A longitudinal investigation of sports-related risk factors for disordered eating in aesthetic sports

A systematic review and meta-synthesis of qualitative research investigating disordered eating and help-seeking in elite athletes

OBJECTIVE

Elite athletes are at elevated risk for disordered eating and eating disorders; however, little is known about risk and maintaining factors, or barriers and facilitators of help-seeking in this cohort. This systematic review synthesized qualitative findings regarding possible risk and maintaining factors for disordered eating, as well as barriers to and facilitators of help-seeking in elite athletes.

METHOD

We conducted a search for qualitative studies that included experiences with body image concerns or disordered eating in elite athletes. A systematic search of CINAHL, PsychINFO, MEDLINE, and Scopus databases identified 828 articles, with 87 retained after title and abstract screening, and 38 included in the review. Quality appraisal was conducted using the checklist for appraising qualitative research (CASP). Data were extracted from each article, including demographic information (e.g., biological sex, age, sport type, level of competition, current, or former athlete) and the text under the "results" or "findings" section. Meta-themes were identified using inductive thematic meta-synthesis.

RESULTS

The extracted data indicated that most studies sampled female athletes from the United States and UK. Eight meta-themes were identified: (1) the power imbalance; (2) hyperfocus on body, food, and exercise; (3) rigidity; (4) the athlete's balance; (5) the athlete identity; (6) overvaluation and oversimplification; (7) shame, fear, and stigma; and (8) knowledge, education, and self-identification.

DISCUSSION

These findings highlighted gaps in the demographic representation of specific groups in this research (e.g., males, para-athletes, and ethnic diversity) and propose hypotheses of how sport pressure might contribute to athletes' experiences with disordered eating.

PUBLIC SIGNIFICANCE

Disordered eating and body image concerns are prevalent and can have debilitating impacts for elite athletes; however, help-seeking is rare for this population. It remains unclear what factors contribute to disordered eating and/or inhibit help-seeking among elite athletes versus the general population. Understanding athletes' perspectives will inform the modification of prevention and treatment strategies to address athlete-specific factors.

Interplay of polygenic liability with birth-related, somatic, and psychosocial factors in anorexia nervosa risk: a nationwide study

BACKGROUND

Although several types of risk factors for anorexia nervosa (AN) have been identified, including birth-related factors, somatic, and psychosocial risk factors, their interplay with genetic susceptibility remains unclear. Genetic and epidemiological interplay in AN risk were examined using data from Danish nationwide registers. AN polygenic risk score (PRS) and risk factor associations, confounding from AN PRS and/or parental psychiatric history on the association between the risk factors and AN risk, and interactions between AN PRS and each level of target risk factor on AN risk were estimated.

METHODS

Participants were individuals born in Denmark between 1981 and 2008 including nationwide-representative data from the iPSYCH2015, and Danish AN cases from the Anorexia Nervosa Genetics Initiative and Eating Disorder Genetics Initiative cohorts. A total of 7003 individuals with AN and 45 229 individuals without a registered AN diagnosis were included. We included 22 AN risk factors from Danish registers.

RESULTS

Risk factors showing association with PRS for AN included urbanicity, parental ages, genitourinary tract infection, and parental socioeconomic factors. Risk factors showed the expected association to AN risk, and this association was only slightly attenuated when adjusted for parental history of psychiatric disorders or/and for the AN PRS. The interaction analyses revealed a differential effect of AN PRS according to the level of the following risk factors: sex, maternal age, genitourinary tract infection, C-section, parental socioeconomic factors and psychiatric history.

CONCLUSIONS

Our findings provide evidence for interactions between AN PRS and certain risk-factors, illustrating potential diverse risk pathways to AN diagnosis.

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.

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.

Loneliness, belonging and psychosomatic complaints across late adolescence and young adulthood: a Swedish cohort study

BACKGROUND

Loneliness and belonging refer to social connectedness and are associated with young people's health; however, the relationship between these constructs and their impact on health is still being discussed. A dual continuum model of belonging and loneliness has been suggested, consisting of four groups depending on the state of loneliness and belonging: socially fulfilled (low loneliness, high belonging), socially indifferent (low loneliness, low belonging), socially searching (high loneliness, high belonging), and socially distressed (high loneliness, low belonging). The aim of this study is to examine loneliness and belonging in a Swedish sample of 17-18-years-olds who were followed over 3 years, and the associations that these aspects share with young people's psychosomatic complaints during these ages.

METHODS

Swedish cohort data collected among late adolescents (age 17-18 in 2019) who were followed up in young adulthood (age 20-21 in 2022) (n = 2684) was used to examine the associations between loneliness, belonging, and psychosomatic complaints. Loneliness and belonging were measured by single items and the cross-combinations of these. Three psychosomatic complaints were assessed: stomach ache, headache, and difficulties falling asleep, and a summary index was calculated.

RESULTS

Linear regression analyses showed that loneliness was positively and belonging was negatively cross-sectionally associated with psychosomatic complaints. The socially fulfilled group reported fewer psychosomatic complaints compared to all other groups, while the socially distressed group reported the highest level of psychosomatic complaints. Additional adjustment for sociodemographic characteristics barely affected the estimates. The prospective analysis supported these patterns; however, after adjustment for earlier psychosomatic complaints, the only statistically significant difference in subsequent psychosomatic complaints was found between the socially fulfilled and the socially distressed groups.

CONCLUSIONS

Loneliness and belonging (separately and the cross-combinations of these) were cross-sectionally associated with psychosomatic complaints in late adolescence and in young adulthood. Prospectively, only the most vulnerable group in the dual continuum model, the socially distressed group, experienced more psychosomatic complaints than the socially fulfilled group, indicating a temporal relationship. Knowledge about the more nuanced links may be useful for developing specific public health recommendations and interventions for youth, targeting the most vulnerable groups.

Parenting Practices and Psychosomatic Complaints Among Swedish Adolescents

Objectives: Parent-adolescent relationships play a crucial role in youth development. This study examines the associations between parenting practices (parental support, knowledge, and rule-setting) and psychosomatic complaints across middle and late adolescence. Methods: The study utilised data from a Swedish national cohort (n = 3,678). Participants completed self-report questionnaires in 2017 (∼15-16 years) and again in 2019 (∼17-18 years). Results: Parental support exhibited the strongest and most consistent inverse cross-sectional associations with psychosomatic complaints during both middle and late adolescence. Furthermore, increases in parental support and parental knowledge were associated with decreases in adolescent psychosomatic complaints. However, parental support and knowledge at age 15-16 were not prospectively associated with psychosomatic complaints at age 17-18. Conclusion: These findings underscore the importance of ongoing parental engagement, particularly in terms of providing constant support, throughout middle and late adolescence.

The Women's Soccer Health Study: From Head to Toe

OBJECTIVES

Women are under-represented in the sports literature despite increasing rates of sports participation. Our objective was to investigate the risks and benefits of an elite women's soccer career in five health domains: general, musculoskeletal, reproductive endocrinology, post-concussion, and mental.

