Aspects of disordered eating continuum in elite high-intensity sports

Nutrition knowledge, body image and food security risk amongst development rugby league players

BACKGROUND

This study aimed to describe the nutrition knowledge, food security risk and eating disorder risk of development male rugby league players.

METHODS

Sixty athletes from one Australian professional rugby league club volunteered. A cross sectional online survey questionnaire consisted of three sections (Eating Disorders Inventory (EDI-3), Nutrition Knowledge and Food Security). All athletes completed the online survey without assistance using a personal electronic device.

RESULTS

The mean total knowledge score was 65.7±13.1%. There was a positive relationship between age and knowledge score, P=0.050, r2=0.06. The majority of players had breakfast everyday (N.=45, 73.8%), took pack lunches (N.=33, 55.0%), and had homemade evening meals (N.=55, 91.7%). The majority of players ate more than 1 hour before training (N.=45, 75%) and all players (n=60, 100%) ate within half an hour of training finishing. The majority of participants agreed that nutrition could influence physical and cognitive aspects of nutrition however, skill-based activities were perceived by fewer participants to be influenced by nutrition. The majority (N.=38, 63.3%) had high food security, six (10.0%) had marginal food security, whereas 10 (16.7%) and six (10.0%) had low and very low security respectively.

CONCLUSIONS

These results show a concerning levels of eating disorder risk, food insecurity and poor nutrition knowledge amongst male development rugby league players. However, it does show that they believe nutrition can impact their health and performance, and they do mostly appear to adhere to the nutrition principals for optimising health and performance.

Resilience profiles of elite athletes and their associations with health-related behaviors, well-being, and performance: A latent profile analysis

Resilience is an important factor in the performances of elite athletes as it helps them overcome the adversity they face on a daily basis. It is a dynamic process with resilience qualities evolving throughout athletes' sporting careers. Recent research has established links between resilience, sports performance, lifestyle, and health-related factors. However, no study has yet focused on the resilience profiles of athletes (i.e., sub-groups of individuals with similar levels of different resilience qualities). The aims of this study were to: (a) explore the resilience profiles of elite athletes, (b) determine the characteristics of these resilience profiles (i.e., health-related behaviors, well-being, perceived social support), and (c) determine the correlates of these profiles at intrapersonal and interpersonal levels. Latent profile analysis was performed on 307 French elite athletes. Results revealed "high resilience" and "moderate resilience" profiles. Athletes with "high resilience" profiles were more likely to be men, exhibit better health-related behaviors, and have higher levels of psychological well-being and perceived performance. High levels of conscientiousness, extraversion, the dimensions of the coach-athlete relationship and the motivational climate were also related to the "high resilience" profile. This study is the first to explore the resilience profiles of elite athletes. The results suggest that a high level of resilience is related to the adoption of health-related behaviors favorable to elite sport. Based on these findings, health promotion programs targeting the concept of resilience should be developed in elite sport centers for athletes, coaches, and parents.

[Review of nutrition and hydration in relation to physical exercise during pregnancy]

Introduction

Studies on nutritional recommendations for pregnant women who exercise are scarce. The objective of this article is not to focus on the diet of pregnant women as a whole, but to review those aspects of it that may be related to physical exercise. To this end, the nutritional and hydration recommendations contained in the main clinical practice guides on physical exercise during pregnancy are collected, including the first Spanish guides. Likewise, the energy requirements required by pregnant women who perform physical exercise during pregnancy for adequate gestational weight gain are addressed, aspects related to macronutrients in the aforementioned population group, and two specific topics, such as nutritional needs in the adolescent who practices physical exercise during pregnancy and eating disorders in pregnant athletes It is concluded by stating that pregnant women who exercise regularly should eat a varied and balanced diet, such as the Mediterranean diet, avoid long periods of fasting to avoid the appearance of hypoglycemia and maintain adequate fluid intake before, during and after physical exercise. Pregnant adolescents who engage in physical exercise require nutritional supervision to achieve adequate gestational weight gain. The pregnant athlete with an eating disorder has a higher risk of complications during pregnancy and childbirth, gynecological, fetal and neonatal, and, therefore, requires close monitoring by specialists in maternal-fetal medicine.

Are Sub-elite Athletes at Higher Risk of Eating Disorders, Exercise Addiction, Depression, and Low Energy Availability Compared With Elite Athletes?

OBJECTIVE

The main objective of this study was to investigate the risk of eating disorders, exercise addiction, depression, and low energy availability (LEA) in Danish female and male elite compared with sub-elite athletes.

DESIGN

A cross-sectional study.

SETTING

An online survey.

PARTICIPANTS

A total of 410 elite athletes (mean age 20.1 years, 51% females) and 206 sub-elite athletes (mean age 21.3 years, 52% females) from 15 different sports.Assessment of Risk Factors: Eating Disorders, exercise addiction, depression, and LEA.

MAIN OUTCOME MEASURES

The Sick Control, One Stone (6.5 kg), Fat, Food, the Eating Disorder Examination-Questionnaire, the Exercise Addiction Inventory, the Major Depression Inventory, and the Low Energy Availability in Females Questionnaire or the Low Energy Availability in Males Questionnaire.

RESULTS

We found that more female sub-elite athletes compared with elite athletes had risk of eating disorders (EDs) (37.4% vs 23.4%; P < 0.012) and the same was found for males (23.2% vs 10.4%; P = 0.005). More athletes with risk of EDs had risk of exercise addiction (12.8 vs 5.4%, P = 0.006), depression (27.3 vs 4.2%, P < 0.001), and LEA (females 55.1 vs 40.7%, P = 0.024, and males 29.4 vs 13.7%, P = 0.036, respectively) compared with athletes without risk of EDs.

CONCLUSIONS

Sub-elite athletes have a higher risk of eating disorders compared with elite athletes. Regular screening of ED symptoms and associated conditions in elite and especially sub-elite athletes may ensure early identification.

Perfectionism, disordered eating and well-being in aesthetic sports: The mediating role of passion

Aesthetic athletes face higher risks of disordered eating, and perfectionism is one of the determinants involved. While research suggests that perfectionism in sport may play a role in physical and psychological well-being, its influence remains to be confirmed. As such, further examination of the influence of perfectionism on health is warranted as it could lead to better interventions. This preregistered research sought to shed new light on these relationships by investigating the mediating role of passion in the perfectionism-disordered eating relationship as well as physical and psychological well-being in aesthetic sports. In Study 1, 229 American recreational and competitive athletes practicing either gymnastics (n = 150) or artistic swimming (n = 79) were recruited on MTurk to complete an online questionnaire. The same recruitment procedure was used for Study 2, with 107 American gymnasts (n = 69) and artistic swimmers (n = 38) completing the questionnaire at two timepoints, one year apart. Results from path analyses showed that socially prescribed perfectionism was associated with obsessive passion, which in turn was associated with disordered eating. Self-oriented perfectionism was associated with both obsessive and harmonious passion, the latter being more adaptative as it was associated with physical and psychological well-being. Thus, the way one engages in aesthetic sports matters, as engaging with obsessive passion may take a toll on one's health and lead to disordered eating. Conversely, fostering harmonious engagement seems to temper the negative associations between perfectionism and health outcomes and promote positive relationships with athlete's well-being, but requires further study.

Eating disorder symptoms and weight pressure in female rowers: associations between self-concept, psychological well-being and body composition

BACKGROUND

Female rowers may be at risk of eating disorders and high weight pressure.

AIM

The purpose of the study was to investigate the prevalence of disordered eating symptoms and weight-related pressure and the associations with self-concept, psychological well-being, socio-demographic data, experience, performance level and body composition in female fixed-bench rowers.

METHODS

Female rowers (n = 208; age ranged mean ± SD 23.6 ± 6.5 years) completed the SCOFF scale, Weight-Pressures in Sport-Females (WPS-F), Physical Self-Concept Questionnaire and the Ryff scales of psychological well-being and provided information on their experience and level of competition. In a subgroup of 115 athletes, body composition was assessed using bioimpedance.

