Eating disorders in ballet dancing students: Problems and risk factors

Body Composition, Eating Habits, and Disordered Eating Behaviors among Adolescent Classical Ballet Dancers and Controls

Adolescent classical ballet dancers are nutritionally vulnerable, as they try to retain a lean body shape during a life period of high nutritional requirements due to rapid growth. Studies conducted on adult dancers have indicated a high risk for the development of disordered eating behaviors (DEBs), but research on adolescent dancers remains scarce. The aim of the present case-control study was to compare the body composition, dietary habits, and DEBs of female adolescent classical ballet dancers and their non-dancer same-sex peers. Self-reported questionnaires, namely the Eating Attitudes Test-26 (EAT-26) and a 19-item Food Frequency Questionnaire (FFQ), were used for the assessment of habitual diet and DEBs. The assessment of body composition included the measurements of body weight, height, body circumference, and skinfolds and bioelectrical impedance analysis (BIA). The results indicate that the dancers were leaner than the controls, with lower weight, BMIs, and hip and arm circumferences, leaner skinfolds, and less fat mass. No differences were observed between the two groups regarding eating habits and the EAT-26 scores, but almost 1 out of 4 (23.3%) participants scored ≥ 20, indicative of DEBs. Participants with an EAT-26 score ≥ 20 had significantly higher body weight, BMIs, body circumferences, fat mass, and fat-free mass than those with a score < 20. Adolescents must be educated on nutrition and healthy methods to control body weight through evidence-based information and programs, and whenever appropriate, also through individual counseling by the appropriate health professionals.

Amateur ballet practicing, body image and eating behaviors: a comparative study of classical ballet dancers, gym users and sedentary women

BACKGROUND

Ballet dancers are a risk group for body image (BI) distortion, dissatisfaction and eating disorders (ED), but few studies have investigated these aspects in amateur adult practitioners. This study aimed to evaluate if amateur female adult classical ballet dancers presented different BI and behaviors for ED than gym users and sedentary women.

METHODS

This is a cross-sectional study where classical ballet dancers (n = 19) were compared to gym users (n = 19) and sedentary women (n = 19). Body mass index (BMI) was assessed, and a figure rating scale was applied to assess BI distortion/dissatisfaction. The body shape questionnaire (BSQ) was used to measure BI concern. The eating attitudes test (EAT-26) and the bulimic investigatory test, Edinburgh (BITE) were used for behaviors toward anorexia and bulimia.

RESULTS

BMI was significantly lower in ballet dancers than gym users and sedentary women (F, p = .04). BI distortion did not differ among the studied groups. BI dissatisfaction was lower (X2, p = .041) in ballet dancers (75.0%) and gym users (70.6%) compared to sedentary women (100%). Correspondence analysis showed ballet dancers were mostly not concerned with BI, which was not observed among the other groups. The EAT-26 did not differ between the studied groups. The BITE score was lower (Tukey's post hoc test, p = .005) in the ballet dancers [mean 5.3 (5.6)] compared to the sedentary women [mean 10.9 (4.8)].

CONCLUSIONS

Data suggest that amateur classical ballet practicing is associated to better BI and fewer behaviors for ED in the studied population. The lower BMI in ballet dancers might explain these findings, and further studies should explore these associations.

Risk Factors of Overweight and Obesity Related to Diet and Disordered Eating Attitudes in Adolescent Girls with Clinical Features of Polycystic Ovary Syndrome

Background: We aimed to find the difference between girls with clinical features of Polycystic ovary syndrome (PCOS), divided into two groups: Overweight/obesity (Ov/Ob) and normal weight (N), related to diet, disordered eating attitudes (DEA), metabolic and hormonal differences, and to identify the risk factors of being overweight or obese. Methods: Seventy-eight adolescents with PCOS, aged 14-18 years, were divided into Ov/Ob and N groups. Patients underwent blood tests for determination of follicle-stimulating hormone (FSH), luteinizing hormone (LH), total testosterone, DHEA-S, estradiol, of sex hormone-binding globulin (SHBG), fasting glucose, insulin, Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), and lipid profile. Nutrition was evaluated using a 3-day food record. To examine the level of DEA, the Eating Attitudes Test-26 (EAT-26) was used. We defined an EAT-26 score ≥20 as positive for DEA. Logistic regression was carried out to identify the independent predictors of being overweight and obese. Results: An increase of 10 g in plant protein intake decreased the probability of being overweight and of obesity (OR = 0.54; p = 0.036). EAT-26 score ≥20 was correlated with a 7-fold (OR = 6.88; p = 0.02) increased odds of being overweight or of obesity. Conclusion: Being overweight and obesity in adolescents with PCOS may be associated with DEA and the type and amount of protein intake.

