Prevalence of eating disorders and disordered eating in athletes: a systematic review and meta-analysis
Stella Nabuco Nasser, Camila Bertini Martins, Gianluca Macedo Cavalcante, Fábio Augusto Do Prado Marmirolli, Angélica De Medeiros Claudino, Thiago Marques FidalgoObjective
To estimate the prevalence of eating disorders (EDs) and disordered eating (DE) among athletes across training levels and assessment methods and to identify moderators associated with prevalence estimates.
Design
Systematic review, meta-analysis and meta-regression conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
Data sources
PubMed/MEDLINE, Scopus, Web of Science and SportDiscus were searched from inception to December 2024.
Eligibility criteria for selecting studies
Studies were eligible if they included active athletes of any sex, age, sport discipline or training level and reported the prevalence of ED and/or DE using standardised assessments, including clinical diagnoses or structured diagnostic interviews for ED, and self-report instruments with established cut-off values for DE. Studies were excluded if they involved retired athletes, participants with pre-existing ED diagnoses, included fewer than 25 participants, reused data or were non-peer-reviewed.
Results
From 1582 identified records, 190 studies (58 335 athletes, 34 628 women) were included in the systematic review and 127 high-quality studies (43 006 athletes) in the meta-analysis. The pooled prevalence of ED/DE was 20.0% (95% CI 17.0% to 23.0%). Subgroup analyses showed no significant differences according to training level or screening method (clinical interview or diagnosis vs self-reported instruments). However, prevalence varied significantly by instrument: Eating Disorder Examination yielded the lowest prevalence estimates (11.9%), whereas Eating Disorder Inventory yielded the highest (28.3%). Meta-regression showed that a higher proportion of women and more recent publication years were associated with higher prevalence estimates.
Conclusions
Approximately one in five athletes experience ED or DE, underscoring the magnitude of this issue in sport. These findings highlight the need for validated, athlete-specific screening instruments and tailored prevention and intervention strategies.