Reducing eating disorder risk among male athletes: A randomized controlled trial investigating the male athlete body project

OBJECTIVE

No study to date has investigated an intervention program for male athletes that targets eating disorder risk factors. The purpose of this study was to measure the effects of the Male Athlete Body Project (MABP), an adaptation of the Female Athlete Body Project on body dissatisfaction, drive for muscularity, body-ideal internalization, and muscle dysmorphia.

METHOD

Participants were 79 male collegiate athletes who were randomized to the MABP (n = 39) or an assessment-only control condition (n = 40). All participants completed psychometrically validated measures at three time points: baseline, post-treatment (3 weeks after baseline for the control condition), and 1-month follow-up.

RESULTS

Hierarchical Linear Modeling assessed differences between conditions across time. Interaction effects revealed that participation in the MABP improved satisfaction with specific body parts and reduced drive for muscularity and body-ideal internalization at post-treatment compared to a control group. Athletes in the MABP also reported increased body areas satisfaction and reductions in drive for muscularity at 1-month follow-up. Reductions in supplement use were observed at 1-month follow-up only.

DISCUSSION

This study provides preliminary evidence of the efficacy of the MABP in reducing some eating disorder risk factors up to 1 month after the intervention; follow-up study considerations are discussed.

CLINICAL TRIAL REGISTRATION NUMBER

NCT04077177 PUBLIC SIGNIFICANCE: This study highlights the importance of eating disorder and body image intervention efforts for male athletes. Findings suggest that male college athletes who attended a 3-session group intervention based on a well-established program for college women experienced an increase in satisfaction with specific body areas and a reduction in some eating disorder risk factors (e.g., drive for muscularity, supplement use, and body-ideal internalization) compared to a control group.

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.

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.

Difficulties in Emotion Regulation, Alexithymia, and Social Phobia Are Associated With Disordered Eating in Male and Female Undergraduate Athletes

Investigations of disordered eating in the athlete population tend to focus on females and the influence of sport level. This leaves unanswered whether, and how, team interdependence (i.e., whether the competition is engaged with one person or as a team) may differentially impact male athletes. In the present study, we recruited a sample of non-athletes, individual athletes, and team athletes and examined the interaction of gender and teammate interdependence on established psychosocial risk factors for disordered eating, including social phobia, alexithymia, and emotion regulation. Although we identified a significant main effect of gender, there was no main effect of team type, nor was there a significant interaction of gender and team type. Using descriptive discriminant analysis, these variables significantly discriminated between genders. Women were defined by higher scores than men on drive for thinness, body dissatisfaction, and emotion recognition and men were defined by relatively higher scores on emotion dysregulation and binge eating. When we combined all athletes and compared them with non-athletes, a significant interaction of gender and athlete status emerged such that female athletes, compared to male athletes and women non-athletes, were defined by higher scores on drive for thinness, emotion dysregulation, and binge eating. Conversely, male athletes, compared to female athletes, were defined by greater difficulty identifying feelings and body dissatisfaction. Non-athletes were not well defined by the discriminant function. These results highlight that emotional processes convey risk of eating disorders in men and women, particularly in athletes, and these risk factors are not uniform.

Psychological risk indicators of disordered eating in athletes

Objectives

This project examined risk factors of disordered eating in athletes by adapting and applying a theoretical model. It tested a previously proposed theoretical model and explored the utility of a newly formed model within an athletic population across gender, age, and sport type to explain disordered eating.

Design

The design was cross-sectional and the first phase in a series of longitudinal studies.

Methods

1,017 athletes completed online questionnaires related to social pressures, internalisation, body dissatisfaction, negative affect, restriction, and bulimia. Structural equation modelling was employed to analyse the fit of the measurement and structural models and to do invariance testing.

Results

The original theoretical model failed to achieve acceptable goodness of fit (χ² [70, 1017] = 1043.07; p < .0001. CFI = .55; GFI = .88; NFI = .53; RMSEA = .12 [90% CI = .111-.123]). Removal of non-significant pathways and addition of social media resulted in the model achieving a parsimonious goodness of fit (χ² [19, 1017] = 77.58; p < .0001. CFI = .96; GFI = .98; NFI = .95; RMSEA = .055 [90% CI = .043-.068]). Invariance tests revealed that the newly revised model differed across gender, age, level, competition status, and length of sport participation.

Conclusion

This study showed that the formation of disordered eating symptomology might not be associated with sport pressures experienced by athletes. It revealed that disordered eating development varies across gender, competition level, sport type, and age, which must be considered to prevent and treat disordered eating in athletes.

