Prevalence of Exercise Addiction Symptomology and Disordered Eating in Australian Students Studying Nutrition and Dietetics

Classifying excessive exercise: Examining the relationship between compulsive exercise with obsessive-compulsive disorder symptoms and disordered eating symptoms

OBJECTIVE

There remains a lack of consensus around nosology for compulsive exercise (CE). Although widely observed in eating disorders (ED), CE shares theoretical overlap with obsessive-compulsive disorder (OCD), where exercise compulsions occur in response to obsessions. Yet, there is limited and mixed evidence of a relationship between CE with OCD. This study aims to explore the appropriate diagnostic classification of CE through examination of CE in relation to OCD, obsessional thinking, and ED symptoms.

METHOD

Two hundred and eighty one adults with mental health symptoms, dieting, and exercise behaviour completed measures of OCD, CE, and disordered eating symptoms. Regression and Receiver Operating Characteristic analyses examined relationships between dimensions of CE with OCD and ED symptoms, and the predictive ability of CE assessment for detecting threshold OCD and ED symptoms.

RESULTS

CE assessment was poor at predicting threshold OCD symptoms, probable Anorexia Nervosa, and Binge Eating Disorder and moderate at detecting probable disordered eating and Bulimia Nervosa. Associations between CE and OCD symptoms were not significant after adjustment for ED symptoms. Obsessional thinking was associated only with lack of exercise enjoyment.

CONCLUSIONS

Results indicate that excessive exercise might represent a distinct disorder, with some shared traits across CE, OCD and ED symptoms. Findings question the utility of adaptation of OCD diagnostic criteria for CE. Assessment and treatment implications are considered.

Exploring the eating disorder curricula of accredited university dietetic programs in Australia and New Zealand

BACKGROUND

Dietitians are viewed as integral members of the multidisciplinary treatment team for people with eating disorders (EDs). However, low levels of perceived confidence, competence, and willingness to practice in this clinical area, have been reported by dietitians and student dietitians. As the extent of ED-specific knowledge and skills-based training within tertiary accredited dietetic programs is currently unknown, this research aimed to: (1) obtain insights into the current ED-specific knowledge base and training content of dietetic curricula in both Australian and New Zealand universities; (2) understand the perspectives of course convenors regarding the role of dietitians in ED treatment and their employment opportunities; and (3) identify gaps and opportunities for improving university programs and the dietetic workforce.

METHODS

Course convenors (or their nominated representative) of Australian and New Zealand accredited dietetic programs were invited to participate in a semi-structured virtual interview. A purpose-built question guide was developed to explore the inclusion and/or integration of ED-specific content into the curricula, and the perspectives of course convenors toward the role of dietitians in the treatment of EDs, and their employment opportunities. The interviews were audio recorded, transcribed verbatim, and analysed qualitatively using inductive thematic analysis.

RESULTS

Thirteen participants who represented 14 universities and 19 individual accredited dietetic programs, were interviewed, with some participants representing more than one university. Three dominant themes emerged: (1) varying ED-specific content and training in dietetic programs; (2) unclear dietitian's role in the treatment of EDs, and (3) contrasting views regarding ED clinical practice and employment.

CONCLUSIONS

ED-specific content was embedded within all the dietetic programs investigated in this study. However, this content was generally limited to an introductory level, with notable variations found between the depth of content and the type of training provided. Risk-mitigation skill development, such as screening for EDs, and early identification of symptoms, also varied between programs. Therefore, it is recommended that ED-specific skill development and knowledge is enhanced within Australian and New Zealand university programs, to support effective, safe, and timely care for people with EDs. This research has implications for current and future university dietetic program development and the broader dietetic workforce.

Understanding exercise addiction, psychiatric characteristics and use of anabolic androgenic steroids among recreational athletes – An online survey study

Background

The purpose of this paper was to explore maladaptive behaviors among physically active individuals, including exercise dependence and use of anabolic steroids. Both exercise addiction (EA) and use of anabolic androgenic steroids (AAS) correlate to high amounts of exercise and EA have been linked to eating disorders and other mental health problems.

Methods

An internet survey was spread through fitness-related social media. Inclusion criteria were age ≥ 15 years and exercise frequency ≥ thrice weekly. Exercise addiction inventory identified those at-risk of EA (rEA). Characteristics of rEA were compared to those not at risk. In a separate analysis, AAS users were compared to AAS-naïve individuals.

