Anxiety of young female athletes with disordered eating behaviors

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.

Initial examination of the mental health disorders: screening instrument for athletes

Introduction

There is a need to psychometrically develop assessment instruments capable of screening mental health disorders in athlete populations. The current study was conducted to determine reliability, validity and clinical utility of the Mental Health Disorders Screening Instrument for Athletes (MHDSIA).

Methods and results

259 collegiate athletes completed the MHDSIA. Factor analysis determined a single factor with good internal consistency, and this factor was positively correlated with an established measure of psychiatric symptomology (Symptom Checklist 90-R), demonstrating its concurrent validity. An optimum clinical cutoff score (i.e., 32) was determined using Receiver Operating Characteristic (ROC) analyses to assist appropriate mental health referrals.

Discussion

Results suggest the MHSIA is a reliable, valid, and relatively quick and easy to interpret screen for the broad spectrum of mental health disorders in collegiate athletes. As expected, NCAA athletes reported lower MHDSIA scores than club and intramural athletes, while males reported similar severity scores as females.

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.

Contributing Factors to Low Energy Availability in Female Athletes: A Narrative Review of Energy Availability, Training Demands, Nutrition Barriers, Body Image, and Disordered Eating

Relative Energy Deficiency in sport is experiencing remarkable popularity of late, particularly among female athletes. This condition is underpinned by low energy availability, which is a byproduct of high energy expenditure, inadequate energy intake, or a combination of the two. Several contributing factors exist that may predispose an athlete to low energy availability, and therefore a holistic and comprehensive assessment may be required to identify the root causes. The focus of the current narrative review is to discuss the primary contributing factors as well as known risk factors for low energy availability among female athletes to help practitioners increase awareness on the topic and identify future areas of focus.

Prevalence of disordered eating in athletes categorized by emphasis on leanness and activity type - a systematic review

BACKGROUND

Disordered Eating (DE) shows a strong association with athletics and can lead to several negative mental and physical health effects. Traditionally, sports have been grouped based upon whether or not the sport emphasizes leanness as a competing factor. Due to sociocultural factors, risk for DE may also be associated with the sport type. The aim of this review is to critically analyze the available research and data in this field to consider the relationship between DE and sport type to see which factors influence prevalence among athletes.

METHOD

A systematic review was completed using keywords specific to DE and sport types. Articles were either excluded due to lack of specification of athlete type or failure to use a standardized screening tool or interview for data collection.

RESULTS

6 out of 7 studies found a significant increase in DE rates among lean sport types. When classifying by sport type reports were less consistent, but show non-lean sports also have increased rates of DE.

CONCLUSION

There are variations in prevalence of DE behaviors depending on athlete type. It is important to identify the risk for DE early in athletes so emphasis can be placed on treatment options to nullify progression to an eating disorder, lower negative impacts on an athlete's performance, and prevent other negative health effects. Using sport groups is important to clinical practice as well as research, as certain sports may have a higher risk for development of DE.

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.

The Unexplored Crossroads of the Female Athlete Triad and Iron Deficiency: A Narrative Review

Despite the severity and prevalence of iron deficiency in exercising women, few published reports have explored how iron deficiency interacts with another prevalent and severe condition in exercising women: the 'female athlete triad.' This review aims to describe how iron deficiency may interact with each component of the female athlete triad, that is, energy status, reproductive function, and bone health. The effects of iron deficiency on energy status are discussed in regards to thyroid function, metabolic fuel availability, eating behaviors, and energy expenditure. The interactions between iron deficiency and reproductive function are explored by discussing the potentially impaired fertility and hyperprolactinemia due to iron deficiency and the alterations in iron metabolism due to menstrual blood loss and estrogen exposure. The interaction of iron deficiency with bone health may occur via dysregulation of the growth hormone/insulin-like growth factor-1 axis, hypoxia, and hypothyroidism. Based on these discussions, several future directions for research are presented.

