Athletics, perfectionism, and disordered eating

A systematic review, meta-analysis, and meta-regression of the prevalence of self-reported disordered eating and associated factors among athletes worldwide

BACKGROUND

The purpose of this meta-analysis was to provide a pooled prevalence estimate of self-reported disordered eating (SRDE) in athletes based on the available literature, and to identify risk factors for their occurrence.

METHODS

Across ten academic databases, an electronic search was conducted from inception to 7th January 2024. The proportion of athletes scoring at or above predetermined cutoffs on validated self-reporting screening measures was used to identify disordered eating (DE). Subgroup analysis per country, per culture, and per research measure were also conducted. Age, body mass index (BMI), and sex were considered as associated/correlated factors.

RESULTS

The mean prevalence of SRDE among 70,957 athletes in 177 studies (132 publications) was 19.23% (17.04%; 21.62%), I2 = 97.4%, τ2 = 0.8990, Cochran's Q p value = 0. Australia had the highest percentage of SRDE athletes with a mean of 57.1% (36.0%-75.8%), while Iceland had the lowest, with a mean of 4.9% (1.2%-17.7%). The SRDE prevalence in Eastern countries was higher than in Western countries with 29.1% versus 18.5%. Anaerobic sports had almost double the prevalence of SRDE 37.9% (27.0%-50.2%) compared to aerobic sports 19.6% (15.2%-25%). Gymnastics sports had the highest SRDE prevalence rate, with 41.5% (30.4%-53.6%) while outdoor sports showed the lowest at 15.4% (11.6%-20.2%). Among various tools used to assess SRDE, the three-factor eating questionnaire yielded the highest SRDE rate 73.0% (60.1%-82.8%). Meta-regression analyses showed that female sex, older age, and higher BMI (all p < 0.01) are associated with higher prevalence rates of SRDE.

CONCLUSION

The outcome of this review suggests that factors specific to the sport affect eating behaviors throughout an athlete's life. As a result, one in five athletes run the risk of developing an eating disorder. Culture-specific and sport-specific diagnostic tools need to be developed and increased attention paid to nutritional deficiencies in athletes.

Examining gender difference in disordered eating behaviour and its associated factors among college and university students in Sarawak

Background: Disordered eating is common among late adolescents and young adults who pursue an idealised body image. Aims: This study aims to determine the prevalence of disordered eating between males and females and its associated factors among college and university students in Sarawak. Methods: A cross-sectional study involving 20 public and private colleges and universities in Sarawak, from September 2017 to March 2020. Respondents completed self-administered questionnaires both in the English and Malay language. Data about sociodemographic characteristics, body mass index, eating attitude, body dissatisfaction, perceived sociocultural pressure, self-esteem, drive for muscularity and perfectionism were collected. Results: A total of 776 respondents (male: 30.9%; female: 69.1%) aged 19 to 25 years old took part in the study. The overall prevalence of disordered eating was 25.2% (95% confidence interval (CI) 21.9; 28.7) with females (28.6%, 95% CI 24.6; 32.9) higher than males (15.6%, 95% CI 10.5; 21.9). Multivariate analysis showed for both male and female models, perceived sociocultural pressure (male: β = 1.125, p < 0.01; female: β = 1.052, p = 0.003), drive for muscularity (male: β = 1.033, p = 0.017; female: β = 1.032, p < 0.01) and perfectionism (male: β = 1.098, p = 0.02; female:β = 1.119, p < 0.01) were predictors for disordered eating. Conclusion: The prevalence of disordered eating among college and university students in Sarawak was high. The findings suggest that although there were gender differences in the prevalence of disordered eating, its associated factors were the same. The findings of this study will be useful for designing and implementing disordered eating prevention and intervention programme.

