Weight perception in female athletes: associations with disordered eating correlates and behavior

Cross-sectional and longitudinal associations between higher weight and eating disorder risk among collegiate athletes

OBJECTIVES

To examine whether higher weight status is associated with increased eating disorder risk in athletes.

DESIGN

Study 1 used cross-sectional (N = 942) and longitudinal (N = 483) data collected over a five-year period from Division I athletes at a Midwestern university. Study 2 used cross-sectional data from athletes competing at various levels at universities across the United States (N = 825).

METHODS

Weight and height were measured in Study 1 and self-reported in Study 2; higher weight was defined as body mass index ≥ 25 kg/m2. Eating disorder risk was assessed with preliminary (Study 1) and final (Study 2) versions of the Eating Disorders Screen for Athletes. Study 1 examined weight status in relation to both concurrent and one-year changes in Eating Disorder Screen for Athletes score. Study 2 examined weight status in relation to both the Eating Disorders Screen for Athletes score and elevated eating disorder risk using the established Eating Disorders Screen for Athletes cut-off. All models adjusted for gender and sport type; Study 2 additionally adjusted for race/ethnicity, age, and competition level.

RESULTS

Across studies, higher weight status was significantly associated with increased eating disorder risk among athletes. This association was observed both cross-sectionally and longitudinally, and the prevelence of elevated eating disorder risk was 43 % greater among athletes with higher weight status than among those without higher weight status.

CONCLUSIONS

Despite existing stereotypes that eating disorders tend to occur with low weight status, findings highlight the importance of screening all athletes for eating disorders, regardless of their weight status.

Using machine learning to explore core risk factors associated with the risk of eating disorders among non-clinical young women in China: A decision-tree classification analysis

BACKGROUND

Many previous studies have investigated the risk factors associated with eating disorders (EDs) from the perspective of emotion regulation (ER). However, limited research has investigated interactions between co-existing risk factors for EDs, especially in China where research in EDs is underrepresented.

METHODS

This study examined core risk factors related to maladaptive eating behaviors and ER, and how their interactions affect the detection of EDs. Using machine learning, a decision tree model was constructed on a data set of 830 non-clinical Chinese young women with an average age of 18.91 years (SD = 0.95). The total data set was split into training and testing data sets with a ratio of 70 to 30%.

RESULTS

Body image inflexibility was identified as the major classifier for women at high risk of EDs. Furthermore, interactions between body image inflexibility, psychological distress, and body dissatisfaction were important in detecting women at high risk of EDs. Overall, the model classifying women at high-risk for EDs had a sensitivity of 0.88 and a specificity of 0.85 when applied to the testing data set.

CONCLUSIONS

Body image inflexibility, psychological distress, and body dissatisfaction were identified as the major classifiers for young women in China at high risk of EDs. Researchers and practitioners may consider these findings in the screening, prevention, and treatment of EDs among young women in China.

The relationship between disordered eating behaviors and injury rates in adolescent athletes

OBJECTIVE

To explore the relationship between disordered eating (DE) and significant sport injury in adolescent athletes.

METHOD

Responses to one item of the Disordered Eating Screen for Athletes and the Eating Attitudes Test (EAT-26) items, administered to n = 308 adolescent athletes, were analyzed with data on injury. Nonparametric statistics and multiple regression analysis were used to examine differences in DE rates amongst known injured adolescent athletes.

RESULTS

The EAT-26 scores of injured females, median score of 9, were significantly higher than all other groupings with H(3) = 17.26 p < .001, η²  = .047. Using regression analyses, injury significantly predicted a rise in EAT-26 score by five points in females, p = .01, R²  = .052.

DISCUSSION

This evidence suggests a relationship between adolescent female sport injury and DE, but no relationship between adolescent male sport injury and DE. These results demonstrate a need to screen for DE in athletes. Given a positive screen, athletes should be educated on the risks associated with relative energy deficiency and potentially referred to a practitioner with knowledge of the associated complications.

