Today’s Dietitian
Vol. 27 No. 9 P. 10
Body image dissatisfaction and disordered eating are significant concerns among athletes, especially those competing in aesthetic, endurance, or weight-sensitive sports.1 While sport participation can improve confidence and body appreciation through skill and physical performance mastery, intense pressures to achieve sport-specific appearance ideals often offset these benefits.2 Female athletes in particular experience greater risk for body dissatisfaction and disordered eating behaviors,3 although male athletes are increasingly affected by muscularity-driven pressures and compulsive training.4
Dietitians are uniquely positioned to support prevention and intervention efforts. By working collaboratively with coaches, sports psychologists, and athletic trainers, RDs can help athletes build healthier relationships with their bodies and food. This article reviews current evidence on gender disparities, sport-specific risk factors, and emerging intervention models, while offering actionable strategies for RDs to promote positive body image and reduce disordered eating behaviors across athlete populations.
Understanding Body Image Dissatisfaction in Athletes
Athletes navigate body ideals shaped by society and the demands of their sports. Although participation in sports can promote body appreciation and confidence through performance and functional strength, it can also heighten dissatisfaction, especially in sports where leanness or aesthetics are valued. Research has shown that female athletes generally report greater body image dissatisfaction than male athletes,2 while men more often experience pressures tied to muscularity.3 However, it is important to recognize that body image concerns can manifest diversely across all genders and sport types. It should not be narrowly assumed to reflect only thinness ideals for women or muscularity ideals for men. Athletes of any gender and sport may experience complex and intersecting body image pressures that warrant individualized attention.
Certain sports carry a higher risk, including gymnastics, diving, distance running, ballet, and wrestling, where appearance or weight categories are closely linked to performance. Athletes may prioritize a “sport-ideal” physique over a socially idealized one, making identifying body dissatisfaction complex.2 Uniforms, public weigh-ins, and comments from coaches or peers can further fuel critical self-evaluation and comparison.5
It is important to distinguish general body image dissatisfaction (BID) from what researchers call sport-specific BID—dissatisfaction linked directly to perceived gaps between one’s current body and what is optimal for performance. Athletes may value body shapes that fit their sport, even if those same shapes differ from mainstream ideals, highlighting the importance of assessing their concerns in the context of their competitive environment.2
Disordered Eating in Athletic Populations
Disordered eating is a significant concern in athletic settings, ranging from overly restrictive food intake to compulsive exercise and other unhealthy behaviors. Disordered eating attitudes and behaviors have been reported in as many as 45% of athletes,1 with elevated risk particularly among those participating in elite and aesthetic-based sports.6
Although disordered eating and clinical eating disorders are often discussed together, they exist on a continuum. Many athletes experience subclinical symptoms, such as rigid food rules or excessive training, that can still harm physical and mental well-being even if they do not meet criteria for a formal eating disorder diagnosis.3 Unfortunately, these behaviors are sometimes normalized within sports culture and misinterpreted as dedication or discipline rather than red flags. Coaches, teammates, and even families may overlook less obvious conditions like orthorexia or muscle dysmorphia, which focus more on “clean” eating or extreme muscle-building than on weight alone.4
Shifts in routine, such as recovering from injury or ending a competitive season, can increase vulnerability to disordered eating patterns.6 Disordered eating, clinical eating disorders, or simply not eating enough to meet sport demands can also lead to Relative Energy Deficiency in Sport (REDs), a condition marked by insufficient energy availability that disrupts multiple body systems, including cardiovascular, bone, immune, and reproductive health, and can contribute to psychological distress.7
Contributing Factors
Many influences combine to shape body image dissatisfaction and disordered eating in athletes. These pressures can be amplified by the type of sport, especially in those where uniforms are revealing or body weight is emphasized. Athletes have described discomfort with uniforms, lack of privacy, and constant comparison during puberty, undermining confidence and enjoyment in sport.5
The sport environment can reinforce unhealthy ideals through routine weigh-ins, appearance-based feedback, or body composition testing.1 In addition, social media and cultural messages that idealize certain body types may intensify self-scrutiny, particularly among younger athletes still developing their sense of identity.8
Although coaches are powerful role models, many lack training to recognize early warning signs or appropriately address body image concerns. Some avoid these conversations altogether out of fear of worsening the problem, leaving athletes without support.4
Emerging Models for Prevention and Intervention
Importantly, athletes have called for programs that celebrate skill, comfort, and functionality over appearance, including their voices in the design of interventions.8 This emphasis on stakeholder involvement, cultural sensitivity, and empowering athletes to advocate for themselves may improve engagement and long-term effectiveness.
