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

The prevalence of disordered eating habits in female collegiate athletes

The prevalence of disordered eating habits in college-aged females is at an all-time high. This population is more likely to experience issues with body image and poor eating behaviors due to the pressure of being a collegiate athlete. The objective of this qualitative study aimed to determine the prevalence of disordered eating habits in female collegiate athletes and determine if playing a sport puts them at risk of harmful behaviors. An anonymous survey was sent out to participants of various sports, asking them to answer a 10-question survey about eating habits and compensatory behaviors such as excessive exercise and caloric restriction. Results indicated that 75% of those surveyed said playing a collegiate sport negatively impacts their relationship with food, and 71% said playing a sport negatively impacts their body image. While some female athletes do not meet the clinical diagnostic criteria for an eating disorder, a large portion still displays disordered eating behaviors, which can be detrimental to their overall well-being. It is essential for the safety of these athletes that staff members, health professionals, and the athletes themselves are aware of these circumstances and can prevent them from progressing into fully diagnosed eating disorders.

Balancing Performance and Health in Elite Hungarian Athletes: The Relationship Among Disordered Eating Risk, Body Composition, and Nutrition Knowledge

BACKGROUND

disordered eating (DE) and eating disorders (ED) can negatively impact athletes' health, wellbeing, and athletic performance.

OBJECTIVE

this cross-sectional study aims to assess DE risk, body composition, and nutrition knowledge among elite Hungarian athletes.

METHODS

DE risk was assessed using DESA-6H and EAT-26 scales, nutrition knowledge through the Abridged Nutrition for Sport Knowledge Questionnaire (A-NSKQ), and body composition with the OMRON BF511 device. The data were analyzed using Kendall's tau correlations, Mann-Whitney U tests, and ROC analysis.

RESULTS

a total of 71 athletes participated (39.4% males, mean age = 24.8 years, SD = 4.8 years and 60.6% females, mean age = 24.3 years, SD = 4.3 years). At-risk scores on the DESA-6H scale were recorded for nine athletes (12.7%), while 32.4% scored in the risk zone on the EAT-26, with female athletes in aesthetic, endurance and weight-dependent sports being most affected. Low BF was observed in four males and four females. Nutrition knowledge (49.1%) was below the acceptable threshold. DESA-6H significantly correlated with EAT-26 scores, BMI, sports nutrition knowledge, and A-NSKQ total scores. A statistically significant difference by gender was found in the EAT-26 total score (p = 0.019, d = 0.65). Risk groups significantly differed in A-NSKQ scores (p = 0.026, d = 0.511) and sport nutrition knowledge, specifically (p = 0.016, d = 0.491). Using EAT-26 to identify at-risk athletes and the DESA-6H recommended cut-off, the ROC analysis showed a sensitivity of 29.1% and a specificity of 95.7%.

CONCLUSIONS

insufficient nutrition knowledge plays a role in being at-risk for DE and ED. These results underscore the need for early detection, early sport nutrition education across all elite athletes, with particular attention to female athletes in aesthetic, endurance and weight-dependent sports, and for monitoring these athletes to prevent DE. Further work is warranted to optimize screening tools such as EAT-26 and DESA-6H for elite athletes.

The Prevalence of and Factors Associated with Disordered Eating Among Adult Athletes in Italy and Lebanon

BACKGROUND/OBJECTIVES

Disordered eating (DE) is a wide-spectrum condition, represented by altered eating patterns, behaviors, and attitudes aimed at controlling food intake, body weight, and shape, which does not necessarily satisfy the diagnostic criteria for an eating disorder of clinical severity. DE is frequently reported among athletes, but its prevalence and associated factors have not been fully elucidated. In this study, we intended to assess the prevalence of DE among adult athletes from different sports disciplines in Italy and Lebanon and to identify the factors associated with DE.

METHODS

A validated questionnaire (Eating Attitude Test [EAT-26]) was administered to determine the prevalence of DE, which was indicated by a score ≥ 17. Sport-related information, such as the type of sport, level of competition, training volume, and years of athletic experience, was also collected.

RESULTS

Among the total sample of 881 athletes, 78 were identified as having DE, with a prevalence of 6.1% (7.8% of females and 4.9% of males) in Italian athletes and 21.3% (27.3% of females and 17.0% of males) in Lebanese athletes. In addition, among male athletes, the risk of having DE was more than threefold in those practicing weightlifting or bodybuilding (odds ratio [OR] = 3.23; 95% confidence interval [CI] = 1.03-10.08, and p < 0.05), while females with more athletic experience had almost 10% less risk of having DE (OR = 0.92; 95%CI = 0.86-0.98, and p < 0.05).

CONCLUSIONS

DE is a prevalent condition among athletes. Therefore, it is crucial that sports federations and committees consider adopting standardized practical guidelines that focus on routinely screening for the early identification of DE in this population and implementing strategies for its timely management. In the future, longitudinal studies are also needed to clarify the impact of DE on athletes' clinical condition as well as their physical fitness and sports performance.