Prospective Associations between Sport Participation and Indices of Mental Health across Adolescence

Youth sport offers physical and psychosocial components that may be beneficial for adolescents' mental health, but the prospective directionality between sport participation and mental health has not been clearly established. The current study examined longitudinal associations between sport participation (individual and team sport) and mental health indices (depressive symptoms, anxiety symptoms, emotional symptoms, hyperactivity symptoms, conduct problems, peer problems, and prosocial behavior) across adolescence (ages 12-17) in a nationally representative Australian sample of 3956 participants at T1 (M_age = 12.41 years, SD = 0.49; 49% female), 3537 at T2 (M_age = 14.41 years, SD = 0.49; 49% female), and 3089 at T3 (M_age = 16.46 years, SD = 0.51; 49% female). Using random intercept cross-lagged panel modeling, several significant within-person effects were found. Notably, greater participation in team sport prospectively predicted fewer symptoms of depression and anxiety at subsequent timepoints. This study increases the understanding of how sport participation may relate to mental health among adolescents and provides critical evidence to inform policy.

Initial validation of a screening tool for disordered eating in adolescent athletes

BACKGROUND

Disordered eating (DE) is a growing problem among all athletes, particularly adolescents. To help prevent the progression of DE to a clinical eating disorder (ED), a brief screening tool could offer an efficient method for early identification of DE in athletes and facilitate treatment. The aim of this study is to validate a screening tool for DE that will identify male and female adolescent athletes of all sports and levels of competition who are at risk for DE. The Disordered Eating Screen for Athletes (DESA-6) consists of only 6 items and was designed for use in both male and female athlete populations.

METHODS

Validation involved two phases: Phase I consisted of screening high school athletes using the Eating Attitudes Test (EAT-26) and the DESA-6; and Phase II included inviting all high school athletes categorized as "at risk" after screening, plus age- and self-reported gender- matched athletes categorized as not "at risk", to complete the same surveys a second time along with clinical interview. Validity and regression analyses were used to compare the DESA-6 to the EAT-26 and EDE 17.0D.

RESULTS

When comparing to clinical interview, the DESA-6 had a total sensitivity of 92% and specificity of 85.96%, respectively. Upon comparison of concurrent validity, Phase II DESA-6 had a strong significant positive correlation for both males and females when compared to Phase II EDE 17.0D.

CONCLUSIONS

A brief, easy to administer screening tool for recognizing DE that can be used by physicians, psychologists, athletic trainers, registered dietitians, and other sport/healthcare staff is of utmost importance for early intervention, which can lead to improved treatment outcomes. The DESA-6 is a promising tool for risk assessment of DE in athletes.

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.

Changes in body-related self-conscious emotions over time among youth female athletes

The current study explored change in body-related self-conscious emotions (e.g., shame, guilt, authentic pride, hubristic pride) over three years, and tested body surveillance, age, weight status, years in sport, and competitive status as baseline predictors of change. Adolescent females engaged in organized sport (N = 518 at baseline, M_age = 14.02, SD = 1.38 years) completed a self-report survey once a year for three years (n = 293 and n = 215 in Years 2 and 3, respectively). Based on the unconditional latent growth model, body-related shame and guilt increased over time, and authentic and hubristic pride decreased over time. There was substantial between-person variability in the intercepts for all emotions and slopes for shame, guilt, and hubristic pride. In the conditional parallel process latent growth model, body surveillance predicted shallower change in shame and guilt over time. Female athletes high in body surveillance also reported higher body-related shame and guilt and lower authentic and hubristic pride at baseline. These findings highlight the importance of studying changes in self-conscious emotions over time in sport, and demonstrate that body surveillance may be an important factor to explore in interventions early in development.

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.

