The Hidden Struggle: The Intersection of Athletic Performance and ARFID
Athletic excellence is, at its core, an act of self-belief. The body performs because the mind believes it can, and the mind believes because the body has shown up enough times before to earn that conviction. When food exists inside that loop as a problem the athlete cannot solve, the whole structure begins to collapse in quiet, almost invisible ways.
What is ARFID? Understanding Avoidant/Restrictive Food Intake Disorder
ARFID is a feeding and eating disorder defined by restriction that is not driven by body image. The avoidance usually falls into one of three patterns, and sometimes more than one at a time.
- Sensory Aversion: Textures, smells, and temperatures feel intolerably wrong.
- Fear of Negative Consequences: A memory of choking, vomiting, or pain builds a fence around large categories of food.
- Low Interest in Eating: Hunger never quite arrives loudly enough to demand action.
ARFID was added to the DSM-5 in 2013, which means we are still, in clinical terms, in the early years of learning what it actually looks like across populations.
The Quiet Vicious Cycle of ARFID in Sports
ARFID does not sit politely beside the demands of sport. The two compound. Training asks for more fuel than the athlete can deliver, the body responds by pulling resources from the places it can spare least, and the resulting fatigue or injury or hormonal disruption produces fresh anxiety around the very foods that might have helped. The cycle, once it begins, runs in silence for a long time, and by the time it surfaces it has often already cost the athlete something they cannot easily get back.
How ARFID Leads to Relative Energy Deficiency in Sport (REDs)
What tends to happen, when ARFID and athletic demand share the same body, is that Relative Energy Deficiency in Sport develops as a downstream consequence. REDs, as defined in the 2023 IOC consensus statement, is what the body produces when its energy intake chronically fails to cover both training and the basic biological work it would do anyway.
In an athlete with ARFID, the conditions for REDs are essentially built in. Safe foods in narrow rotations, at the volumes ARFID typically allows, often cannot carry the load of serious training. The math will not work. The body is honest in a way the rest of the system rarely is, and it begins to compensate. Cycles go quiet. Bones thin. Immunity drops. Mood flattens. Performance, which the athlete has often built their identity upon, begins to slide for reasons that look from the outside like a character flaw and from the inside like a slow betrayal.
When ARFID and Body Image Issues Overlap
I should also say that body image is often present in these cases, even when it did not start there. Athletes with ARFID receive the same cultural messages every other athlete receives about leanness and shape and what an athletic body is supposed to look like, and over time the original sensory or fear-based avoidance can begin to braid together with concerns about size. The thread that started in childhood becomes difficult to separate from the thread that arrived in adolescence. By the time these athletes find their way into my office, both threads are usually pulling at once, and good care has to be careful about which one it loosens first.
Case Study 1: The Adolescent Athlete Hiding ARFID
Consider a sixteen-year-old varsity distance runner. His freshman season was strong. By sophomore year his times had begun to slip, and by junior year he was getting injured every few months, anxious before meets in a way he had not been before. His parents described him as a picky eater, a phrase his pediatrician had been writing on charts since he was five, and no one had ever named what was actually there.
He had had sensory-based ARFID for as long as he could remember. His safe foods were a small constellation. He did not dislike his body. He did not want to lose weight. He simply could not eat what his teammates ate after long runs, and he had been hiding the size of that gap for years because he did not want to be the kid who was still picky. His ferritin was low. He carried two stress fractures behind him. His mood had dropped, which his family attributed to junior year, and his coach, who liked him, had gently suggested that he needed to want it more. He wanted it. He just could not fuel for it.
The Psychological Toll on Athletic Identity and Self-Belief
I want to spend a careful moment on what this kind of long, hidden struggle does to an athlete’s sense of self, because the conversation tends to skip it in favor of more measurable things, and it should not. An athlete’s self-belief is not a soft skill. It is part of how performance actually works. The athlete who trusts their training and trusts their body and trusts that they belong in the room generally outperforms the equally talented athlete who does not, and this is not a motivational sentiment. Any coach who has watched a confident athlete and a doubtful athlete run the same race in the same body knows it instinctively.