RESULTS

It was found that 42.3% of the athletes scored ≥ 2 on SCOFF and mean ± SD value of WPS-F score was 3.65 ± 0.82. Stepwise regression analysis revealed that self-concept of strength and pressure from teammates and the uniform were associated with higher ED symptoms, whereas better psychological well-being in terms of autonomy, self-concept of attractiveness, and age were protective factors for ED symptoms. BMI, athletes' physical condition, strength, and experience were associated with more weight-related pressure and better self-concept of attractiveness and physical well-being of autonomy were significantly associated with less pressure. In body composition analysis, higher extra cellular water, self-acceptance, and physical condition were associated with more weight-related pressure in female rowers, being attractiveness and the environmental mastery protective elements.

CONCLUSIONS

The prevalence of ED symptomatology and weight-related pressure are high in female fixed bench rowing. The psychological factors of well-being and self-concept, team environment, body image concerns and body composition analysis should be considered to promote healthy eating behaviours in female rowers.

Evidence of weight loss in junior female judo athletes affects their development

Purpose

The facile manipulation of body weight in junior athletes has the potential to pose significant risks to their lifelong health. In judo, which is a weight class sport, pre-competition weight loss is widespread even among juniors, but information on the current situation is scarce, especially for female athletes, for whom it is important to provide adequate nutrition and enhance bone mass during the growth period, and the details of the current situation are not clear. Therefore, the purpose of this study was to determine the actual weight loss during the growth period in junior female judo athletes and its subsequent impact on their health.

Methods

The survey was a cross-sectional survey of junior female judo athletes in Japan using a questionnaire. Participants were asked to respond via an online questionnaire about their weight, height, weight loss experience, menstruation, competition results, and other lifestyle.

Results

51.8% of subjects experienced weight loss for competition during their junior high school years (ages 12-15). Those who experienced weight loss during secondary sexual characteristics were found to be significantly shorter in current height than those who did not (p < 0.05). Weight loss during secondary sexual characteristics did not affect current menstrual cycle. There was no significant difference in competition results due to the experience of weight loss during junior high school (χ 2 = 4.485, df = 3, n.s.).

Conclusions

These findings suggest that weight loss during the growth spurt phase may adversely impact normal development. It also suggested that weight loss during the junior high school years may not be a strategy to bring about better competition results. These observations indicate the need for education on appropriate class selection and weight control for junior athletes in weight class competitions.

Personal risk factors and types of sport associated with drive for thinness and drive for muscularity in NextGen athletes

Introduction

Professional and student-athletes are at risk of developing symptoms of eating disorders (ED), including drive for thinness and muscularity due to personal risk factors (e.g., low self-esteem) and sport-specific characteristics (e.g., sport requirements). However, limited studies have focused on ED symptoms among NextGen athletes (identified in Canada as élite or relève) who compete at the provincial, national, and international levels but are not yet part of national teams. As such, they have access to fewer financial resources and support from their sport federations, which can create additional stress for these athletes. The present study aimed to identify personal risk factors and types of sports associated with (a) drive for thinness and (b) drive for muscularity in NextGen athletes.

Methods

These athletes (n = 254) aged between 14 and 25 years old completed an online questionnaire. Perfectionism, self-esteem in sport, drive for thinness, and drive for muscularity were, respectively, assessed by the Multidimensional Inventory of Perfectionism in Sport, the Sport State Self-Esteem Scale, the Eating Attitude Test-26, and the Drive for Muscularity Scale. Other personal risk factor (e.g., athletic status) were measured using in-house questions. Each personal risk factor was included in two multiple linear regressions, respectively, to determine which factors were most associated with drive for thinness and drive for muscularity.

Results

Analyses revealed that perfectionist aspirations during training were linked to a stronger desire for thinness. In addition, not being in school or not having a job were also linked to a stronger desire for thinness. Several variables were found to be associated with a greater desire for muscularity: being a male athlete, playing team sport, weight category sport or endurance sport (as opposed to esthetic sport), having elite status, being less satisfied with one's current sporting performance and having higher perfectionist aspirations during training.

Discussion

This study offers initial insights into the factors influencing EDs among NextGen athletes, which provides a foundation for deeper exploration and the creation or modification of targeted interventions. These findings can guide sport organizations in creating guidelines and programs to better support the next generation of national athletes (e.g., create programs to help athletes maintain investments outside).

Body image concerns among individuals with different levels of sporting engagement and exercise: A longitudinal study

This longitudinal study examined whether body image concerns (general; sporting) predicted eating disorder psychopathology, and whether the link differed according to nature of sport engagement. Participants were competitive sports engagers, non-competitive sports engagers, or sports non-engagers. At baseline, 510 adults completed online measures of sports demographics, eating psychopathology and body image. Eating psychopathology and body image measures were taken at follow-up (6 months later). Competitive sports engagers had better body image than the other two groups. Poorer body appreciation and better appearance-related body image predicted higher eating disorder psychopathology. Engaging in sports competitively may be beneficial for body image. However, positive appearance-related sporting body image may pose a risk for later eating psychopathology.

Mental Health and Disordered Eating in Athletes

Disordered eating (DE) and eating disorders (EDs) are more prevalent in athletes than non-athletes, and can cause devastating health and performance consequences. Although they can affect any athlete, DE/EDs are more common among women and athletes in lean sports, where there is a perceived competitive advantage to being lean. The sports medicine provider plays a crucial role in screening, diagnosis, and treatment of DE/ED. Treatment should involve a multidisciplinary team with a physician, dietitian, and mental health provider. Preventative efforts should seek to educate athletes and their coaches/support staff and should foster a healthy environment, which deemphasizes weight or body image.

Disordered eating is not associated with musculoskeletal injury in university athletes

TAKE HOME MESSAGE

Musculoskeletal injuries and disordered eating are prevalent in varsity-level athletes but are not associated in our participants.

Investigating pre-professional dancer health status and preventative health knowledge

Introduction

Dance is a highly demanding physical pursuit coupled with pressure to conform to aesthetic ideals. Assessment of health status and preventative health knowledge of pre-professional dancers may help inform educational strategies promoting dancers' health and career longevity. The aim of this research was to establish a baseline understanding of dance students at a single pre-professional institution based on metrics focused on current health, nutrition, lifestyle, and wellbeing while also gauging knowledge of longer-term health implications.

Methods

Adopting a cross-sectional study design, the Dance-Specific Energy Availability Questionnaire was tailored for Australian participants and administered online.

Results

The response rate was 59.5% (69/116 eligible students) and the survey was completed in full by 63 students. Mean BMI was 20 kg/m2, although among females, 47% had a BMI < 20 (range 16 to 25 kg/m2), and at their lowest reported weight BMI was 14 to 25 kg/m2. Over a third had either experienced (31%) or were currently experiencing (3.4%) secondary amenorrhea (period absence ≥ 3 consecutive months). Most dancers did not exclude food groups, however, 24% had been advised to exclude particular foods in the past, mostly by dance teachers. A large percentage used nutritional supplements (68%) with 60% supplementing with iron and more than half (53%) taking two or more supplements. Only 25% had ever utilised a qualified dietitian, although 16% reported a history of eating disorders and 25% reported vegetarian or vegan eating patterns. REDs risk scores ranged from -16 to +16 points with negative scores indicating LEA and higher risk of REDs. The mean score for males was 5.2 (SD = 3.9) and 2.1 (SD = 5.9) for females, with 33.3% producing a negative score.

Conclusion

Results provide insight to health knowledge and particular issues pertinent for dancers and highlights the need for specific education strategies to promote a preventative health focus for those entering a pre-professional programme. This study also highlights the need for improved awareness of LEA and REDs among all practitioners working with dancers along with cultural and structural changes within the broader dance community to help protect and promote the wellbeing of dancers.