Somatotype Components as Useful Predictors of Disordered Eating Attitudes in Young Female Ballet Dance Students

The current study used receiver operating characteristic (ROC) curve analysis to examine the accuracy of somatotype components in correctly classifying disordered eating attitudes (DEA) in female dance students. Participants were a sample of 81 female dancers distributed in two groups: beginner training (BT; age (mean ± SD) = 10.09 ± 1.2 years, n = 32) and advanced training (AT; age = 15.37 ± 2.1 years, n = 49). For evaluation of DEA, the Eating Attitudes Test- 26 (EAT-26) questionnaire was used. We defined an EAT-26 score ≥20 as positive for DEA. Somatotype components were calculated using the Heath-Carter anthropometric method. The risk of presenting DEA was 28.1% (n = 9) in the BT group and 6.1% (n = 3) in the AT group. In the BT group, mesomorphy demonstrated moderate-high accuracy in predicting DEA (area under the curve (AUC) = 0.82, 95% confidence interval (CI): 0.64-0.93). The optimal cut-off of 6.34 yielded a sensitivity of 0.77 and a specificity of 0.95. Ectomorphy showed moderate accuracy in predicting DEA (AUC = 0.768, 95% CI: 0.58-0.89). The optimal cut-off of 2.41 yielded a sensitivity of 0.78 and a specificity of 0.78. In the AT group, none of the components demonstrated accuracy in predicting DEA. Somatotype components were good predictors of disordered eating attitudes in the younger dance student group (beginner training). Further research is needed to identify the determinants of these differences between the two groups.

The Effect of Stress and Social Media Use on the Eating Behavior in University Students

Aim: It is possible to be phisicially and mentally healthy and maintain health at every stage of life with adequate and balanced nutrition. Stress, social media, family and peer influence are also factors affecting the nutrition attitude. The aim of this study is to investigate the effects of stress and social media usage on eating behaviors in university students. Methods: Retrospective-descriptive study data were collected by using the interview form consisted of four parts. Those four parts were “general informations” for demographic informations, “Eating Attitudes Test” for eating attitudes diagnosis, “Depression, Anxiety, Stress Scale” for diagnosis of psychological disorders and “Social Media Use”. Results: A total of 422 people, 329 women and 93 men participated in the survey conducted at the Faculty of Health Sciences of Trakya University. There was a statistically significant difference between stress degree and eating behavior disorder and it was determined that the increase in stress severity caused abnormal eating behavior. There was a statistically significant difference between the time allocated to social media and eating behavior disorder, and it was determined that increased time allocated to social media caused eating behavior disorder. Conclusion: In our study, it was determined that stress and social media use had significant negative effects on students' eating behaviors. Keywords: students, stress, social media, feeding behavior

Factors Dancers Associate with their Body Dissatisfaction

Body dissatisfaction constitutes an important factor in the development of eating pathologies, particularly among dancers. The aim of this research was to test the factors that dancers identified as relevant to their body dissatisfaction using an exploratory mixed method design. Participants were 369 dancers from two Spanish dance conservatories. Questionnaires assessed body dissatisfaction, abnormal eating attitudes and behaviors, and risk factors to eating disorders in the dance domain. Nine factors were found; the "teacher", the "uniform", and the "mirrors" were the most common. Individuals with a greater likelihood of developing an eating disorder identified teacherś influence as a key factor in their body dissatisfaction. Specifically, ballet dancers were more likely to indicate that teachers were a negative influence compared to students in other dance genres (contemporary, flamenco, and Spanish dance). Programs to reduce negative body image and improve positive body image in dance conservatories are needed, specifically focusing on teachers.