METHODS

An online survey was distributed to retired US college, semi-professional, professional, and national team soccer players using personal networks, email, and social media. Short validated questionnaires were used to evaluate the health domains, including the Patient-Reported Outcomes Measurement Information System (PROMIS), Single Assessment Numerical Evaluation (SANE), Post-Concussion Symptom Scale (PCSS), and Patient Health Questionnaire (PHQ).

RESULTS

A total of 560 eligible players responded to the survey over a 1-year period. The highest competitive levels were 73% college, 16% semi-professional, 8% professional, and 4% national team. The mean number of years since retirement was 12 (SD = 9), and 17.0% retired for involuntary reasons. The mean SANE scores (0-100 scale as percentage of normal) were knee = 75% (SD = 23), hip = 83% (SD = 23), and shoulder = 87% (SD = 21). The majority (63%) reported that their current activity level included participation in impact sports. A substantial proportion of players reported menstrual irregularities during their careers: 40% had fewer periods with increasing exercise and 22% had no periods for ≥ 3 months. The players (n = 44) who felt that post-concussion symptoms were due to soccer reported more time-loss concussions (F[2] = 6.80, p = 0.002) and symptom severity (F[2] = 30.26, p < 0.0001). Players who recently retired (0-5 years) reported the highest anxiety/depression scores and lowest satisfaction rates compared with those who retired 19+ years ago.

CONCLUSION

Health concerns include musculoskeletal injuries, post-concussion symptoms, and lower mental health in the early years following retirement. This comprehensive survey provides initial results that will lay the foundation for further analyses and prioritize research studies that can help all female athletes.

Best practice recommendations for body composition considerations in sport to reduce health and performance risks: a critical review, original survey and expert opinion by a subgroup of the IOC consensus on Relative Energy Deficiency in Sport (REDs)

BACKGROUND

The assessment of body composition (BC) in sport raises concern for athlete health, especially where an overfocus on being lighter or leaner increases the risk of Relative Energy Deficiency in Sport (REDs) and disordered eating.

METHODS

We undertook a critical review of the effect of BC on performance (29 longitudinal, prospective or intervention studies) and explored current practice related to BC considerations via a follow-up to a 2013 internationally distributed survey.

RESULTS

The review found that a higher level of body fat was negatively associated with endurance performance, while a gain in muscle mass resulted in performance benefits across sports. BC did not contribute to early talent identification, and no unique cut-off to signify a performance advantage for BC was identified. BC appears to be one of an array of variables impacting performance, and its influence should not be overstated. The survey (125 practitioners, 61 sports and 26 countries) showed subtle changes in BC considerations over time, such as an increased role for sport dietitian/nutrition practitioners as BC measurers (2013: 54%, 2022: 78%); less emphasis on reporting of body fat percentage (2013: 68%, 2022: 46%) and reduced frequency of BC assessment if ≥every fourth week (2013: 18%, 2022: 5%). Respondents remained concerned about a problematic focus on BC (2013: 69%, 2022: 78%). To address these findings, we provide detailed recommendations for BC considerations, including an overview of preferable BC methodology.

CONCLUSIONS

The 'best practice' guidelines stress the importance of a multidisciplinary athlete health and performance team, and the treatment of BC data as confidential medical information. The guidelines provide a health focus around BC, aiming to reduce the associated burden of disordered eating, problematic low energy availability and REDs.

Eating disorder risk in adolescent and adult female athletes: the role of body satisfaction, sport type, BMI, level of competition, and training background

BACKGROUND

Eating disorders negatively influence athletes' health and performance. To achieve a high level of performance and conform to cultural expectations regarding an athletic body type, female athletes often restrict their diets, which can lead to eating disorders. In addition to factors related to the sports environment, adolescent athletes are subject to changes caused by the maturation process. Therefore, the same factors may have different effects on eating disorder risk among adolescent and adult athletes. This study examined the relationship between eating disorder risk, specific aspects of the sports environment (sport type, level of competition [national and international], and training background), and individual aspects (body satisfaction and body mass index) in two groups of athletes: adolescents and adults.

METHODS

The sample included 241 highly trained female athletes aged 12-30 years (M = 20.68, SD = 4.45) recruited from different sports clubs in Poland. The subgroup of adolescents consisted of 82 athletes, while the number of adult athletes was 159. The Eating Attitudes Test questionnaire was used to assess the eating disorder risk among the athletes. Body satisfaction was measured using the Feelings and Attitudes Toward Body Scale incorporated into the Body Investment Scale.

RESULTS

Eating disorder risk was prevalent among 14.6% of the adolescent and 6.9% of the adult athletes. Significant associations between eating disorder risk and the studied variables were noted only among adolescent athletes. Univariate logistic regression analysis revealed that the occurrence of eating disorder risk was associated with participation in lean non-aesthetic sports (OR = 11.50, 95% CI: 3.58-37.09). Moreover, eating disorder risk was associated with athletes' lower body satisfaction (OR = 0.80, 95% CI: 0.70-0.92). Body mass index was not included in the final regression model.

CONCLUSIONS

The study indicated that eating disorder risk in adolescent female athletes was related to sport type and body satisfaction. The findings showed that, in adolescent athletes, eating disorder risk was the most associated with practicing lean non-aesthetic sports. Coaches and athletes should be aware that eating disorder risk increases among individuals with a lower body image.

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.

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.

The Impact of Sports Involvement on Body Image Perception and Ideals: A Systematic Review and Meta-Analysis

Concerns about body image may affect athletes, mainly because of specific sports models to achieve successful performance. This systematic review reports on body image dissatisfaction (BID) in athletes following the guidelines for systematic reviews and meta-analyses. From a total of 887 articles identified through a systematic search of electronic databases, 15 articles conducted on 2412 athletes were included in this review. To be eligible for inclusion, the studies must have been published in the last ten years up until September 2022 and analyze body image perception using body figure drawings and anthropometric profiles. The quality of the included studies was evaluated using the adapted Newcastle-Ottawa Scale for observational studies. These studies were compared through thematic analysis of BID to develop four general issues, including gender, sport type and level, and weight status. According to the meta-analyses, the significant medium and small effect sizes found for gender and weight status, respectively, indicated that male athletes had lower BID than females and that, among the latter, normal-weight athletes had a higher BID than underweight ones. The implications and limitations of the included studies are discussed extensively in this review, highlighting the need for further research on BID examined both in the social and the sports contexts. Sports activity should be carried out following healthy lifestyles, and promoting positive BI.

Athlete-specific risk factors for the development of disordered eating behaviors in first-year college athletes

OBJECTIVE

The current study tested whether proposed sport-related risk factors for disordered eating behaviors were associated with increases in disordered eating over first-year college athletes' first four months of collegiate sport participation.

PARTICIPANTS

Participants included a sample of first-year college athletes (N = 59, 45% female) from a Division I National Collegiate Athletics Association (DI) university.

METHOD

This follow-up study tested whether 1) wearing a uniform that emphasizes body concerns, 2) participating in a lean sport, and 3) perceived pressure for thinness from coaches and teammates would lead to increases in weight/shape concerns and disordered eating behaviors over the first four months of collegiate sport participation.

