Brian Pollack, LCSW, CEDS-C
Brian is the Founder and Clinical Director of Hilltop Behavioral Health, a boutique eating disorder specialty practice in Summit, NJ. He is one of the few male master’s-level Certified Eating Disorder Specialists in the country, with expertise in FBT, male clients, athletes, and muscle dysmorphia. He hosts the Minding Men podcast and serves as an adjunct professor at Yeshiva University.
Learn more about Brian →Practice ends at six. She is the last one still running sprints, alone, after the coach has gone home. Nobody made her stay. She tells her parents it is because she wants to make varsity. That is true. It is also not the whole truth.
At dinner she pushes food around her plate and talks about her workout. Breakfast she skips, because there is a scale in the locker room and a number she is trying to beat. Her teammates call her the hardest worker on the team. Her coach calls her coachable. Nobody calls it what it might be.
This is how eating disorders in athletes usually begin: quietly, inside behavior everyone around the athlete is trained to praise.
Why Eating Disorders in Athletes Hide in Plain Sight
Sport rewards exactly the behaviors that eating disorders require to survive undetected. Restriction looks like discipline. Over exercising looks like commitment. Weighing in looks like professionalism, not obsession. A coach who sees an athlete skip the postgame pizza sees willpower, not a warning sign.
The numbers tell a different story than the praise does. The National Eating Disorders Association reports that prevalence rates for eating disorders run higher in athletes than in non-athletes, ranging from 6 to 45 percent in female athletes and 0 to 19 percent in male athletes, depending on the sport and how it is measured. Those ranges are wide because so much of this goes unscreened and unreported. An athlete who is winning does not get pulled aside and asked how she is eating.
Risk is not spread evenly across every sport. Weight class sports (wrestling, rowing, boxing), aesthetic sports (gymnastics, dance, figure skating, diving), and endurance sports (cross country, track, swimming) carry some of the highest documented rates, because leanness in those sports is treated as a direct performance advantage rather than a coincidence. That framing is exactly what makes the eating disorder so hard to see from the outside. The behavior and the sport goal look identical.
What Coaches and Parents Consistently Miss
Most of the adults around a young athlete are watching for weight loss. That is often the last sign to appear, not the first.
Earlier signs look like this: irritability that only shows up around meals, a sudden new set of food rules (“clean eating,” cutting entire food groups, refusing anything the team doesn’t approve of), gastrointestinal complaints, missed periods in female athletes, stress fractures or repeated soft tissue injuries that do not have an obvious mechanical cause, and a mood that tracks tightly with performance rather than with anything else in the athlete’s life. Sports medicine now has a name for the physical consequence of chronic underfueling: Relative Energy Deficiency in Sport, or RED-S, a syndrome first defined by the International Olympic Committee where the body pulls energy away from bone density, immune function, and hormone production to protect basic survival functions first. An athlete can be performing well and still be quietly breaking down.
Two-a-days, tryouts, and preseason weigh-ins put a spotlight on all of this at once. The pressure to make a roster, hold a weight class, or prove readiness for a new season is concentrated into a few brutal weeks, right when a body that has been resting all summer is being asked to perform like it never stopped. That collision, not the calendar page turning to September, is what makes late summer such a high risk window every single year.
Coaches are not usually the ones who catch this early, and that is not a criticism. Their job is performance, not diagnosis. A coach watching from the sideline sees effort, focus, and results. They are not positioned to notice that the athlete who never misses a rep also has not eaten a real meal since Tuesday. That is a gap parents and clinicians have to fill, and it is exactly why so much of this only gets named after an injury, a fainting episode, or a pediatrician’s bloodwork forces the conversation that sport culture had been avoiding.
How Eating Disorders in Athletes Show Up in Male Athletes
Eating disorders in athletes do not stop at the locker room door marked “girls.” Male athletes in wrestling, rowing, and weight lifting face their own version of restriction and cutting, often with even less language available to describe what is happening to them. A wrestler who starves and dehydrates himself to make weight is following his coach’s plan. A lifter who cycles between bulking and cutting hard enough to blur into disordered eating is following a program, not breaking a rule. Neither one is likely to use the words “eating disorder” about himself, and neither is his coach.
This is the same blind spot our eating disorder treatment for men center was built to close, and it overlaps closely with what we see in muscle dysmorphia: a body that never feels lean enough, or never feels big enough, driving eating and training behavior that everyone around the athlete reads as dedication.
Getting Help Without Giving Up the Sport
Parents and athletes often delay treatment for one specific fear: that getting help means quitting the sport entirely. That fear keeps a lot of athletes silent for a long time.
“The athletes I work with almost never walk in saying they have an eating disorder,” says Brian Pollack, LCSW, CEDS-C, founder of Hilltop Behavioral Health. “They walk in saying they want to get back to feeling like themselves, or that a parent made them come. The eating disorder is usually the last thing anyone names, even though it’s been running the show for a while.”
At Hilltop Behavioral Health, treatment for eating disorders in athletes does not start from the assumption that the sport is the enemy. It starts from figuring out what the athlete’s relationship with food and their body actually is, separate from what the sport has trained them to perform. Our team, led by founder Brian Pollack, LCSW, CEDS-C, one of a small number of master’s level clinicians nationally holding the CEDS-C credential, works with athletes and their families to build a plan that treats the eating disorder seriously without pretending the sport does not matter to the athlete’s identity. Some of what looks like “clean eating” in an athlete’s routine is worth a closer look too. We’ve written before about where orthorexia and anorexia overlap and where they differ, which is often the more accurate starting point for athletes whose restriction hides behind the language of nutrition rather than weight loss.
If your athlete is heading into fall tryouts, weigh ins, or two a days and something about their eating or their relationship to their body has started to worry you, that instinct is worth listening to. Our full team provides eating disorder treatment in New Jersey for adolescents, adults, and athletes, in person in Summit and via telehealth across the state.
The first conversation is free. Reach out today to talk with our team about what you’re seeing and what support could look like. Prefer to talk it through first? One call is enough to start: (973) 637-0572.