Eating behaviour, body image, and mental health: updated estimates of adolescent health, well-being, and positive functioning in Aotearoa New Zealand

Introduction Body image dissatisfaction and its associated challenges have been related to poorer health outcomes among adolescents worldwide, including disordered eating behaviour, depression, and anxiety. However, current prevalence estimates of these issues in Aotearoa New Zealand or, relatedly, the estimates of positive attitudes and behaviours, such as intuitive eating and body appreciation are dated. Aim The primary aim of this paper was to provide updated estimates for a variety of constructs related to eating behaviours and body image, sourced from a diverse range of early adolescent participants. Methods For this report, a brief online survey was advertised to adolescents throughout Aotearoa New Zealand (n  = 893) via school and community noticeboards. Results Approximately one-in-three male participants and one-in-two female participants reported body image dissatisfaction. One in four participants reported clinically significant symptoms of depression and anxiety. Discussion Given such issues, there is clearly still much progress to be made in advancing positive health among early adolescents. Identifying potentially protective constructs such as intuitive eating and body appreciation may offer guidance into the best targets for prevention and early intervention.

Protocol for a 2-year longitudinal study of eating disturbances, mental health problems and overuse injuries in rock climbers (CLIMB)

INTRODUCTION

Rock climbing is a rapidly growing sport in which performance may be affected by participant's weight and leanness, and there may be pressure on athletes with respect to their eating behaviour and body weight. However, there is sparse research performed on climbers, constituting a knowledge gap which the present study aims to fill. The primary outcomes of the study are to examine disordered eating and overuse injuries in rock climbers. Secondary variables are body image, indicators of relative energy deficiency, mental health problems, compulsive training, perfectionism, sleep quality and bone density.

METHOD AND ANALYSIS

This prospective longitudinal study aims to recruit Swedish competitive rock climbers (>13 years) via the Swedish Climbing Federation. A non-athlete control group will be recruited via social media (n=equal of the climbing group). Data will be collected using streamlined validated web-based questionnaires with three follow-ups over 2 years. Inclusion criteria for rock climbers will be a minimum advanced level according to International Rock-Climbing Research Association. The non-athlete control group is matched for age and gender. Exclusion criteria are having competed at an elite level in any sport as well as training more often than twice per week. Statistical analyses will include multinominal logistic regression, multivariate analysis of variance (MANOVA) and structural equation modelling (SEM). We will assess effect measure modification when relevant and conduct sensitivity analyses to assess the impact of lost to follow-up.

ETHICS AND DISSEMINATION

The Rock-Climbers' Longitudinal attitudes towards Injuries, Mental health and Body image study, CLIMB, was approved by the Swedish ethics authority (2021-05557-01). Results will be disseminated through peer-reviewed research papers, reports, research conferences, student theses and stakeholder communications.

TRIAL REGISTRATION NUMBER

NCT05587270.

Body image concerns across different sports and sporting levels: A systematic review and meta-analysis

Mixed findings exist regarding whether athletes have different levels of body image concerns to non-athletes. Such body image concerns have not been reviewed recently, meaning that new findings need to be incorporated into our understanding of the adult sporting population. This systematic review and meta-analysis aimed first to characterise body image in adult athletes versus non-athletes, and second to explore whether specific sub-groups of athletes report different body image concerns. Impact of gender and competition level were considered. A systematic search identified 21 relevant papers, mostly rated moderate quality. Following a narrative review, a meta-analysis was conducted to quantify the outcomes. While the narrative synthesis indicated possible differences between types of sport, the meta-analysis demonstrated that athletes in general reported lower body image concerns than non-athletes. In general, athletes had a better body image than non-athletes, with no reliable differences between different type of sport. A combination of prevention and intervention strategies might assist athletes in focusing on the benefits to their body image without encouraging restriction/compensation or overeating. Future research should define comparison groups clearly, along with attending to training background/intensity, external pressures, gender and gender identity.

Intersection of mental health issues and Relative Energy Deficiency in Sport (REDs): a narrative review by a subgroup of the IOC consensus on REDs

Overall athlete health is a stated priority by the International Olympic Committee (IOC), yet it can be difficult for athletes to safely balance nutritional needs, training load, recovery, social interactions, expectations and other demands. The effect of energy intake and, especially, low energy availability (LEA) on athlete mental health, is understudied. In this narrative review, we examine research that has included psychological factors and mental health variables when investigating the effect of LEA, dieting/restrictive eating and Relative Energy Deficiency in Sport (REDs), since the 2018 IOC consensus statement on REDs. Based on currently available data, early psychological indicators associated with problematic LEA are mood changes, fatigue and psychological conflict. More severe mental health outcomes associated with REDs are reduced well-being, elevated anxiety, depressive symptoms and eating disorders. We propose a psychological model that helps structure how possible risk factors (eg, body dissatisfaction, environmental demands or increased training load) and moderating (eg, gender, sport) and/or potential mediating (eg, social climate, self-esteem) factors are associated with LEA and ultimately REDs. The current scientific literature underscores the importance of including mental health factors when screening for REDs and for developing a clinical approach to address the psychological sequelae of REDs once diagnosed. An interdisciplinary perspective is recommended. Lastly, and importantly, the athlete perspective urges clinicians to not underestimate the drive for success and denial of health consequences that athletes demonstrate when pursuing their sport goals.

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.

A mixed method approach to evaluating eating-related psychopathologies in collegiate student-athletes

OBJECTIVE

To examine the presence of body image concerns, drive for muscularity, and disordered eating behaviors in collegiate student-athletes.

PARTICIPANTS

One hundred and one NCAA Division I student-athletes participated in Phase I; 15 of these also participated in Phase II.

METHODS

This study employed a mixed method, sequential explanatory design. Participants first completed survey measures assessing body image concern, drive for muscularity, and eating behaviors. These results influenced open-ended, semi-structured interviews, which were thematically analyzed.

RESULTS

Body image and disordered eating behaviors were of greater concern than drive for muscularity. Student-athletes reported engaging in eating behaviors as opposed to not eating, yet these eating behaviors trended toward disordered behaviors such as obsessive "healthy eating" or orthorexia.

CONCLUSIONS

This study took a novel methodological approach to examining student-athlete body image and eating behaviors. Results emphasize the need for further support and education for student-athletes around body image and eating behaviors.

Symptoms of eating disorders and low energy availability in recreational active female runners

Objectives

This retrospective, cross-sectional study aimed to investigate symptoms of eating disorders (EDs) and low energy availability (LEA) among recreational female runners.

Methods

Females (18-39 years) (n=89) participating in running group sessions organised by running clubs and companies were recruited via social media and completed an anonymous online survey compromising the Eating Disorder Examination Questionnaire (EDE-Q) and Low Energy Availability in Females Questionnaire (LEAF-Q). An EDE-Q global score ≥2.3 and a LEAF-Q total score ≥8 (in combination with an injury score≥2 and/or menstruation dysfunction score≥4) were used to categorise subjects as having symptoms of EDs and LEA, respectively.

Results

Among the subjects fulfilling the age criteria (n=85), 18% (n=15) had symptoms of EDs and 19% (n=16) had symptoms of LEA. Of those with symptoms of EDs, 13% (n=2) had concomitant symptoms of LEA. The higher the EDE-Q dietary restraint score, the higher the gastrointestinal problem score (r=0.23, p=0.04), otherwise no other associations were found between EDE-Q global or subscale scores and LEAF-Q scores.

Conclusion

Our results indicate that symptoms of EDs and LEA are frequent among adult females at all athletic levels, including the recreational level. Hence, to prevent the negative health consequences of EDs and LEA, preventative initiatives are also needed in recreational running communities.