RESULTS

Wearing a uniform that emphasizes body concerns and perceived coach pressure for thinness predicted increases in weight/shape concern. Both teammate and coach pressure for thinness predicted increases in restrained eating behaviors.

CONCLUSION

Findings suggest that there are identifiable, athlete-specific risk factors for the development of disordered eating behaviors among first-year college athletes.

A cross-sectional study of anxiety and depression caseness in female competitive figure skaters in Sweden

Objectives

Little is known about figure skaters' mental health. This study aimed to describe anxiety and depression caseness (defined as a screening condition qualifying for psychiatric examination) in competitive figure skaters and analyse factors associated with such caseness.

Methods

A cross-sectional study was performed in April 2019 among all competitive figure skaters in the south-eastern region of Sweden (N=400). The primary outcomes were anxiety caseness, measured using the short-form Spielberger State-Trait Anxiety Inventory and depression caseness, measured using the WHO-5 index. Multivariable logistic regression models were employed to determine the association between anxiety caseness and explanatory factors.

Results

In total, 36% (n=142) of the invited skaters participated. Only females (n=137), mean age 12.9 (SD 3.0) years) were selected for analysis. Of the participating skaters, 47% displayed anxiety caseness and 10% depression caseness. Overweight body image perception (OR 5.9; 95% CI 2.0 to 17.6; p=0.001) and older age (OR 1.2; 95% CI 1.1 to 1.4; p=0.005) were associated with anxiety caseness. Skaters reporting no caseness were younger than those reporting only anxiety caseness (mean age difference -1.9 years; 95% CI -3.1 to -0.7; p=0.001) or anxiety and depression caseness (OR -3.5 years; 95% CI -5.6 to -1.5 years; p<0.001).

Conclusion

Anxiety caseness was associated with overweight body image perception and older age in female competitive figure skaters. Older skaters reported generally worse mental health. More research on the mental health of figure skaters is warranted, considering comorbidity and focusing on those needing further assessment and support.

Self-compassion, body satisfaction, and disordered eating symptoms in male collegiate athletes: A longitudinal analysis

Male athletes are a subpopulation at risk for developing eating disorders and disordered eating concerns, primarily due to the presence of socioculturally-based factors, including body dissatisfaction. Self-compassion may alleviate this risk by improving body satisfaction. To date, no study has examined longitudinally self-compassion's effect on body satisfaction and, ultimately, disordered eating in male athletes. Across two time points separated by four months, we assessed self-compassion, body satisfaction, and disordered eating in 454 male collegiate athletes. Through cross-lagged, panel analysis, after controlling for the Time 1 scores, we determined that: (a) Time 1 self-compassion was neither directly related to Time 2 body satisfaction (β = 0.02, p = .755), nor indirectly to Time 2 disordered eating (β = -0.002, 95% BCaCI [-0.028, 0.014]), and (b) Time 1 body satisfaction directly predicted Time 2 disordered eating (β = -0.12, p < 0.05). Our findings extend past research, demonstrating that body satisfaction is a primary antecedent to disordered eating among male athletes. However, the proposed effects of self-compassion on the body satisfaction to disordered eating relationship were not supported and may be dependent on gender and athlete status.

Comparison of eating disorders symptoms and body image between individual and team sport adolescent athletes during the COVID-19 pandemic

BACKGROUND

COVID-19 has significantly disrupted the routines of school sports for adolescent athletes, which can affect their usual eating behaviors and body image. Specific pressures of individual sports (which tend to emphasize "leanness" as a means to improving performance), versus team sports (which tend to not require "leanness" for an athlete to be competitive), may further increase the risk of disordered eating (DE), eating disorders (ED), and distorted body image. An additional factor to consider is the gender of the athletes, with participation in "lean" sports associated with increased DE and body dissatisfaction for male, but not female, athletes.

METHODS

Participants of the study included 124 Iranian male adolescent athletes residing in Mazandaran province (one of the most affected areas of Iran during COVID-19), who played in 1 of 6 sports (3 individual, 3 team). ED symptoms were assessed by the Eating Attitudes Test-26 (EAT-26), and body image was assessed by the Body-Esteem Scale for Adolescents and Adults (BESAA).

RESULTS

The individual athlete group (n = 62) had significantly higher EAT-26 subscale scores for Bulimia and Food Preoccupation (p = 0.019), as well as significantly higher BESAA subscale scores for Appearance (p = 0.001), Weight (p = 0.001), and Attribution (p = 0.001), compared to the team athlete group (n = 62). However, there were no significant differences between the two athlete groups on the EAT-26 Dieting and Oral Control subscales.

CONCLUSIONS

COVID-19 presents specialized issues for adolescent athletes, particularly those at risk for, or experiencing, DE, ED, and distorted body image. While individual athletes had significantly higher scores than team athletes on most subscales, there were no differences between groups on subscales of dieting and oral control. Overall, the findings highlight the need for sport psychologists, coaches, and other sports professionals working with male adolescent athletes (individual and team) to monitor DE, ED, and distorted body image during COVID-19, in order to provide early intervention, and mitigate the risk of long-term consequences. COVID-19 has significantly disrupted the routines of school sports for adolescent athletes, which can affect their usual eating behaviors and body image. Specific pressures of individual sports (which tend to emphasize "leanness" as a means to improving performance), versus team sports (which tend to not require "leanness" for an athlete to be competitive), may further increase the risk of disordered eating (DE), eating disorders (ED), and distorted body image. An additional factor to consider is the gender of the athletes, with participation in "lean" sports associated with increased DE and body dissatisfaction for male, but not female, athletes. Participants of the study included 124 Iranian male adolescent athletes in Mazandaran province (one of the most affected areas of Iran during COVID-19), who played in 1 of 6 sports (3 individual, 3 team). The individual athlete group (62 participants) had significantly higher scores on measures of ED (Bulimia, Food Preoccupation), and body image (Appearance, Weight, Attribution), versus the team athlete group (62 participants). However, there were no significant differences between groups on other measures of ED (Dieting, Oral Control). Findings highlight the need for sport professionals working with adolescent athletes to monitor DE and body image during COVID-19 for early intervention.

Eating-disorder psychopathology in female athletes and non-athletes: A meta-analysis

OBJECTIVE

There is ongoing discussion about whether sports participation is a risk or protective factor for eating disorders (EDs). Research is mixed, with some studies suggesting that athletes have higher mean levels of ED psychopathology compared to nonathletes, while other studies suggest the opposite effect or no differences. The purpose of the current meta-analysis was to identify whether female athletes reported higher mean levels of ED psychopathology compared to nonathletes.

METHOD

Following PRISMA guidelines, we identified 56 studies that reported ED psychopathology for female athletes and nonathletes. A three-level random-effects model of between- and within-study variance was completed for the following outcome variables: overall ED psychopathology, body dissatisfaction, drive for thinness, restricting, and loss-of-control eating.