Results

In total, 3,029 participants completed the questionnaire. Of these, 11% screened positive for being rEA, and 23% for ED. Factors associated with EA included daily exercise, social phobia, eating disorders and OCD. Risk consumption of alcohol was a negative predictor. Thirty seven participants had taken AAS the last year. These were mainly men, bodybuilders/powerlifters and more often used amphetamines and opioids.

Discussion

This exploratory study supports EA being strongly associated with eating disorders. Identified associations between EA and compulsive or anxiety disorders warrant further research to clarify if these associations arise prior to, together with, or secondary to EA.

Dietary Regimen, Overweight, and Obesity in Human Nutrition Students and Other Majors: A Cross-Sectional Study

Background

Choosing a healthy diet is an increasingly a challenge for university students. The objective of this study was to compare diet and overweight/obesity in human nutrition students (HNS) and students of other careers (SOC) from a university located in Lima, Peru.

Methods

It was a cross-sectional study consisting of 158 students out of an initial sample of 170. Information was collected on the sociodemographic and anthropometric characteristics of the participants and a validated questionnaire was applied to evaluate the frequency of food consumption.

Results

There was no significant difference in diet between HNS and SOC (p > 0.05). HNS most frequently consumed yellow/orange vegetables (p = 0.020), purple vegetables (p = 0.049), citrus fruits (p = 0.029), eggs (p = 0.002), whole milk (p = 0.013), yogurt (p = 0.017), tofu (p = 0.003), olive oil (p = 0.003), other vegetable oils (p < 0.001), and alcoholic beverages (p = 0.037) than SOC. In contrast, HNS had a lower frequency of nonfried tuber intake (p = 0.039), fried tubers (p < 0.001), milk desserts (p = 0.048), flour fritters (p = 0.027), cookies with chocolate (p = 0.050), croissants (p = 0.030), cookies with filling (p = 0.024), candies (p = 0.006), and soda (p = 0.016) than SOC. Overweight/obesity was not different between HNS and SOC (p > 0.05).

Conclusions

This study found significant differences in the consumption of some foods between HNS and SOC. However, it found no significant difference in diet and overweight/obesity between HNS and SOC.

Intuitive eating: associations with body weight status and eating attitudes in dietetic majors

PURPOSE

Intuitive eating (IE), an adaptive eating pattern characterized by eating in response to physiological hunger and satiety cues, has been associated with positive psychosocial and physical health outcomes. This study aimed to determine associations between IE behavior with body weight status and eating attitudes in dietetic students and dietitians, who are a risky population for disordered eating and body dissatisfaction.

METHODS

Participants (n = 785) completed a self-administered questionnaire which featured socio-demographic characteristics, the eating attitudes test 26, the three-factor eating questionnaire, and the intuitive eating scale-2 with four facets unconditional permission to eat (UPE), eating for physical rather than emotional reasons (EPR), reliance on hunger and satiety cues (RHSC) and body-food choice congruence (B-FCC).

RESULTS

When controlled for potential covariates in the multivariate regression analysis, greater total IE and all subscale scores were associated with reduced BMI in dietetic majors having a BMI of ≥ 18.5 kg/m² (p < 0.05). Participants with a high IE score had 41%, 74%, and 89% lower risk of developing an eating disorder, uncontrolled eating, and emotional eating, respectively (p < 0.001). While higher UPE, EPR, and RHSC scores were associated with lower odds of disordered eating (p < 0.001), EPR, RHSC, and B-FCC scores were inversely related to the risk of uncontrolled eating and emotional eating (p < 0.05).

CONCLUSION

Considering these inverse associations, IE may be helpful for weight management and a useful skill to reduce eating disorder symptomatology among the dietetic community.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Mental disorders in individuals at risk for exercise addiction - A systematic review

Introduction

Exercise addiction is one of several behavioral addictions which has not yet been designated as an addictive disorder in the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5). This is in part due to a lack of clarity concerning co-occurring mental disorders of individuals at risk for exercise addiction. The aim of this review is to summarise the spectrum of psychopathology in populations at risk of exercise addiction.

Methods

The MEDLINE, Web of Science and PsycINFO databases were searched. All studies from the date of database creation until February 2020 were considered eligible. Terms used were "exercise addiction" and other mental disorders mentioned in conjunction with substance-related and addictive disorders. Studies were included if they assessed risk for exercise addiction and at least one other mental disorder.