Eating disorder risks and awareness among female elite cyclists: an anonymous survey

Background

Eating disorders (EDs) are an increasingly recognized concern in professional sports. Previous studies suggests that both female gender and endurance sports put athletes at risk. Female elite cyclists are hence of specific interest. The present study aimed at evaluating the distribution of the individual risk of ED in this group. Further the association between individual risk and both the awareness for the topic ED and the deviation from “normal” weight was depicted.

Methods

Female cyclists registered with the Union Cycliste Internationale were contacted via email or facebook and asked to complete a survey comprising age, weight, the Eating-Attitude-Test (EAT-26), and questions regarding ED awareness. The observed distribution of the EAT-26 score was compared to results from previous studies in normal subjects and athletes. The distribution of the ED awareness was described and ED awareness was correlated with the EAT-26 score. Both the deviation from ideal weight and the body mass index (BMI) were correlated with the EAT-26 score.

Results

Of the 409 registered athletes 386 could be contacted, 122 completed the questionnaire. Age ranged from 20-44yrs, BMI from 17.0 to 24.6 kg/m². In the EAT-26, 39 cyclists (32.0%) scored above 20 points indicating a potential benefit from clinical evaluation, 34 cyclists (27.9%) scored 10–19 points suggesting disordered eating. Sixteen athletes (13.2%) had been treated for an ED. About 70% of athletes had been pressured to lose weight. The mean EAT-26 score was above the average observed in normal female populations. It was also above the average observed in many female athlete populations, but lower than in other leanness focussed sports. More than 80%of athletes perceived elite cyclists at risk for developing ED. Increased ED awareness and deviation from the ideal weight were associated with higher EAT-26 scores, but not the body mass index.

Conclusion

Female cyclists are at risk of developing ED and they are aware of this risk. To improve their health and well-being, increased efforts to support elite cyclists and their teams in preventive activities and early detection are crucial.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13102-022-00563-6.

Are they too perfect to eat healthy? Association between eating disorder symptoms and perfectionism in adolescent rhythmic gymnasts

OBJECTIVE

Eating disorders are associated with perfectionism in adults, but evidence is lacking in adolescent competitive athletes. This study examined eating disorder symptoms and perfectionism in a sample of 13-15 years old, adolescent rhythmic gymnasts.

METHODS

Eighty-nine female rhythmic gymnasts (41 international and 48 recreational level gymnasts), completed the Eating Attitudes Tests 26 (EAT-26), the Sport Perfectionism Questionnaire (SPQ), the Social Desirability Scale (SDS) and provided information on their training.

RESULTS

It was found that 41.46% of the international and 14.58% of the recreational level gymnasts scored ≥20 in EAT-26. International level gymnasts also scored higher than recreational in EAT-26 (p = 0.002), and its subscales Dieting (p = 0.012) and Oral Control (p ˂ 0.001) and in the Sport Perfectionism Questionnaire (p = 0.005) and the subscales Striving for Perfectionism (p ˂ 0.001) and Personal Standards (p ˂ 0.001). No differences were found between groups in the subscales Concerns over Mistakes (p = 0.429), and Negative Reactions to Imperfection (p = 0.096). Multiple regression analysis in international level gymnasts, showed that Negative Reactions to Imperfection, body mass index and training experience accounted for 33.2% of the variance in EAT-26 (adjusted R² = 0.332, F = 6.786, p ˂ 0.001). A negative association was observed between training experience and eating disorder symptoms in international level athletes. No association was found between the subscales of perfectionism and EAT-26 in recreational gymnasts (p ˃ 0.316).

CONCLUSIONS

International level, adolescent rhythmic gymnasts show more eating pathology than recreational. Negative Reactions to Imperfection and BMI seem relevant for gymnasts' dieting behaviour while training experience may help adolescent athletes to cope with disturbed eating behaviours.

Development and Validation of the Eating Disorders Screen for Athletes (EDSA): A Brief Screening Tool for Male and Female Athletes

OBJECTIVES

To develop and validate the Eating Disorders Screen for Athletes (EDSA), a brief eating disorders screening tool for use in both male and female athletes.