RESULTS

Athletes reported lower levels of body dissatisfaction compared to nonathletes (g = -.21, p < .0001). Athletes and nonathletes reported similar levels of overall ED psychopathology, drive for thinness, restricting, and loss-of-control eating on average. Sport type significantly moderated standardized mean difference effect sizes of ED psychopathology in athletes versus nonathletes. Effect sizes comparing levels of drive for thinness, restricting, and loss-of-control eating in athletes versus nonathletes were larger for studies with athletes participating in aesthetic/lean sports compared to nonaesthetic/nonlean sports.

DISCUSSION

Findings from this meta-analysis could inform future ED prevention and treatment in female athletes by providing further evidence that athletes in aesthetic/lean sports may report higher levels of ED psychopathology. Participating in nonaesthetic/nonlean sports may be a protective factor for experiencing less body dissatisfaction.

PUBLIC SIGNIFICANCE STATEMENT

The current meta-analysis summarized findings from 56 studies that assessed levels of disordered eating, body dissatisfaction, dietary restricting, and loss-of-control eating in female athletes and nonathletes. Athletes reported lower levels of body dissatisfaction compared to nonathletes, highlighting that participation in sport could have some protective factors. Athletes participating in sports that require weight categories (e.g., judo) and sports that emphasize thinness/leanness (e.g., gymnastics and distance running) had higher levels of disordered eating relative to athletes participating in other types of sports that do not emphasize thinness/leanness (e.g., volleyball and basketball).

Disordered eating- and exercise-related behaviors and cognitions during the first year college transition

ObjectiveDuring the college transition, vulnerability to disordered eating and exercise behaviors and cognitions may increase. We studied how behaviors and cognitions change differentially over time, in the context of gender, athletic participation, and contingencies of self-worth. Participants: 229 diverse, first-year students at a competitive liberal arts college. Methods: Three-wave longitudinal study employing surveys before, during, and following the first semester, using linear mixed model analyses. Results: There were changes over time in one measure of disordered exercise-related cognitions and exercise frequency; disordered eating showed no significant changes over time. Athletic participation and basing a lower amount of self-worth on appearance were protective against subclinical disordered cognitions and behaviors; gender was not predictive. Conclusion: Health personnel should consider athletic participation and contingencies of self-worth when assessing students' risk for ED symptoms, in both genders. Early interventions may be useful, as changes were observed within the first three months of college.

Weight Pressures and Eating Disorder Symptoms among Adolescent Female Gymnasts of Different Performance Levels in Greece

This study examined the weight pressures within the gymnastics environment and explored associations between these pressures and eating disorder (ED) symptoms in adolescent female gymnasts. One hundred and forty-seven competitive gymnasts and 122 recreational-level gymnasts (11–17 years old) completed the Eating Attitudes Test (EAT-26), the Weight-Pressures in Sport-Females (WPS-F), the Social Desirability Scale (SDS) and provided information on their training. It was found that 16.3% of competitive gymnasts and 7.4% of non-competitive gymnasts scored ≥20 in EAT-26, indicating disordered eating behavior. Competitive gymnasts scored higher than non-competitive in the total score of EAT-26 (p = 0.027), as well as in the total score of WPS-F, the sport and coaches weight pressures sub-scale and the appearance and performance weight pressures sub-scale (p < 0.001). Multiple regression analyses indicated that sport and coaches weight pressures, appearance and performance weight pressures and body mass index accounted for 30.3% of the variance of EAT-26 in competitive gymnasts, while the appearance and performance weight pressures sub-scale accounted for 16.3% of the variance of EAT-26 in non-competitive gymnasts. Sport and coaches weight pressures are associated with ED in competitive gymnasts, while body appearance and performance demands correlate with ED in female gymnasts irrespective of competitive level.

Health outcomes among former female collegiate gymnasts: the influence of sport specialization, concussion, and disordered eating

Objective: Gymnastics is a popular sport with high injury rates, especially at the collegiate level. There is limited evidence, however, regarding the risks of early specialization in this sport, the rate of concussions in gymnasts, and the long-term effects of disordered eating in gymnasts. We sought to describe health-related outcomes of former collegiate gymnasts and the association with early sport specialization, concussion history, and disordered eating.Methods: We distributed an online survey through social media outlets. A total of 473 former female collegiate gymnasts completed the survey and were grouped according to early (<14 years) specialization, presence or absence of concussion history, and history of disordered eating. We determined the number of participants who had time-loss injuries, injuries requiring surgery, and injuries resulting in retirement. We also evaluated menstrual history, reasons for sport retirement, functional outcome measures, and mental health.Results: The median age of gymnastics specialization was 8 years [interquartile range = 6-11 years]. The proportion of injuries sustained during college did not significantly differ by specialization age. A significantly greater proportion of early specializers required surgery for college sports-related injuries (60% vs. 44%; p = 0.02). Forty-two percent of the respondents reported concussion history, and a greater proportion of those with concussion history reported seeking mental health treatment during college (32% vs. 23%; p = 0.03), and anxiety disorder diagnosis (16% vs. 9%; p = 0.01). Disordered eating history was reported by 34% of the respondents, and this group had a higher proportion of time-loss injury (78% vs 65%; p = 0.004), and osteoporosis (4% vs 0%; p = 0.003) during college, and worse current pain (11.5 vs 10.2; p = 0.007) and physical function (12.2 vs 11.0; p = 0.01) than those without disordered eating.Conclusion: Athletes and clinicians should be aware of the long-term effects of early specialization, concussions, and disordered eating in gymnastics as these issues are common in female collegiate gymnasts.

Overtraining Syndrome (OTS) and Relative Energy Deficiency in Sport (RED-S): Shared Pathways, Symptoms and Complexities

The symptom similarities between training-overload (with or without an Overtraining Syndrome (OTS) diagnosis) and Relative Energy Deficiency in Sport (RED-S) are significant, with both initiating from a hypothalamic-pituitary origin, that can be influenced by low carbohydrate (CHO) and energy availability (EA). In this narrative review we wish to showcase that many of the negative outcomes of training-overload (with, or without an OTS diagnosis) may be primarily due to misdiagnosed under-fueling, or RED-S, via low EA and/or low CHO availability. Accordingly, we undertook an analysis of training-overload/OTS type studies that have also collected and analyzed for energy intake (EI), CHO, exercise energy expenditure (EEE) and/or EA. Eighteen of the 21 studies (86%) that met our criteria showed indications of an EA decrease or difference between two cohorts within a given study (n = 14 studies) or CHO availability decrease (n = 4 studies) during the training-overload/OTS period, resulting in both training-overload/OTS and RED-S symptom outcomes compared to control conditions. Furthermore, we demonstrate significantly similar symptom overlaps across much of the OTS (n = 57 studies) and RED-S/Female Athlete Triad (n = 88 studies) literature. It is important to note that the prevention of under-recovery is multi-factorial, but many aspects are based around EA and CHO availability. Herein we have demonstrated that OTS and RED-S have many shared pathways, symptoms, and diagnostic complexities. Substantial attention is required to increase the knowledge and awareness of RED-S, and to enhance the diagnostic accuracy of both OTS and RED-S, to allow clinicians to more accurately exclude LEA/RED-S from OTS diagnoses.