Current trends and perspectives in the exploration of anorexia athletica-clinical challenges and therapeutic considerations

Elite athletes are exposed to a considerable amount of physical and psychological stress throughout their entire professional life, but the exploration of the consequences of this stressful regimen on mental health is still in its early stages. Eating disorders (EDs), substance use disorders, and behavioral addictions represent only several domains that are worth more investigation in this vulnerable population, in order to find preventative and therapeutic strategies. The exploration of EDs in athletes is important because this population is very vulnerable to the impact that weight and body shape may have on their professional performances, and epidemiological studies support this concern, i.e., the prevalence of EDs in athletes is significantly higher than in the general population. This article is dedicated to the synthesis of available data regarding a specific pathology reported in elite athletes, i.e., anorexia athletica (AA), based on a narrative reviewing methodology. The information about risk factors, pathophysiology, positive and differential diagnosis, epidemiology, structured evaluation, and treatment of AA have been summarized and future research directions have been highlighted. While tentative diagnostic criteria for AA and a self-administered questionnaire exist, its pathophysiology is still insufficiently explored, and the treatment is not based on good-quality trials. According to the retrieved data, more research targeting the physical and mental health of elite athletes, especially those practicing esthetic sports, is needed, in order to implement adequate screening and early intervention programs. Future studies targeting various sub-populations of elite athletes, i.e., esthetic vs. non-esthetic sports, individuals presenting a history of ED vs. those without such a history, and those practicing individual sports vs. team sports are needed to reach the objective of improving the quality of life in this population.

Athletes with Eating Disorders: Analysis of Their Clinical Characteristics, Psychopathology and Response to Treatment

Eating disorders (ED) have frequently been described among athletes. However, their specific features and therapy responses are lacking in the literature. The aims of this article were to compare clinical, psychopathological and personality traits between ED patients who were professional athletes (ED-A) with those who were not (ED-NA) and to explore differences in response to treatment. The sample comprised n = 104 patients with ED (n = 52 ED-A and n = 52 matched ED-NA) diagnosed according to DSM-5 criteria. Evaluation consisted of a semi-structured face-to-face clinical interview conducted by expert clinicians and a psychometric battery. Treatment outcome was evaluated when the treatment program ended. ED-A patients showed less body dissatisfaction and psychological distress. No differences were found in treatment outcome among the groups. Within the ED-A group, those participants who performed individual sport activities and aesthetic sports presented higher eating psychopathology, more general psychopathology, differential personality traits and poor therapy outcome. Individual and aesthetic sports presented more severity and worse prognosis. Although usual treatment for ED might be similarly effective in ED-A and ED-NA, it might be important to develop preventive and early detection programs involving sports physicians and psychologists, coaches and family throughout the entire athletic career and afterwards.

New perspectives in functional hypogonadotropic hypogonadism: beyond late onset hypogonadism

Functional hypogonadotropic hypogonadism (FHH) is an increasingly frequent condition, whose pathological mechanisms are not yet fully clarified. The concept of FHH has now completely replaced that of late onset hypogonadism, that only concerned the ageing man. FHH is the result of an impairment of the hypothalamic-pituitary gonadal axis (HPG-A) function, resulting in decreased testosterone concentrations associated with low or inappropriately normal gonadotropin levels and infertility; it can be diagnosed once organic causes of hypogonadism are excluded. The growing occurrence of FHH derives from its association with widespread conditions, such as obesity and diabetes mellitus, but also to the increasing ease and frequency of use of several drugs, such as opioids, glucocorticoids, and sex steroids. Moreover, given the tendency of many subjects to excessive physical activity and drastic reduction in caloric intake, FHH may also be secondary to low energy availability. Finally, the association with HIV infection should not be overlooked. Therefore, there is an important variability in the diseases that can lead to FHH. Despite the heterogeneity of the underlying pathologies, the mechanisms leading to FHH would seem quite similar, with the initial event represented by the impairment at the HPG-A level. Nevertheless, many different biological pathways are involved in the pathogenesis of FHH, therefore the aim of the current paper is to provide an overview of the main relevant mechanisms, through a detailed analysis of the literature, focusing specifically on pathogenesis and clinical, diagnostic and therapeutic aspects.

The Comparison of Disordered Eating, Body Image, Sociocultural and Coach-Related Pressures in Athletes across Age Groups and Groups of Different Weight Sensitivity in Sports

The aim of the present study was to compare disordered eating (DE), body image, and sociocultural and coach-related pressures between athletes of different age groups (adolescents and adults) and between athletes participating in weight-sensitive (WS) and less WS groups. A total of 1003 athletes participated in this study. The age range of the sample was 15 to 44 years, and the mean age was 18.9 ± 5.8 years (51.3% were female). Athletes who voluntarily agreed to participate in the study were provided with the study measures on DE, body image and sociocultural attitudes towards appearance. Vomiting, laxative misuse and excessive exercise were more prevalent in adolescent female athletes than adults, while dietary restraint was more common in adult male athletes than adolescents. Adolescent female athletes experienced higher sociocultural (family, peers) and sport-related (coach) pressures and a less positive body image compared with adult female athletes. Adult male athletes experienced higher overweight preoccupation, more DE and unhealthy eating habits, and engaged in more frequent self-weighing behaviour compared with adolescent males. When the effect of weight sensitivity in sports was tested, a higher prevalence of DE and overweight preoccupation, more frequent self-weighing, and higher body-image-related pressure from coaches were observed in female athletes participating in aesthetic weight-sensitive (WS) sports as compared with those participating in less WS sports. No differences in positive body image were observed in female WS and less WS sports. Special DE prevention and positive body image promotion programs are necessary for female competitive athletes and parents of adolescent female athletes, especially those participating in aesthetic ones. For adult male athletes, special programs aiming to promote healthy eating should be implemented to prevent DE and body image concerns. Special education about DE prevention is compulsory for coaches who train female athletes.

An integrative model as a step toward increasing the awareness of eating disorders in the general population

Eating disorders (EDs) represent a contradictory chapter of clinical psychiatry, i.e., although they are associated with significant prevalence and risks in the long term (including vital risk, especially for anorexia nervosa), the therapeutic resources are minimal and based on low-quality data. Another contradiction arose in the last few decades, i.e., a variety of new EDs have been described, either by clinicians or signaled by mass media, but their systematic exploration is progressing very slowly. Entities like "food addiction," "orthorexia nervosa," or "emotional eating disorder" still require intensive exploration in order to find the most accurate diagnostic instruments, diagnosis criteria, prevalence data, vulnerability factors, and therapeutic approaches. This article is focused on integrating into a comprehensive model a variety of EDs not specified or loosely defined by the current international classifications of psychiatric disorders. This framework is intended as an instrument for stimulating clinical and epidemiological research, with potential favorable consequences for therapeutic research. The dimensional model suggested here includes four main categories that accommodate the already recognized EDs (i.e., anorexia nervosa, bulimia nervosa, and binge eating disorder) as well as ten EDs that still need intensive research to find their clinical and pathophysiological characteristics. More good-quality studies are urgently required regarding this topic, based on the mental and physical negative impact these EDs may have in the short and long term, especially in vulnerable populations (e.g., pregnant women, athletes, adolescents, etc.).

Clinical Considerations and Practical Advice for People Living With Type 2 Diabetes Who Undertake Regular Exercise or Aim to Exercise Competitively

This article provides practical tips for advising people with type 2 diabetes on how to engage in regular exercise safely and effectively. Its focus is on individuals who wish to exceed the minimum physical activity recommendation of 150 minutes/week of moderate-intensity exercise or even compete in their chosen sport. Health care professionals who work with such individuals must have a basic understanding of glucose metabolism during exercise, nutritional requirements, blood glucose management, medications, and sport-related considerations. This article reviews three key aspects of individualized care for physically active people with type 2 diabetes: 1) initial medical assessment and pre-exercise screenings, 2) glucose monitoring and nutritional considerations, and 3) the combined glycemic effects of exercise and medications.

