Eating disordered behaviours in Portuguese athletes: The influence of personal, sport, and psychological variables

Associations between anthropometry, body composition, and body image in athletes: a systematic review

Introduction

Poor body image is a potent risk factor for disordered eating and eating disorders. Athletes are a population at increased risk for eating disorders despite reports of lower body image concerns compared to non-athletes. Body size and composition may influence an athlete's susceptibility to poor body image.

Methods

Five electronic databases (PubMed, Cochrane Library, PsycINFO, Web of Science, SPORTDiscus) were searched to systematically evaluate the literature regarding the association between body measures (i.e., anthropometric and body composition indicators) and body image in athletes. The systematic review was completed following PRISMA guidelines and 27 cross-sectional studies were identified for inclusion and evaluated using the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies.

Results

Studies differed in methodological assessment of anthropometry or body composition (i.e., self-reported versus researcher-measured), methods for evaluating aspects of body image, geographic location, and sport type. Higher body mass index (BMI) or percent body fat (%BF) was significantly associated with greater body dissatisfaction in 16 of 22 studies (72.7%). Positive associations between body measures and aspects of negative body image were most consistently observed among studies that assessed BMI based on self-reported heights and weights, while significant associations between body composition measures (e.g., %BF, fat mass, fat-free mass) were less common. Four of seven studies assessing relationships between BMI and an aspect of positive body image reported significant inverse relationships, while three revealed insignificant associations.

Discussion

Overall, higher BMI and body fat were associated with body dissatisfaction among athletes. Future studies are needed to confirm these findings within focused populations and utilizing body composition methods (e.g., bioelectrical impedance techniques).

Systematic review registration

https://www.crd.york.ac.uk/prospero/, CRD42023446518.

Stress, Sport Anxiety, Neuroticism, and Coping in Student-Athletes: Implications for Patient Mental Health

CONTEXT

Patients' mental health has been recognized as important in providing patient-centered care in athletic training.

OBJECTIVE

To evaluate stress, sport anxiety, neuroticism, and coping in student-athletes.

DESIGN

Cross-sectional study.

SETTING

University athletics.

PATIENTS OR OTHER PARTICIPANTS

The sample comprised 86 student-athletes competing in National Collegiate Athletic Association (NCAA) Division III.

MAIN OUTCOME MEASURE(S)

The Perceived Stress Scale, Sport Anxiety Scale-2, neuroticism scale of the Big Five Inventory, and Brief COPE were used to measure stress, sport anxiety, neuroticism, and coping, respectively.

RESULTS

Sport anxiety was positively related to stress (r = 0.446, P < .001) and neuroticism (r = 0.311, P < .01) and not related to emotion-focused coping (r = 0.270, P = .804). Neuroticism was a negative predictor of emotion-focused coping (b = -0.373, P < .001), and sport anxiety and stress were predictors of dysfunctional coping (b = 0.120, P < .05; b = 0.037, P < .05). Stress, sport anxiety, and neuroticism were not predictors of problem-focused coping.

CONCLUSIONS

Support was evident for the relationship among stress, sport anxiety, neuroticism, and coping in NCAA Division III student-athletes. Such results warrant future exploration to inform behavioral interventions targeting student-athlete psychosocial factors to promote improved performance, reduce injury risk factors (eg, stress, personality, coping), and enhance student-athlete mental health and well-being.

Differences between boulderers and top rope climbers in the relationship between anxiety and disordered eating

Purpose

Disordered eating (DE) has been associated with elevated anxiety, high stress, and low self-esteem and occurs often in sports where weight is a limiting factor. Sport climbing in general provides a combination in these aspects but the relevance of a low body weight differs in the different climbing types (e.g., weight supported top rope climbing vs non-supported bouldering). To date, these differences have yet been investigated, while they might provide useful insight into the mechanisms of disordered eating and potential preventative strategies. This study aimed to assess the influence of different types of climbing (bouldering vs top rope) on the relation between anxiety and DE.