A systematic review of the relationship between weight status perceptions and weight loss attempts, strategies, behaviours and outcomes

It is commonly assumed that a person identifying that they are 'overweight' is an important prerequisite to successful weight management. However, there has been no systematic evaluation of evidence supporting this proposition. The aim of the present research was to systematically review evidence on the relationship between perceived overweight and (i) weight loss attempts, (ii) weight control strategies (healthy and unhealthy), (iii) weight-related behaviours (physical activity and eating habits), (iv) disordered eating and (v) weight change. We synthesized evidence from 78 eligible studies and evaluated evidence linking perceived overweight with outcome variables separately according to the gender, age and objective weight status of study participants. Results indicated that perceived overweight was associated with an increased likelihood of attempting weight loss and with healthy and unhealthy weight control strategies in some participant groups. However, perceived overweight was not reliably associated with physical activity or healthy eating and was associated with greater disordered eating in some groups. Rather than being associated with improved weight management, there was consistent evidence that perceived overweight was predictive of increased weight gain over time. Individuals who perceive their weight status as overweight are more likely to report attempting weight loss but over time gain more weight.

Secular Trend in Thinness Prevalence for 26 Years (1989 - 2014) among High School Runners in Japan

Background

Female distance runners are predisposed to thinness for performance reasons and at greater risk for health-related consequences than the general population.

Objectives

The aim of the study was to evaluate the secular trends in thinness among competitive distance runners in Japanese high schools with sex-specific comparison.

Methods

Body mass index (BMI) were analysed in 9,881 female and 12,786 male runners participating in the annual national road relay races between 1989 and 2014 using the directory of a track and field magazine. The age-specific trends of these variables and the prevalence of thinness were tested by linear and logistic regression, respectively.

Results

Although BMI declined significantly among both male and female runners (coefficients: boys, -0.033, -0.030, and -0.032; girls, -0.033, -0.034, and -0.034 [all P < 0.001] in 15.5-, 16.5-, and 17.5-year-olds, respectively), the prevalence of severely thin runners significantly increased only among girls (odds ratios for the yearly change = 1.05 and 1.06 [both P < 0.01] for 16.5- and 17.5-year-olds, respectively). Only 0.13% of male runners were regarded as severely thin throughout the study period.

Conclusions

The results suggested that severely thin girl runners has steadily increased. Surveys on the health consequences of extreme thinness are necessary for the female adolescent runners.

Comparison of disordered eating symptoms and emotion regulation difficulties between female college athletes and non-athletes

The purpose of the study was to compare the prevalence of disordered eating between female college athletes and non-athletes and explore emotion regulation as a potential mediator of the link between participation in athletics and disordered eating symptoms. Data for this cross-sectional study came from 527 college students in a mid-western state of the USA in fall of 2013 (376 non-athletes and 151 athletes). Disordered eating symptoms and emotion regulation were assessed utilizing the Eating Attitudes Test and the Difficulties with Emotion Regulation Scale in a survey-based format. The prevalence of disordered eating was higher in non-athletes (16.5%, vs. 6.6%; X(2)=62.8; p<.05). Non-athletes reported more signs and symptoms of disordered eating than athletes (p<.01). A linear regression approach indicated a statistically significant indirect effect (0.63, CI95=0.18, 1.20) of athletic-status on disordered eating via emotion regulation; however, this effect did not reach practical significance. Our findings show that female athletes in our sample were somewhat protected from disordered eating compared to non-athletes, but the mechanism of this relationship is unclear. A further in-depth examination of other factors, such as self-esteem and body satisfaction, that may have contributed to this finding is warranted utilizing a large sample of female college students and athletes representing a variety of sports.

Disordered eating in male athletes: a meta-analysis

We examined the propensity for male athletes to exhibit symptoms of disordered eating. Using meta-analytic techniques, we examined overall effect size, individual effect sizes for specific sport types, standard of athletic competition and diagnostic tools from 31 studies. When all studies were considered as a homogeneous group, male athletes did not have symptoms of disordered eating that were significantly different from non-athletic controls. However, significant moderator effects emerged for sport type and measurement: (a) wrestling reported a greater incidence of disordered eating; and (b) studies that reported data from the Eating Attitudes Test yielded a significantly greater incidence of disordered eating in male athletes compared to non-athletes. Although some sports seem to present a higher risk of disordered eating compared to others, the effects are weak and heterogeneous. We make suggestions for the development of the research area, which has been severely hampered by the diagnostic tools that have been available for the study of men.