Hungry runners - low energy availability in male endurance athletes and its impact on performance and testosterone: mini-review

Low Energy Availability (LEA) arises from the inability to cover energy needs and requirements of training or normal physiological functions. This value differs from the energy balance, which takes into account the total daily energy intake compared to all the energy expended, regardless of the amount of fat-free mass. Insufficient energy consumption affects recovery, adaptation processes, increases the risk of injury or illness, so all of this can negatively affect performance. This mini-review is written on research articles in Pubmed database related to LEA in endurance-trained men and its impact on performance and testosterone. This article also clarifies the prevalence of LEA in male endurance athletes and its correlation to Relative Energy Deficiency in Sports (RED-S). LEA occurs in male endurance athletes and correlates with decreased testosterone levels, decreased bone density and also Resting Metabolic Rate. In endurance-trained men, there is great potential for the negative consequences of low energy availability. It can also be said that there are possibilities for primary screening, so we recommend regular check-ups of blood markers, body structure and keeping not only training but also dietary records, which can increase awareness of an adequate energy balance.

The Relationship Between Eating Disorders, Disordered Eating, and Injury in Athletes: A Critically Appraised Topic

CLINICAL SCENARIO

Eating disorders (EDs) and disordered eating (DE) result in numerous physical and psychological complications for female and male athletes. Besides bone-related injury, little research exists investigating what injuries EDs and/or DE contribute to.

CLINICAL QUESTION

Are EDs and/or DE a risk factor for injury incidence in athletes?

SUMMARY OF KEY FINDINGS

We searched for prospective studies assessing EDs or DE as a risk factor for injury in female or male athletes high school age and older. Our search returned 5 studies. One study found Eds, or DE were not a risk for any type of injury in female cross-country and track-and-field athletes. Two studies found a possible relationship between EDs or DE, as one contributing factor of others, in the incidence of bone stress injuries (BSIs) in female athletes who compete in various sports. One study found female, but not male, cross-country and track-and-field athletes with a history of EDs were more at risk for stress fractures than those without a history. One study found Eds, or DE were not a risk for BSI in female runners and triathletes.

CLINICAL BOTTOM LINE

Large and important gaps in the literature exist investigating injuries related to EDs or DE outside of BSIs. There is low-moderate evidence that EDs and/or DE are either a sole, or contributing, risk factor for BSIs in female athletes.

STRENGTH OF RECOMMENDATION

Grade B evidence exists to support the idea that EDs and/or DE are a risk factor for a specific type of injury (BSI) in female athletes only.

Exploring the impact of the COVID-19 pandemic on perceptual disturbances and dysfunctional eating attitudes and behaviors: A review of the literature

From the outbreak of the novel coronavirus 2019 (COVID-19) a new physical and social distancing environment has changed our lives and, more particularly, the way of perceiving oneself, as well as eating attitudes and behaviors. An increasing number of studies have highlighted a risky scenario in terms of negative perceptions of one’s body as well as disordered eating and eating disorder patterns in both clinical and general population. With regard to this postulate, this literature review posits two main concepts—perceptual disturbances and dysfunctional eating attitudes and behaviors—in the general and (sub-)clinical populations, to provide an understanding of these phenomena during the COVID-19 pandemic. The main objective of this article is to provide a comprehensive and critical review of published scientific literature about perceptual disturbances (i.e., negative body image, body image disturbances, low body esteem) and dysfunctional eating attitudes and behaviors, including disordered eating (e.g., restrictive eating, binge-eating episodes, overeating, emotional eating) and eating disorders features in community (i.e., general population) and clinical and sub-clinical samples worldwide during the COVID-19 pandemic. The PubMed, ScienceDirect, Ebsco, and Google Scholar databases were searched. The initial search produced 42 references. Scientific publications from March 2020 to April 2022 were included, and among the works compiled, only published research articles have been retained. Purely theoretical papers were also excluded. The final selection consisted of 21 studies, covering both community, clinical (i.e., eating disorder population), and sub-clinical samples. The details of the results are discussed taking into consideration the potential impact of changes in the way we perceive ourselves and interact with others (e.g., the popularity of videoconferencing and the over-use of social network sites due to social isolation) as well as changes in eating attitudes and behaviors, physical activity and exercise (e.g., as an emotional response to the insecurity generated by the pandemic context), in community and (sub-)clinical samples. The discussion sheds light on two outcomes: (1) a summary of findings with methodological considerations; (2) an intervention continuum to deal with the consequences of the COVID-19 pandemic; (3) and a final conclusion.

Risk factors for eating disorders: findings from a rapid review

BACKGROUND

Risk factors represent a range of complex variables associated with the onset, development, and course of eating disorders. Understanding these risk factors is vital for the refinement of aetiological models, which may inform the development of targeted, evidence-based prevention, early intervention, and treatment programs. This Rapid Review aimed to identify and summarise research studies conducted within the last 12 years, focusing on risk factors associated with eating disorders.

METHODS

The current review forms part of a series of Rapid Reviews to be published in a special issue in the Journal of Eating Disorders, funded by the Australian Government to inform the development of the National Eating Disorder Research and Translation Strategy 2021-2031. Three databases were searched for studies published between 2009 and 2021, published in English, and comprising high-level evidence studies (meta-analyses, systematic reviews, moderately sized randomised controlled studies, moderately sized controlled-cohort studies, or population studies). Data pertaining to risk factors for eating disorders were synthesised and outlined in the current paper.

RESULTS

A total of 284 studies were included. The findings were divided into nine main categories: (1) genetics, (2) gastrointestinal microbiota and autoimmune reactions, (3) childhood and early adolescent exposures, (4) personality traits and comorbid mental health conditions, (5) gender, (6) socio-economic status, (7) ethnic minority, (8) body image and social influence, and (9) elite sports. A substantial amount of research exists supporting the role of inherited genetic risk in the development of eating disorders, with biological risk factors, such as the role of gut microbiota in dysregulation of appetite, an area of emerging evidence. Abuse, trauma and childhood obesity are strongly linked to eating disorders, however less conclusive evidence exists regarding developmental factors such as role of in-utero exposure to hormones. Comorbidities between eating disorders and mental health disorders, including personality and mood disorders, have been found to increase the severity of eating disorder symptomatology. Higher education attainment, body image-related factors, and use of appearance-focused social media are also associated with increased risk of eating disorder symptoms.

CONCLUSION

Eating disorders are associated with multiple risk factors. An extensive amount of research has been conducted in the field; however, further studies are required to assess the causal nature of the risk factors identified in the current review. This will assist in understanding the sequelae of eating disorder development and in turn allow for enhancement of existing interventions and ultimately improved outcomes for individuals.

Eating Behaviours in Sportswomen from the Silesian Training in Different Sports Disciplines

Eating disorders are characterized by abnormal, unhealthy eating habits, and disordered body image. In severe cases, it can cause serious health consequences, including cardiac problems, osteoporosis, infertility, or missing menstrual periods. In women competitively training sports, the main cause for disordered eating behaviours are factors associated with dissatisfaction with their appearance and body image and a need to reduce body weight. Factors related to dissatisfaction with one's own appearance and body image, a need to reduce body weight, a negative perception of themselves and their bodies, the pressure in sports circles, and stress are predictors for eating disorders. The aim of the study was to compare eating behaviours, body satisfaction, and taking various actions related to body mass reduction among women training competitively in volleyball, athletics, gymnastics, and young women not participating in sports.

MATERIAL AND METHODS

The study covered a group of girls and young women from the Silesian, Poland, who represented three sports disciplines (volleyball, athletics, and gymnastics), of which 30 girls were used as a control group (B). The study was conducted using a study questionnaire.

RESULTS

The study participants ate regularly and consumed all food groups during a week. The majority of girls from A1 (83.33%), A3 (53.33%), and B (80%) groups expressed their dissatisfaction with their body weight. In the group of gymnasts, a positive correlation was noted between the need to reduce body weight and regular eating (r = 0.449; p = 0.013). In the group of volleyball players, it was demonstrated that the higher the competitive experience and the greater the training load, the more regular their eating was (r = 0.475; p = 0.009).

CONCLUSIONS

The importance of a diagnosis of early signs of eating disorders in girls and women as a basic component contributing to FAT development implies that further studies in this area, as well as education of the entire sports circle are necessary.