Methods

59 rock climbers (male, n = 38; female, n = 21; mean age = 28.33 ± 7.4 years) completed a survey (including the Dutch Eating Behavior Questionnaire, Mental toughness Questionnaire, Cattell's Anxiety Scale Questionnaire) investigating preferred climbing style, trait anxiety, mental toughness, and eating behavior.

Results

Boulderers showed a higher anxiety score compared to top rope climbers. Among boulderers, higher anxiety levels were associated with lower mental toughness. Among top rope climbers, anxiety was associated with emotional and external eating behavior.

Conclusion

Findings showed a higher anxiety in boulderers but no greater measures of DE. It is possible that, through their experience in a high anxiety environment, boulderers have been able to develop effective coping strategies that have a protective effect against DE.

What Is Behind Disordered Eating Behaviors? An Exploratory Study With Female Adolescents From Individual Esthetic and Nonesthetic Sports

This study explored the differences in shame, perception of performance, the need to present a perfect body image, and disordered eating among 223 female athletes from esthetic (n = 114; Mage = 14.30; SDage = 1.65; Myearsofpractice = 6.62) and nonesthetic (n = 109; Mage = 14.75; SDage = 1.87; Myearsofpractice = 4.56) individual sports. Descriptive, t test, and correlational analyses were performed. Moreover, path analyses were conducted to examine the link between the variables. The two groups did not present significant differences in variables, except in perception of performance. The path model analyses explained 47% of disordered eating. Results suggested that individual characteristic of sports practice seems relevant in shame. This study suggests that female athletes from individual sports who experience inferiority tend to adopt perfectionist defensive strategies and engage in disordered eating behaviors. This study highlights the relevance of intervention and educational programs that promote more adaptative emotional regulation strategies in female athletes from individual sports.

Does weight change relate to psychological variables and eating behaviours in combat sports?

PURPOSE

Athletes who perform combat sports tend to engage in weight-management strategies to fit in a specific weight class that are characterized by disordered eating behaviours. This study aimed to (1) characterize eating behaviours and adaptation to stress regarding an unwanted weight change before a competition; (2) evaluate the differences between athletes who consider unwanted weight changes as a challenge or as a threat in regard to emotions, coping strategies and eating behaviours; and (3) evaluate whether some of these variables related to the unwanted weight change (e.g., emotions, cognitive appraisal of the situation) are predictors of disordered eating behaviours in combat sports.

METHODS

A total of 166 combat sports athletes (75.3% male), aged between 14 and 56 years (M = 22.73; SD = 8.03), filled out a set of questionnaires that evaluated personal variables, cognitive appraisal (threat/challenge), coping, emotions, and eating behaviours related to an unwanted weight change before a competition.

RESULTS

Most of the athletes (57.3%) reported high levels of stress related to the experience of an unwanted weight change before a competition. Athletes who perceived this experience as more of a threat had significantly more eating concerns, anxiety, dejection, anger, active confrontation and emotional support. Athletes who perceived it as more of a challenge experienced more excitement and happiness. Athletes who perceived a high threat and low challenge experienced significantly increased anxiety levels and athletes who perceived this experience as a low threat and the low challenge had decreased anxiety. The desire to weigh less, the perception of a threat regarding weight changes, the ability to cope with denial, and anxiety emerged as predictors of disordered eating behaviours.

CONCLUSION

To prevent or reduce disordered eating behaviours, it is important to promote adequate strategies to deal with weight changes before a competition and, consequently, positive emotions among sports combat athletes.

LEVEL OF EVIDENCE

Level III, case-control analytic study.