Results

Twenty studies were included. The disorders assessed were eating disorders (n = 14), depression (n = 6), anxiety (n = 4), other substance-related and addictive disorders (n = 5), and borderline personality disorder (n = 1). In thirteen of the studies, evidence was found for higher rates of at least one mental disorder (most commonly eating disorders, anxiety and other addictive disorders) in individuals at risk for exercise addiction, compared to those not at risk.

Conclusions

Individuals at risk for exercise addiction show a broad range of mental disorders as assessed by self-report, which is in line with sufferers of other addictive disorders. Systematic psychological and clinical assessments in those at risk of exercise addiction are worthwhile, and will serve to characterize the mental health problems of individuals suffering from exercise addiction.

Altered health knowledge and attitudes among health sciences students following media exposure

Communications media that fails to present information supported by evidence-based practice has the potential to adversely influence knowledge and, ultimately, behaviors. We assessed the immediate effect of a health science documentary on knowledge, attitude, and beliefs among collegiate health sciences students enrolled in an entry-level nutrition course using surveys administered online. Participants (n = 160) completed the pre-survey, watched the documentary What the Health, and immediately completed the post-survey in one setting. Compared with pre-survey scores, participants reported a significant decrease in knowledge, change in attitude to health toward regulation of animal products, and increased agreement with all seven, pre-selected contradictory health claims presented in the documentary. Post-documentary, most participants reported they were planning to make a change in their dietary habits to reflect a plant-based diet. Documentaries providing health information contradictory to the current body of scientific literature are persuasive and can potentially increase negative health behaviors. Inclusion of practices within the health curriculum that encourage, and ultimately, improve health literacy among students before entering the health care workforce is essential.

Morbid exercise behaviour and eating disorders: A meta-analysis

BACKGROUND AND AIMS

This study examined the relationship between self-reported symptoms of morbid exercise behaviour (MEB) and eating disorders (ED) using meta-analytic techniques.

METHODS

We systematically searched MEDLINE, PsycINFO, Web of Science, SciELO and Scopus. Random effects models were used to compute pooled effect sizes estimates (r). The robustness of the summarized estimates was examined through sensitivity analyses by removing studies one at a time.

RESULTS

Sixty-six studies comprising 135 effect-sizes (N = 21,816) were included. The results revealed: (a) small-sized relationship in the case of bulimic symptoms (r = 0.19), (b) small- (r = 0.28) to medium-sized relationships (r = 0.41) in the case of body/eating concerns, and (c) medium-sized relationships in the case of overall ED symptoms (r = 0.35) and dietary restraint (r = 0.42). Larger effect sizes were observed in the case of overall ED symptoms in clinical, younger, and thinner populations, as well as when employing a continuously-scored instrument for assessing ED or the Compulsive Exercise Test for assessing MEB. Larger effect sizes were also found in female samples when the ED outcome was dietary restraint.

CONCLUSIONS

The identified gaps in the literature suggest that future research on the topic may benefit from: (a) considering a range of clinical (in terms of diagnosed ED) and non-clinical populations from diverse exercise modalities, (b) addressing a wide range of ED symptomatology, and (c) employing longitudinal designs that clarify the temporal direction of the relationship under consideration.

Prevalence of Risk for Exercise Dependence: A Systematic Review

BACKGROUND

Exercise dependence (EXD) can be considered an addictive behaviour because it presents signs typical of other addictive behaviours. Despite possible health problems related to EXD, the prevalence of risk for EXD has never been systematically reviewed.

OBJECTIVE

This article aimed to systematically review the prevalence of risk for EXD.

METHODS

Studies were identified from searches in the ERIC, PsycINFO, PubMed, Scopus, SPORTDiscus, and Web of Science electronic databases up to June 2018. Empirical studies were selected if (1) they included the outcomes of the prevalence of EXD; (2) participants were regular exercisers; and (3) they were published in either the English, French, Portuguese, or Spanish languages. A total of 34 articles met the inclusion criteria.

RESULTS

The prevalence of risk for EXD was estimated to be between 3 and 7% of regular exercisers and the university student population, and between 6 and 9% of the athlete population.

CONCLUSION

The results of this review indicated that the prevalence of risk for EXD varies with the characteristics of the exerciser, but an overall prevalence of 3-9% is estimated. Risk for EXD is a cause for concern and, from a public health point of view, is a problem that has to be addressed.