In this continuing education webinar, The Athlete’s Body Remembers: Treating Eating Disorders Shaped by a Lifetime of Performance Culture, Betsy Brenner, JD, athlete, author, speaker, and coach, and Kate Craigen, PhD, Director of Clinical Integrity at Monte Nido, explored how athletic identity shapes the development, masking, and treatment of eating disorders across the lifespan.

For many individuals, athletic history is not simply a past experience. It is something that is carried in the body, shaping how hunger, movement, and self-worth are understood long after competition ends. When eating disorders emerge in athletes, particularly in midlife, they are often rooted in patterns that have been normalized, reinforced, and even rewarded for decades.

Key Takeaways

• Athletic identity can shape eating disorder risk long after competition ends.  Performance-driven beliefs about food, control, and body image may persist across the lifespan.
• Eating disorders in athletes are often hidden or normalized.  Discipline, fitness focus, and structured behaviors can mask significant psychological and physical distress.
• Treatment should address identity, grief, and performance culture. Recovery often involves redefining movement, self-worth, and the relationship with the body.

The “delayed fuse” of eating disorders in athletes

Eating disorders in athletes do not always emerge during active competition. Instead, they may develop or re-emerge later in life, often triggered by transitions that disrupt identity, routine, or physical capacity.

A conceptual model presented in the session outlined this progression:

• Athletic career
• Identity transition
• Midlife stressor
• Eating disorder emergence or relapse

Midlife athletes are described as one of the fastest-growing and most under-identified groups in eating disorder treatment. In many cases, disordered patterns have been present for years but remained hidden or normalized.

Common midlife triggers include:

• Aging and body changes
• Menopause
• Retirement from sport
• Transition into coaching or different roles
• Injury or chronic illness
• Grief or life transitions such as an empty nest

These stressors can activate long-standing beliefs about control, performance, and body composition, creating conditions where eating disorders re-emerge or intensify.

The enduring impact of athletic identity on body image

Athletic identity often persists long after competition ends, shaping how individuals interpret physical and emotional experiences. Messages learned in sport can continue to influence behavior in subtle but powerful ways.

Examples of internalized beliefs include:

• Discomfort is something to push through
• Hunger signals effort or success
• Body fat is a barrier to performance
• The body is something to control or optimize
• Illness or injury should be ignored

These beliefs are not inherently pathological within a performance context. However, outside of sport, they can contribute to disordered eating patterns and difficulty responding to the body’s needs.

Even decades later, individuals may continue to interpret food, rest, and body cues through a performance lens, reinforcing behaviors that align with past training rather than current health needs.

The masking effect in high-functioning individuals

One of the most significant clinical challenges is that eating disorders in athletes are often masked by traits that are socially reinforced and even admired.

What clinicians may initially observe includes:

• Discipline
• High functioning behavior
• Structured eating patterns
• Focus on fitness and health

However, beneath these surface-level observations, individuals may be experiencing:

• Decades of normalized restriction
• Chronic under-fueling framed as discipline
• Internalized coaching or performance-driven voices
• Body image concerns framed as motivation
• Long-term medical consequences
• Unprocessed identity loss or grief

This discrepancy highlights the gap between what appears functional and what may actually reflect significant impairment. Individuals with athletic backgrounds may be particularly skilled at maintaining this appearance, making detection more difficult.

Why standard eating disorder screening tools fall short

Traditional eating disorder screening tools often rely on language and assumptions that do not fully capture the experiences of athletes. As a result, individuals may screen as subclinical despite meaningful symptoms.

For example:

• Questions about “feeling fat” may not resonate when body composition is framed as a performance variable
• Questions about satisfaction with weight may be interpreted through optimization rather than well-being
• Weight loss may be normalized in sports that involve weight cycling
• Compensatory exercise may appear typical within training culture

This creates a gap between how symptoms are measured and how they are experienced. Athletes may appear well within traditional screening frameworks while still experiencing significant impairment.

An athlete-informed eating disorder assessment approach

To improve detection, assessment must account for the unique context of athletic experience. This includes exploring not only behaviors, but also identity, history, and meaning.

