According to the National Eating Disorders Association (NEDA), the prevalence of eating disorders is shown to be higher in athletes compared to non-athletes, with up to 45% of female athletes and up to 19% of male athletes experiencing some type of disordered eating.
As a two-time collegiate Division I national champion, Yamilet Molina, MS, NCC, LPC, understands the demands of competing in sports. Her personal and professional experiences led her to open her own practice, YM Counseling Services, where she works specifically with athletes struggling with eating disorders.
Although Molina believes the innate desire to be the “best” is a big contributing factor, she recognizes that eating disorders in athletes stem from a mix of both internal and external pressures.
“Sport-specific expectations, particularly in weight-dependent sports like gymnastics, swimming, cheer, and endurance running, where leanness is often seen as a performance advantage, can be a huge trigger,” says Molina. “Athletes in these sports may feel significant pressure to manipulate their weight due to influences from coaches, teammates, judges, or cultural norms.”
Other contributing factors can include control, perfectionism, past trauma, and/or self-worth, according to Molina.
“Athletes live structured lives with strict training, competition schedules, and responsibilities. They hold themselves to high standards and feel defined by their performance. The fear of failure, injury, or retirement can lead to disordered eating to maintain control or protect their athletic identity,” says Molina.
Molina maintains that the most effective approach in working with athletes with eating disorders is individualization, as each client presents with their own experiences, pressures, and motivations.
“I utilize a combination of evidence-based therapy and sports psychology principles, while collaborating with other professionals when necessary, to understand what’s driving their disordered eating and tailor the process to fit their individual needs,” says Molina.
For Molina, this process almost always includes helping athletes reconnect with their bodies in a way that feels safe and sustainable. Many athletes override hunger cues, push through exhaustion, or see food purely as fuel. Shifting that relationship so they take care of themselves and support both their performance and overall well-being is crucial.
Careful and compassionate communication also becomes critical when working with athletes with eating disorders. Molina offers numerous tips to consider:
- Avoid food labeling. It’s important not to label food as “good” or “bad,” or “healthy” or “unhealthy,” as this language can increase rigidity and fear of food.
- Utilize weight “recovery” instead of weight “gain.” “Recovery” promotes healing, while “gain” can affirm anxiety or fear.
- Externalize the eating disorder. Don’t view the athlete as the problem, but rather the eating disorder as something they are fighting against.
- Avoid language that implies blame. Such verbiage can worsen feelings of guilt or isolation.
- Focus on feelings, not appearance. Avoid comments about their physical appearance, which may already be a source of insecurity.
- Validate their experience. Showing empathy helps them feel supported, rather than misunderstood.
Although the core principles of eating disorder treatment—addressing underlying emotions, challenging disordered beliefs, and rebuilding a healthy relationship with food—remain the same, Molina points out the unique challenges and considerations of working with athletes with eating disorders versus non-athletes with eating disorders.
“Unlike the general population, many athletes won’t just stop exercising during recovery. Training is integral to their identity, and in some cases, their career,” says Molina. “Treatment requires a nuanced approach—helping them restore adequate nutrition while also maintaining their ability to train safely.”
Molina warns about fixating on weight as a marker of progress. While weight restoration might be part of recovery for some athletes, the bigger picture should focus on performance, energy levels, mental clarity, and overall health.
“Focusing too much on numbers can reinforce disordered thoughts instead of challenging them,” states Molina.
Injury risk is another concern Molina offers. Athletes that do not fuel properly may perform well in the short term, but they can eventually experience declining performance, with the potential for long-term health consequences.
“A big part of counseling athletes is helping them understand that proper nutrition and mental well-being enhance performance, not hinder it,” says Molina.
While the primary goal for non-athletes centers on daily functioning, return-to-play decisions for athletes add another layer of complexity. Molina stresses the importance of collaborating with other professionals (e.g., coaches, medical doctors, sports dietitians, and perhaps even psychiatrists who can address any co-occurring mental health conditions) at this time to ensure comprehensive care.
“The most successful outcomes result from a collaborative approach, where all team members are aligned in their goals and communication, ensuring the athlete receives holistic care and support on their recovery journey,” says Molina.
For counselors and counselors-in-training with a desire to serve athletes with eating disorders, Molina suggests obtaining an educational background in both mental health counseling and sports psychology while earning specialized certifications in eating disorders.
Molina also emphasizes that understanding what “healing” looks like for one athlete with an eating disorder can vary greatly from another. Recovery is not necessarily about being completely free of all eating disorder behaviors, but achieving a state of balance, awareness, and control. For those with deeply ingrained patterns of perfectionism, learning how to manage and challenge those tendencies, rather than eradicating them, is a stronger indicator of recovery.
“Ultimately, the goal is to help athletes become empowered in their recovery—to reach a place where they feel confident in their ability to navigate challenges without reverting to old, destructive behaviors. For some, this means achieving long-term healing with minimal ongoing support, while for others, periodic guidance may be helpful in managing the complexities of their life as high-performing individuals,” concludes Molina.
Yamilet Molina, MS, NCC, LPC, is the founder of YM Counseling Services in Texas, where she specializes in sports performance counseling, eating disorder therapy, and anxiety therapy. As a two-time Division I national champion, she brings personal and professional expertise to her work. Molina also utilizes sports psychology techniques to help athletes navigate performance anxiety, mental blocks, and the challenges of sports retirement.