When ARFID enters the picture, that self-belief begins to erode in a particular and quiet way. The athlete watches themselves fail at something others seem to find easy. They notice the gap between their plate and everyone else’s plate. They learn to hide it, and the hiding takes its own toll. Slowly, the athlete loses the ability to distinguish “I am underfueled” from “I am not good enough.” Research on disordered eating in elite athletes has identified athletic identity itself as a unique risk factor, which is to say: the very thing that makes someone good at their sport can become the thing that makes the eating disorder hardest to see and hardest to heal.
Case Study 2: Fear-Based ARFID and REDs in Adult Athletes
Consider a thirty-three-year-old ultrarunner with a history of unexplained gastrointestinal symptoms, recurrent stress fractures, and four years of amenorrhea she had been told was a normal consequence of training. Her ARFID was fear-based, the residue of a severe gastroenteritis episode in her early twenties that had left her terrified of vomiting and unable to approach foods she associated with that experience. Her safe foods had narrowed gradually across the decade since, even as her training had grown.
She fueled, mostly, on bars and gels and plain rice and one specific brand of yogurt, and she had been told by three different providers that she had REDs and needed to eat more. She did not disagree. She agreed entirely. But no one had named “the why” underneath the difficulty, and so the advice had remained advice, hovering above her life without ever quite touching it. The question, when we finally sat down together, was not whether she needed to eat more. She had known that for years. The question was what made it so hard.
A Guide for Sports Coaches and Parents: Why "Just Eat It" Doesn't Work
I want to speak directly to coaches and parents for a moment, because this part of the conversation has been too soft in places it should not be. “Just eat it” is not a treatment plan. It has not worked the previous many thousands of times the athlete tried it, and asking an athlete with sensory-based ARFID to push through the same way they push through a hard set is asking them to do a fundamentally different kind of work using a tool that was built for something else. This has never been about discipline.
To parents, with the same care, “they will grow out of it” is a hope and not a plan. Many adolescents with ARFID do not grow out of it on their own. They grow into hiding it, and if your child is also an athlete, the pressure to hide it intensifies with every season. None of this is about blame. Plenty of attentive parents and good coaches have missed exactly what I am describing, because the field has not, until very recently, given them a framework that named it. But the cost of missing it is not abstract. The earlier we name what is actually there, the more of the harm we get to prevent.
Comprehensive Treatment Strategies for Athletes with ARFID
What care has to look like, when it finally happens, is not just a meal plan. It is a slow, coordinated, and difficult effort that runs on a small handful of principles:
- Prioritize Caloric Adequacy: It has to fuel the body with the foods the athlete can presently eat, before it tries to expand variety, because adequacy comes first and adequacy always will.
- Nervous System Regulation: It has to take the sensory or fear-based roots of the avoidance seriously enough to meet the nervous system where it actually is, with structured exposure work that respects how alarmed the body actually feels.
- Multidisciplinary Sports Medicine: It has to address the REDs picture alongside a sports medicine physician and the rest of the team, not afterward, because the body needs medical attention while the eating disorder care is still slow.
- Collaborative Support Systems: It has to bring the family or partner in as allies and not as enforcers.
- Healing the Body Image Relationship: Most importantly, it has to leave room for the long, quiet work of helping the athlete remember that their body is a teammate, and not a problem.
Early Intervention: Breaking the Loneliness of ARFID in Sports
I have come to think of athletes with ARFID as living in one of the loneliest corners of eating disorder care. Their illness often looks like discipline, or pickiness, or shyness around the team dinner, or simply that is just how they are. The athletes who live in this overlap deserve clinicians, coaches, and families who can hold both conditions at once, in the same room, without forcing either one to be smaller than it actually is.
They deserve to be seen as whole. The field, slowly, is learning how to see them, and there is no need to wait for the injury or the diagnosis or the breaking point to begin the work. The earlier the work begins, the more of the athlete’s life remains theirs to live.
ANAD is proud to offer free virtual peer support groups for both athletes struggling with food or body concerns and individuals with ARFID. To view our full schedule and learn more, please visit anad.org/groups.
