Eating Disorders in Male Athletes

Assessment of Eating Disorder Risk According to Sport Level, Sex, and Social Media Use among Polish Football Players: A Cross-Sectional Study

BACKGROUND/OBJECTIVES

Eating disorders (EDs) pose a significant health issue affecting athletes, with risk factors varying by sport level, sex, and social media use. This study assesses the risk of EDs among professional and amateur football players, considering these factors, and compares findings with a control group of non-athletes.

METHODS

The study involved 170 participants, including non-athletes as a control group, categorized by sex and sport level. The mean age of participants was 24.3 ± 4.20, with an age range of 18-36. The Eating Attitudes Test (EAT-26) and body mass index (BMI) assessments were used to determine ED risk.

RESULTS

Results showed a higher prevalence of ED risk among professional athletes, especially women, compared to amateurs and non-athletes. Social media use and body comparisons were linked to increased ED risk, with professional athletes exhibiting higher vulnerability due to performance pressures. Women, particularly those in professional sports, showed a higher risk of EDs than men, influenced by social and aesthetic pressures.

CONCLUSIONS

The findings highlight the need for targeted interventions, promoting healthier body image perceptions and addressing social media's role in shaping body dissatisfaction. Psychological support and sex-specific strategies should be integrated into athlete care programs to mitigate these risks.

Junior athletes' nutritional demands: a narrative review of consumption and prevalence of eating disorders

Information regarding the dietary requirements and consumption of young athletes is limited. Hence, the aim of this narrative review is to provide a comprehensive combination of research and review papers on the nutritional status of young athletes aged 5-18 years old, as well as quantitative, qualitative, wholesome foods, food choices, and eating disordered data concerning the dietary requirements for growing young athletes. This study involved systematic searches of electronic databases, including Google Scholar, PubMed, Science Direct, Scopus, and Web of Science. The specific criteria for identifying research papers published in English from July 1980 until May 2024 were included. Only 48 studies out of 1,262 were included in this narrative review. The findings of this study suggest that, compared with adults, junior athletes need a unique approach to meet their dietary needs. Growth, development, and general athletic performance depend on macronutrients, as they are vital nutrients for young active athletes. However, research on enhancing junior athletes' performance is still in progress, and studies on hydration status, and eating disorders are limited.

Assessment of eating disorder symptoms, compulsive exercise, body dissatisfaction and depression in Swedish national team gymnasts, with a one-year follow-up

PURPOSE

The purpose of this study was to explore changes in symptoms of eating disorders, compulsive exercise, and depression, between two assessments 12 months apart, among elite gymnasts.

METHOD

Factors related to the development of mental health symptoms in male and female Swedish national team gymnasts were investigated using baseline and 1-year follow-up scores in two subscales of the Eating Disorders Inventory 3; drive for thinness and body dissatisfaction, two subscales of the Compulsive Exercise Test; avoidance and rule-driven behavior and exercise for weight control, and the Montgomery-Åsberg Depression Rating Scale-Self report (MADRS-S). Linear mixed models were used to investigate the influence of drive for thinness, exercise for weight control, avoidance and rule-driven behavior, and MADRS-S on body dissatisfaction.

RESULTS

Body dissatisfaction increased from baseline to the follow-up assessment, while drive for thinness and depression remained stable. Symptoms of eating disorders and depression were generally low in this group of elite gymnasts at both assessments. Drive for thinness, exercise for weight control, and symptoms of depression were associated with body dissatisfaction.

DISCUSSION

Our findings indicate that there were no significant changes over time in eating disorders and depression symptoms but significant associations with body dissatisfaction. Furthermore, we found independent effects of drive for thinness, exercise for weight control and symptoms of depression for body dissatisfaction.

Increased prevalence of lower extremity soft tissue injuries and surgeries in patients with anorexia nervosa and bulimia nervosa

PURPOSE

An abundance of literature exists linking eating disorders and fracture risk. However, no studies, to our knowledge, have investigated the impact of eating disorders on lower extremity soft tissue injury or surgery risk. The purpose of this study was to determine if anorexia nervosa and bulimia nervosa are associated with prevalence of lower extremity soft tissue injuries and surgeries.

METHODS

Patients with anorexia nervosa or bulimia nervosa over 2010-2020 were identified through the International Classification of Diseases (ICD) codes in the PearlDiver Claims Database. Patients were matched by age, gender, comorbidities, record dates, and region to control groups without anorexia or bulimia. Soft tissue injuries were identified through ICD codes, and surgeries were identified through Current Procedural Terminology codes. Differences in relative prevalence were analyzed using chi-square analysis.