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.

Growth and body composition in Brazilian female rhythmic gymnastics athletes

The aim was to analyse the physical growth and body composition of rhythmic gymnastics athletes relative to their level of somatic maturation. This was a cross-sectional study of 136 athletes on 23 teams from Brazil. Mass, standing height and sitting height were measured. Fat-free and fat masses, body fat percentages and ages of the predicted peak height velocity (PHV) were calculated. The z scores for mass were negative during all ages according to both WHO and Brazilian references, and that for standing height were also negative for all ages according to WHO reference but only until 12 years old according to Brazilian reference. The mean age of the predicted PHV was 12.1 years. The mean mass, standing and sitting heights, body fat percentage, fat-free mass and fat mass increased significantly until 4 to 5 years after the age of the PHV. Menarche was reached in only 26% of these athletes and mean age was 13.2 years. The mass was below the national reference standards, and the standing height was below only for the international reference, but they also had late recovery of mass and standing height during puberty. In conclusion, these athletes had a potential to gain mass and standing height several years after PHV, indicating late maturation.

Weight pressures in sport: examining the factor structure and incremental validity of the weight pressures in sport - females

Due to pressures within the sport environment, such as from coaches, teammates, uniforms and judges, female athletes may develop unhealthy eating practices to lose weight or change their body size/shape to become more competitive and meet societal and sport-related physique ideals. However, up until the development of the Weight Pressures in Sport for Females (WPS-F; Reel, SooHoo, Petrie, Greenleaf, & Carter, 2010) there was no way to quantify sport-specific weight pressures with female athletes. In this study, the psychometric properties of the scale were further examined using a sample of 414 female collegiate athletes. Sample 1 [n=207; M=19.27 years; SD=1.16] and Sample 2 [n=207; M=19.19 years; SD=1.66] participants were of a similar age and were used for exploratory and confirmatory analyses respectively. A two factor structure was confirmed and it was established that the scale was unique from general sociocultural pressures that all women experience, predicting female athletes' internalization, body dissatisfaction, dietary intent, and bulimic symptomatology. Specifically, the following factors, Coach and Sport Pressures about Weight (Factor 1) and Pressures Regarding Appearance and Performance (Factor 2), were found to have strong internal consistency and the emerging reliable and valid WPS-F has practical implications for screening and identifying weight-related sport pressures within female athletes. WPS-F can also serve to educate sport professionals about environmental pressures so that disordered eating and body image disturbances can be prevented.

Indicadores antropométricos de insatisfação corporal e de comportamentos alimentares inadequados em jovens atletas

INTRODUÇÃO: Altos valores de índice de massa corporal (IMC) e percentual de gordura (%G) parecem estar associados à insatisfação corporal (IC) e aos comportamentos alimentares inadequados (CAI). OBJETIVO: Identificar a influência de variáveis antropométricas sobre a IC e o CAI em atletas adolescentes competitivos. MÉTODO: Trata-se de uma análise transversal com 580 participantes com idades entre dez e 19 anos de ambos os sexos, praticantes de diversas modalidades esportivas. Aplicou-se o Body Shape Questionnaire para mensurar a IC. Utilizou-se o Eating Attitudes Test para avaliar CAI. Foram aferidas dobras cutâneas para estimar o percentual de gordura (%G). Mensurou-se peso e estatura para calcular-se o IMC. Conduziu-se regressão linear múltipla para avaliar influências das variáveis independentes sobre os desfechos do estudo. RESULTADOS: Os resultados evidenciaram que a IC no sexo feminino foi modulada apenas pelo %G, ao contrário do sexo masculino, em que IMC e %G, juntos, explicaram parte de sua variância (p < 0,05). O CAI no sexo masculino foi pouco influenciado pelo %G. CONCLUSÃO: O %G foi a única variável que influenciou a IC em ambos os sexos. Ademais, os CAI em jovens atletas parecem não ser influenciados por características antropométricas.