METHODS

Data from Division I athletes at a Midwestern university (N=434) were used to conduct exploratory factor analysis (EFA) by gender. Data from athletes competing at various levels at universities across the United States (N=862) were then used to conduct confirmatory factor analysis (CFA) and receiver operator characteristic (ROC) curve analysis by gender. Athletes from a range of lean and non-lean sports were included. Gender-specific empirically derived cut-offs on the Eating Disorder Examination-Questionnaire were used to classify high eating disorder risk for ROC curve analysis. Measurement invariance by gender, level of competition, and sport type was also examined.

RESULTS

A six-item, one-factor structure for the EDSA was supported by EFA and CFA in both genders, and internal consistency was good for both male (α=. 80) and female athletes (α=.86). ROC curve analyses indicated that the EDSA was highly accurate in predicting eating disorder risk status and identified a score of 3.33 as the optimal cut-off for both male (sensitivity=.96, specificity=.80) and female athletes (sensitivity=.96, specificity=.64). Results also supported strong measurement invariance for the EDSA by gender, level of competition (Division I versus club), and sport type (lean versus non-lean).

CONCLUSIONS

The EDSA shows promise as a brief screening tool to identify male and female athletes at risk for eating disorders.

Psychological risk indicators of disordered eating in athletes

Objectives

This project examined risk factors of disordered eating in athletes by adapting and applying a theoretical model. It tested a previously proposed theoretical model and explored the utility of a newly formed model within an athletic population across gender, age, and sport type to explain disordered eating.

Design

The design was cross-sectional and the first phase in a series of longitudinal studies.

Methods

1,017 athletes completed online questionnaires related to social pressures, internalisation, body dissatisfaction, negative affect, restriction, and bulimia. Structural equation modelling was employed to analyse the fit of the measurement and structural models and to do invariance testing.

Results

The original theoretical model failed to achieve acceptable goodness of fit (χ² [70, 1017] = 1043.07; p < .0001. CFI = .55; GFI = .88; NFI = .53; RMSEA = .12 [90% CI = .111-.123]). Removal of non-significant pathways and addition of social media resulted in the model achieving a parsimonious goodness of fit (χ² [19, 1017] = 77.58; p < .0001. CFI = .96; GFI = .98; NFI = .95; RMSEA = .055 [90% CI = .043-.068]). Invariance tests revealed that the newly revised model differed across gender, age, level, competition status, and length of sport participation.

Conclusion

This study showed that the formation of disordered eating symptomology might not be associated with sport pressures experienced by athletes. It revealed that disordered eating development varies across gender, competition level, sport type, and age, which must be considered to prevent and treat disordered eating in athletes.

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.

Mental Health Symptoms Related to Body Shape Idealization in Female Fitness Physique Athletes

Physical activity relates to optimal health, still the prevalence of mental health issues is high among athletes. Being young, female, and competing in aesthetic sports is a high-risk combination for mental health symptoms. Fitness physique athletes (FA) match this profile but are understudied. We aimed to study the intensity of mental health symptoms (i.e., body image, eating behaviour, relation to and routines for exercise, and perfectionism) in FA and in female references (FR), and to evaluate how preparing for fitness sport competitions affects these mental health symptoms. Before competition, FA had higher levels of drive for leanness (DFL) and eating restraint compared to FR. At the time of competition, eating restraint increased in FA only, concurrent with a reduction in symptoms of disordered eating. The levels of DFL, drive for muscularity, eating restraint, and exercising for figure toning were higher in FA compared to FR. At one-month post-competition, the differences between groups from competition time remained. Generally, perfectionism correlated with eating restrictions in FA and with disordered eating in FR. Overall, FA coped with the dieting, but self-control deteriorated post-competition with higher levels of disordered eating and an increased body shape concern. High DFL generally associated with more disordered eating behaviour, specifically in FR.

