EDCare program will get the benefits of sport-specific programming, including (click to expand):

Eating disorders among athletes are different and require specialized treatment. In addition to our knowledge of eating disorders, our team has specialized training and a rich understanding of athletics and performance cultures. Group therapy, sport psychology, nutrition designed to fuel your sport are incorporated. Additionally, we will work with your coaches and athletic personnel to help you not only recover but return to sport stronger and healthier.

When the treatment team has decided that a patient is physically and mentally healthy enough to return to training, a patient is granted permission to train again for sport. To determine this, we consider:

  • Acknowledging true intentions of exercise, with a growing commitment to not engaging in training to engage in maladaptive behaviors (e.g., control body size/weight, self-harm, purge, etc.)
  • Demonstrating consistent, active participation in programming
  • Following program guidelines and procedures
  • Following team’s recommendations
  • Medically cleared by our team physician
  • Consistent compliance with the meal plan (i.e., able to actively consume appropriate nutrition for demands of their sport)

We also meet weekly to assess how each individual is progressing and modify recommendations and training plans as necessary to align with treatment planning and implementation of both the eating disorder and sport.

We utilize CBT (Cognitive Behavioral Therapy), DBT (Dialectical Behavior Therapy), ACT (Acceptance and Commitment Therapy), Motivational Interviewing, and Sport Psychology principles. We also consider how your life’s relationships, systems, and cultures impact your thoughts, feelings, and behaviors.

Treatment includes individual therapy (2x/week) and family therapy (1x/week). The goal of therapy is to help athletes build healthy coping skills to manage emotions, anxiety, and mood while also focusing on a strong return to sport.

Length can vary from person to person and is dependent upon readiness, commitment, and participation during treatment. We consider unique circumstances around sport and work to provide recommendations for treatment based on what is most recovery-focused for each individual.

Treatment generally begins in our Partial Hospitalization Program (PHP), seven days per week, 10 hours every day.

Once patients have learned to internalize the recovery skills needed in the Partial Hospitalization Program (PHP), they can begin the transition back into daily life at home with the support of our transitional Intensive Outpatient Program (IOP).

At this stage in their eating disorder recovery, patients transition to more meals/training sessions independently and spend more time away from the program. Our transitional Intensive Outpatient Program consists of a five-hour day anywhere from 3-7 days a week. Patients gradually step down before they discharge to an outpatient team.

The Connections House is part of our commitment to providing a supportive recovery setting. This tranquil, off-site home is located about 3 miles from our treatment center, accommodating up to 13 patients. Transportation between Connections House and EDCare Denver is provided at no additional cost. This clinically supported setting allows patients to practice the skills they have learned, connect with others, and build strong relationships on their journey to recovery. 

Patients can also choose to stay at a nearby hotel close to the treatment facility. There is no clinical supervision on staff at the hotel, and patients are encouraged to support their peers and find ways to practice skills they are learning during the program in a more independent setting. 

Housing is typical $30/day; however, accommodations can be made depending on circumstances.

Your team will work with you to create an individualized treatment program. Every week you will meet with your primary counseling and sport psychologist (2x), sport psychiatrist (1x), family therapist (1x), sport certified dietician (1x), mental performance coach (2-3x), physician (PRN), and strength and conditioning coach (frequency TBD). During weekly staffing meetings, changes to treatment plans/recommendations are discussed with the athlete.

The treatment team consists of:

  • You
  • Your team/family supports
  • Counseling & sport psychologist
  • Mental performance coach
  • Sport certified dietician
  • Sport certified psychiatrist
  • Physician
  • Strength & conditioning coach
  • Family therapist

Upon completing your time at EDCare, we will have a CAMSA® ceremony to celebrate your success. Additionally, your treatment team will help you establish an aftercare treatment team for continued support and guidance.

Our team will establish a relationship with your coach, team, and support system to educate them on eating disorders and prepare them to offer informed support in your recovery.

We are committed to providing the most cost-effective treatment possible. We accept over 35 insurance plans, including some state-funded programs. We work with each individual to address specific financial issues, including single case agreements and out-of-network insurance carriers. We are your advocates for good health and will work with you and your insurance company to obtain coverage.

Many collegiate and professional athletic organizations offer funds to help their athletes’ wellbeing. Contact your performance organization to enquire about funds through your organization and see if they have recommendations for outside grants/scholarships/loans for healthcare-related costs.

It is possible to continue working/going to school while in treatment. Many patients utilize online/virtual platforms. This is only advised if your schoolwork/job is flexible and does not interfere with program hours or quality of treatment. You should discuss this topic with your treatment team regularly.

We are aware of athletes’ conflicting responsibilities, so we strive to make accommodations, especially if decisions align with and support long-term recovery. However, we believe it is our responsibility to put an athlete’s health before their vocational & academic responsibilities.

Patients come from various performance backgrounds, including ball sports, aesthetic sports, endurance sports, anti-gravity sports, etc. Patients in this track identify as athletes and performers and actively participate in their performance domain. Criteria for the track include:

  • Active participation in an athletic domain at the collegiate, semi-professional, professional, Olympic, or Paralympic level
  • Funding through salary, grants, scholarships, or sponsorships
  • An intention to return to sport post-treatment

Patients do not need to be referred to EDCare. EDCare provides free, confidential assessments. Please note these assessments are designed for our program only and not intended for eating disorder diagnoses. If you think you have an eating disorder, take our Online Screening before contacting EDCare.

A typical day at EDCare varies on the needs of the individual patient. The day begins with check-ins and a staff-supported breakfast. After meal processing, patients will start a full day of individual and group therapy sessions. Groups and individual sessions are scheduled around staff-supported meals and snack times. Full PHP participation runs from approximately 8:30 am until 6:00 pm daily.

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The first step on your journey to recovery is contacting EDCare to schedule a free, confidential assessment and ask any questions you have about treatment.

Let’s get you back to loving life and sport.