Body dissatisfaction in normal weight children - sports activities and motives for engaging in sports

Body dissatisfaction is a phenomenon that may already occur in childhood and is linked to a variety of psychosocial risks. As the role of physical activity in the context of body dissatisfaction is still ambivalent, a cross-sectional study with 602 normal weight children (50.2% girls; M_age = 9.23 years; SD = 0.79) was conducted. The children filled in the MoMo-Questionnaire, including items about their physical activities and motives for being physically active, as well as Bender's Body Esteem and Muscularity Concern Scale with the three subscales "body satisfaction", "weight and shape concerns", and "muscularity concerns". Independent t-tests revealed that girls were less worried about muscularity than boys (M_girls= 1.94, SD_girls= 1.11 vs. M_boys= 3.12, SD_boys= 1.43; t(560) = 11.33, p < .001, Cohen's d = 0.92), whereas girls showed greater weight and shape concerns than boys (M_girls= 2.24, SD_girls= 0.97 vs. M_boys= 2.05, SD_boys= 0.92; t(549) = 2.32, p = .02, d = 0.20). In boys, physical activity is associated with less muscularity, weight, and shape concerns. Body satisfaction increases with health and fitness motives. In girls, the role of physical activity is ambivalent: girls who engage in sports do not differ in body dissatisfaction from non-active girls. In sportive girls, weight and shape concerns increased with more health and fitness motives. Finally, the study provides first insights into body dissatisfaction and the different role of physical activity in boys and girls in childhood.

Occupational Health and the Performing Arts: An Introduction

OBJECTIVE

Workplace hazards in the performing arts cause injuries, disabilities, and deaths every year. Occupational health professionals are familiar with most of these hazards and are particularly qualified to contribute to efforts to reduce them. This article reviews current health issues in the performing arts and highlights opportunities for occupational health contributions.

METHODS

Recognized experts in performing arts medicine were consulted and articles illustrating performing arts health issues were reviewed. Literature sources included medical databases, unindexed art-health publications, and popular press articles.

RESULTS

Resources discussing hazards and health issues in theater, dance, voice, and instrumental musicians were located and reviewed.

CONCLUSIONS

Treatment providers have a history of involvement with segments of the performing arts. The occupational health approach to workplace health issues can effectively complement these efforts. Sources of further information on performing arts health concerns are available.

Comorbid psychiatric diagnosis and psychological correlates of eating disorders in dance students

BACKGROUND/PURPOSE

Although dancers are at risk for eating disorders (EDs), little is known about the features of EDs among the dance population. This study explores the prevalence of EDs, and their psychiatric comorbidities and correlates in dance students.

METHODS

In total, 442 female high-school dance students participated in a two-phase survey. All participants completed screening questionnaires as well as measures assessing teasing, self-esteem, perfectionism, body dissatisfaction, and personality. Of the participating students, 311 underwent the Structured Clinical Interview for DSM-IV-TR Axis I Disorders.

RESULTS

Sixty-eight individuals (15.4%) had an ED by DSM-IV diagnosis. The prevalence of any co-occurring mood (47.1%) and anxiety disorders (30.9%) was high. Although low self-esteem, high neuroticism, and high psychological distress were associated with EDs in univariate analysis, only teasing for overweight and body image dissatisfaction were significantly associated with EDs by multivariate analysis.

CONCLUSION

Prevention and intervention programs for dance students should include recognition and management of emotional disorders and strategies promoting positive body image and reducing the incidence of negative weight-related comments.

Prevalence of eating disorders amongst dancers: a systemic review and meta-analysis

Eating disorders in dancers are thought to be common, but the exact rates remain to be clarified. The aim of this study is to systematically compile and analyse the rates of eating disorders in dancers. A literature search, appraisal and meta-analysis were conducted. Thirty-three relevant studies were published between 1966 and 2013 with sufficient data for extraction. Primary data were extracted as raw numbers or confidence intervals. Risk ratios and 95% confidence intervals were calculated for controlled studies. The overall prevalence of eating disorders was 12.0% (16.4% for ballet dancers), 2.0% (4% for ballet dancers) for anorexia, 4.4% (2% for ballet dancers) for bulimia and 9.5% (14.9% for ballet dancers) for eating disorders not otherwise specified (EDNOS). The dancer group had higher mean scores on the EAT-26 and the Eating Disorder Inventory subscales. Dancers, in general, had a higher risk of suffering from eating disorders in general, anorexia nervosa and EDNOS, but no higher risk of suffering from bulimia nervosa. The study concluded that as dancers had a three times higher risk of suffering from eating disorders, particularly anorexia nervosa and EDNOS, specifically designed services for this population should be considered.