Disordered Eating Attitudes, Anxiety, Self-Esteem and Perfectionism in Young Athletes and Non-Athletes

Eating disorders are associated with short and long-term consequences that can affect sports performance. The purposes of this study were to investigate whether female athletes, particularly gymnasts and footballers, exhibit more eating problems compared to female non-athletes, and to identify individual personality characteristics including anxiety, self-esteem, and perfectionism as possible contributors to eating disorder risk. In a sample of 120 participants, 80 adolescent female athletes were compared to a control condition of 40 non-athletes (mean age 17.2 ± 2.82). Participants responded to a questionnaire package to investigate the presence of disordered eating (SCOFF) and psychological variables in relation to disordered eating symptoms or eating disorder status. Subsequently, anthropometric measures were obtained individually by trained staff. There were statistically significant differences between conditions. One of the most important results was the score in SCOFF (Mann-Whitney = 604, p < 0.05; Cohen's d = 0.52, r = 0.25), being higher in control than in the gymnast condition. These results suggest that non-athlete female adolescents show more disturbed eating behaviours and thoughts than female adolescents from aesthetic sport modalities and, therefore, may have an enhanced risk of developing clinical eating disorders.

Systematic review of risk factors for eating psychopathology in athletes: A critique of an etiological model

OBJECTIVE

The theoretical model by Petrie and Greenleaf (2007, 2012) is an admirable attempt to collate the causal factors of disordered eating in athletes. The aims of this systematic review are (a) to provide an overview of the findings from the relevant literature, (b) to assess whether the model is supported by the existing research, (c) to evaluate the different designs, methods, and measures used to test the mediators in the model, and (d) to highlight areas for improvements and future research.

METHOD

A systematic review of four major online databases identified 37 relevant papers on risk factors of disordered eating in athletes, which were reviewed and critically compared with the theoretical model.

RESULTS

There is a lack of longitudinal research with the relevant mediators in athlete populations, which makes it difficult to determine whether the potential mediators described by Petrie and Greenleaf are causal risk factors rather than simply correlates of disordered eating for athletes. Findings for all the potential mediators are inconsistent, and the range of measures used makes it problematic to draw conclusions.

CONCLUSIONS

Future research needs to use gold standard measures and longitudinal designs in order to fully test and possibly update the model.

DO TRAINING REGIMEN AND COMPETITIVE LEVEL AFFECT BODY IMAGE DISSATISFACTION (LEANNESS AND MUSCLE TONE) IN FEMALE ATHLETES?

ABSTRACT Introduction Studies that seek analyze the relationship between sport variables and body image are importants, because indicate if the competitive sport environment influence on body feelings of athlete. Objective To analyze the relationship between sports variables (training regimen and competitive level) and dissatisfaction in regard to leanness and muscle tone in female athletes. Methods One hundred and eighty female athletes aged over 12 years from various sport disciplines participated in the study. We used the Body Shape Questionnaire (BSQ) to assess dissatisfaction in regard to leanness. The dissatisfaction subscale of Drive for Muscularity Scale (DMS) was used to evaluate dissatisfaction with muscle tone. Training regimen (frequency x daily hours of training) and competitive level were acquired through a questionnaire developed by the actual investigators. Results The findings indicated a statistically significant relationship between the training regimen (F(1, 179)=4.01; p=0.047) and competitive level (F(2, 178)=3.59; p=0.031) and the BSQ scores. Moreover, the results indicated a statistically significant relationship between the training regimen (F(1, 179)=4.01; p=0.047) and the competitive level (F(2, 178)=3.59; p=0.031), with DMS dissatisfaction subscale scores. Conclusion Sports variables (training regimen and competitive level) were related to dissatisfaction in regard to leanness and muscle tone, although they demonstrated different magnitudes. Level of evidence III; study case-control.