RESULTS

Patients with anorexia had a significantly increased prevalence of meniscus tears (RR = 1.57, CI 1.22-2.03, p = 0.001) or deltoid ligament sprains (RR = 1.83, CI 1.10-3.03, p = 0.025), and patients with bulimia had a significantly increased prevalence of meniscus tears (RR = 1.98, CI 1.56-2.51, p < 0.001), medial collateral ligament sprains (RR = 3.07, CI 1.72-5.48, p < 0.001), any cruciate ligament tears (RR = 2.14, CI 1.29-3.53, p = 0.004), unspecified ankle sprains (RR = 1.56, CI 1.22-1.99, p < 0.001), or any ankle ligament sprains (RR = 1.27, CI 1.07-1.52, p = 0.008). Patients with anorexia had a significantly increased prevalence of anterior cruciate ligament reconstructions (RR = 2.83, CI 1.12-7.17, p = 0.037) or any meniscus surgeries (RR = 1.54, CI 1.03-2.29, p = 0.042), and patients with bulimia had a significantly increased prevalence of partial meniscectomies (RR = 1.80, CI 1.26-2.58, p = 0.002) or any meniscus surgeries (RR = 1.83, CI 1.29-2.60, p < 0.001).

CONCLUSIONS

Anorexia and bulimia are associated with increased prevalence of soft tissue injuries and surgeries. Orthopedic surgeons should be aware of this risk, and patients presenting to clinics should be informed of the risks associated with these diagnoses and provided with resources promoting recovery to help prevent further injury or surgery.

A systematic review, meta-analysis, and meta-regression of the prevalence of self-reported disordered eating and associated factors among athletes worldwide

BACKGROUND

The purpose of this meta-analysis was to provide a pooled prevalence estimate of self-reported disordered eating (SRDE) in athletes based on the available literature, and to identify risk factors for their occurrence.

METHODS

Across ten academic databases, an electronic search was conducted from inception to 7th January 2024. The proportion of athletes scoring at or above predetermined cutoffs on validated self-reporting screening measures was used to identify disordered eating (DE). Subgroup analysis per country, per culture, and per research measure were also conducted. Age, body mass index (BMI), and sex were considered as associated/correlated factors.

RESULTS

The mean prevalence of SRDE among 70,957 athletes in 177 studies (132 publications) was 19.23% (17.04%; 21.62%), I2 = 97.4%, τ2 = 0.8990, Cochran's Q p value = 0. Australia had the highest percentage of SRDE athletes with a mean of 57.1% (36.0%-75.8%), while Iceland had the lowest, with a mean of 4.9% (1.2%-17.7%). The SRDE prevalence in Eastern countries was higher than in Western countries with 29.1% versus 18.5%. Anaerobic sports had almost double the prevalence of SRDE 37.9% (27.0%-50.2%) compared to aerobic sports 19.6% (15.2%-25%). Gymnastics sports had the highest SRDE prevalence rate, with 41.5% (30.4%-53.6%) while outdoor sports showed the lowest at 15.4% (11.6%-20.2%). Among various tools used to assess SRDE, the three-factor eating questionnaire yielded the highest SRDE rate 73.0% (60.1%-82.8%). Meta-regression analyses showed that female sex, older age, and higher BMI (all p < 0.01) are associated with higher prevalence rates of SRDE.

CONCLUSION

The outcome of this review suggests that factors specific to the sport affect eating behaviors throughout an athlete's life. As a result, one in five athletes run the risk of developing an eating disorder. Culture-specific and sport-specific diagnostic tools need to be developed and increased attention paid to nutritional deficiencies in athletes.

Mental Health and Disordered Eating in Athletes

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

Media's Effect on Athletes' Mental Health

This article explores the athlete's relationship with both traditional and social (digital) media and describes athletes' media obligations and the pressures of media attention. It explains the difference in the representation of diverse groups, and the potential positive and negative outcomes of the media on an athlete's mental health. The article will review the emergence of social media, its limitless reach, and ways in which it diverges from traditional media coverage of athletic performance. Finally, the article concludes with a discussion of ways that athletes' multidsciplinary medical teams may become advocates for healthy and supportive interactions between athletes and media.

The general nutrition practices of competitive powerlifters vary by competitive calibre and sex, weight, and age class

PURPOSE

To characterise self-reported nutrition practices and beliefs of powerlifters.

METHODS

Actively competing male (n = 240) and female (n = 65) powerlifters completed a cross-sectional online survey of self-reported nutrition practices across the competitive cycle, within specific competitive phases, and hard and easy training days. Data are presented as number (n) and percentage (%) of all powerlifters practicing a given strategy followed by a % of responses reporting various practices or beliefs within this strategy. Differences in categorical sub-groups (sex, age, and weight class; and competitive calibre) were analysed with a chi-square test and denoted where significant (p ≤ 0.05).

