A longitudinal investigation of performance and injury outcomes associated with disordered eating in elite athletes

Background: Disordered eating is common in elite athletes and may be motivated by perceived performance advantages associated with becoming leaner. However, few studies have examined the performance outcomes associated with disordered eating over time in this population. This study investigated self-reported performance and days missed from training/competition due to injury as longitudinal outcomes of disordered eating. Methods: Current elite athletes predominantly from Australia and the US (N = 178; 72.4% female, M_age=23.9, SD_age=7.0) completed online surveys between March-September 2023 at baseline (T1), and after 6-months (T2; N = 110) and 12-months (T3; N = 91), including measures of demographic data, disordered eating, self-reported performance in training and competition, and days missed due to injury over the last 6-months. T1-disordered eating was examined as a predictor of T2-performance and T2-days missed due to injury via multiple regression controlling for autocorrelations, with multiple imputation to account for data attrition. The relationships over 12-months were examined via multilevel mixed-effects analyses. Results: Greater T1-disordered eating significantly predicted a greater increase in days missed due to injury at 6-month (B = 0.04, 95% CI = 0.01–0.07), but not 12-month, follow-up, controlling for gender. Greater disordered eating was significantly associated with poorer self-reported performance across timepoints (r = −.23, p =.027 to r = −.39, p <.001); however, T1-disordered eating did not predict a significant change in performance over time, controlling for gender. Conclusions: Disordered eating should not be considered as either normal or necessary to improve athletic performance, but rather a potential pathway towards injuries and absences from training and/or competition. These findings highlight a need for future research investigating outcomes associated with disordered eating across more specific aspects of performance and injury.