Comparative validity of the chinese versions of the bulimic inventory test edinburgh and eating attitudes test for DSM-IV eating disorders among high school dance and nondance students in Taiwan

OBJECTIVES

To compare the validity of the Eating Attitudes Test (EAT) and the Bulimic Investigatory Test Edinburgh (BITE) as screening tools for eating disorders (EDs), and to identify a new threshold for each questionnaire to detect ED cases among dance and nondance students.

METHOD

Dance students enrolled in high schools with gifted dance programs and nondance students randomly chosen from the same or nearby schools were invited to participate in a 2-phase ED survey. Participants completed the EAT and BITE questionnaires in the first phase. All participants who screened positive and 10% of the participants who screened negative were interviewed blindly using the Structured Clinical Interview for DSM-IV-TR Axis I Disorders Patient Edition.

RESULTS

The BITE had better accuracy than the EAT in detecting ED in general among both dance and non-dance students. BITE scores of 19 and 16 were the optimal cutoff values for determining ED among dance and nondance students, respectively. The optimal cutoff value for the EAT to diagnose an ED was 19 for dance students and 12 for nondance students. Both questionnaires showed higher sensitivity and lower specificity in dance students than nondance students at the same cutoff points.

DISCUSSION

The BITE had better diagnostic performance than the EAT in this nonclinical population, although its ability to detect restrictive behaviors is likely as limited as that of the EAT. Plausible explanations for these results and limitations of this study are discussed in the text.

Identifying high-school dance students who will develop an eating disorder: a 1-year prospective study

This study examined the changes in eating disorder (ED) status over 1 year and identified risk factors for EDs among female dance students. In 2003, all students enrolled in each of the nation's 12 high schools with gifted dance programs participated in a two-phase survey. The same participants were invited to take part in a follow-up survey 1 year later. In all, 583 persons completed the phase 1 questionnaire survey, and 245 persons completed interviews twice at baseline and follow-up. Thirty-five females had a newly developed ED, and less than half of the ED cases found at baseline had recovered at follow-up. Being a grade 12 student carried a reduced risk of EDs, whereas higher baseline scores on the Bulimic Investigatory Test Edinburgh (BITE) increased risks of developing an ED after 1 year. A 10-item BITE questionnaire validly identified girl dance students who would develop EDs later in high school. EDs were more commonly developed during middle adolescence, and we suggest that prevention work against EDs begin in this period among the dance student population. The brief screening questionnaire might help detect intervention targets of a prevention program among adolescent dance students.

Changes in eating attitudes, eating disorders and body weight in Chinese medical university students

BACKGROUND

Eating disorders is a particular problem for university students. However, little is known about this problem among medical students who often have high stress.

AIMS

The aims of this study were to describe the changes in eating attitudes and eating disorders from 2006 to 2008 in a medical student sample, and to compare the gender differences of eating attitudes and body mass index (BMI, kg/m(2)) with this sample.

METHODS

This study was conducted in Changsha city, Mainland China. Self-reported questionnaires, including the Eating Attitudes Test (EAT) and Eating Disorders Assessment Questionnaire (CETCA), were employed to examine the changes in eating attitudes and eating disorders from 2006 to 2008 in a medical student sample (N = 500).

RESULTS

Self-reported findings suggest that tentative eating disorders prevalence was 0.90% (anorexia nervosa (AN): 0; bulimia nervosa (BN): 4 females) in 2006 and 1.44% (AN: 1 male; BN: 1 male and 3 females) in 2008 of the full sample. The present data showed that 2.26% (2 males and 9 females) in 2006 and 2.47% (4 males and 6 females) in 2008 of all students obtained scores greater than 20 on the EAT-26 indicative of distorted eating attitudes and behaviour. Male students kept lower distorted eating attitudes and behaviours than female students, while female students kept a lower BMI than male students in both 2006 and 2008. However, there were no statistically significant changes in eating attitudes, distorted eating attitudes and CETCA in either male or female students from 2006 to 2008.