Perfectionism, Body Satisfaction and Dieting in Athletes: The Role of Gender and Sport Type

Athletes are often at a greater risk for disordered eating development due to their perfectionistic tendencies, as well as physical performance- and appearance-related demands of various sports in which they compete. Therefore, the purpose of this study was to examine the possibility of independent contributions of perfectionism and body satisfaction on dieting behaviour among male and female athletes. Two-hundred-eighty (192 male; 88 female) athletes provided their answers on the Eating Attitudes Test 26 (EAT-26), Positive and Negative Perfectionism Scale (PANPS) and modified Body Image Satisfaction Scale from Body Image and Body Change Inventory. No gender or sport type differences were observed in dieting behaviour and body satisfaction was the only significant predictor of dieting for female athletes. Mediation analysis demonstrated that body satisfaction is a mediator between both adaptive and maladaptive perfectionism and dieting. These findings emphasize the important role that body satisfaction has in disordered eating development in female athletes.

Compulsive exercise as a mediator between clinical perfectionism and eating pathology

The aim of this study was to examine whether compulsive exercise mediates the relationship between clinical perfectionism and eating pathology, based on the cognitive behavioral model of compulsive exercise. Participants were 368 adults who participated regularly in sport/exercise and completed online measures of perfectionism, compulsive exercise and eating disorders. In support of the well-established link between perfectionism and eating disorders, clinical perfectionism predicted eating pathology both directly and indirectly mediated by compulsive exercise. In addition, there were also direct effects of clinical perfectionism on the avoidance/rule-driven behavior, weight control, and mood improvement subscales of the Compulsive Exercise Test (CET). There was a direct effect of the CET weight control subscale on eating pathology and a negative direct effect of the CET subscale mood improvement on eating pathology. Findings lend support to the cognitive behavioral model of compulsive exercise in which clinical perfectionism is conceptualized as related to eating disorders directly and indirectly through the mediation of compulsive exercise. Compulsive exercise was also found to have a direct effect on eating disorders. Compulsive exercise may be a symptom of eating pathology, rather than an antecedent, however causal inferences could not be established given the correlational design. Longitudinal research using cross-lagged panel designs to examine a bidirectional relationship between compulsive exercise and eating disorders is needed.

Bone strength estimates relative to vertical ground reaction force discriminates women runners with stress fracture history

PURPOSE

To determine differences in bone geometry, estimates of bone strength, muscle size and bone strength relative to load, in women runners with and without a history of stress fracture.

METHODS

We recruited 32 competitive distance runners aged 18-35, with (SFX, n=16) or without (NSFX, n=16) a history of stress fracture for this case-control study. Peripheral quantitative computed tomography (pQCT) was used to assess volumetric bone mineral density (vBMD, mg/mm³), total (ToA) and cortical (CtA) bone areas (mm²), and estimated compressive bone strength (bone strength index; BSI, mg/mm⁴) at the distal tibia. ToA, CtA, cortical vBMD, and estimated strength (section modulus; Zp, mm³ and strength strain index; SSIp, mm³) were measured at six cortical sites along the tibia. Mean active peak vertical (pkZ) ground reaction forces (GRFs), assessed from a fatigue run on an instrumented treadmill, were used in conjunction with pQCT measurements to estimate bone strength relative to load (mm²/N∗kg^-1) at all cortical sites.

RESULTS

SSIp and Zp were 9-11% lower in the SFX group at mid-shaft of the tibia, while ToA and vBMD did not differ between groups at any measurement site. The SFX group had 11-17% lower bone strength relative to mean pkZ GRFs (p<0.05).

CONCLUSION

These findings indicate that estimated bone strength at the mid-tibia and mean pkZ GRFs are lower in runners with a history of stress fracture. Bone strength relative to load is also lower in this same region suggesting that strength deficits in the middle 1/3 of the tibia and altered gait biomechanics may predispose an individual to stress fracture.