Newer prevention programs in sports are moving beyond simply reducing risk to actively building positive body image and resilience. One promising approach is the Healthy Body Image (HBI) intervention, which combines body functionality, self-care, and media literacy education. Research has shown that girls who participated in the HBI program experienced sustained improvements in positive embodiment and health-related quality of life for up to 12 months.9
Coach-centered educational interventions have shown encouraging results by increasing coach confidence and reducing harmful, weight-focused communication.10 These programs equip coaches with practical tools to recognize early warning signs of eating disorders and to initiate conversations with athletes in a supportive, nonjudgmental way.11 In addition, validated measures such as the Coach Self-Efficacy Body Image Scale12 offer a promising way to assess coach knowledge and confidence, helping tailor future education efforts and strengthen positive messaging within sport environments.10
Dietitians working with athletes and teams may benefit from familiarizing themselves with these types of coach-focused interventions and screening tools, so they can help integrate them into a broader support network for athlete health.
The RD’s Role in Prevention and Support
Dietitians are essential partners in creating healthier sport environments. By collaborating with coaches, athletic trainers, and sport psychologists, RDs can help shift the focus from appearance to performance, skill development, and overall well-being.1 Education is a powerful tool. Dietitians can offer evidence-based guidance on balanced fueling, macronutrient timing, and REDs prevention, which remains underrecognized in many coaching settings despite its serious consequences for health and performance.11
Dietitians are well-positioned to deliver athlete education sessions that build supportive messaging and reinforce functionality over aesthetics. They can also advocate for sensitive and appropriate use of body composition testing, ensuring such assessments are medically indicated and performed in an athlete-centered, respectful manner.1
Screening and early detection are other key areas where dietitians can lead. Dietitians can use validated tools to identify athletes at risk of disordered eating, particularly during vulnerable times such as puberty, injury recovery, or sport transitions.6 Working alongside multidisciplinary teams supports a more holistic approach, blending nutrition with psychological skills and medical oversight.13
Supporting coaches and parents is another critical role for dietitians. By addressing knowledge gaps around sports nutrition, including common misconceptions about supplements, protein, and restrictive diets, RDs can help ensure that athletes and their support networks have accurate, evidence-based guidance.14 They can also champion programs that highlight positive embodiment, encouraging athletes to appreciate their bodies for their capabilities, rather than their appearance.9
By reinforcing body-respectful practices, RDs can be catalysts for healthier sport cultures, helping athletes build resilience and a lifelong positive relationship with food, performance, and their bodies.
Conclusion
Athletes deserve more than a performance-ready body; they deserve a sports culture that honors their health, confidence, and identity. Dietitians can move beyond correcting nutrition plans to helping reshape the very systems that fuel harmful ideals. By partnering with coaches, challenging outdated norms, and encouraging evidence-based, athlete-centered strategies, dietitians can help redefine what thriving in sport truly means: not just winning, but sustaining a strong, resilient sense of self.
— Krissy Ladner-Lines, DHSc, MS, RD, CSSD, CPT, is a sports dietitian and sports performance director with nearly 20 years of experience in nutrition and sports medicine. She is a media-trained dietitian, adjunct lecturer, and membership director for WISE San Diego. Based in San Diego, she supports athletes globally across performance, nutrition, and body image initiatives.
Takeaways for Practice
• Female athletes remain at higher risk, but male athletes also deserve attention for muscularity-driven pressures and compulsive training patterns.
• Dietitians are well-positioned to lead educational efforts and collaborate with coaches and other professionals to create a performance-focused, body-supportive culture.
• Screening, providing practical resources, and consistent messaging about body functionality over aesthetics can help protect athletes’ well-being.
• Emerging prevention programs highlight the benefits of culturally sensitive, athlete-informed, and multisession interventions.
References
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2. Zaccagni L, Gualdi-Russo E. The impact of sports involvement on body image perception and ideals: a systematic review and meta-analysis. Int J Environ Res Public Health. 2023;20(6):5228.
3. Power K, Power MD. Pushing beyond the limits: disordered eating, compulsive exercise, and body image dissatisfaction in collegiate athletes. J Sport Behav. 2024;47(4):66-92.
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5. Schneider J, Matheson EL, Tinoco A, et al. A six-country study of coaches’ perspectives of girls’ body image concerns in sport and intervention preferences: template analysis of survey and focus group data. Body Image. 2023;46:300-312.
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9. Sundgot-Borgen C, Friborg O, Kolle E, et al. The healthy body image (HBI) intervention: effects of a school-based cluster-randomized controlled trial with 12-months follow-up. Body Image. 2019;29:122-131.
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11. Hamer J, Desbrow B, Irwin CG. Are coaches of female athletes informed of relative energy deficiency in sport? A scoping review. Women Sport Phys Act J. 2020;29(1):1-9.
12. Silva-Breen H, Schneider J, Tinoco A, Matheson EL, LaVoi NM. Development and preliminary validation of the Coach Self-Efficacy Body Image Scale (CSEBIS). Body Image. 2022;43:408-419.
13. Martinsen M, Sherman RT, Thompson RA, Sundgot-Borgen J. Coaches’ knowledge and management of eating disorders: a randomized controlled trial. Med Sci Sports Exerc. 2015;47(5):1070-1078.
14. Trakman GL, Forsyth A, Devlin BL, Belski R. A systematic review of athletes’ and coaches’ nutrition knowledge and reflections on the quality of current nutrition knowledge measures. Nutrients. 2016;8(9):570.
