Table 3

Warning signs or red flags for disordered eating and eating disorders in athletes4 10 14 17 18

Behavioural changes
  • Preoccupation with food, calories, body shape and weight

  • Polarised/dichotomous thinking (including but not limited to thoughts about food, body or exercise)

  • Avoidance of food-related social activities

  • Restrictive eating, for example, cutting down or cutting out food groups, nutrients, reducing overall energy intake, counting, measuring and weighing food

  • Bathroom visits after meals

  • Evidence of binge eating (large amounts of food purchased/consumed, evidence of food wrappers hidden in the bin or another location)

  • Restriction followed by binge eating

  • Secretive behaviour regarding food intake and/or exercise behaviour

  • Increasing rigidity or inflexibility in situations

Physical changes
  • Wearing baggy or layered clothing that hides body shape

  • Relentless, excessive exercise

  • Exercise through injury/illness with inadequate recovery

  • Bone stress injury

  • Hormone dysfunction (including dysregulated menstrual cycle, libido and erectile function)

  • Frequent illness

  • Low body fat

  • Dehydration

  • Bad breath, sore gums or signs of enamel loss on teeth

  • Swelling around jaw

  • Skin effects, including dry skin, fine hairs growing around the face or signs of calluses on the knuckles

  • Unexpected weight gain beyond that expected from growth/development/puberty

  • Dramatic or rapid weight loss or gain or fluctuation

Psychological changes
  • Persistently poor and/or declining mental health

  • Increased attention to and/or criticism of one’s body

  • Feeling out of control with regard to food

  • Body image dissatisfaction and distortion