A Review of Prevention, Diagnosis, and Treatment of Relative Energy Deficiency in Sport in Artistic (Synchronized) Swimming

The syndrome of relative energy deficiency in sport (RED-S) is a clinical entity characterized by low energy availability, which can negatively affect the health and performance of both male and female athletes. The underlying mechanism of RED-S is an inadequacy of dietary energy to support optimal health and performance. This syndrome refers to impaired physiological function, including metabolic rate, menstrual function, bone health, immunity, protein synthesis, and cardiovascular health, with psychological consequences that can either precede (through restrictive dietary habits) or result from RED-S. The term RED-S extends beyond the condition termed the "Female Athlete Triad." Formerly known as synchronized swimming, artistic swimming is an Olympic sport requiring a high level of fitness as well as technical skill and artistry. The risk of RED-S is high in artistic swimming as it is an aesthetic, judged sport with an emphasis on a lean physique. RED-S is of significant concern in the sport of artistic swimming because of the potential negative effects on physical and mental health as well as consequences on athletic performance. This paper reviews health and performance consequences associated with low energy availability resulting in RED-S in artistic swimming. Medical and nutritional considerations specific to artistic swimming are reviewed, and methods to help detect and manage RED-S are discussed. Prevention and management of RED-S in this athlete population should be a priority for coaches, and the sport medicine professionals working with artistic swimming athletes should utilize the RED-S CAT, a Clinical Assessment Tool for screening and managing RED-S.

Variability in Institutional Screening Practices Related to Collegiate Student-Athlete Mental Health

CONTEXT

Universal screening for mental health concerns, as part of the preparticipation examination in collegiate sports medicine settings, can be an important and feasible strategy for facilitating early detection of mental health disorders.

OBJECTIVE

To assess whether sports medicine departments at National Collegiate Athletic Association (NCAA) member colleges have policies related to identifying student-athlete mental health problems, the nature of preparticipation examination screening related to mental health, and whether other departmental or institutional screening initiatives are in place. I also aimed to characterize the variability in screening by institutional characteristics.

DESIGN

Cross-sectional study.

SETTING

College sports medicine departments.

PATIENTS OR OTHER PARTICIPANTS

Team physicians and head athletic trainers at NCAA member colleges (n = 365, 30.3% response rate).

MAIN OUTCOME MEASURE(S)

Electronic survey of departmental mental health screening activities.

RESULTS

A total of 39% of respondents indicated that their institution had a written plan related to identifying student-athletes with mental health concerns. Fewer than half reported that their sports medicine department administers a written or verbal screening instrument for symptoms of disordered eating (44.5%), depression (32.3%), or anxiety (30.7%). The strongest predictors of mental health screening were the presence of a written plan related to identifying student-athlete mental health concerns and the employment of a clinical psychologist. Additionally, Division I institutions and institutions with a greater ratio of athletic trainers to student-athletes tended to engage in more screening.

CONCLUSIONS

The substantial among-institutions variability in mental health screening suggests that opportunities exist to make these practices more widespread. To address this variability, recent NCAA mental health best-practice guidelines suggested that institutions should screen for a range of mental health disorders and risk behaviors. However, at some institutions, staffing deficits may need to be addressed to allow for implementation of screening-related activities.

Understanding how organized youth sport maybe harming individual players within the family unit: a literature review

Within the United States, close to 45 million youths between the ages of 6 and 18 participate in some form of organized sports. While recent reviews have shown the positive effects of youth sport participation on youth health, there are also several negative factors surrounding the youth sport environment. To date, a comprehensive review of the negative physical and psychological effects of organized sport on youth has not been done and little to date has documented the effect organized sport has on other players within a family, particularly on parents and siblings. Therefore the purpose of this paper is to conduct a review of papers on the negative effects of organized sport on the youth athlete and their parents and siblings. Articles were found by searching multiple databases (Physical Education Index and Sociology, Psychology databases (Proquest), SPORTDiscus and Health, History, Management databases (EBSCOhost), Science, Social Science, Arts and Humanities on Web of Science (ISI), SCOPUS and Scirus (Elsevier). Results show the darker side of organized sport for actors within the family unit. Ideas for future research are drawn and recommendations are made to optimize the youth sport experience and family health.

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.

Health state, eating and body image disorders among beauticians

Introduction: Beauticians are considered as risk populations for eating disorders and body image disorders, as their work is closely related to beauty and fashion. Aim: The aim of the authors was to examine whether eating and body image disorders occur more frequently among beauticians than in control subjects. Methods: Eating disorders were assessed using the Eating Attitudes Test, Eating Behaviour Severity Scale, and body image measures included the Human Figure Drawings Test, the Body Dissatisfaction Subscale of the Eating Disorders Inventory, the Body Attitudes Test, and the Body Investment Scale. The study sample included 56 beauticians from Transylvania and 59 from Hungary. These groups were compared with control groups including 57 subjects from Transylvania and 54 subjects from Hungary. Questionnaire data were analysed. Results: The occurrence of weight reducing methods such as binge eating was significantly more prevalent in the beautician groups than in controls. Subclinical eating disorders were more frequent in the Transylvanian beautician group. Conclusions: Clinical and subclinical eating disorders occur more frequently in beauticians than in control subjects. Orv. Hetil., 2013, 154, 665–670.