Eating Disorders and Disordered Eating in Competitive Cycling: A Scoping Review

This article reports on the findings from a scoping review on eating disorders and disordered eating in competitive cycling. The review was informed by a scoping review methodological framework as well as the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for scoping reviews (PRISMA-ScR) reporting guidelines. PubMed, SPORTDiscus and Web of Science were used to identify relevant literature for review. Fourteen studies met the eligibility criteria and were included in the full review. A narrative synthesis was used to summarise the main findings and themes across the included literature. Findings from the review are presented under the following themes: cycling as an 'at-risk' discipline; power to weight ratio; energy requirements and risk of low energy availability; the social environment of cycling; nutrition support provision; relationship between eating disorders/disordered eating and exercise addiction; and recommendations made in identified literature. Overall, the literature suggests competitive cycling is a sport with a high prevalence of disordered eating and/or eating disorders and a sport with unique risk factors that contribute to this. Crucially, more research is needed in this area. The article concludes with the gaps in the literature highlighted, implications for future research, and applications to policy and practice suggested.

Elite female footballers in England: an exploration of mental ill-health and help-seeking intentions

OBJECTIVES

Mental health research in sport is almost entirely focused on elite male athletes. However, recent research suggests that elite female athletes are at higher risk for mental ill-health when compared to their male counterparts. Given the recent growth of women's football in England and lack of research surrounding mental health in this population, this study sought to explore the prevalence of, and factors associated with depression, anxiety, and eating disorder symptoms in females competing in the top two tiers of English football.

METHODS

An anonymous online questionnaire pack, which measured personal and player characteristics and included the Patient Health Questionnaire (PHQ-9), Generalised Anxiety Disorder scale (GAD-7), Brief Eating Disorder Questionnaire (BEDA-Q), and General Help-Seeking Questionnaire (GHSQ), was completed between November 2020 and March 2021 by elite female footballers competing in the Women's Super League (WSL) and Women's Championship.

RESULTS

A total of 115 players completed the questionnaire (63 from the WSL; 52 from the Women's Championship). 36% displayed eating disorder symptoms (BEDAQ) 11% displayed moderate to severe anxiety symptoms (GAD-7), and 11% displayed moderate to severe depression symptoms (PHQ-9). Significant associations emerged between starting status, want for psychological support, student-athlete status, help-seeking intentions score, and mental ill-health symptoms.

CONCLUSION

In summary, elite female footballers in England reported significant mental health symptoms, particularly disordered eating symptoms. Further research should explore the experiences of mental ill-health in this population, focusing on the factors that were important in this study.

Anorexic Readiness Syndrome in Elite Female Acrobatic Gymnasts-International Study

Anorexic Readiness Syndrome (ARS) is a concept used in research for the early detection of disordered eating (DE). It is a set of indicators located primarily within the cognitive and behavioral sphere of an individual's functioning. The aim of this study was to examine whether among the elite acrobats there are girls showing a high level of anorexic tendency, and if so, what behaviors and attitudes are the most common. In addition, an attempt to determine what sport-related factors or other non-sport variables may increase the risk of ARS was conducted. The study group was made up of 133 acrobatic gymnasts aged 10-19, representing six countries that participated in the Acro World Cup competition held in Poland. The study procedures included surveys (personal questionnaire and the Eating Attitudes Questionnaire), anthropometric measurements such as weight, height, waist circumference (WC) and determination of the Body Mass Index (BMI), fat percentage (Fat%), and waist to height ratio (WHtR). A high level of ARS was found in 9.8% of acrobats. This group most often declared attitudes and behaviors indicative of anorexic tendencies. A strong relationship with the level of ARS was noted in the following: the use of fasting and diets (p ≤ 0.001; V = 0.54), limiting of fats and carbohydrates (p ≤ 0.001; V = 0.60), feeling angry after eating too much (p ≤ 0.001; V = 0.55), knowing the caloric value of many food products (p ≤ 0.001; V = 0.59), and the desire to improve the appearance of one's body (p ≤ 0.001; V = 0.52). The role played in the acrobatic partnership and the region of residence were considered as the sport-related risk factors. Among non-sport factors, the strongest predictor of ARS was the age of gymnasts (β = 0.516; p ≤ 0.001).

The impact of dieting culture is different between sexes in endurance athletes: a cross-sectional analysis

Background

Frequent dieting is common in athletes attempting to achieve a body composition perceived to improve performance. Excessive dieting may indicate disordered eating (DE) behaviors and can result in clinical eating disorders. However, the current nutrition patterns that underly dieting culture are underexplored in endurance athletes. Therefore, the purpose of this study was to identify the sex differences in nutrition patterns among a group of endurance athletes.

Methods

Two-hundred and thirty-one endurance athletes (females = 124) completed a questionnaire regarding their dieting patterns and associated variables.

Results

The majority of athletes did not follow a planned diet (70.1%). For endurance athletes on planned diets (n = 69), males were more likely follow a balanced diet (p = 0.048) and females were more likely to follow a plant-based diet (p = 0.021). Female endurance athletes not on a planned diet (n = 162) were more likely to have attempted at least one diet (p < 0.001). Male athletes attempted 2.0 ± 1.3 different diets on average compared to 3.0 ± 2.0 for females (p = 0.002). Female athletes were more likely to attempt ≥ three diets (p = 0.022). The most common diet attempts included carbohydrate/energy restrictive, plant-based, and elimination diets. Females were more likely to attempt ketogenic (p = 0.047), low-carbohydrate (p = 0.002), and energy restricted diets (p = 0.010). Females made up the entirety of those who attempted gluten-/dairy-free diets (F = 22.0%, M = 0.0%).

Conclusions

Being a female athlete is a major determinant of higher dieting frequency and continual implementation of popular restrictive dietary interventions. Sports dietitians and coaches should prospectively assess eating behavior and provide appropriate programming, education, and monitoring of female endurance athletes.

Disordered eating in collegiate English equestrian athletes in aesthetic and nonaesthetic disciplines

Little is known about the rates of disordered eating behaviors in the athletes who compete in the disciplines that comprise collegiate English Equestrian sports. Importantly, in some subdisciplines, riders' scores depend upon judges' assessment of their appearance while riding, rather than upon solely objective measures such as time to complete a course. The purpose of the present research was to 1) assess the current rate of disordered eating behaviors in college equestrian athletes, 2) test whether certain disciplines of English riding (i.e., those that focus on aesthetics or non-aesthetics) at the collegiate level have higher rates of disordered eating behaviors, and 3) test whether these athletes face different pressures for appearance and weight if they specialize in aesthetic riding disciplines. English equestrian student athletes from across the United States (N = 330; 97 % female) and from the following disciplines were surveyed: equitation (aesthetic), dressage (aesthetic), hunters (aesthetic), jumpers (non-aesthetic), and eventing (non-aesthetic). The results suggest a high prevalence of disordered eating in the sport (35 % met cut off for disordered eating using the EAT-26). Findings suggest similar rates of disordered eating behaviors between the aesthetic and non-aesthetic disciplines. Findings also indicate that student athletes in aesthetic disciplines were much more likely to say that they were weighed by coaches and pressured to lose weight. Thus, the current study lends empirical support to the notion that coaches can be a source of pressure for these athletes. Issues of addressing disordered eating in coaching and future research are discussed.