CONCLUSIONS

The results of this study suggest that there were no statistically significant changes from 2006 to 2008 in eating attitudes, distorted eating attitudes and CETCA. However, females showed significantly higher eating disorders and distorted eating attitudes compared to males in both 2006 and 2008. This study is furthering our understanding of eating disorders in a Chinese cultural context.

Prevalence and sport-related predictors of disturbed eating attitudes and behaviors: Moderating effects of sex and age

Very few studies examined the prevalence and sport-related predictors of disturbed eating attitudes and behaviors (DEABs) among adolescents involved in sport practice, and their results are mixed and inconclusive. These inconsistencies are most likely due to their methodological heterogeneity and to the fact that none of these studies took into consideration the potentially relevant characteristics of the sport practice context. This study attempts to answer this limitation among French adolescents not involved or involved in various sports contexts defined based on their organization, leanness-centration, and competitive level. Participants were 335 adolescents involved in sport practice, and 435 adolescents not involved in any form of regular sport practice. The DEABs were measured using the Eating Attitudes Test-26. Global results do not showed any significant association between the status of the participants and DEAB. However, these results drastically changed when we considered the potential moderating role of sex and age on these relations. Indeed, sports involvement in general, and involvement in leanness and competitive sports were found to exert sex- and age-differentiated effects on the risks of presenting clinically significant levels of DEAB. This study suggests the importance of monitoring, preventive, and early intervention mechanisms within the context of practice, particularly for adolescent girls.

Correlates of disordered eating attitudes among male and female young talented dancers: findings from the UK centres for advanced training

Correlates of disordered eating attitudes were examined with a mixed-sex sample of 347 young talented dancers aged 10-18 years from all UK Centres for Advanced Training. Equal proportions of females (7.3%) and males (7.6%) were symptomatic for disordered eating but correlates differed: for females, self-evaluative perfectionism, waking up > twice/night and hours of non-dance physical activity were predictive while for males, only the combination of self-evaluative and conscientious perfectionism was significant. Differences between menstrual status groups were evident, with young dancers (pre-menarcheal/within first year of menarche) reporting the least disordered eating attitudes and those with dysfunctional menses reporting the most.

Prevalence of eating disorders symptoms in nonelite ballet dancers and basketball players: An exploratory and controlled study among French adolescent girls

BACKGROUND

Until recently, very few controlled studies have examined the prevalence of eating disorders (ED) symptoms among nonelite adolescent female athletes. Moreover, results are mixed and inconclusive. Therefore, the aim of this exploratory study was to examine the prevalence of ED symptoms (underweight, bulimia, drive for thinness, body dissatisfaction) among French nonelite adolescent female athletes (ballet dancers and basketball players) and nonathletes.

METHOD

The sample of adolescent girls (aged between 12 and 16 years), consisted of 43 basketball players, 52 ballet dancers and 49 nonathlete controls. The eating disorder inventory and a demographic-personal information questionnaire (date of birth, experience of ED, week training time, etc.) were filled out by the participants. Additionally, all participants were measured and weighed. The frequencies of ED symptoms were compared between the groups (athletes versus nonathletes, ballet dancers versus basketball players) using a series of χ² tests.

RESULTS

The χ² tests did not show significant differences in frequencies of underweight and body dissatisfaction symptoms between nonelite athletes and nonathletes. However, results highlighted a nonsignificant trend toward higher frequency of: (i) drive for thinness (P=0.05) symptoms in nonelite athletes compared with nonathletes, and (ii) bulimia (P=0.06) symptoms in nonathletes compared with nonelite athletes. Additional analyses performed among the sport groups revealed that the prevalence of drive for thinness symptoms was significantly two-fold higher in ballet dancers than basketball players (34.6% versus 16.3%). Nevertheless, no significant differences were found in the frequencies of underweight, bulimia and body dissatisfaction symptoms among the sport groups.

CONCLUSION

This study showed that the frequency of ED symptoms is equivalent in nonelite athletes and nonathletes. However, these nonsignificant results should be interpreted with caution regarding the weak statistical power of the analyses and the small sample size. Detailed analysis revealed a significantly higher prevalence of drive for thinness symptoms in ballet dancers in comparison with basketball players. Consequently, these results should be viewed as preliminary and further studies are needed before they can be generalized to French adolescent female athletes.