RESULTS

Most powerlifters reported following a specific diet long-term (n = 203, 66.6%) of which If It Fits Your Macros (IIFYM)/flexible dieting was most common (n = 159, 78.3%). Over half reported introducing a special diet for a competitive phase (n = 162, 53.1%), of which IIFYM/flexible dieting was most followed for competition preparation (n = 80, 63%) and off-season (n = 48, 71.6%). Compared to normal dietary intake, most reported eating more on harder training days (n = 219, 71.8%) and refraining from eating less on easier training days (n = 186, 61%).

CONCLUSIONS

IIFYM/flexible dieting is commonly followed by powerlifters to support performance and body composition goals. Females seemed to report more often restricting energy and dieting for body composition reasons than males. Powerlifters tailor their energy intake on harder training days to the higher training demands but refrain from reducing energy intake on rest/easier training days.

Body dissatisfaction, disordered eating and exercise behaviours: associations with symptoms of REDs in male and female athletes

Objectives

Disordered eating and compulsive exercise behaviours are common among athletes and can increase the risk of relative energy deficiency in sport (REDs). Contrarily, the prevalence of muscle dysmorphia and its relationship with REDs are unknown. This cross-sectional study aimed to evaluate associations of all three with REDs symptoms.

Methods

Elite and subelite Icelandic athletes (n=83, 67.5% females) answered the Low Energy Availability in Females/Males Questionnaires (LEAF-Q/LEAM-Q), Eating Disorder Examination-Questionnaire Short (EDE-QS), Exercise Addiction Inventory (EAI) and Muscle Dysmorphic Disorder Inventory (MDDI). Body composition was assessed via dual-energy X-ray absorptiometry; resting metabolic rate via indirect calorimetry; and blood samples were drawn for analysis of nutrition and hormonal status. Females were compared based on LEAF-Q total score (≥8 (at risk) vs <8). Simple linear regression was applied to evaluate associations of (a) testosterone with other objective measures and LEAM-Q scores in males; and (b) LEAF-Q/LEAM-Q scores with EDE-QS, EAI and MDDI scores.

Results

In total, 8.4% of participants scored above cut-off on EDE-QS, 19.3% on EAI and 13.3% on MDDI. Females with LEAF-Q total score ≥8 had higher median scores on EDE-QS, EAI and MDDI compared with those scoring <8. Testosterone was positively associated with iron and inversely with total iron-binding capacity but was not associated with scoring on any of the administered questionnaires.

Conclusion

Drive for muscularity and aesthetic physique may play a role in the complex presentation of REDs. Screening for muscle dysmorphia, in addition to disordered eating and compulsive exercise, could therefore facilitate early detection of REDs.

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

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

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

CLINICAL SCENARIO

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

CLINICAL QUESTION

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

SUMMARY OF KEY FINDINGS

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

CLINICAL BOTTOM LINE

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

STRENGTH OF RECOMMENDATION

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

Peripheral actions and direct central-local communications of melanocortin 4 receptor signaling

Melanocortin 4 receptor (MC4R), the most important monogenetic cause of human metabolic disorders, has been of great interest to many researchers in the field of energy homeostasis and public health. Because MC4R is a vital pharmaceutical target for maintaining controllable appetite and body weight for professional athletes, previous studies have mainly focused on the central, rather than the peripheral, roles of MC4R. Thus, the local expression of MC4R and its behavioral regulation remain unclear. In an attempt to shed light on different directions for future studies of MC4R signaling, we review a series of recent and important studies exploring the peripheral functions of MC4R and the direct physiological interaction between peripheral organs and central MC4R neurons in this article.

The Prevalence of "at Risk" Eating Disorders among Athletes in Jordan

Eating disorders (EDs) are addressed as one of the expanding mental health problems worldwide. While an ED is a clinical psychiatric diagnosis that can only be established after a psychiatric assessment, it is important to note that "at-risk" refers to people who will exhibit aberrant eating patterns but do not fully meet the requirements for an ED diagnosis. This study was designed to address the ED symptoms (i.e., "at-risk") in Jordanian athletes and their association with age, sex, body mass index (BMI), and type of sport. A convenient, cross-sectional study was conducted among 249 athlete participants by answering the Eating Attitude Test (EAT-26). The EAT-26 results indicated an ED prevalence of 34% among Jordanian athletes. Within "at-risk" ED athletes, sex, age, and BMI had no significant differences in the rates of EDs. Outdoor sports had the least effect on EDs, while the highest was amongst gymnastics. EDs prevalence is alarming among Jordanian athletes. Gymnastics is a risk factor for increasing EDs. Our results should be taken into consideration by physicians, mental health professionals, sports nutritionists, coaches, and sport medicine specialists. We recommend establishing strategies pertaining to mental health, especially EDs in sports centers, along with screening programs for those who demand additional assessment and supervision.