Athlete Identity and Eating Pathology in Distance Runners: When Compulsive Exercise Matters

Purpose: The current study evaluated associations between exercise identity (Exercise Identity Scale; EIS), compulsive exercise (Compulsive Exercise Test; CET), and their association with Eating Disorder Examination – Questionnaire (EDE-Q) scores among adult runners registered for mid- and long-distance races (N = 282, 48.2% male). Methods: Runners of half and full marathon races completed the EIS, CET, and EDE-Q. Results: Regression analyses indicated that increased EIS, b = −.21, and CET, b = −3.25, scores contribute to decreased eating pathology amongst half-marathon runners; a significant interaction effect emerged for EIS × CET scores, b = .08, such that relations between EIS and EDEQ scores were significant among runners reporting either lower or higher CET scores. These associations were not demonstrated in marathon runners. Conclusions: Results suggest that it is beneficial to consider running status when addressing the effect that exercise identity and compulsive exercise may have on eating pathology in competitive runners.

Athletic identity, compulsive exercise and eating psychopathology in long-distance runners

Having a high athletic identity is thought to increase vulnerability for compulsive exercise and Eating Disorder (ED) psychopathology. This study examined whether there is an association between athletic identity and levels of compulsive exercise and ED psychopathology in long-distance runners. A sample of 501 long-distance runners completed the Athletic Identity Measurement Scale (AIMS), Compulsive Exercise Test (CET) and Eating Disorders Examination Questionnaire (EDEQ). There was a significant positive association between participants' AIMS and total CET scores (moderate effect size; r=0.34 for males and 0.33 for females). BMI did not influence the relationship between AIMS and CET scores in males. However, for females, AIMS scores were positively associated with levels of Weight Control Exercise when covarying for BMI (small to moderate effect size, r=0.22). No significant associations with EDEQ scores were found (negligible to small effect sizes; r=0.06 for males and r=0.14 for females). Following replication, coaches might need to be vigilant to the welfare of endurance runners that have a strong athletic identity, since this could be linked to them exercising compulsively. Future work should examine whether having a strong athletic identity predicts ED psychopathology when this identity is challenged (e.g., due to injury).

Disordered eating in French high-level athletes: association with type of sport, doping behavior, and psychological features

PURPOSE

Over the last few years, disordered eating in athletes has received increasing attention. According to several studies, athletes could be more vulnerable to disordered eating and some characteristics specific to the athletic community could be in favour of an increased risk of poor body image and disturbed eating habits in athletes. However, the literature is sparse and some methodological issues in studies have been pointed out. In this context, we aimed at determining the prevalence of disordered eating in French high-level athletes using clinical interviews of three different clinicians and identifying what are the factors associated with disordered eating in athletes.

METHODS

In France, all athletes registered on the French high-level list have to undergo a yearly evaluation. Data collected during the somatic assessment, the dietary consultation, and the psychological of the yearly evaluation were used. Multivariate analysis was performed for identification of factors associated with disordered eating.

RESULTS

Out of the 340 athletes included, 32.9% have been detected with a disordered eating. They were difficult to detect by clinicians, as usual criteria did not seem to be reliable for athletes. Competing in sports emphasizing leanness or low body weight was associated with disordered eating; however, gender was not.

CONCLUSION

These results highlight the need for the development of specific screening tools for high-level athletes. Furthermore, the identification of factors associated with disordered eating could improve early detection and prevention program effectiveness.

Eating-Disordered Behaviour in Adolescents with Type 1 Diabetes

OBJECTIVES

To evaluate dysfunctional eating behaviour, self-esteem, social physique anxiety and quality of life in adolescents with type 1 diabetes who have differing desired weights and to evaluate the predictors of dysfunctional eating behaviour in these adolescents, with a focus on personal and psychological variables.

METHODS

We evaluated 79 adolescents with type 1 diabetes (mean age of 15.71 years) of both sexes (58.2% females) using the Eating Disorders Examination Questionnaire (EDE-Q), the Rosenberg Self-Esteem Scale (RSES), the Social Physique Anxiety Scale (SPAS-R) and the Diabetes Quality of Life (DQoL) measure.