Key areas of assessment include:

Sport history

Understanding the individual’s athletic background can provide important context for current behaviors:

• Type and level of sport
• Exposure to weigh-ins or body composition targets
• Messages from coaches about body and performance
• Experience transitioning out of sport

Food and exercise patterns

Assessment should explore how decisions around food and movement are made:

• How food intake is determined
• Emotional and behavioral responses to missed workouts
• Changes in eating when not exercising

Identity and grief

For many individuals, the loss of athletic identity can be a significant but underrecognized factor:

• How the body is perceived now compared to athletic years
• What the body represents in the present
• Whether there is grief for a previous version of self

Medical history

Long-term physical effects of athletic patterns should also be considered:

• History of stress fractures or low bone density
• Amenorrhea
• Effects of weight cycling
• Cardiovascular health
• Impact of menopause

This broader framework allows clinicians to move beyond symptom checklists and better understand the full clinical picture.

Barriers to eating disorder identification in midlife athletes

Eating disorders in midlife athletes are often underrecognized, particularly in individuals who do not identify as elite athletes.

Most cases occur in recreational contexts rather than professional sport. This can contribute to underdiagnosis, as behaviors may be perceived as part of a healthy or active lifestyle.

Additional barriers include:

• Self-minimization of symptoms
• Social reinforcement of restrictive or exercise-driven behaviors
• Limitations in screening tools

These factors can delay diagnosis and access to appropriate care.

Treatment considerations for midlife athletes

Treatment for athletes with eating disorders requires attention to both physical recovery and the psychological impact of athletic identity.

Movement and exercise

In many cases, pausing sport or exercise is necessary to support recovery.

Key considerations include:

• Temporary restriction of exercise to support weight restoration and medical stability
• Collaboration with medical providers
• Gradual return to movement based on treatment progress
• Aligning return-to-sport goals with nutritional and recovery benchmarks

The goal is not permanent restriction, but a safe and structured return to movement when appropriate.

Addressing identity and emotional regulation

Athletic identity often plays a central role in how individuals regulate emotions and define themselves.

Treatment may include:

• Exploring the role of sport in emotional regulation
• Expanding identity beyond performance
• Processing grief related to loss of athletic identity or capacity

This work is essential, particularly when eating disorder behaviors have served as a way to maintain a sense of control or identity.

Redefining movement and control

For many individuals, recovery involves rethinking the meaning of movement and control.

Considerations include:

• Exploring movement as something beyond performance or compensation
• Recognizing that rigid control strategies may no longer serve the individual
• Adapting expectations to align with a changing body

Approaches that emphasize simply “letting go of control” may not be effective and can increase distress if not carefully adapted.

Engaging support systems

Collaboration with others in the individual’s environment can support recovery.

This may include:

• Partners
• Coaches or trainers
• Healthcare providers

Clear communication about nutrition, rest, and movement can help align expectations and reduce mixed messaging.

Supporting long-term eating disorder recovery in athletes

Recovery in this population involves not only addressing eating disorder behaviors, but also reshaping deeply ingrained beliefs about the body, performance, and self-worth.

The body may “remember” years of training, restriction, and reinforcement. At the same time, it has the capacity to learn new patterns.

This shift includes:

• Moving away from performance-based self-worth
• Relearning hunger, rest, and recovery cues
• Recognizing the body as deserving of care, not optimization

A key reframe highlighted in the session involves shifting focus from appearance to function, emphasizing what the body can do when it is adequately nourished and supported.

Moving forward in clinical practice

Eating disorders shaped by performance culture require clinicians to look beyond traditional presentations and consider the long-term impact of athletic identity.

Improving care for this population involves:

• Recognizing the delayed and often hidden nature of symptoms
• Using assessment approaches that account for athletic history
• Adapting treatment to address identity, grief, and control
• Challenging assumptions about what “healthy” behaviors look like

For clinicians, this work requires both clinical expertise and curiosity. When the full context of an individual’s experience is understood, treatment can more effectively address the underlying drivers of the eating disorder and support sustainable recovery.

Explore more Monte Nido continuing education resources.

‍