Effects of perfectionism and exercise on disordered eating in college students

PURPOSE

This study examined two dimensions of perfectionism (Standards and Discrepancy), two aspects of exercise (cardiovascular and strength), and the interaction of these variables as predictors of disordered eating in female and male college students.

METHODS

Recruited participants (N=314; n=204 women) completed self-report measures of disordered eating (Eating Attitudes Test), perfectionism (Almost Perfect Scale-Revised; Standards and Discrepancy subscales), and exercise (strength and cardiovascular).

RESULTS

Among women, there was a significant three-way interaction between the two dimensions of perfectionism (Standards and Discrepancy) and cardiovascular exercise. Also among women, there was a significant two-way interaction between the Standards dimension and strength exercise and between the Discrepancy dimension and strength exercise. There were no significant main effects or interactions among men.

CONCLUSIONS

We found some support for the hypotheses that adaptive perfectionism (higher Standards coupled with lower Discrepancy) is a protective factor for disordered eating and that maladaptive perfectionism (higher Standards coupled with higher Discrepancy) is a risk factor, although, only among women who engaged in lower, but not higher, levels of cardiovascular exercise. The findings also suggest that it may be beneficial to consider dimensions of perfectionism and exercise separately when studying disordered eating.

Measuring eating disorder attitudes and behaviors: a reliability generalization study

BACKGROUND

Although score reliability is a sample-dependent characteristic, researchers often only report reliability estimates from previous studies as justification for employing particular questionnaires in their research. The present study followed reliability generalization procedures to determine the mean score reliability of the Eating Disorder Inventory and its most commonly employed subscales (Drive for Thinness, Bulimia, and Body Dissatisfaction) and the Eating Attitudes Test as a way to better identify those characteristics that might impact score reliability.

METHODS

Published studies that used these measures were coded based on their reporting of reliability information and additional study characteristics that might influence score reliability.

RESULTS

Score reliability estimates were included in 26.15% of studies using the EDI and 36.28% of studies using the EAT. Mean Cronbach's alphas for the EDI (total score = .91; subscales = .75 to .89), EAT-40 (total score = .81) and EAT-26 (total score = .86; subscales = .56 to .80) suggested variability in estimated internal consistency. Whereas some EDI subscales exhibited higher score reliability in clinical eating disorder samples than in nonclinical samples, other subscales did not exhibit these differences. Score reliability information for the EAT was primarily reported for nonclinical samples, making it difficult to characterize the effect of type of sample on these measures. However, there was a tendency for mean score reliability to be higher in the adult (vs. adolescent) samples and in female (vs. male) samples.

CONCLUSIONS

Overall, this study highlights the importance of assessing and reporting internal consistency during every test administration because reliability is affected by characteristics of the participants being examined.

The Eating Disorder Examination Questionnaire (EDE-Q) among university men and women at different levels of athleticism

The aim of the current study was to establish norms for the Eating Disorder (ED) Examination Questionnaire (EDE-Q) among competitive athletes and to explore the contribution of level of athletic involvement and gender to ED psychopathology, as measured by the EDE-Q. University students (n = 1637) from ten United States universities were recruited online via a social networking website and asked to complete an anonymous survey. The sample was then divided according to gender and level of sports participation. Females scored higher than males regardless of level of athleticism. Lower mean scores were frequently observed among those involved in competitive sports exclusively and highest scores among those involved in recreational sports (alone or in addition to competitive athletics). Recreational activity seems to be important in stratifying risk among competitive athletes; gender is an important interaction term in athletic populations.

