Eating disorder recovery among athletes: A grounded theory of key people and actions involved in athletes’ recovery and reintegration into sports

Sport participation can contribute to physical, mental, and social health, yet athletes face elevated risk of eating disorders (EDs), with up to 45% of women and 33% of men athletes being affected. To support athletes in experiencing the benefits of sport participation, the purpose of this study was to develop a conceptual framework of who should support athletes during recovery and sport reintegration, and how. Data were collected in two rounds. In round one, athletes (n = 17) from various sports (e.g., boxing, running, gymnastics, and rowing) completed a semi-structured interview where they first constructed a visual representation of their support network, then elaborated on each network member’s role. In round two, individuals who supported athletes during recovery and sport reintegration (e.g., coaches, family, psychologists, dietitians) (n = 12) were recruited for a semi-structured interview. Data were iteratively analyzed using a constructionist grounded theory methodology. Our framework depicts six layers to athletes’ experiences: (1) development of ED behaviors, (2) turning point, (3) early recovery, (4) toward full(er) recovery, (5) future self, and a superimposed sixth layer outlining interpersonal and systemic considerations. Within each layer, specific people and actions that can collaboratively ensure athletes’ physical and psychological safety during recovery are delineated. Central to our framework is that with support from important others, athletes became increasingly empowered to (re)define their relationship with their body, food, sport, and self. This study provides a conceptual framework that can be used by sports psychologists, coaches, and practitioners, and applied within sport organizations to support athletes in a healthy return-to-sport.