Investigating the prevalence of low energy availability, disordered eating and eating disorders in competitive and recreational female endurance runners

Eating disorders (ED), disordered eating (DE) and low energy availability (LEA) can be detrimental to health and performance. Previous studies have independently investigated prevalence of ED, DE or LEA, however limited studies have combined methods identifying risk within female runners. The aim of this study was to identify prevalence of ED, DE and LEA in United Kingdom-based female runners and associations between age, competition level and running distance. The Female Athlete Screening Tool (FAST) and Low Energy Availability in Females Questionnaire (LEAF-Q) were used in a cross-sectional study design. A total of n = 524 responses eligible for analysis were received. A total of n = 248 (47.3%), n = 209 (40%) and n = 49 (9.4%) athletes were at risk of LEA, DE and ED, respectively. LEAF-Q scores differed based upon age (Age: H₍₃₎ =  23.998, p≤0.05) and competitive level (Comp: H₍₁₎ =  7.682, p≤0.05) whereas FAST scores differed based on age (Age: F_(3,523) =  4.753, p≤0.05). Tukey's post-hoc tests showed significantly higher FAST scores in 18-24 years compared to all other age categories (p≤0.05). Stepwise multiple regression demonstrated age and competitive level modestly predicted LEAF-Q scores (R²_adj = 0.047, F(2,523)  =  13.993, p≤0.05, VIF = 1.0) whereas age modestly predicted FAST scores (R²_adj = 0.022, F(_1,523)  =  12.711, p≤0.05, VIF = 1.0). These findings suggest early identification, suitable screening methods and educational intervention programmes should be aimed at all levels of female endurance runners.

Extreme weight control behaviors among adolescent athletes: Links with weight-related maltreatment from parents and coaches and sport ethic norms

The use of extreme weight-control behaviors is prevalent among adolescent athletes and may result from individual and sport-specific factors. Weight-related maltreatment from coaches and parents, and conformity to sport ethic norms have recently been linked to the use of extreme weight-control behaviors. This study aims to investigate the role of sport ethic norms and weight-related maltreatment from coaches and parents in the use of extreme weight-control behaviors among adolescent athletes. A sample of 999 French-Canadian athletes aged 14-17 years competing in a variety of sports completed an online survey assessing extreme weight-control behaviors, weight-related maltreatment from coaches and parents, and conformity to sport ethic norms. A total of 16.9% of the adolescent athletes reported having adopted extreme weight-control behaviors during their athletic careers. Extreme weight-control behaviors were significantly more prevalent among girls (19.75% vs 9.7% in boys) and weight-class-sport athletes (44%). In addition, 7.4% of the sample experienced at least one type of weight-related maltreatment by coaches or parents. Sex, weight-related neglect by coaches and parents, and weight-related psychological violence by coaches explained 24.4% of extreme weight-control behaviors variance. Indeed, participants who engaged in extreme weight-control behaviors experienced significantly more violence than the other participants did. In contrast, no differences were observed between people who engaged in extreme weight-control behaviors and those who did not due to conformity to sport ethic norms.

Prevalence of Risk Factors of the Female Athlete Triad among Young Elite Athletes of Pakistan

BACKGROUND

Female athletes who are not vigilant about their food choices and choose extraneous physical activities may head towards negative health effects.

PURPOSE

The purpose was to determine the prevalence of risk factors that may lead to the Female Athlete Triad among young elite athletes in Pakistan.

STUDY DESIGN & METHODS

A cross sectional questionnaire-based study was conducted in 2018 at Pakistan Sports Board to investigate the risk factors of The Female Athlete Triad among young elite athletes based in national training camps of major metropolitan cities. Trained and professional female elite athletes of age 18 - 25 years, able to comprehend questionnaire in English were included. Athletes completed the questionnaire including demographics, educational qualifications, Body Mass Index, sports participation, and playing hours. The Eating Aptitude Test-26 (EAT-26) and questionnaires on risks of amenorrhea and risks of low bone mineral density were completed. Individual prevalence of the risk factors of three components was assessed. The data were analyzed using SPSS-20 and descriptive statistics applied.

RESULTS

A sample of 60 elite athletes, (23.57 + 2.37 years, BMI 21.97 +1.90) who participated in various sports were included. EAT-26 results indicated that 50% of athletes were at risk of an eating disorder. Disordered Eating behaviors in need of referral were identified in 83.3%. Risks for amenorrhea were identified in 15%, and concerning low Bone Mineral Density, no risks were identified, except the intake of caffeinated beverages in 51.7%.

CONCLUSION

The prevalence of risk for disordered eating was found to be significant among female elite athletes of Pakistan, but risk of amenorrhea and low bone mineral density were not of major concern.

LEVEL OF EVIDENCE

3b.

Disordered eating and eating disorders among women seeking fertility treatment: A systematic review

The purpose of this systematic review is to evaluate the prevalence of disordered eating and eating disorders among women seeking fertility treatment.Observational studies were searched in Ovid MEDLINE, Web of Science, Embase, and PsycInfo. Studies published prior to September 2020 when the search was conducted were considered. Inclusion criteria included (1) original and empirical research, (2) published in a peer-reviewed journal, and (3) reported on disordered eating among women seeking fertility treatment in the sample or reported on prevalence of eating disorders among women seeking fertility treatment in the sample. Independent screening of abstracts was conducted by two authors (LH and AH). Ten studies met the inclusion criteria. Sample size, study location, measures, and results for each study in this review were reported.Among women pursuing fertility treatment, rates of current eating disorders ranged from 0.5 to 16.7%, while past eating disorder prevalence rates ranged from 1.4 to 27.5%. Current anorexia nervosa or bulimia nervosa was reported by up to 2% and 10.3% of women, respectively, while history of anorexia nervosa or bulimia nervosa was reported by up to 8.5% and 3.3% of women, respectively. Binge eating disorder or other eating disorders were reported by up to 18.5% and 9.1% of women, respectively. Disordered eating pathology was endorsed by 1.6 to 48% of women seeking fertility treatment. Endorsement of pathological eating attitudes was generally higher among women seeking fertility treatment with current or past eating disorders as compared to community samples, with the exception of dietary restraint. Rates of current and past eating disorders are higher among women seeking fertility treatment than in the general population. Providers treating women with infertility should be cognizant of these prevalence rates and consider screening for eating pathology in their patients as this may contribute to their likelihood of successful conception and/or subsequent pregnancy outcomes.

Examination of the Prevalence of Female Athlete Triad Components among Competitive Cheerleaders

The purpose of this study was to examine individual and combined Female Athlete Triad components within collegiate cheerleaders, an at-risk group. Cheerleaders (n = 19; age: 20.3 ± 1.2 years) completed anthropometric measurements, health history questionnaires, resting metabolic rate, the eating disorder inventory-3 and symptom checklist, blood sample, and DXA scan. Participants completed dietary and exercise logs for 7 days and used heart rate monitors to track daily and exercise energy expenditure. Proportions were calculated for low energy availability (LEA) risk, disordered eating risk, and pathogenic behaviors. Chi-square analysis was used to determine the difference between cheerleaders who experience low EA with or without disordered eating risk. All cheerleaders demonstrated LEA for the days they participated in cheerleading practice, 52.6% demonstrated LEA with eating disorder risk and 47.4% demonstrated LEA without eating disorder risk, 52.6% self-reported menstrual dysfunction, 14% experienced menstrual dysfunction via hormonal assessment, and 0% demonstrated low bone mineral density. Overall, 47.7% presented with one Triad component, 52.6% demonstrated two Triad components using self-reported menstrual data, and 10.5% demonstrated two Triad components using hormonal assessments. All cheerleaders displayed LEA. These findings support the need for increased education on the individual components of the Triad and their potential consequences by qualified personal.

Weight loss practices and eating behaviours among female physique athletes: Acquiring the optimal body composition for competition

Little is known about weight loss practices and eating behaviours in female physique athletes. This study investigated the weight loss history, practices, and key influences during the pre-competition period in a large cohort of female physique athletes stratified by division and experience level. Eating attitudes and behaviours were assessed to identify whether athletes were at risk of developing an eating disorder. Using a cross-sectional research design, female physique athletes (n = 158) were recruited and completed an anonymous online self-reported survey consisting of two validated questionnaires: Rapid Weight Loss Questionnaire and Eating Attitudes Test-26. Irrespective of division or experience, female physique athletes used a combination of weight loss practices during the pre-competition phase. Gradual dieting (94%), food restriction (64%) and excessive exercise (84%), followed by body water manipulation via water loading (73%) were the most commonly used methods. Overall, 37% of female physique athletes were considered at risk of developing an eating disorder. Additionally, 42% of female physique athletes used two pathogenic weight control methods with 34% of Figure novice athletes indicating binge eating once a week or more. The coach (89%) and another athlete (73%) were identified as key influences on athletes' dieting practices and weight loss. The prevalence of athletes identified with disordered eating symptoms and engaging in pathogenic weight control methods is concerning. In future, female physique athletes should seek advice from registered nutritionists to optimise weight management practices and minimise the risk of developing an eating disorder.

