Essentials for Best Practice: Treatment Approaches for Athletes With Eating Disorders
Open accessAbstract
Eating disorders (EDs) and disordered-eating behaviors (DEBs), pose a high risk of morbidity and mortality, threatening physical health, emotional health, and overall quality of life. Unfortunately, among athletes, prevalence rates continue to increase. This document summarizes the challenges of establishing and navigating the multidisciplinary care needed to effectively treat EDs and DEBs among athletes. The benefits of timely and frequent communication within the multidisciplinary treatment team (MDTT) are emphasized and discussed. Authors advise who should be selected as members of the MDTT and suggest that all personnel, including athletic coaches, athletic trainers, physical therapists, and certified fitness professionals be ED-informed and ED-sensitive. Vital components of care are noted including use of a variety of evidence-based psychotherapeutic modalities, interventions which target emotional regulation, and prioritize values based compassionate care. Authors caution that performance decrements and medical/physiological changes are not always easily observable in individuals with EDs and DEBs and therefore, attuned, consistent, and ongoing monitoring is needed. Consensus regarding previously established parameters for return to play and careful titration of physical activity throughout the ED recovery process are suggested as important for preserving health, preventing re-injury, or relapse and facilitating successful return to sport participation.
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Being in a state of relative energy deficiency can predispose athletes to developing anxiety, depression, or other mental illnesses even without a history of psychological problems.
“Even in those without a history of psychological problems, being in a state of relative energy deficiency can predispose athletes to developing anxiety, depression, or other mental illnesses [17,18].”
From Low Energy Availability and Relative Energy Deficiency in Sport: A Systematic Review and Meta-analysis (2025) · cites this paper as [18]
Clinical Treatment Implications (page unavailable) says prolonged energy deficiency in athletes with eating disorders can have far-reaching health consequences. Adjusting Physical Activity (page unavailable) describes emotional dysregulation and anxiety in the context of eating disorders, overtraining, or recovery. It does not establish that relative energy deficiency itself predisposes athletes without prior psychological problems to develop anxiety, depression, or other mental illnesses. (LLM, conf=0.78)
Experimental — accuracy not yet measuredUsing CBT is a particularly effective treatment for REDs if the energy deficiency is related to an underlying mental illness.
“Using CBT is a particularly effective treatment for REDs if the energy deficiency is related to an underlying mental illness [18].”
From Low Energy Availability and Relative Energy Deficiency in Sport: A Systematic Review and Meta-analysis (2025) · cites this paper as [18]
The Evidence-Based Psychotherapy section lists CBT as an evidence-based treatment for eating disorders and says behavioral therapies have the strongest empirical support for eating-disorder symptoms and related psychiatric disorders. It does not say CBT is particularly effective for relative energy deficiency in sport (RED-S) when the energy deficiency stems from an underlying mental illness. Page numbers were not available in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measuredCognitive Behavioral Therapy (CBT) is an effective psychological treatment to address eating disorders, anxiety, and/or depression, while also helping the patient develop a healthy relationship with food and exercise.
“Similarly, Cognitive Behavioral Therapy (CBT) is an effective psychological treatment to address eating disorders, anxiety, and/or depression, while also helping the patient develop a healthy relationship with food and exercise.”
From Low Energy Availability and Relative Energy Deficiency in Sport: A Systematic Review and Meta-analysis (2025) · cites this paper as [18]
The Evidence-Based Psychotherapy section identifies CBT as an evidence-based treatment for eating disorders and says behavioral therapies have strong support for related psychiatric disorders. It describes normalized eating as a treatment target, but does not specifically say CBT treats anxiety or depression or helps patients develop a healthy relationship with exercise; the Adjusting Physical Activity section assigns exercise-related support to the multidisciplinary team. Page numbers are unavailable in our copy. (LLM, conf=0.85)
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Cited by
Sorted by citations
Gallant, T. L., Ong, L. F., Wong, L., Sparks, M., Wilson, E., Puglisi, J. L., & Gerriets, V. A. (2025) · Sports Medicine · doi:10.1007/s40279-024-02130-0 · Cited by 75 · see citing works
“Even in those without a history of psychological problems, being in a state of relative energy deficiency can predispose athletes to developing anxiety, depression, or other mental illnesses [17, 18].”
- Authors
- Conviser, J. H., Schlitzer Tierney, A., & Nickols, R.
- Affiliations
- Northwestern University (US)
- 2The Victory Program at McCallum Place
- Venue
- Journal of Clinical Sport Psychology
- Publisher
- Human Kinetics
- Published
- 2018-12-01
- Volume
- 12
- Issue
- 4
- Pages
- 495-507
- ISSN
- 1932-9261 (ISSN-L)
- 1932-927X
- OpenAlex
- W2801521537
- Cited by
- 24
- References
- 2
- Citations by year
- 2026: 5 · 2025: 4 · 2024: 5 · 2023: 4 · 2022: 2 · 2021: 1 · 2020: 2 · 2019: 1
- FWCI
- 1.18
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Clinical Sport Psychology (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Keywords
- eating disorders, disordered eating, athletes, multidisciplinary healthcare teams, psychotherapeutic interventions, emotion regulation, compassionate care, performance decrement, return to sport, relapse prevention, reinjury prevention, monitoring
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