RESULTS

Of the adolescents, 44 with type 1 diabetes reported the desire to maintain or increase their current weight, and 35 reported the desire to reduce their current weight. The participants with the desire to weigh less were mainly females who exercised regularly and demonstrated more frequent binge eating and purging. Additionally, this group exhibited an increased frequency of eating disturbances, such as restraint and eating, weight and shape concerns. Moreover, this group demonstrated increased social physique anxiety and decreased diabetes quality of life in relation to the impact of diabetes, worries about diabetes and satisfaction with life. Finally, predictors of eating disturbances included the desire for lower weight, higher social physique anxiety and lower diabetes-related quality of life.

CONCLUSIONS

The desire for a lower weight in adolescents with type 1 diabetes may increase problems related to eating behaviour and general quality of life.

Risk Factors for Eating Disorders among Male Adolescent Athletes

OBJECTIVE

Eating disorders (ED) are an important and increasing problem in adolescents. The objective of this study was to examine the risk factors and the prevalence of risk for ED among male adolescent elite athletes and nonathletic controls. Differences between male athletes competing in aerobic, anaerobic and aerobic-anaerobic sports were examined as well.

METHODS

This was a cross-sectional epidemiological study. A cross-sectional questionnaire survey and anthropometric measurements were conducted on 351 adolescents (athletes n = 228; controls n = 123). All participants were aged 15-17 at the time of measuring. Risk for ED was determined using a SCOFF questionnaire.

RESULTS

The overall prevalence of the risk for ED in male adolescents was 24.8%, with no significant differences among athletes and controls or different subgroups of athletes (p>0.05), although the highest prevalence (37.2%) was registered in aerobic subgroup of athletes. Higher number of attempts to lose weight was associated with increased risk of ED in each group (athletes and controls). Other predictors referred to lack of breakfast and body composition in aerobic subgroup of athletes and number of meals and training frequency in anaerobic subgroup. The most common reasons for dieting were improvement of sport results (19.6-44.2%) and better self-esteem (41.5%) in athletes and controls respectively.

CONCLUSIONS

Participation in the competitive sport itself is not associated with the increased risk for ED. It seems that risk factors for ED for adolescent athletes competing in aerobic and anaerobic sports represent a subject that deserves consideration and further investigation in the future.

The influence of BMI and predictors of disordered eating and life satisfaction on postmenopausal women

This study aims to compare eating behaviors, body satisfaction, exercise, and life satisfaction between normal-weight and overweight postmenopausal women and to examine the predictors of disordered eating and life satisfaction among postmenopausal women (n = 294). The overweight group had more eating disordered behavior, more body dissatisfaction, and lower physical quality of life. The increase of age predicted less disordered eating. Higher BMI, the perception of an ideal weight lower than the current one, lower body satisfaction, and physical quality of life predicted disordered eating. Higher body satisfaction, less psychosocial discomfort, and a greater degree of sexual symptom discomfort predicted life satisfaction.

Efeitos do estado de humor sobre os comportamentos alimentares inadequados de atletas de atletismo

O objetivo do presente estudo foi analisar os efeitos do estado de humor sobre os comportamentos alimentares inadequados (CAI) em atletas. Participaram 68 atletas de atletismo, do sexo feminino, com idades entre 12 e 17 anos. Utilizaram-se o Eating Attitudes Test (EAT-26) e a Escala de Humor de Brunel (BRUMS) para avaliar os CAI e o distúrbio total do humor (DTH), respectivamente. Dois modelos de regressão linear não indicaram influência estatisticamente significativa da BRUMS nas subescalas Dieta (p=0,42) e Bulimia e Preocupação com Alimentos (p=0,81) do EAT-26. Ao contrário, a BRUMS (p=0,04) demonstrou impacto significante (7%) sobre os escores da subescala Autocontrole Oral. Concluiu-se que as atletas com DTH elevado podem estar mais susceptíveis à influência ambiental para a ingestão alimentar.

Are inappropriate eating behaviors and anxiety related with track and field in adolescent athletes?