The prevalence of disordered eating and possible health consequences in adolescent female tennis players from Rio de Janeiro, Brazil

The aim of this study was to estimate the prevalence of disordered eating and possible health consequences in adolescent female tennis players. This cross-sectional controlled study investigated the pubertal development (Tanner stages); body composition (dual energy X-ray absorptiometry-DXA); dietary intake (food record); presence of disordered eating (EAT-26, BITE and BSQ); menstrual status (questionnaire) and bone mineral density (DXA). The Female Athlete Triad (FAT) was divided into two severity stages. The study included 45 adolescents (24 athletes and 21 controls) at some pubertal developmental stage. The athletes exhibited better body composition profiles. We found that 91.7%, 33.3% and 25% of athletes and 71.4%, 9.5% and 33.3% of controls met criteria for disordered eating and/or low energy availability, menstrual irregularities and low bone mass, respectively. A greater percentage of athletes than controls presented with 1 and 2 FAT components (stage I), and 4.2% presented with the full syndrome. In conclusion, tennis players appear to present with more severe disorders than controls and should be monitored to avoid damage to their performance and health.

Sport-related performance anxiety in young female athletes

The prevalence of anxiety disorders in adolescents range from 6% to 20%, and it is much higher for anxiety symptoms not meeting criteria for a specific anxiety disorder. The prevalence is much higher in females. Athletes participating in sports experience different levels of stress from competitive sports. For most young athletes (generally 13 to 24 years old, i.e., high-school and college age group) sport participation is reported to be no more stressful than many other activities of daily student or work life in general where competition is involved and performance is measured. Some level of sport related performance anxiety is considered to be normal and healthy; however, extreme anxiety in athletes can be detrimental in these performance situations. A number of factors may contribute to the development, severity, and persistence of performance anxiety related to sport participation. This article reviews the definitions, theories, clinical presentation, evaluation, and management principles of performance anxiety symptoms in young athletes.

Distúrbios de atitudes alimentares e distorção da imagem corporal no contexto competitivo da ginástica rítmica

OBJETIVO: Investigar a presença e a relação entre comportamentos sugestivos de transtornos de conduta alimentar e distorção da imagem corporal de atletas de ginástica rítmica participantes do contexto esportivo competitivo. MÉTODOS: Participaram do estudo 48 atletas de ginástica rítmica, das categorias: infantil, juvenil e adulta e 48 estudantes do ensino fundamental e médio (controle). Para a identificação da presença de transtornos de conduta alimentar utilizou-se o Teste de Atitudes Alimentares (EAT-26) e, para determinar a insatisfação com a imagem corporal, o Body Shape Questionnaire (BSQ). Para a análise estatística utilizou-se o teste de Kruskal-Wallis (p < 0,05) e a correlação de Spearman. RESULTADOS: Não houve diferenças estatísticas significativas entre o grupo de ginastas e o de estudantes na presença de transtornos de conduta alimentar; constatou-se correlação significativa entre o transtorno de conduta alimentar e distorção de imagem corporal para as ginastas da categoria infantil (10-12 anos) e juvenil (13-14 anos). A análise descritiva revela que 27,2% (quatro ginastas/10-12 anos); 20,0% (quatro ginastas/13-14 anos) apresentaram atitudes sugestivas de comportamento de transtorno de conduta alimentar. Duas ginastas de 10-12 anos (10,0%), cinco ginastas de 13-14 anos (15%) e as cinco ginastas acima 15 anos (100%) apresentaram distorção da imagem corporal. CONCLUSÃO: As evidências apontam que a percepção comportamental e cognitiva das adolescentes em relação às exigências estéticas dos ambientes nos quais estão inseridas parece ser um fator primordial a ser considerado quando da presença de comportamentos sugestivos de transtorno de conduta alimentar e da distorção da imagem corporal.

Overuse injuries in female athletes

The last three decades have witnessed a tremendous increase in female sports participation at all levels. However, increased sports participation of female athletes has also increased the incidence of sport-related injuries, which can be either acute trauma or overuse injuries. Overuse injuries may be defined as an imbalance caused by overly intensive training and inadequate recovery, which subsequently leads to a breakdown in tissue reparative mechanisms. This article will review the most frequent overuse injuries in female athletes in the context of anatomical, physiological, and psychological differences between genders.