Determinants of Sports Injury in Young Female Swedish Competitive Figure Skaters

Introduction: Although figure skating attracts several hundred thousand participants worldwide, there is little knowledge about physical health and sports injuries among young skaters. The present study aimed to describe the health status of a geographically defined Swedish population of licensed competitive figure skaters and to examine injury determinants.

Methods: All licensed competitive skaters in the southeastern region of Sweden were in April 2019 invited to participate in a cross-sectional study using an online questionnaire. Multiple binary logistic regression was used for the examination of injury determinants. The primary outcome measure was the 1-year prevalence of a severe sports injury episode (time loss >21 days). The secondary outcome measure was the point prevalence of an ongoing injury. The determinants analyzed were age, skating level, relative energy deficiency indicators, and training habits.

Results: In total, 142 (36%) skaters participated, 137 (96%) girls [mean (SD) age: 12.9 (SD 3.0) years]. Participating boys (n = 5) were excluded from further analysis. The 1-year prevalence of a severe sports injury episode was 31%. The most common injury locations for these injuries were the knee (25%), ankle (20%), and hip/groin (15%). In the multiple model, having sustained a severe injury episode was associated with older age (OR 1.2, 95% CI 1.1–1.4; p = 0.002) and an increased number of skipped meals per week (OR 1.1, 95% CI 1.0–1.3; p = 0.014). The point prevalence of an ongoing injury episode was 19%. The most common locations were the knee (24%), ankle (24%), and foot (24%). Having an ongoing injury episode was associated with older age (OR 1.4, 95% CI 1.2–1.7; p < 0.001) and an increased number of skipped meals per week (OR 1.1, 95% CI 1.0–1.3; p = 0.049).

Conclusion: One-third of young female Swedish competitive figure skaters had sustained a severe injury episode during the past year, and a fifth reported an ongoing episode. Older age and an increased number of skipped meals per week were associated with a sports injury episode. Long-term monotonous physical loads with increasing intensity and insufficient energy intake appear to predispose for injury in young female figure skaters. Further examination of injury determinants among competitive figure skaters is highly warranted.

Psychosocial predictors of eating classification in female athletes: From collegiate sport to retirement

OBJECTIVE

Due to high prevalence, female athletes are considered a high-risk group for eating disorders (i.e., clinical ED = 2.0% to 19.9%; subclinical ED = 7.1% to 49.2%). Cross-sectional and longitudinal research have identified psychosocial factors that influence current and future disordered eating (e.g., appearance pressures, body satisfaction), but are limited in design (e.g., timeframe, active competitors). Quantitative evaluations of psychosocial predictors of female athletes' disordered eating in retirement are lacking.

METHOD

The current study investigated the predictive ability of psychosocial risk factors (e.g., body dissatisfaction, negative affect) from Time1, when collegiate female athletes were actively competing, to Time2, 6 years later when the women were retired (N = 194; M_age = 25.75 years [SD = 1.19]).

RESULTS

From Time1 to Time2, 23.5% of the women who were Healthy moved to the Disordered classification; 51% remained in Disordered. The full model for athletes who maintained their Disordered status correctly classified 76% of the athletes. Dietary intent, pressure to exercise and change appearance, body satisfaction, and internalization significantly predicted athletes' maintenance as Disordered.

DISCUSSION

Early intervention efforts that address appearance pressures, body image, and healthful eating when athletes are actively competing are vital to help alleviate future distress, particularly in retirement.

Eating Disorder Symptoms in Elite Spanish Athletes: Prevalence and Sport-Specific Weight Pressures

We determined the prevalence of eating disorder (ED) symptoms among elite Spanish athletes from a broad range of sports and levels of competition and examined the associations between the presence of symptoms and perceived sport-specific weight pressures. We surveyed 646 elite athletes (16.7 ± 4.4 years; 51.08% females) representing 33 sports from top-division teams and two elite athlete training centers in Catalonia. Based on the results of the Eating Attitudes Test-26 responses, 5.1% of athletes (7.6% of females and 2.5% of males) were at risk of EDs. The highest rates of ED symptoms were observed in male endurance athletes and female esthetic athletes. Competition level was not a risk factor. The only gender differences in the presence of ED symptoms by competing level were observed in athletes competing at the national level. Female athletes with ED symptoms scored higher on the two subscales of the Spanish version of the Weight Pressures in Sport (WPS) tool: coach and sport-specific pressures and pressures from teammates and due to uniform. Male athletes with ED symptoms scored higher on the pressures due to uniform subscale. Finally, symptomatic female but not male athletes competing at international and national levels also perceived greater sport-specific weight pressures.

Eating disorder diagnosis and the female athlete: A longitudinal analysis from college sport to retirement

OBJECTIVES

Female athletes experience eating disorders (EDs) at clinical, and subclinical, levels; most studies have determined point-prevalence rates through cross-sectional methodologies. To date, few studies have examined the long-term stability of EDs in female athletes; none extend into retirement.

DESIGN

A longitudinal investigation of ED classification (i.e., Clinical ED, Subclinical ED, Healthy) and weight control behaviors (e.g., vomiting, laxative use) from when athletes actively competed (T1) into their retirement (T2).

METHODS

Participants included U.S. female athletes (N=193) who were collegiate competitors (T1) and eventually were retired from their collegiate sports six years later (T2).

RESULTS

At T2, athletes were classified as Healthy (69.9%), Subclinical ED (26.9%), and Clinical ED (3.1%). Overall percentage of Subclinical EDs increased from 18.7% (T1) to 26.9% (T2); 52.8% of T1 Subclinical ED athletes continued to meet criteria for either Subclinical or Clinical ED at T2. Of the 13 Clinical ED athletes at T1, six (46.2%) continued to meet criteria for either a subclinical or clinical ED at T2. Though exercising (2+ hours/day; n=8, 4.1%) and dieting/fasting (4+ times/year; n=14, 7.3%) were the most frequently used weight control behaviors at T2, rates were substantially lower than at T1.

CONCLUSIONS

Retirement does not result in immediate remittance of eating concerns among female athletes; many continue or develop Subclinical and Clinical ED symptoms. Thus, addressing healthy body image and nutrition when athletes are competing is imperative to assist prevention and intervention efforts that may alleviate ED symptoms as athletes transition from sport.

Influence of organised sports practice during adolescence on health of adult women with special emphasis on participation in aesthetic sports

This study aimed to assess the differences in psychosocial health and cardiometabolic risk during adulthood in women based on previously organised sport (OS) participation during adolescence and current activity levels, with emphasis on participation in aesthetic sports. The study included 1947 women aged 18-55 years who were categorised into four groups: 355 aesthetic athletes during adolescence, 494 non- aesthetic athletes during adolescence, 791 non-athletes during adolescence with similar current levels of physical activity (PA) to OS groups and 307 currently inactive non-athletes during adolescence. Participants answered questionnaires regarding sport participation, psychosocial health and cardiometabolic risk. The results show that non-athletes during adolescence who are currently inactive reported significantly lower psychosocial health and higher cardiometabolic risk scores. Women with currently homogenous PA levels (χ² = 0.514) reported similar physical quality of life (QoL), exercise addiction, anxiety and depression symptoms regardless of participation in OS during adolescence (P > .05), except aesthetic athletes who reported the worst sleep and mental QoL. Very high training volumes in aesthetic athletes did not influence psychological outcomes and cardiometabolic risk in adulthood compared to lower training volumes. In conclusion, the effects of PA during adulthood appear to be powerful enough to induce beneficial adaptations in health outcomes that match those observed in women who participate in OS during adolescence, except for aesthetic sports participants, who show a high risk of lower quality of sleep in adulthood. PA should be promoted in adults and especially women who have not participated in OS during adolescence.