Different effects on bone strength and cell differentiation in pre pubertal caloric restriction versus hypothalamic suppression

Hypothalamic amenorrhea and energy restriction during puberty affect peak bone mass accrual. One hypothesis suggests energy restriction alters hypothalamic function resulting in suppressed estradiol levels leading to bone loss. However, both positive and negative results have been reported regarding energy restriction and bone strength. Therefore, the purpose of this study was to investigate energy restriction and hypothalamic suppression during pubertal onset on bone mechanical strength and the osteogenic capacity of bone marrow-derived cells in two models: female rats treated with gonadotropin releasing hormone antagonists (GnRH-a) or 30% energy restriction. At 23 days of age, female Sprague Dawley rats were assigned to three groups: control group (C, n=10), GnRH-a group (n=10), and Energy Restriction (ER, n=12) group. GnRH-a animals received daily injections for 27 days. The animals in the ER group received 70% of the control animals' intake. After sacrifice (50 days of age), body weight, uterine and muscle weights were measured. Bone marrow-derived stromal cells were cultured and assayed for proliferation and differentiation into osteoblasts. Outcome measures included bone strength, bone histomorphometry and architecture, serum IGF-1 and osteocalcin. GnRH-a suppressed uterine weight, decreased osteoblast proliferation, bone strength, trabecular bone volume and architecture compared to control. Elevated serum IGF-1 and osteocalcin levels and body weight were found. The ER model had an increase in osteoblast proliferation compared to the GnRH-a group, similar bone strength relative to body weight and increased trabecular bone volume in the lumbar spine compared to control. The ER animals were smaller but had developed bone strength sufficient for their size. In contrast, suppressed estradiol via hypothalamic suppression resulted in bone strength deficits and trabecular bone volume loss. In summary, our results support the hypothesis that during periods of nutritional stress the increased vertebral bone volume may be an adaptive mechanism to store mineral which differs from suppressed estradiol resulting from hypothalamic suppression.

Bone geometry, strength, and muscle size in runners with a history of stress fracture

PURPOSE

Our primary aim was to explore differences in estimates of tibial bone strength, in female runners with and without a history of stress fractures. Our secondary aim was to explore differences in bone geometry, volumetric density, and muscle size that may explain bone strength outcomes.

METHODS

A total of 39 competitive distance runners aged 18-35 yr, with (SFX, n = 19) or without (NSFX, n = 20) a history of stress fracture were recruited for this cross-sectional study. Peripheral quantitative computed tomography (XCT 3000; Orthometrix, White Plains, NY) was used to assess volumetric bone mineral density (vBMD, mg x mm(-3)), bone area (ToA, mm(2)), and estimated compressive bone strength (bone strength index (BSI) = ToA x total volumetric density (ToD(2))) at the distal tibia (4%). Total (ToA, mm(2)) and cortical (CoA, mm(2)) bone area, cortical vBMD, and estimated bending strength (strength-strain index (SSIp), mm(3)) were measured at the 15%, 25%, 33%, 45%, 50%, and 66% sites. Muscle cross-sectional area (MCSA) was measured at the 50% and 66% sites.

RESULTS

Participants in the SFX group had significantly smaller (7%-8%) CoA at the 45%, 50%, and 66% sites (P <or= 0.05 for all), significantly lower SSIp (9%-10%) at the 50% and 66% sites, and smaller MCSA (7%-8%) at the 66% site. The remaining bone parameters including vBMD were not significantly different between groups. After adjusting for MCSA, there were no differences between groups for any measured bone outcomes.

CONCLUSIONS

These findings suggest that cortical bone strength, cortical area, and MCSA are all lower in runners with a history of stress fracture. However, the lower strength was appropriate for the smaller muscle size, suggesting that interventions to reduce stress fracture risk might be aimed at improving muscle size and strength.

Personality and psychological factors as predictors of disordered eating among female collegiate athletes

This article examined the relationship of perfectionism, psychological well-being (self-esteem and optimism), reasons for exercising and appearance orientation to eating disorder classification among 204 female collegiate athletes. Multivariate analyses showed that only self-esteem, exercising to improve appearance and be more attractive, and appearance orientation differentiated significantly between the symptomatic/eating disordered athletes and those who were asymptomatic. No differences existed between the two groups of athletes on perfectionism, optimism, or exercising for fitness/health. For athletes, self-esteem, appearance orientation and exercising to be attractive and improve appearance were most important for understanding their level of disordered eating.

