Disordered Eating in Female Athletes: Know the Signs

September 22, 2026

University Hospitals Rainbow Babies & Children'sExperts in Children's Health

A young gymnast eats an energy breakfast before training and prepares for a morning workout in the gym

Most female athletes are driven, goal-oriented and willing to push themselves hard to perform their best. But those same qualities can make it difficult to recognize when their relationship with food has shifted from healthy to harmful.

Amanda Weiss Kelly, MD, a pediatric sports medicine specialist at University Hospitals Drusinsky Sports Medicine Institute, explains disordered eating in young female athletes — what it looks like, what it can do to the body, and how parents, coaches and physicians can support healthy eating habits.

From Undereating to Full Disorder

Studies show disordered eating affects up to 45% of female athletes, with the highest rates seen in gymnastics, dance, figure skating and distance running, where leanness is part of performance or judged subjectively. Disordered eating in athletes exists on a wide continuum, and eating disorders like anorexia or bulimia are a small part of the picture.

At one end of the spectrum are athletes who are simply not fueling enough for the demands of their sport — not because of a psychological barrier, but because it’s genuinely hard to eat enough when you’re in school all day and training hard.

“Telling a patient her vitamin D or iron is low, and she’s not getting enough fuel to support her sport, is often education enough to change her eating habits,” Dr. Weiss Kelly explains. “These athletes don’t actually have eating disorders, because there’s no psychological barrier to their increasing caloric intake.”

In the middle are athletes who believe that being lighter means performing better, sometimes reinforced by coaches or sports culture. “To some extent it’s true: losing a couple of pounds can make you a faster runner,” Dr. Weiss Kelly acknowledges. “The problem is when that goes too far the body is not adequately supported by food, so training suffers and injury risk rises.” These athletes may agree to change their eating habits, but often find it difficult to follow through and need counseling alongside nutritional support.

At the far end of the spectrum are athletes with true eating disorders, who can’t increase their fuel intake without intensive intervention. “In these cases, you have to address more than just habits and calorie counting, because there’s a real psychological barrier there,” Dr. Weiss Kelly says.

Signs to Watch For

Because disordered eating often develops gradually, it can be hard to spot. Some signs worth paying attention to include:

Changes in menstrual cycles. Irregular, lighter or absent periods are one of the most reliable indicators that a female athlete is not eating enough to support her body’s needs.
Stress fractures and overuse injuries. Bone injuries or other overuse injuries in young athletes, especially recurring ones, are a red flag for inadequate nutrition.
Performance plateau or decline. An athlete who is training hard but not improving or actively declining may not be fueling adequately.
Persistent fatigue or unexplained symptoms. Low iron, low vitamin D and other nutritional deficiencies can manifest as leg pain, chronic tiredness and symptoms that mimic overuse injuries.
Failure to follow through. Athletes with true disordered eating often appear motivated and agreeable in clinical settings. “For the first couple of visits, they say, ‘Absolutely, I can add more fuel,’ but then you see them again and they have a lot of excuses why they haven’t made those changes,” Dr. Weiss Kelly says. Repeated failure to follow through could be a signal that more support is needed.

Why It Matters: Bone Health, Iron and Sleep

The medical consequences of under-fueling in female athletes are serious, and some of them don’t become apparent until much later in life. Bone health is Dr. Weiss Kelly’s biggest concern. During the adolescent years, girls build the bone density that will carry them through adulthood; by the time they graduate from high school, that process is 90 percent complete. An athlete who under-fuels during this time may never reach her genetic potential for bone density — raising her lifetime risk of stress fractures, osteoporosis and hip fractures decades down the road.

“Kids aren’t thinking about fracturing their hip in their 50s,” Dr. Weiss Kelly acknowledges, “But even stress fractures now can take you out of your sport for six to sixteen weeks. That tends to get athletes’ attention.”

Iron deficiency is another significant, frequently overlooked issue. Female athletes who menstruate lose iron monthly, and it can be challenging to replace those stores through diet alone, particularly for endurance athletes. Low iron affects energy, recovery and performance in ways that are easy to blame on overtraining or other causes. Checking ferritin, a marker of iron stores in the body, is a critical part of female athlete care. “So many girls are low in iron,” Dr. Weiss Kelly says. “When we fix it, the improvement in how they feel and perform can be remarkable.”

Sleep is another important part of the picture. Research consistently shows that increasing sleep by even one to two hours per night measurably improves athletic performance, from reaction time to free-throw percentage.

Building the Right Support Team

Caring for a young athlete who isn’t fueling adequately requires a team effort based on where she falls on the continuum. A registered sports dietitian is often the first step, offering individualized strategies for athletes who need help fueling for a demanding training and school schedule. “It can be as simple as drinking a high-protein smoothie on the way to school,” Dr. Weiss Kelly says.

For athletes who struggle to make changes, a psychologist experienced in working with athletes can help address the fear that makes change feel challenging. And for those with true eating disorders, a coordinated team — mental health specialists, medical monitoring, family and often coaches — is essential.

Parents and coaches are often the ones who notice something first, and responding with these ideas in mind can help:

Lead with health and performance, not appearance. Framing concerns around energy, strength, recovery and bone health is more likely to land than comments about weight or body size. “A lot of athletes are willing to do more if it will help their performance,” she says.
Pay attention to periods. For female athletes, absent or irregular periods deserve a conversation with a physician.
Take persistent symptoms seriously. Fatigue, leg pain, recurring injury and performance decline that doesn’t resolve with rest all warrant medical evaluation, including nutrition and iron.
Be mindful of messages. Even well-intentioned comments about body size can have a lasting impact. Positive reinforcement around performance, energy and health is more helpful.
Seek help early. The earlier under-fueling is identified and addressed, the less likely it is to progress to something more serious and harder to treat.

“If you don’t feel your athlete is performing her best, or she doesn’t feel quite right, consult with your healthcare provider,” Dr. Weiss Kelly says. “Total body health is what we’re really aiming for.”