Training Patterns and Mental Health of Bodybuilders and Fitness Athletes During the First Lockdown of the COVID-19 Pandemic—A Cross-Sectional Study

Background:

Government restrictions during the first COVID-19 lockdown, such as the closure of gyms and fitness centers, drastically limited the training opportunities of bodybuilders and fitness athletes (BoFA) who rely on indoor training facilities. This provided a unique situation to investigate the effect of training limitations on the training patterns, training adaptive strategies and mental health of BoFAs.

Objectives

The primary aim of this study was to investigate differences in the training patterns and the mental health of BoFA before and during the first COVID-19 lockdown. The secondary aim was to assess whether BoFA who exhibited features of muscle dysmorphia were affected differently from the group that did not.

Methods

A cross-sectional study was conducted with 85 BoFAs by means of an online questionnaire asking about sports activity, intensity, subjective physical performance, and economic status, including primary or secondary occupations before (from memory) and during lockdown, current physical health problems and financial fears, symptoms of depression, sleep disorders, anxiety (trait and state), muscle dysmorphia, coping mechanisms and actions during the first lockdown in Switzerland.

Results

Training patterns and mental health of BoFA were influenced by the COVID-19 pandemic and first lockdown. During lockdown, the physical activity on the BoFA dropped significantly from 2.3 ± 0.8 h per day to 1.6 ± 0.9 h per day (p &lt; 0.001), the subjective training intensity decreased significantly from 85.7 ± 13.2% to 58.3 ± 28.3% (p &lt; 0.001) and the subjective performance declined significantly from 83.4 ± 14.3% to 58.2 ± 27.8% (p &lt; 0.001) of maximal performance. In comparison to those without risk for body dysmorphia, participants at risk rated their maximal performance significantly lower and scored significantly higher for depression, sleep disorders and anxiety.

Conclusion

This study showed the significant changes on the training patterns of BoFA before and during the first COVID-19 lockdown and poor mental health scores of BoFA during the lockdown itself, with those at risk of muscle dysmorphia scoring statistically worse regarding mental health than those with no risk of muscle dysmorphia. To better understand the particularities of BoFA, further investigation is needed to understand their psychology and in particular the effect of training restrictions on it.

Examining the Relationship between Exercise Dependence, Disordered Eating, and Low Energy Availability

Both dietary and exercise behaviors need to be considered when examining underlying causes of low energy availability (LEA). The study assessed if exercise dependence is independently related to the risk of LEA with consideration of disordered eating and athlete calibre. Via survey response, female (n = 642) and male (n = 257) athletes were categorized by risk of: disordered eating, exercise dependence, disordered eating and exercise dependence, or if not presenting with disordered eating or exercise dependence as controls. Compared to female controls, the likelihood of being at risk of LEA was 2.5 times for female athletes with disordered eating and >5.5 times with combined disordered eating and exercise dependence. Male athletes with disordered eating, with or without exercise dependence, were more likely to report signs and symptoms compared to male controls-including suppression of morning erections (OR = 3.4; p < 0.0001), increased gas and bloating (OR = 4.0-5.2; p < 0.002) and were more likely to report a previous bone stress fracture (OR = 2.4; p = 0.01) and ≥22 missed training days due to overload injuries (OR = 5.7; p = 0.02). For both males and females, in the absence of disordered eating, athletes with exercise dependence were not at an increased risk of LEA or associated health outcomes. Compared to recreational athletes, female and male international caliber and male national calibre athletes were less likely to be classified with disordered eating.

Evaluation of Protein Content in the Diet of Amateur Male Bodybuilder

Public gyms and fitness clubs promote active lifestyles. At the same time, numerous nutritional errors and the phenomenon of incorrect supplementation are being observed among the given study group. Behavior can lead to malaise, injury, or lack of progression. One of the most serious mistakes is the incorrect level of protein in the diet. The aim of the study is to assess the quantity and quality of protein consumed by men undertaking recreational strength training in Szczecin. The study involved 35 men aged 18-35, practicing amateur strength training, from Szczecin (Poland). The author's questionnaire collected information on supplementation, physical activity, and subjective assessment of nutritional knowledge. The obtained test results were subjected to statistical analysis performed in the Statistica12 program. On average, respondents consumed 1.8 g of protein/kg, with the highest recorded conversion rate of 3.7 g of protein/kg of body weight, and the lowest of 0.9 g/kg of body weight. Total protein consumption ranged from 70.2 to 295.7 g, and the average value was 147.8 g (22%), which differs from the study group, that is, 129-133 g, which gives 14% energy proteins. It was found that the protein supplementation, on average, provided 31% of the total protein intake of the study group. The results show inappropriate dietary behavior regarding food supplementation among the examined group. Further education on the nutritional value of the food and a healthy and balanced diet is being recommended for the individuals practicing strength sports.