Development and Initial Evaluation of the Athlete Eating Psychopathology Observation Questionnaire for Sport Professionals

Eating psychopathology symptoms are common in athletes; however, it is unknown which symptoms are detected and to what extent by sport professionals. This study aimed to develop and evaluate a self-report questionnaire to explore which features of eating psychopathology in athletes are detected by sport professionals, and how observation of these symptoms might vary. Thirty-one questions were developed and 232 sport professionals (56% male) participated in the study. Exploratory Factor Analysis revealed a 20-item, five-factor solution (Negative Affect, Dieting Practices, Fear of Eating in Social Contexts, Bingeing and Purging, and Compulsive Exercise). Participants most frequently reported observing athletes’ dieting practices, while symptoms of a fear of eating in social contexts were observed least frequently. This study has developed and preliminarily tested the Athlete Eating Psychopathology Observation Questionnaire (AEPOQ), which now requires further validation. The findings provide important directions for education initiatives with sport professionals regarding identification of eating psychopathology symptoms.

Beyond Description and Deficits: How Computational Psychiatry Can Enhance an Understanding of Decision-Making in Anorexia Nervosa

PURPOSE OF REVIEW

Despite decades of research, knowledge of the mechanisms maintaining anorexia nervosa (AN) remains incomplete and clearly effective treatments elusive. Novel theoretical frameworks are needed to advance mechanistic and treatment research for this disorder. Here, we argue the utility of engaging a novel lens that differs from existing perspectives in psychiatry. Specifically, we argue the necessity of expanding beyond two historically common perspectives: (1) the descriptive perspective: the tendency to define mechanisms on the basis of surface characteristics and (2) the deficit perspective: the tendency to search for mechanisms associated with under-functioning of decision-making abilities and related circuity, rather than problems of over-functioning, in psychiatric disorders.

RECENT FINDINGS

Computational psychiatry can provide a novel framework for understanding AN because this approach emphasizes the role of computational misalignments (rather than absolute deficits or excesses) between decision-making strategies and environmental demands as the key factors promoting psychiatric illnesses. Informed by this approach, we argue that AN can be understood as a disorder of excess goal pursuit, maintained by over-engagement, rather than disengagement, of executive functioning strategies and circuits. Emerging evidence suggests that this same computational imbalance may constitute an under-investigated phenotype presenting transdiagnostically across psychiatric disorders. A variety of computational models can be used to further elucidate excess goal pursuit in AN. Most traditional psychiatric treatments do not target excess goal pursuit or associated neurocognitive mechanisms. Thus, targeting at the level of computational dysfunction may provide a new avenue for enhancing treatment for AN and related disorders.

Examining Eating Attitudes and Behaviors in Collegiate Athletes, the Association Between Orthorexia Nervosa and Eating Disorders

Purpose: Orthorexia nervosa (Orthorexia) is an eating attitude and behavior associated with a fixation on healthy eating, while eating disorders (EDs) are clinically diagnosed psychiatric disorders associated with marked disturbances in eating that may cause impairment to psychosocial and physical health. The purpose of this study was to examine risk for Orthorexia and EDs in student-athletes across sex and sport type and determine the association between the two.

Methods: Student-athletes (n = 1,090; age: 19.6 ± 1.4 years; females = 756; males = 334) completed a survey including demographics, the ORTO-15 test (<40 and <35 threshold values), the Eating Attitudes Test-26 (EAT-26; >20 score), and additional questions about pathogenic behaviors to screen for EDs.

Results: Using a <40 threshold value for the ORTO-15, 67.9% were at risk for Orthorexia, a more restrictive threshold value of <35 determined 17.7% prevalence across student-athletes with significant differences across sex [ <40: χ(1,1,090)2 = 4.914, p = 0.027; <35: χ(1,1,090)2 = 5.923, p = 0.015). Overall, ED risk (EAT-26 and/or pathogenic behavior use) resulted in a 20.9% prevalence, with significant differences across sex (χ² = 11.360, p < 0.001) and sport-type category (χ² = 10.312, p = 0.035). Multiple logistic regressions indicated a significant association between EAT-26 subscales scores and Orthorexia, and between Orthorexia positivity, ORTO-15 scores, and risk for EDs.

Conclusions: Risk for Orthorexia and ED is present in collegiate student-athletes. While healthy and balanced eating is important, obsessive healthy eating fixations may increase the risk for EDs in athletes. More education and awareness are warranted to minimize the risk for Orthorexia and EDs in student-athletes.

Female Hyperandrogenism in Elite Sports and the Athletic Triad

Essential hyperandrogenism seems to be overrepresented in female elite athletes. This applies to mild forms such as polycystic ovary syndrome, as well as rare differences/disorders of sex development (DSD). The reason is likely a selection bias since there is increasing evidence that androgens are beneficial for athletic performance by potent anabolic effects on muscle mass and bone mass, and stimulation of erythropoiesis. XY DSD may cause a greatly increased production of testosterone in the male range, that is, 10 to 20 times higher than the normal female range. The established regulations concerning the eligibility of female athletes with severe hyperandrogenism to compete in the female classification remain controversial. The most common cause of menstrual disorders in female athletes, however, is probably an acquired functional hypothalamic disturbance due to energy deficiency in relation to energy expenditure, which could lead to low bone mineral density and increased risk of injury. This condition is particularly common in endurance and esthetic sports, where a lean body composition is considered an advantage for physical performance. It is important to carefully evaluate endocrine disturbances and menstrual disorders in athletes since the management should be specific according to the underlying cause.

Manipulation of Dietary Intake on Changes in Circulating Testosterone Concentrations

Elevations in the circulating concentration of androgens are thought to have a positive effect on the anabolic processes leading to improved athletic performance. Anabolic-androgenic steroids have often been used by competitive athletes to augment this effect. Although there has been concerted effort on examining how manipulating training variables (e.g., intensity and volume of training) can influence the androgen response to exercise, there has been much less effort directed at understanding how changes in both macronutrient and micronutrient intake can impact the androgen response. Thus, the focus of this review is to examine the effect that manipulating energy and nutrient intake has on circulating concentrations of testosterone and what the potential mechanism is governing these changes.

Self-Reported Restrictive Eating, Eating Disorders, Menstrual Dysfunction, and Injuries in Athletes Competing at Different Levels and Sports

The purpose of this study was to investigate the prevalence of self-reported restrictive eating, current or past eating disorder, and menstrual dysfunction and their relationships with injuries. Furthermore, we aimed to compare these prevalences and associations between younger (aged 15–24) and older (aged 25–45) athletes, between elite and non-elite athletes, and between athletes competing in lean and non-lean sports. Data were collected using a web-based questionnaire. Participants were 846 female athletes representing 67 different sports. Results showed that 25%, 18%, and 32% of the athletes reported restrictive eating, eating disorders, and menstrual dysfunction, respectively. Higher rates of lean sport athletes compared with non-lean sport athletes reported these symptoms, while no differences were found between elite and non-elite athletes. Younger athletes reported higher rates of menstrual dysfunction and lower lifetime prevalence of eating disorders. Both restrictive eating (OR 1.41, 95% CI 1.02–1.94) and eating disorders (OR 1.89, 95% CI 1.31–2.73) were associated with injuries, while menstrual dysfunction was associated with more missed participation days compared with a regular menstrual cycle (OR 1.79, 95% CI 1.05–3.07). Our findings indicate that eating disorder symptoms and menstrual dysfunction are common problems in athletes that should be managed properly as they are linked to injuries and missed training/competition days.