An Exploration of the Relationship Between Disordered Eating, Exercise Dependence, and Athletic Injury

Athletes can be at elevated risk for developing eating disorders, the effects of which can be devastating. Few researchers have examined the influence of a predisposition toward an eating disorder on athletic injury. Exercise dependence might bridge the gap toward understanding this relationship. This study sought to examine the relationship between predisposition toward an eating disorder and exercise dependence and looked at both as predictors of athletic injury. College students (n = 132) completed the Eating Disorders Inventory and the Exercise Dependence Questionnaire, as well as provided demographic, activity, and injury information. Subscales of the Eating Disorders Inventory and Exercise Dependence Questionnaire were significant predictors of having at least one athletic injury in the preceding year. These findings suggest that both predisposition toward an eating disorder and exercise dependence may be contributing factors to injury.

Group and longitudinal intra-individual networks of eating disorder symptoms in adolescents and young adults at-risk for an eating disorder

Several studies have identified risk factors that predict future onset of eating disorders (ED) in adolescence, however, it is currently unknown how specific ED symptom dynamics operate both across time and within individuals. Advances in network methodologies allow for the study of how dynamic symptoms interrelate and predict each other within-persons and across time. In the current study, we used longitudinal group-level (N = 1272) (addressing symptom interrelations across people and across time; between-subjects, contemporaneous, and temporal networks) and intra-individual (symptom interrelations within each person and across time; contemporaneous and temporal networks) network analyses (subset n = 50) in prospective 48-month interview data in at-risk adolescents and young adults. We computed between-subject networks (how symptoms are associated on average, for group sample only), contemporaneous networks (how symptoms are associated at one time point, accounting for previous time points), and temporal networks (examining how symptoms predict each other across time). We replicated prior network results which suggest that overvaluation of weight and shape are central in at-risk adolescents and young adults. We found that individual networks (n = 1 networks) were highly variable across individuals. Overall, our results show how both group-level and longitudinal intra-individual network analysis can inform our understanding of how EDs develop in adolescence and point to the importance of conceptualizing development on an individual level of analysis.

Female Athletes in Retirement: A Test of a Psychosocial Model of Bulimic Symptomatology

Although researchers have examined eating disorders in female athletes, few such studies have been done with athletes who are retired, and even fewer have been quantitative. Thus, the authors empirically tested an established eating disorder theoretical model with 218 former NCAA Division-I female collegiate athletes who had been retired for 2-6 years. In retirement, participants completed measures of general sociocultural pressures related to body and appearance, thin-ideal internalization, body dissatisfaction, dietary restraint, negative affect, and bulimic symptomatology. Through structural equation modeling, the authors examined the direct and indirect relationships among the latent variables while controlling for body mass index and years since retirement. The model fit the data well, supporting the hypothesized direct and indirect relationships among the variables and explaining 54% of the variance in bulimic symptomatology. Despite no longer being exposed to sport pressures that contribute to eating disorders, female athletes experience such symptoms long into retirement.

Indicators and correlates of low energy availability in male and female dancers

OBJECTIVES

To investigate indicators and correlates of low energy availability (LEA) in male and female dancers.

METHODS

A Dance-Specific Energy Availability Questionnaire (DEAQ) was developed and administered online internationally to dancers training at preprofessional, professional or advanced amateur level. The DEAQ drew on current validated, published questionnaires for LEA, linked to the clinical outcomes of relative energy deficiency in sport (RED-S). Questions addressed recognised physiological indicators and consequences of LEA in the context of dance, together with potential correlates. LEA was quantified using a scoring system to include these characteristics.

RESULTS

247 responses to the DEAQ were analysed (225 female and 22 male), mean age 20.7 years (SD 7.9) with 85% practising ballet. Psychological, physiological and physical characteristics consistent with LEA were reported by 57% of the female dancers and 29% of male dancers, indicating a risk of RED-S. The unique nature of dance training, in terms of demands and environment, was found to be potentially influential in development of this situation. Less than one-third (29%) of dancers were aware of RED-S.

CONCLUSION

This study found dancers to be a specific group of high-level artistic performers displaying indicators of LEA and consequently at risk of developing the adverse clinical health and performance consequences of RED-S. Awareness of RED-S was low. The DEAQ has the potential to raise awareness and be a practical, objective screening tool to identify dancers in LEA, at risk of developing RED-S.

Disordered eating and eating disorders in male elite athletes: a scoping review

Background

Eating disorders (ED) and disordered eating (DE) among male elite athletes share some of the characteristics seen in female elite athletes and the population, but also exhibit some key differences.

Objective

Scoping review of ED and DE in male elite athletes.

Methods

In May 2020, a comprehensive systematic literature search was conducted for DE and ED in male elite athletes.

Results

We identified 80 studies which included 47 uncontrolled, 14 controlled studies, one interventional trial and 18 reviews.

Discussion

There was a wide range of definitions of DE and a high level of heterogeneity regarding competitive level, age and sport type. In adult male elite athletes, ED prevalence rates up to 32.5% were found, higher than in the general population. Prevalence was not higher in young/adolescent male elite athletes. The most frequently associated factor was competing in weight-sensitive sports. Male elite athletes tended to exhibit less body dissatisfaction than controls and were not always associated with DE. There were no studies looking at the prognosis or reporting an evidence-based approach for the management of DE in male elite athletes.

Conclusion

Existing literature indicates high prevalence of DE and ED in male elite athletes, with a wide range of aetiopathogenesis. There is a need for longitudinal studies to characterise the pathology and long-term outcomes, as well as develop standardised tools for assessment and treatments.

A comprehensive model of disordered eating among aesthetic athletic girls: Exploring the role of body image-related cognitive fusion and perfectionistic self- presentation

The incidence of disordered eating among athlete populations is considerably higher than in the general population. Less well understood is the body image-related emotional processes that might lead to disordered eating attitudes and behaviours, specifically among aesthetic athletic girls. Thus, the aim of the present study was to explore the role that body image-related cognitive fusion plays in disordered eating, and the mediating role of body image-related perfectionist self-presentation on this relationship, in aesthetic athletic girls. This study comprised 142 young female athletes from aesthetic sports, who completed self-report measures. A path analysis was conducted to explore the proposed theoretical model, while controlling for age and zBMI. The path model revealed an excellent fit and explained 71% of the severity of disordered eating. Results showed that body image-related cognitive fusion influences disordered eating behaviours, through the mechanism of body image-related perfectionist self-presentation, even when controlling for age and zBMI. Findings suggested that, in aesthetic athletic girls, the entanglement in body image-related thoughts may be associated with the need to present a perfect body image to others, which may lead to disordered eating attitudes and behaviours, adopted as a means to control weight and body shape. The present study highlights the relevance of body image-related processes in disordered eating and suggests the importance of educational programmes that target the development of more adaptive emotion regulation strategies concerning body image in athletes, particularly from aesthetic sports.