Teammate influences and relationship quality are associated with eating and exercise psychopathology in athletes

Teammates have a powerful influence on athletes' eating attitudes/behaviours, but less is known about the relative importance of teammate influence mechanisms. The primary aim of this study was to explore the relationships and predictive associations between teammate influences (e.g., modelling of teammates' disordered eating; supportive teammate friendships) and athletes' eating and exercise attitudes and behaviours. A further aim was to identify the presence of any gender differences. Athletes (N = 1172, mean age 24 years, n = 727 female) completed a survey exploring multiple teammate influences, eating and exercise attitudes and behaviours, and psychological wellbeing (anxiety, depression, self-esteem). Many significant relationships were identified between teammate influences and eating/exercise psychopathology. Stepwise regression analysis revealed that a perceived pressure from teammates to lose weight/change shape and perceptions that teammates engaged in disordered eating practices were the best predictors of higher eating and exercise psychopathology. Supportive teammate friendships was the best predictor of lower eating psychopathology and higher levels of healthy exercise behaviours. Encouragement/discouragement to eat healthily were also significant predictors. Teammate influences explained more variance in exercise than eating psychopathology, and total variance explained by teammates was higher for females compared to males. Teammates may have a positive and negative influence on the eating and exercise attitudes/behaviours of athletes; however, gender differences are apparent. Understanding teammate influences on the eating and exercise practices of athletes is important for the development of team-based interventions to reduce or prevent disordered eating and exercise. Future research should explore these relationships longitudinally, considering the role of moderating factors (e.g., sport type, stage of season).

Bulimic Symptomatology Among Male Collegiate Athletes: A Test of an Etiological Model

We tested Petrie and Greenleaf's psychosocial model in relation to male athletes' bulimic symptomatology. Through structural equation modeling, we cross-sectionally examined the direct and indirect effects of general and sport-specific appearance pressures, internalization, body satisfaction, drive for muscularity, negative affect, and dietary restraint on bulimic symptomatology. Participants were U.S. male collegiate athletes (N = 698; M_age = 19.87 years) representing 17 sports. With minor respecifications, the model had acceptable fit, and the psychosocial variables explained 48% of the bulimic symptomatology variance. Although all variable paths were significant, sport pressures, such as from coaches and teammates about weight, importance of appearance, and looking good in a uniform, were the most salient latent variable. Athletes' engagement in muscle-building behaviors added uniquely and substantively as well. Our analysis begins to clarify the complex interactions among these psychosocial variables in understanding male athletes' bulimic symptomatology and provides a base from which to develop prevention programming.

White public regard: associations among eating disorder symptomatology, guilt, and White guilt in young adult women

OBJECTIVE

As a novel investigation of the role of White racial identity, the current study explored the link between White guilt and disordered eating.

PARTICIPANTS

Young adult women (N=375), 200 of whom self-identified as White.

METHODS

Measures assessed disordered eating, trait guilt, White guilt, and affect.

RESULTS

White guilt is interrelated with disordered eating, particularly bulimic symptomatology. Distress tolerance and tendency to experience negative affect moderated the relation between White guilt and several disordered eating variables.

CONCLUSIONS

Exploration of White guilt in clinical and research settings can inform understanding and treatment of disordered eating.

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

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

Adolescent athletes: psychosocial challenges and clinical concerns

PURPOSE OF REVIEW

To review the recent literature (over the past 18 months) regarding psychosocial challenges and clinical concerns among adolescent athletes, and to address the advances made in understanding adolescent athletes' coping processes.

RECENT FINDINGS

Coping research has moved from identifying discrete stressors and coping strategies to examining the processes of coping over time. Parents and coaches play an important role in young athletes' sport experiences and athletes' use and development of coping strategies. In terms of clinical concerns, findings regarding the prevalence of disordered eating have been equivocal. However, disordered eating may be of greater concern among athletes participating in 'leanness' sports. Sport participation may contribute to increased alcohol consumption among adolescent athletes but decreased use of drugs and smoking cigarettes, while steroid use appears to be relatively rare compared with athletes' use of alcohol and cigarettes.

SUMMARY

The reviewed studies have implications for future research by identifying opportunities for intervention and education regarding clinical and nonclinical psychosocial challenges. Researchers have emphasized the importance of athletes' social context and relationships in coping with psychosocial challenges in sport. One concern is that adolescent athletes' disordered eating and substance use may reflect maladaptive coping. Experimental and intervention research is limited; however, incorporating members of athletes' social network into future research and interventions may be a practical avenue to achieving positive outcomes among adolescent athletes.

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

Previous studies have indicated a higher risk of disordered eating in certain types of elite sports such as aesthetic sports (e.g., rhythmical gymnastics, figure skating). But even though some studies on risk factors for disordered eating in sports exist, most research on this topic is based on cross-sectional data with limitations on causal inferences. We examined sports-related risk factors for disordered eating in a 1-year longitudinal study with two assessment points. The participants were 65 adolescent athletes from aesthetic sports (mean age 14.0  ±.2.2 years) who completed measures of disordered eating, social pressure from the sports environment, sports-related body dissatisfaction, desire to be leaner to improve sports performance, and emotional distress resulting from missed exercise sessions. All variables were relatively stable in the mean. Individual changes in the desire to be leaner to improve sports performance were associated with individual changes in disordered eating. Furthermore, a cross-lagged partial correlation analysis showed that the desire to be leaner to improve sports performance was predictive of disordered eating and not vice versa. The results of our study indicate that athletes are more at risk for disordered eating if they believe it is possible to enhance their sports performance through weight regulation.