Binge Eating Disorder in Athletes: What We Need to Talk About

Leilanie Pakoa
Jun 1
5 min read

Over the past couple months I have completed close to 30 hours of professional development on binge eating disorder (BED), thanks to the ANZAED Autumn workshop series. I have come away from that training with a renewed conviction that this is one of the most underdiagnosed, misunderstood, and inadequately supported conditions in the athlete population and that current trends in weight-loss medication are making the situation more urgent, not less.

What Is Binge Eating Disorder?

Binge eating disorder is the most common eating disorder in adults. It is characterised by recurrent episodes of eating large quantities of food — often very rapidly and past the point of physical comfort — accompanied by a profound sense of loss of control. Unlike bulimia nervosa, BED does not involve compensatory behaviours such as purging, excessive exercise, or fasting after a binge episode.

According to DSM-5 diagnostic criteria, a BED diagnosis requires binge eating episodes occurring at least once per week for three months, accompanied by three or more of the following:

eating much more rapidly than normal
eating until uncomfortably full
eating large amounts when not physically hungry
eating alone due to embarrassment
feeling disgusted, depressed, or very guilty afterwards
(American Psychiatric Association, 2013).

What is often not included in the diagnostic criteria but is clinically significant, is the cognitive dimension of BED: the persistent preoccupation with food, the mental energy consumed by thoughts about eating, the shame and self-criticism that operate before and after a binge episode, not just during it. Treating only the behaviour without addressing the underlying cognitive and emotional patterns leaves the root of the problem untouched.

How Common Is BED in Athletes?

BED affects approximately 3–5% of the general population, making it more prevalent than anorexia nervosa and bulimia nervosa combined. In athletic populations, rates are harder to establish because BED is rarely screened for in sport health checks and athletes are often reluctant to disclose.

What we do know is that the conditions that increase BED risk are common in sport: intense pressure around body weight and composition, perfectionism, a history of restrictive dieting, emotional regulation difficulties, and significant stress.

Many athletes who binge eat do not identify what they are experiencing as an eating disorder, they may see it as a failure of willpower, a character flaw, or something shameful to hide rather than something to seek help for.

The ADHD Connection

One of the most important emerging areas of research is the significant comorbidity between ADHD and binge eating disorder. Studies indicate that individuals with ADHD are approximately 4.1 times more likely to have BED than the general population, with ADHD prevalence in BED populations estimated at nearly 20% (PMC, 2024).

The mechanism makes sense when you understand both conditions. ADHD involves impairment in impulse control and executive function including the ability to regulate emotional responses and delay gratification. Food can function as a rapid, reliable source of dopamine in a brain that is chronically under-stimulated or emotionally dysregulated.

Binge eating, in this context, is not simply ‘overeating’, it is often a self-regulatory response to an emotional or neurological need that has not been addressed in any other way. For athletes with undiagnosed ADHD who are also dealing with the pressures of performance, body image, and eating, this dynamic can be particularly significant.

Sensory Processing and Sleep

Two other areas that are often overlooked in discussions of BED are sensory processing and sleep. Sensory processing differences, more common in individuals with ADHD or autism, can significantly influence eating behaviour.

Some individuals experience intense emotional and physiological responses to sensory input, which can both restrict food choices and trigger seeking out high-stimulation foods during periods of stress or overwhelm. Binge eating can function, in some cases, as a form of sensory regulation (Cobbaert et al., 2024).

Sleep disruption has a bidirectional relationship with BED. Poor sleep disrupts the hormonal regulation of hunger and satiety, increasing cravings for high-calorie, high-carbohydrate foods particularly in the evening and at night. And binge eating itself, particularly late-night episodes, disrupts sleep onset and quality. For athletes managing demanding training schedules and high physiological and psychological stress, this cycle can become entrenched quickly.

What Therapy Works?

The evidence base for treating BED has grown considerably. Three approaches stand out. Cognitive Behavioural Therapy (CBT) is considered first-line treatment and has the strongest evidence base. CBT addresses the thoughts, beliefs, and behavioural patterns that maintain binge eating, particularly the overevaluation of shape and weight, the black-and-white thinking around food, and the shame and self-criticism that follow episodes.

Dialectical Behaviour Therapy (DBT) has shown particular promise for BED, especially where emotional dysregulation is central to the binge eating cycle. DBT builds skills in mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. Research suggests DBT may produce less relapse than CBT at six-month follow-up (Linardon et al., 2022).

Acceptance and Commitment Therapy (ACT) helps individuals develop a different relationship with difficult thoughts and emotions rather than fighting against cravings or shame, ACT builds the capacity to notice these experiences without being driven by them, making it particularly useful in relapse prevention.

A Word on GLP-1 Medications

I cannot write this blog without addressing the rapidly growing use of GLP-1 receptor agonists i.e. medications such as semaglutide (Ozempic, Wegovy) as weight management tools in both general and sporting populations.

The concern is this: GLP-1 medications suppress appetite and produce rapid weight loss, but they do not address the psychological, neurological, or emotional drivers of disordered eating.

For individuals with underlying BED, these medications may suppress the symptom while leaving the root causes entirely untouched or, in some cases, may exacerbate them. A forced reduction in appetite can feel like sudden restriction to a brain already prone to compensatory bingeing. Rapid weight loss can reinforce disordered beliefs about the body and food.

The critical issue is that BED is rarely screened for before these medications are prescribed. Healthcare providers and sports medicine practitioners need to be assessing for underlying eating disorder pathology before initiating GLP-1 treatment not as an afterthought, but as a standard part of the clinical process (NEDA, 2024). This is a patient safety issue, and it needs to be taken seriously.

Seeking Help

BED is a serious but treatable condition. Athletes who recognise themselves in any of this deserve to know that help is available, that recovery is possible, and that what they are experiencing is not a character flaw, it is a complex condition with real biological, psychological, and environmental contributors. The first step is reaching out to a trusted support who might be able to help link you in with someone qualified to help: a psychologist, psychiatrist, or GP with experience in eating disorders.

References

American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). APA Publishing.
Cobbaert, L., et al. (2024). Sensory processing across eating disorders: A systematic review and meta-analysis. International Journal of Eating Disorders, 57(7), 1465–1488. https://doi.org/10.1002/eat.24184
Jimenez-Murcia, S., et al. (2016). Symptoms of attention deficit hyperactivity disorder among adult eating disorder patients. BMC Psychiatry, 16(1). https://doi.org/10.1186/s12888-016-1093-1
Linardon, J., Hindle, A., & Brennan, L. (2022). Dialectical behaviour therapy for eating disorders: A systematic review and meta-analysis. Eating Disorders, 30(2), 184–204.
National Eating Disorders Association (NEDA) (2024). GLP-1 medications and eating disorders. https://www.nationaleatingdisorders.org/glp-and-eating-disorders/
PMC (2024). Attention deficit hyperactivity disorder and eating disorders: An overlooked comorbidity. https://pmc.ncbi.nlm.nih.gov/articles/PMC10100596/