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

BACKGROUND

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

METHOD

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

RESULTS

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

CONCLUSION

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

Disordered Eating Attitudes, Anxiety, Self-Esteem and Perfectionism in Young Athletes and Non-Athletes

Eating disorders are associated with short and long-term consequences that can affect sports performance. The purposes of this study were to investigate whether female athletes, particularly gymnasts and footballers, exhibit more eating problems compared to female non-athletes, and to identify individual personality characteristics including anxiety, self-esteem, and perfectionism as possible contributors to eating disorder risk. In a sample of 120 participants, 80 adolescent female athletes were compared to a control condition of 40 non-athletes (mean age 17.2 ± 2.82). Participants responded to a questionnaire package to investigate the presence of disordered eating (SCOFF) and psychological variables in relation to disordered eating symptoms or eating disorder status. Subsequently, anthropometric measures were obtained individually by trained staff. There were statistically significant differences between conditions. One of the most important results was the score in SCOFF (Mann-Whitney = 604, p < 0.05; Cohen's d = 0.52, r = 0.25), being higher in control than in the gymnast condition. These results suggest that non-athlete female adolescents show more disturbed eating behaviours and thoughts than female adolescents from aesthetic sport modalities and, therefore, may have an enhanced risk of developing clinical eating disorders.

Gym Members Show Lower Nutrition Knowledge than Youth Engaged in Competitive Sports

OBJECTIVE

Adolescents may be vulnerable to misleading nutritional information and adopt unhealthy food habits. In addition, specific features related to physical training, either aimed to improve fitness or to comply with sport demands, may influence food habits of the youth. This cross-sectional study was aimed to compare nutrition knowledge, food habits and adherence to Mediterranean diet in youth engaged in fitness training, competitive sports or inactive.

METHODS

Three questionnaires, the General and Sport Nutrition Knowledge (GeSNK) questionnaire, a food habit questionnaire and the KIDMED were administered to gym members, athletes engaged in volleyball, long-distance swimming, and gymnastics, and inactive adolescents.

RESULTS

The total sample included 211 youth (age 16.8 ± 1.7 years). Gym members, like the inactive youth, had lower general and sport-related nutrition knowledge compared to athletes (p = 0.001). In the whole sample, general nutrition knowledge was positively associated with healthy food habits (p < 0.01) and adherence to the Mediterranean diet pattern (p < 0.02).

CONCLUSIONS

Gym members had a level of nutrition knowledge lower than young athletes and similar to inactive youth. Healthy food habits were related with nutrition knowledge among adolescents. Specific nutritional education programs are needed to address food habits in fitness settings.

Self-reported eating disorder risk in lean and non-lean NCAA Collegiate Athletes

PURPOSE

The purpose of this present study was to examine gender differences in overall scores on the Eating Attitudes Test (EAT-26) in National Collegiate Athletic Association (NCAA) college athletes in "lean" sports versus "non-lean" sports.

METHODS

Using a self-report survey design, this study examined eating disorder risk in 121 NCAA college athletes, using the EAT-26. We expected that female athletes and athletes in "lean" sports would report higher scores on the EAT-26.

RESULTS

There was a significant effect of sport type (lean vs. non-lean) on eating attitudes and behaviors, with those in non-lean sports reporting higher scores, on average, on the attitudinal measure and those in lean sports reporting, on average, higher scores on the behavioral measure. There was an interaction between gender and sport type (lean vs. non-lean) on eating attitudes and behaviors. Male athletes in non-lean sports had the highest overall average scores on the attitudinal portion of the EAT-26, and males in lean sports had the lowest scores. However, on the EAT-26 behavioral portion, men in lean sports reported significantly higher scores than did men in non-lean sports. Female athletes, regardless of sport type, reported similar scores on both the EAT- 26 attitudinal and behavioral sections.

CONCLUSIONS

Our findings suggest that athletes, regardless of sport type and gender, may be affected by eating disorder symptomatology. Gender differences may be smaller in athletic populations than previously thought. Sport type may affect whether disordered eating symptomatology presents as attitudinal or behavioral in nature, especially in male athletes.

LEVEL OF EVIDENCE

Descriptive study, Level V.

Disordered eating behaviours in female physique athletes

Despite substantial growth in participation rates in physique sports, little is known about the modern day female physique athlete. The extreme physique traits of successful female physique athletes suggest this population may be particularly at risk of developing disordered eating (DE). The aim of this study was to determine if female physique athletes across the main divisions of bikini, fitness, figure and bodybuilding were at risk of DE and to explore possible associated risk factors. Furthermore, we aimed to investigate differences in incidence of DE across divisions given differences in physique requirements. Female physique athletes (n = 348) were recruited using targeted methods and completed an online survey based on validated questionnaires, including the Drive for Thinness, Body Dissatisfaction, and Bulimia subscales of the Eating Disorder Inventory (EDI), Pathogenic Weight Control Measures (PWCM), and the Cognitive Dietary Restraint subscale of the Three-Factor Eating Questionnaire (TFEQ-CDR). Athletes scoring above the cut off values for one or more of the EDI subscales or engaged in at least one of the most concerning PWCM (binge eating, laxative use, and self-induced vomiting) were considered at risk of DE. Approximately half of the participants were identified with DE (46.6%), independent of division, with 27.3% exhibiting clinical and 19.3% having subclinical DE. Furthermore, approximately half (48.9%) of participants engaged in at least one of the most concerning PWCM within the past three months, with a smaller proportion (5.2%) engaging in all three PWCM. Weak but significant correlations were found between some EDI subscales and reason for sport participation, BMI and body composition goals. Drive for thinness and body dissatisfaction were positively associated with use of PWCM. In conclusion, a high proportion of female physique athletes were identified with DE, with a concerning number of athletes engaging in harmful PWCM.

Systematic review of risk factors for eating psychopathology in athletes: A critique of an etiological model

OBJECTIVE

The theoretical model by Petrie and Greenleaf (2007, 2012) is an admirable attempt to collate the causal factors of disordered eating in athletes. The aims of this systematic review are (a) to provide an overview of the findings from the relevant literature, (b) to assess whether the model is supported by the existing research, (c) to evaluate the different designs, methods, and measures used to test the mediators in the model, and (d) to highlight areas for improvements and future research.

METHOD

A systematic review of four major online databases identified 37 relevant papers on risk factors of disordered eating in athletes, which were reviewed and critically compared with the theoretical model.

RESULTS

There is a lack of longitudinal research with the relevant mediators in athlete populations, which makes it difficult to determine whether the potential mediators described by Petrie and Greenleaf are causal risk factors rather than simply correlates of disordered eating for athletes. Findings for all the potential mediators are inconsistent, and the range of measures used makes it problematic to draw conclusions.

