Many youth athletes quietly struggle with eating disorders – Colorado mandates new training that could turn things around

Colorado requires middle, junior high and high school coaches in public and private schools to attend training on mental health. Currently, training is required to cover concerns specific to young athletes such as anxiety disorders, depression and suicide prevention.

These training requirements result from 2026 legislation called Alyssa’s Youth Concussion and Mental Health Protection Act. It was named after a young athlete who died by suicide at age 13, following mental health struggles likely connected with multiple concussions.

But these trainings could also address an overlooked mental health struggle: eating disorders. If eating disorders were also included, Colorado could increase coaches’ ability to identify and support athletes who are at risk of or who have an eating disorder.

I am an eating disorder clinician and researcher, youth volleyball coach of 12 years and former youth athlete. In my clinical work with eating disorders, many of my patients are athletes. Addressing their concerns related to eating, body image and athletics is complex.

Alyssa’s act does not explicitly include eating disorder education. If it did, I believe this law could dramatically increase coaches’ abilities to identify and support athletes who have or are at risk of an eating disorder.

Consequences of eating disorders

In Colorado alone, 501,370, or about 9% of Coloradans, will experience an eating disorder in their lifetime, according to Harvard’s Strategic Training Initiative for the Prevention of Eating Disorders. As the thinnest state in the nation, Colorado may face particularly strong pressures for disordered eating.

A 2020 report on the social and economic cost of eating disorders in the United States found that eating disorders cost Colorado an estimated US$1.1 billion annually in healthcare costs, lost productivity and informal care. They are responsible for 938 emergency room visits and 410 inpatient hospitalizations yearly.

Nationally, one person dies every 52 minutes from an eating disorder.

Scientists have identified athlete-specific risk factors for these illnesses. These include weight cycling – when a person’s weight quickly falls and rises – and dieting pressure, such as recommendations from coaches to lose weight or bulk up. It also includes praise from coaches or parents for weight loss.

Disordered eating attitudes and behaviors contribute to poorer performance in sports, increased injuries and increased dropout rates.

Beyond sports performance, eating disorders are linked to significant medical consequences, elevated mortality rates and social, educational and vocational impacts.

Medically, eating disorders also impact development of the female athlete triad, which includes energy deficiency, menstrual disruption and low bone mineral density – all of which can contribute to increased injuries and poorer mental health. A similar phenomenon, the male athlete triad, involving energy deficiency, hormonal disruption to testosterone and poor bone health, is also observed.

Opportunity to address eating disorders

Before Alyssa’s act was passed, Colorado law required youth coaches to attend concussion recognition trainings. Now, coaches are required to learn about a broader range of mental health concerns. These include stress, anxiety disorders, depression, trauma, substance abuse and suicide prevention.

This education is also mandated to cover how coaches affect athlete mental health. Research is starting to investigate how coaches can support athletes’ mental health and reduce eating disorder risk. Though this research is still developing, the NCAA previously developed guidelines for coaches to help reduce eating disorders.

The guidelines suggest coaches be aware of eating disorder symptoms, de-emphasize weight and screen proactively. They also encourage coaches to help athletes seek out mental health support and ensure all athletic community members are aware of the risk factors, symptoms and consequences of eating disorders.

Why sports participation can either help or harm

While estimates vary, a 2024 review addressing the prevalence of eating disorders in athletes found that 2% to 52% of U.S. athletes are estimated to have an eating disorder. Globally, a 2026 systematic review estimated that 1 in 5 athletes have an eating disorder or disordered eating behaviors or symptoms. Those include dieting, skipping meals, binge eating and excessive exercise.

Regarding risk, a 2023 study found that 77.7% of youth athletes were at risk of an eating disorder, with no differences in sex. Further, while data on the proportion of eating disorders among transgender athletes is not yet available, trans individuals typically display elevated rates of eating disorders compared with their peers.

While athletes and nonathletes show similar rates of eating disorders, research shows that participating in athletics can both increase risk for eating disorders or protect against them. The difference depends on the sport and setting.

For example, participation in team sports that are not focused on weight, like soccer, basketball and hockey, tends to protect against eating disorder risk. Individual sports – particularly those that have more emphasis on an athlete’s physique, like gymnastics, wrestling and distance running – show increased risks of eating disorders and worse mental health outcomes.

Research has also shown that eating disorder risk is impacted by the level of performance. Competing at a higher performance level reveals worse mental health outcomes compared with lower levels, particularly for women and girls.

Other studies in men suggest eating disorder risk is more driven by pressures from coaches or family regarding weight than sport type. Younger athletes at higher weights are particularly vulnerable.

Importantly, among athletes, eating disorders can be particularly complex. Many of the characteristics that facilitate athletic success can also increase disordered eating symptoms. These include excessive exercise, perfectionism, rule following, deference to coaches, high achievement and obsessive-compulsive traits.

Recognizing and treating eating disorders

Recognizing eating disorders quickly and intervening early can significantly improve outcomes and reduce time spent in illness. But recognizing the disorder can be tricky. Only 6% of people with eating disorders are considered medically underweight. The stereotypes of emaciated patients can lead to providers and loved ones often missing the signs that their loved one is struggling.

People of all ages, genders and races experience eating disorders. But stereotypes about who gets an eating disorder may make it harder for someone to recognize their disorder and access treatment. People of color and those from lower socioeconomic groups are less likely to access treatment due to costs and family and employment responsibilities.

If you are concerned for yourself or someone else, consider consulting this guide for athletes, accessing a free assessment or attending a free support group. There are also treatment programs tailored to athletes, including those offered by Monte Nido, Equip and Opal Food and Body.

Coaches and athletic trainers may also benefit from this free online training about promoting body inclusion and positive body image in fitness spaces.

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