Prevalence of disordered eating in national-level rugby: a mixed-methods study of male and female players in England

Athletes are recognised as being at elevated risk of disordered eating (DE), with particularly high prevalence observed in ‘weight-sensitive’ sports. However, limited research has examined this issue within contact sports such as rugby, where unique physical demands and cultural norms may shape eating behaviours differently. This study aimed to investigate the prevalence, characteristics, and contextual drivers of DE among national-level male and female rugby union and rugby league players in England. A mixed-methods, cross-sectional design was employed utilising an online questionnaire, incorporating the Eating Disorders Examination Questionnaire (EDEQ), the Muscularity Orientated Eating Test (MOET) and open-ended qualitative questions. Participants (n = 182) included current players from Premiership Women’s Rugby, Gallagher Premiership, Women’s Super League, and Men’s Super League. Quantitative data were analysed using descriptive and non-parametric statistics and qualitative responses underwent reflexive content analysis. Data from the EDEQ showed 28% of female and 9% of male players exceeded clinical thresholds for DE, with the highest prevalence among front-row forwards and players with a self-reported body mass index of >25 kg/m². Muscularity-oriented DE was similar in both sexes (MOET mean scores: females = 13.8; males = 13.0). Athletes reported DE behaviours including binge eating (40% of participants), compulsive exercise (33%), vomiting (2%), and laxative use (1%). Qualitative findings revealed a perceived link between body composition and performance, with 82% of players attempting to manipulate their bodies in the previous 12 months. 63% of players reported pressure to change their body composition, commonly driven by coaches (17%) or intrinsic motivations (16%). 44% experienced body-related comments in the rugby setting, frequently perceived as insults/jokes (19%), with players reporting emotional distress in response (11%). National-level rugby players – particularly females, forwards, and individuals with self-reported high-BMI – are at elevated risk for DE. The findings reveal a high-pressure sporting culture in which physical size is paradoxically required and ridiculed. To address this complex issue, comprehensive and system-wide prevention strategies are urgently needed. These include challenging harmful cultural norms, cultivating psychological safety, and prioritising the holistic health and wellbeing of players across both men’s and women’s national-level rugby.