CONCLUSIONS

Future research needs to use gold standard measures and longitudinal designs in order to fully test and possibly update the model.

Motivational Climate Profiles, Pubertal Status, and Well-Being Among Female Adolescent Aesthetic Sport Athletes

PURPOSE

Girls participating in aesthetic sports may be at risk for disordered eating and low self-esteem. Informed by self-determination theory, the authors examined motivational climate profiles to understand how climate dimensions differentially relate to psychological needs satisfaction, self-esteem, and disordered eating.

METHODS

Female gymnasts, divers, and figure skaters (N = 183; mean age = 13.5) completed a survey to assess perceptions of the motivational climate, perceived sport competence, autonomy, relatedness, self-esteem, and dieting. Pubertal status was assessed to control for developmental differences.

RESULTS

Three profiles emerged: High Important Role/Low Performance, High Effort and Cooperation/High Rivalry, and Low Mastery/High Unequal Recognition and Punishment. A 3 × 2 multivariate analysis of variance revealed profile groups significantly differed on perceived autonomy, coach relatedness, and teammate relatedness. In addition, perceived competence, self-esteem, and dieting significantly differed by pubertal status. For autonomy, the High Important Role/Low Performance group reported the highest scores. For coach and teammate relatedness, the Low Mastery/High Unequal Recognition and Punishment group reported significantly lower scores than the other 2 groups. Postpubertal girls reported lower sport ability and self-esteem and greater dieting.

CONCLUSION

Physical maturity and social context were important in explaining girls' psychological needs satisfaction and well-being. Results add to the authors' understanding of the complex nature and influence of the motivational climate.

DO TRAINING REGIMEN AND COMPETITIVE LEVEL AFFECT BODY IMAGE DISSATISFACTION (LEANNESS AND MUSCLE TONE) IN FEMALE ATHLETES?

ABSTRACT Introduction Studies that seek analyze the relationship between sport variables and body image are importants, because indicate if the competitive sport environment influence on body feelings of athlete. Objective To analyze the relationship between sports variables (training regimen and competitive level) and dissatisfaction in regard to leanness and muscle tone in female athletes. Methods One hundred and eighty female athletes aged over 12 years from various sport disciplines participated in the study. We used the Body Shape Questionnaire (BSQ) to assess dissatisfaction in regard to leanness. The dissatisfaction subscale of Drive for Muscularity Scale (DMS) was used to evaluate dissatisfaction with muscle tone. Training regimen (frequency x daily hours of training) and competitive level were acquired through a questionnaire developed by the actual investigators. Results The findings indicated a statistically significant relationship between the training regimen (F(1, 179)=4.01; p=0.047) and competitive level (F(2, 178)=3.59; p=0.031) and the BSQ scores. Moreover, the results indicated a statistically significant relationship between the training regimen (F(1, 179)=4.01; p=0.047) and the competitive level (F(2, 178)=3.59; p=0.031), with DMS dissatisfaction subscale scores. Conclusion Sports variables (training regimen and competitive level) were related to dissatisfaction in regard to leanness and muscle tone, although they demonstrated different magnitudes. Level of evidence III; study case-control.

The Female Athlete Triad: A Comparison of Knowledge and Risk in Adolescent and Young Adult Figure Skaters, Dancers, and Runners

STUDY OBJECTIVE

The female athlete triad is often found in sports that value leanness and aesthetics and can lead to adverse health effects. We aimed to compare knowledge and risk of the triad among adolescent figure skaters, dancers, and runners.

DESIGN, SETTING, PARTICIPANTS, AND MAIN OUTCOME MEASURES

We advertised our survey on social media platforms: sports-specific forums; Facebook; and Instagram. We received 928 responses. We included female figure skaters, dancers, and runners aged 25 years or younger (N = 712). We asked participants to name the triad components and dichotomized knowledge scores as high or low. We developed a 6-question triad risk scale and defined "at risk" if participants endorsed 3 or more questions.

RESULTS

Of 712 participants: 60% were figure skaters; 28% dancers; 12% runners; 78% were adolescents (≤17 years of age); 22% young adults (18-25 years); 12% had heard of the triad. A higher proportion of runners than figure skaters and dancers had high knowledge of the triad (16% vs 6% vs 5%, P < .01). Overall 60% of athletes were "at risk" of the triad, 25% skipped a period for 3 or more months, and 34% had a history of stress fractures or shin splints. Young adults vs adolescents and dancers vs figure skaters and runners had nearly twice the odds of triad risk.

CONCLUSION

Most athletes were at risk of the triad but few knew about it. Dancers were at higher risk compared with figure skaters and runners. Efforts should be made to raise awareness of the triad among athletes, parents, and coaches, with special attention paid to the dance community.

Bodies in Motion: An empirical evaluation of a program to support positive body image in female collegiate athletes

Female athletes are at risk for eating disorders due to the experience and internalization of pressures regarding various aspects of their bodies, including weight and appearance. Evaluating programs that address psychosocial antecedents and may reduce female athletes' risk is critical. We examined Bodies in Motion, a program based on cognitive dissonance and mindful self-compassion principles that integrates components of social media. Female athletes across nine NCAA athletic departments were assigned to Bodies in Motion (n = 57) or a wait-list control group (n = 40). Athletic department personnel were trained in the standardized program. Data were collected at three time-points - baseline, post-program, and three to four months later. Using Holm's algorithm to control for multiple comparisons, repeated measures ANOVAs showed that, after program completion, Bodies in Motion athletes reported less thin-ideal internalization, as compared to the control athletes, over time. We also observed varying group trajectories in outcome responses upon visual inspection of profile plots. These findings serve as the basis for future research suggestions involving larger sample sizes and prolonged measurement of outcomes.

Athletes’ Body Talk: The Role of Contextual Body Image in Eating Disorders as Seen Through the Eyes of Elite Women Athletes

The aim of the study was to investigate if and how body image, taken from a contextual perspective, contributes to the eating disorder history. This qualitative study investigated the process of eating disorder development in eight elite women athletes in at-risk sports. The results showed that the relationship between eating disorder symptomatology and the sports environment was clearly recognized by the elite women athletes. Contextual body image, more specifically negative body-evaluations and upward body comparisons, appeared as an important factor in the development of eating disorders, particularly in the athletic context. It became clear that the two aesthetic and two endurance athletes as well as the two weight-class athletes in rowing described quite negative body evaluations in the context of sport, while some of them also recognized an impact of body image experiences in daily life. However, for both judokas, their eating disorder had nothing to do with their body image but was attributed to the weight-classes in their sport and accompanying weight making. Several unique trajectories and individual eating disorder histories were distinguished which confirms the value of taking a qualitative approach in investigating eating disorders in sport. We also discovered links between what the athletes had reported as contributors to their eating disorder history and how they told their stories by combining content analysis and narrative inquiry. Furthermore, the present study also highlights several critical aspects for prevention and treatment that should support sport federations and clinical sport psychologists in taking appropriate actions to deal more effectively with eating disorders in athletes.