Sport-specific and sociocultural pressures associated with disordered eating in athletes: a systematic review and multilevel meta-analysis

Background Athletes encounter sport-specific and sociocultural pressures concerning weight, shape, appearance, eating, and body composition. Diverse outcomes and correlated estimates complicate the estimation of their associations with disordered eating. We synthesized associations between perceived external pressure and validated disordered-eating outcomes in current athletes. Methods Six databases were searched from inception through 15 August 2026. Two reviewers independently screened reports, extracted data, and applied revised Joanna Briggs Institute critical appraisal tools. All eligible evidence was synthesized narratively. Comparable concurrent Pearson-equivalent correlations entered a three-level random-effects model. Inference used sample-family-clustered variance estimation with the bias-reduced linearization (CR2) small-sample adjustment. Model-based context marginals equally weighted global psychopathology, restraint, and binge or bulimic symptoms on the Fisher- z scale before back-transformation. Sensitivity analyses, sample-family influence, and small-study effects were examined separately. Results Fifty-five reports (63 analytic cohorts; cohort n = 17–1,172) met criteria; a unique participant total was not estimable because samples overlapped. Narrative synthesis of 48 reports generally indicated positive concurrent associations, with null, inverse, and model-dependent findings. Longitudinal evidence from seven reports was heterogeneous; baseline-adjusted results were mixed. The primary meta-analysis synthesized 192 concurrent Pearson-equivalent associations from 24 cohorts in 21 reports (21 sample families). Sport-specific pressure ( r = 0.378, 95% CI, 0.229–0.510) and sociocultural pressure ( r = 0.392, 95% CI, 0.300–0.476) were positively associated with disordered-eating psychopathology. Only six cohorts contributed to both contexts. The full-model context contrast was imprecise and did not establish equivalence or relative ranking (Δ z = −0.0158, 95% CI, −0.1977 to 0.1660). Core-domain estimates were positive. Heterogeneity was substantial. Excluding the largest sample family reduced the sport-specific estimate to 0.312; associations remained positive. Risk of bias was low in one report, some concerns in 33, and high in 21. Conclusion Both evidence streams showed positive marginal associations with disordered-eating psychopathology. The evidence base did not permit a reliable direct comparison between pressure contexts. Evidence concentrated in female and weight-sensitive sport samples, with no primary effects drawn solely from non-weight-sensitive sports. Predominantly cross-sectional self-report evidence and substantial heterogeneity limit causal interpretation. Assessment and prevention should consider athletic and broader sociocultural environments. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420261488202 , identifier: CRD420261488202.