OBJECTIVE: The study analyzed the relationship between anxiety and inappropriate eating behaviors in adolescent female athletes. METHODS: Eighty-eight track and field athletes aged 12 to 17 years participated in the study. We used the Eating Attitudes Test-26 subscales to assess inappropriate eating behaviors and the Brazilian State - Trait Anxiety Inventory subscales to assess State and Trait anxiety. RESULTS: State - Trait Anxiety Inventory - State (p=0.18) or State - Trait Anxiety Inventory - Trait (p=0.14) had no significant influence on the Dieting subscale score. The Bulimia and Food Preoccupation subscale score was also not influenced by State - Trait Anxiety Inventory - State (p=0.25) or State - Trait Anxiety Inventory - Trait (p=0.21). However, State - Trait Anxiety Inventory - Trait (p=0.048) had a significant impact on the Oral Control subscale score, but State - Trait Anxiety Inventory - State (p=0.19) did not explain its variance. CONCLUSION: Only State - Trait Anxiety Inventory - Trait was related to oral control and the environmental and social forces that encourage food intake in female athletes.

2014 Female Athlete Triad Coalition consensus statement on treatment and return to play of the female athlete triad: 1st International Conference held in San Francisco, CA, May 2012, and 2nd International Conference held in Indianapolis, IN, May 2013

The Female Athlete Triad is a medical condition often observed in physically active girls and women, and involves 3 components: (1) low energy availability with or without disordered eating, (2) menstrual dysfunction, and (3) low bone mineral density. Female athletes often present with 1 or more of the 3 Triad components, and an early intervention is essential to prevent its progression to serious endpoints that include clinical eating disorders, amenorrhea, and osteoporosis. This consensus statement represents a set of recommendations developed following the first (San Francisco, California) and second (Indianapolis, Indianna) International Symposia on the Female Athlete Triad. It is intended to provide clinical guidelines for physicians, athletic trainers, and other health care providers for the screening, diagnosis, and treatment of the Female Athlete Triad and to provide clear recommendations for return to play. The 2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad Expert Panel has proposed a risk stratification point system that takes into account magnitude of risk to assist the physician in decision-making regarding sport participation, clearance, and return to play. Guidelines are offered for clearance categories, management by a multidisciplinary team, and implementation of treatment contracts. This consensus paper has been endorsed by The Female Athlete Triad Coalition, an International Consortium of leading Triad researchers, physicians, and other health care professionals, the American College of Sports Medicine, and the American Medical Society for Sports Medicine.

Validierung einer deutschen Version des ATHLETE Fragebogens für Hochleistungssportlerinnen

Der ATHLETE ( Hinton & Kubas, 2005 ) ist ein speziell für Sportlerinnen entwickelter Fragebogen, der sportspezifische psychosoziale Risikofaktoren für gestörtes Essverhalten erfasst. Ein vergleichbares deutschsprachiges Instrument existiert bisher nicht. Die vorliegende Studie entwickelte eine deutsche Version des ATHLETE und überprüfte dessen Faktorenstruktur und psychometrische Kennwerte für Hochleistungssportlerinnen. Daten von 103 deutschen Athletinnen wurden mittels mehrerer Fragebögen und klinischem Interview an zwei Messzeitpunkten erhoben. Mit drei der ursprünglichen und drei neuen Faktoren weicht die Faktorenstruktur des deutschen ATHLETE von der der Originalversion ab. Reliabilität und konvergente Validität der Skalen sind akzeptabel bis sehr gut. Ergebnisse zur Kriteriumsvalidität fallen heterogen aus: Skalen zu Sportleridentität, Misstrauen, Perfektionismus und Elternverhalten zeigen keine oder mäßige Zusammenhänge zu Essstörungsproblemen. Nur die neuen Skalen Körper und Sport und Training zur Gewichtsregulation überzeugen als Maße zur Abschätzung der Gefährdung für gestörtes Essverhalten. Sie sind Prädiktoren für die Essstörungspsychopathologie nach 12 Monaten.