Orthorexia nervosa: a frequent eating disordered behavior in athletes

Striving for enhancing athletic performance, many sportsmen undergo rigid dietary habits, which could lead to eating disorders (EDs) or Orthorexia Nervosa (ON), a psychopathological condition characterized by the obsession for high quality food. The aim of the study was to examine the occurrence of ON in athletes and to verify the relationship between ON and EDs. Five-hundred-seventy-seven athletes and 217 matched controls were administered the following tests: ORTO-15, Eating Attitude Test 26 (EAT-26), Body Uneasiness Test (BUT) and Yale-Brown-Cornell Eating Disorder Scale (YBC-EDS). High positivity to ORTO-15 (28%) and EAT-26 (14%) emerged in athletes, whereas a high rate of BUT positivity was evident among controls (21%). Multivariate logistic regression analysis revealed that independent predictors of ON are previous dieting, age, positivity to YBC-EDS, positivity to EAT-26, competition level, and number of YBC-EDS preoccupations and rituals. Sharing many features with both EDs and Obsessive-Compulsive Spectrum, ON represents a crossroad between these pathologic conditions and might compromise the health state of an athlete. Therefore, coaches should consider important to detect symptoms of EDs and ON in their athletes.

Influência de fatores afetivos, antropométricos e sociodemográficos sobre o comportamento alimentar em jovens atletas

OBJETIVO: O objetivo do estudo foi analisar a influência de diversos fatores sobre o comportamento alimentar inadequado (CAI) em jovens atletas femininas. MÉTODOS: Participaram 116 esportistas. Avaliou-se o CAI mediante aplicação do Eating Attitudes Test (EAT-26). A insatisfação corporal e o comprometimento psicológico ao exercício foram avaliados pelo Body Shape Questionnaire e pelo Commitment Exercise Scale, respectivamente. O nível econômico foi obtido pelo "Critério de Classificação Econômica Brasil". Aferiram-se peso e estatura para calcular o índice de massa corporal (IMC) e dobras cutâneas para estimar o percentual de gordura. Conduziu-se regressão linear múltipla utilizando o software SPSS 17.0 e adotando nível de significância de 5%. RESULTADO: A insatisfação corporal, seguida do percentual de gordura, foram as únicas variáveis que modularam as pontuações do EAT-26. Contudo, o modelo de regressão linear múltipla explicou um terço da variância do CAI nessas esportistas. CONCLUSÃO: Concluiu-se que o CAI de atletas femininas foi influenciado basicamente pela insatisfação corporal.

Impacto de variáveis antropométricas sobre a insatisfação corporal e o comportamento alimentar em jovens atletas

OBJETIVO: Identificar a influência de variáveis antropométricas sobre a insatisfação corporal (IC) e o comportamento alimentar inadequado (CAI) em atletas adolescentes competitivos. MÉTODOS: Participaram 580 jovens (464 meninos e 116 meninas) com idades entre 10 e 19 anos, de ambos os sexos. Aplicou-se o Body Shape Questionnaire para mensurar a IC. Utilizou-se o Eating Attitudes Test para avaliar CAI. Foram aferidas dobras cutâneas para estimar o percentual de gordura (%G). Mensuraram-se peso e estatura para calcular o IMC. RESULTADOS: Os resultados evidenciaram que a IC no sexo feminino foi modulada apenas pelo %G, ao contrário do sexo masculino, em que IMC e %G, juntos, explicaram parte de sua variância (p < 0,05). O CAI no sexo masculino foi pouco influenciado pelo %G. CONCLUSÃO: Pode-se concluir que o %G foi a única variável que influenciou a IC em ambos os sexos. Ademais, os CAI em jovens atletas parecem não ser influenciados pelas características antropométricas mensuradas neste estudo.