The Relationship Between Body Dissatisfaction and Bulimic Symptoms in Female Collegiate Athletes

In this study, we extended past research (Brannan & Petrie, 2008; Tylka, 2004) by examining perfectionism, optimism, self-esteem, and reasons for exercising as moderators of the body dissatisfaction-bulimic symptoms relationship among female collegiate athletes (N= 204). Hierarchical moderated regression was used to control for social desirability and physical size and then tested the main and interactive effects of the models. Body dissatisfaction was related to the measure of bulimic symptoms, accounting for 24% of the variance. Four variables were statistically significant as moderators. More concern over mistakes and being motivated to exercise to improve appearance and attractiveness or to socialize and improve mood increased the strength of the relationship between body dissatisfaction and bulimic symptoms. Self-esteem had a buffering effect that resulted in a weakened relationship.

Evaluation of the BOD POD for estimating percent body fat in collegiate track and field female athletes: a comparison of four methods

This investigation examined the accuracy of the BOD POD on a group of Division I collegiate track and field female athletes (N = 30). Hydrostatic weighing (HW) was used as the gold standard method. Body density (Db) values obtained from the BOD POD (Db BP) were compared with those determined by HW (Db HW). Both Db values were converted to percent body fat (%BF) using the Siri equation for comparison. Percent body fat values obtained from the BOD POD (BF BP) were also compared with those obtained from dual-energy X-ray absorptiometry (DXA, BF DXA) and skinfold (SF, BF SF). The validity of the BOD POD was assessed using repeated-measures analysis of variance (ANOVA), and the relationship between the methods was examined through Pearson correlation. Average Db BP was 0.00890 g x cm(-3) lower (p < 0.05) than Db HW, resulting in a significant overestimation of %BF (p < 0.05) by the BOD POD. Values for BFDXA and BFBP also differed significantly (p < 0.05). On the other hand, BFSF and BF BP were not significantly different. The correlation between percent body fat values obtained from HW (BFHW) and BF BP was good (r = 0.88, SEE = 2.30) as well as between BF SF and BF BP (r = 0.85, SEE = 2.05). Conversely, the correlation between BFDXA and BF BP was poor (r = 0.25, SEE = 5.73). The strong correlation between BF BP and BF HW presented here suggests that the BOD POD has the potential to be used as a body composition analysis tool for female athletes. The advantages of the BOD POD over HW encourage further investigation of this instrument. However, the fact that the BOD POD and SF results did not differ significantly might suggest that the SF could be used in its place until a better rate of accuracy for this instrument is established.

National athletic trainers' association position statement: preventing, detecting, and managing disordered eating in athletes

OBJECTIVE

To present recommendations for the prevention, detection, and comprehensive management of disordered eating (DE) in athletes.

BACKGROUND

Athletes with DE rarely self-report their symptoms. They tend to deny the condition and are often resistant to referral and treatment. Thus, screenings and interventions must be handled skillfully by knowledgeable professionals to obtain desired outcomes. Certified athletic trainers have the capacity and responsibility to play active roles as integral members of the health care team. Their frequent daily interactions with athletes help to facilitate the level of medical surveillance necessary for early detection, timely referrals, treatment follow-through, and compliance.

RECOMMENDATIONS

These recommendations are intended to provide certified athletic trainers and others participating in the health maintenance and performance enhancement of athletes with specific knowledge and problem-solving skills to better prevent, detect, and manage DE. The individual biological, psychological, sociocultural, and familial factors for each athlete with DE result in widely different responses to intervention strategies, challenging the best that athletics programs have to offer in terms of resources and expertise. The complexity, time intensiveness, and expense of managing DE necessitate an interdisciplinary approach representing medicine, nutrition, mental health, athletic training, and athletics administration in order to facilitate early detection and treatment, make it easier for symptomatic athletes to ask for help, enhance the potential for full recovery, and satisfy medicolegal requirements. Of equal importance is establishing educational initiatives for preventing DE.

