Prevalence of eating disorders and disordered eating in athletes: a systematic review and meta-analysis

OBJECTIVE: To estimate the prevalence of eating disorders (EDs) and disordered eating (DE) among athletes across training levels and assessment methods and to identify moderators associated with prevalence estimates. DESIGN: Systematic review, meta-analysis and meta-regression conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES: PubMed/MEDLINE, Scopus, Web of Science and SportDiscus were searched from inception to December 2024. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Studies were eligible if they included active athletes of any sex, age, sport discipline or training level and reported the prevalence of ED and/or DE using standardised assessments, including clinical diagnoses or structured diagnostic interviews for ED, and self-report instruments with established cut-off values for DE. Studies were excluded if they involved retired athletes, participants with pre-existing ED diagnoses, included fewer than 25 participants, reused data or were non-peer-reviewed. RESULTS: From 1582 identified records, 190 studies (58 335 athletes, 34 628 women) were included in the systematic review and 127 high-quality studies (43 006 athletes) in the meta-analysis. The pooled prevalence of ED/DE was 20.0% (95% CI 17.0% to 23.0%). Subgroup analyses showed no significant differences according to training level or screening method (clinical interview or diagnosis vs self-reported instruments). However, prevalence varied significantly by instrument: Eating Disorder Examination yielded the lowest prevalence estimates (11.9%), whereas Eating Disorder Inventory yielded the highest (28.3%). Meta-regression showed that a higher proportion of women and more recent publication years were associated with higher prevalence estimates. CONCLUSIONS: Approximately one in five athletes experience ED or DE, underscoring the magnitude of this issue in sport. These findings highlight the need for validated, athlete-specific screening instruments and tailored prevention and intervention strategies.