Disordered eating in runners
Evidence: moderate
Disordered eating is more common in endurance and lean-aesthetic sports than in the general population. It runs on a spectrum from mild restriction to a clinical eating disorder, drives RED-S and bone stress injuries, and places a duty of care on coaches.
Not medical advice
This is a general knowledge base, not medical or dietary advice. If you are injured, unwell or weighing up a supplement or a change to your diet, speak to a doctor, physiotherapist or registered dietitian who knows your situation.
Distance running selects for and rewards the traits that also predispose to disordered eating: discipline, a tolerance for discomfort, and a belief that lighter is faster. This page treats the subject factually. Disordered eating is a common, treatable problem in runners, not a moral failing, and recognising it early prevents serious harm.
Higher prevalence in running
Disordered eating is most common in sports that emphasise leanness, aesthetics, weight class or endurance, and distance running sits in that group (Mancine et al. 2020). Across a large meta-analysis of 177 studies and almost 71,000 athletes, the mean prevalence of self-reported disordered eating was about 19%, with female sex and lean-sport participation among the risk factors (2024 meta-analysis). The true figure is uncertain because most studies rely on self-report screening, which can both under- and over-count.
A spectrum, not a category
Disordered eating describes a range, not a single diagnosis. At one end sit restrictive habits, rigid food rules, skipped meals, fixation on weight, that fall short of a clinical disorder but still impair health. At the other end are clinical eating disorders such as anorexia nervosa and bulimia nervosa, which are serious psychiatric illnesses with high medical risk. A runner can sit anywhere on that line and can move along it over time. The important point is that harm to bone and hormones starts well before the clinical end.
Why it matters for runners specifically
The route to injury runs through energy availability
Disordered eating is one of the main ways runners end up in chronic low energy availability, the root cause of RED-S. That suppresses bone-building hormones and raises bone stress injury rates (Gallant et al. 2024). Recurrent stress fractures, especially at high-risk sites, are a known red flag for an underlying energy and eating problem (Tenforde et al. 2024).
A runner who keeps fracturing, loses their period, or is repeatedly ill is not simply unlucky. These are downstream signs that often trace back to underfuelling, and the IOC RED-S framework treats disordered eating as a core driver to screen for (Mountjoy et al. 2023).
Warning signs
Signs worth taking seriously include rapid or continued weight loss, rigid or secretive eating, avoidance of whole food groups, training through injury or illness, preoccupation with weight or body shape, loss of menstruation, and recurrent bone stress injuries. No single sign is diagnostic. A cluster of them warrants a careful, non-judgemental conversation and referral.
The coach’s duty of care
Refer, do not diagnose or police food
A coach is not a clinician. The role is to notice the pattern, raise it with care, and route the athlete to a sports physician and a registered dietitian, with mental-health support where needed, as the RED-S management pathway sets out (Mountjoy et al. 2018). Comments about weight, public weigh-ins and ‘race weight’ targets can trigger or worsen the problem and are best avoided.
Coaches and training environments shape eating behaviour, for better or worse. Framing food as fuel for performance, avoiding weight talk, and treating recurrent injury or lost periods as signals rather than inconveniences are the practical levers within a coach’s control.