Gender role, eating disorder symptoms, and body image concern in ballet dancers

OBJECTIVE

Our objective was to evaluate the relationships between gender role, eating behavior, and body image in nonprofessional female ballet dancers.

METHODS

One hundred ten female ballet dancers and 59 controls were administered the Bem Sex Role Inventory, the Eating Disorder Examination (EDE), the Body Uneasiness Test (BUT), and the Beck Depression Inventory.

RESULTS

Ballet dancers scored higher than controls in most of the items evaluating body image and eating behaviors; a high number of ballet dancers with undifferentiated gender role were also observed. In the dancers group, male-typified subjects showed higher median scores of EDE and BUT scales, while in the control group, the highest median scores of EDE and BUT scales were found in undifferentiated subjects.

CONCLUSION

Ballet schools' cultural pressure towards an ideal of leanness could interfere with the process of gender role acquisition. Ballet dancers appear to be overconcerned with performance; this could reinforce the internalization of several constructs that are generally considered as typically male.

Gender differences in disordered eating and its correlates

The goal of this study was to examine gender differences in the prevalence of disordered eating and body dissatisfaction as well as examine gender differences in several risk factors: mass media, self-esteem and perfectionism. Three hundred fifty-three undergraduates completed surveys about their body dissatisfaction, disordered eating habits, exposure to and influence of mass media, self-esteem and perfectionistic tendencies. As expected, women experienced more symptoms of disordered eating as well as body dissatisfaction than did their male counterparts. There were also gender differences in the risk factors. For women, mass media, self-esteem, and perfectionism related to disordered eating behaviors, whereas for men, only perfectionism and mass media related to disordered eating behaviors. For women, mass media and self-esteem related to body image dissatisfaction, whereas for men, mass media and perfectionism related to body image dissatisfaction. The results of the present study indicate that risk factors for disordered eating and body dissatisfaction for men and women may be different, which has implications for understanding the etiology of body dissatisfaction and disordered eating and for possible treatment interventions.

Female athlete triad

Although eating disorders have received much attention over the last few years in athletics, its prevalence was not always well appreciated. Over the years, professional organizations began to pay close attention to the effects of eating disorders, and with this heightened awareness, professionals as well as the general public began to recognize eating disorders as a major problem in our society. In the early 1990s, the American College of Sports Medicine (ACSM) convened the Task Force on Women's Issues in Seattle, Washington . During this conference, members of the ACSM discussed issues related to females and athletics with specific attention to eating disorders, amenorrhea, and osteoporosis. They collectively called these pathologies the Female Athlete Triad (Triad) and hence coined the phrase in 1993. Since the publication, much time and effort has been devoted towards research and understanding of the Triad. In trying to understand this complicated problem, one must grasp the concept that the three pathologies are interrelated and difficult to explain without the influence of any of the other components.

The female athlete and menstrual function

PURPOSE OF REVIEW

In the past year, there have been remarkable advancements in the understanding of the female athlete's pathology and in recognizing the specific needs of women participating in both recreational and competitive sports. The purpose of this review is to highlight the recent developments in the field of female athletes and menstrual function.

RECENT FINDINGS

Although the female athletic triad, consisting of disordered eating, amenorrhea and osteoporosis, has been clinically recognized, there have been few studies quantifying the long-term effects. This review summarizes recently explored topics, including: disordered eating as a main culprit of menstrual irregularities, long-term longitudinal studies following female athletes through to retirement, and current treatment options.

SUMMARY

Understanding the causes, profiles and the prevention of menstrual irregularities in the female athlete should help decrease its prevalence among women involved in athletics. The literature reviewed in this article stresses the importance of early detection, as well as the consequences of eating disorders, menstrual disturbances and bone loss left untreated.