Exploring adolescents' experiences navigating the intersection of their gender, sport, and dietary identities: an interpretative phenomenological study

Not all adolescents have positive sport experiences. Research has repeatedly identified ties between unfavorable eating patterns and food beliefs (i.e., a dietary identity) that hinder an athletes' health and performance. Gender norms and pressures over idealized bodies (e.g., boys are muscular whereas girls are thin) play a critical role in the manifestation of unfavorable eating habits. However, most research has focused on the experiences of athlete girls in elite sport spaces (e.g., high performance), leaving gaps in our understanding of how diverse youth in high school spaces are impacted. To address this gap, we aimed to explore the intersections between adolescents' sport, dietary and gender identities in high school. We conducted 33 interviews with high school athletes (n = 9 girls and n = 9 boys) and non-athletes (n = 4 non-binary, n = 6 boys and n = 5 girls) using methods informed by an interpretative phenomenological approach. We generated three themes capturing adolescents' experiences: (1) De-gendering protein and muscles; (2) Food displays what I value; and (3) Being [too] masculine is bad. Athletes recognized ties between masculinity and sport, but spoke about traditionally masculine eating habits (e.g., valuing protein) and body ideals (e.g., being muscular) as part of their athletic identity, not gender. Regardless of sport involvement, adolescents altered their outward expression of their dietary habits to demonstrate pieces of their identities, like being an athlete (e.g., eating protein) or feminine (e.g., smaller bites). Adolescents also spoke about using food to pursue idealized bodies that show deviation from traditional gender norms. Finally, adolescents held conflicting views about masculinity as being both toxic and useful for competition. By understanding identity intersections, coaches, trainers, parents, and sport decisions-makers can make more informed decisions about sport policy, programs, and practice that involve dietary advice to support this population.

Beyond knowledge: Unveiling the hidden link between body image and dietary intake in elite race walkers at risk of relative energy deficiency in sport

Background: Nutritional knowledge and body image concerns are key factors influencing dietary intake and health among athletes, particularly in lean-type sports. This study investigates these variables among elite race walkers from the United Kingdom and Ireland, a cohort selected for the prominence of race walking in their national sports programmes and unique cultural contexts. Aim: The study aims to assess the relationship between nutritional knowledge, body image, and dietary intake in elite race walkers, and explore the potential risk of relative energy deficiency in sport (RED-S). Methods: Eight elite race walkers (seven males, one female) were assessed using the Body Image Avoidance Questionnaire (BIAQ) and the Abridged Nutrition for Sport Knowledge Questionnaire. Dietary intake was evaluated through detailed food diaries and analysed against established nutritional guidelines. The Goldberg cut-off method was employed to identify dietary misreporters. Results: Despite moderate nutritional knowledge (58.93 ± 8.68%), athletes displayed suboptimal dietary habits with prevalent over-reporting. Carbohydrate intake was below recommended levels (5.4 ± 1.0 g/kg/day), while protein intake exceeded guidelines (2.0 g/kg/day). Body image dissatisfaction was common, particularly in the single female athlete, who scored highest on both nutritional knowledge and body image avoidance (BIAQ score: 62). The findings suggest a possible link between body image concerns and inappropriate dietary behaviours, increasing the risk of RED-S. Conclusion: While the study highlights the complex interplay between nutritional knowledge, body image dissatisfaction, and dietary intake, the small sample size (N = 8), particularly the inclusion of only one female athlete, limits the generalizability of the findings and introduces a potential bias in sex-specific interpretations. Future research should include larger, more diverse populations.

Eating Attitudes and Characteristics of Physical Activity Practitioners and Athletes in Riyadh, Saudi Arabia

Background: Disordered eating among athletes and physical activity practitioners is a growing concern that can negatively impact health and performance. Understanding the prevalence and predictors of disordered eating in these populations is essential for developing effective interventions. Objective: To investigate disordered eating tendencies among athletes and physical activity practitioners in Riyadh, Saudi Arabia. Methods: Participants from five athletic clubs and six fitness centers were surveyed. Data were collected using an interviewer-administered questionnaire that included the Eating Attitudes Test (EAT-26), the Abridged Nutrition for Sport Knowledge Questionnaire (ANSKQ), and the Global Physical Activity Questionnaire (GPAQ). Anthropometric data were also collected. The study comprised a sample of 263 individuals, who were divided into two groups: athletes (n = 121) and physical activity practitioners (n = 142). Results: The average age of the participants was 26.41 years with a standard deviation of 8.1 years. Females comprised nearly two thirds of the sample, representing 60.8% of the participants. Physical activity practitioners exhibited higher disordered eating scores compared to athletes. The total EAT-26 scores were significantly higher in practitioners (15.63 ± 4.12) than in athletes (13.21 ± 3.89; p < 0.001). Subscale scores for Dieting (8.95 ± 2.73 vs. 7.49 ± 2.58; p = 0.001) and Bulimia (3.32 ± 1.15 vs. 2.20 ± 1.03; p < 0.001) were also higher in practitioners. BMI was a significant predictor of higher total EAT-26 scores and its subsets, indicating a greater risk of disordered eating behaviors in individuals with higher BMI. Participants with lower levels of sports nutritional knowledge and those engaging in low-intensity physical activities were more likely to exhibit disordered eating tendencies. Conclusions: The findings highlight that physical activity practitioners are at a higher risk of disordered eating compared to athletes. Addressing BMI and improving nutritional knowledge are key strategies for preventing and managing disordered eating behaviors in physically active populations. Interventions targeting these areas may enhance health outcomes and performance among athletes and practitioners.

Body image experiences in retired Olympians: Losing the embodied self

Athlete body dissatisfaction is prevalent across sports and can lead to disordered eating, negative affect, and poor mental health. Whether body image concerns persist into athletic retirement is a focus of research, predominately involving survey-based data in usually sub-elite athletic samples. This study is the first to focus on the meanings elite athletes ascribe to their bodies in retirement. We recruited 31 retired elite athletes, including 23 former Olympians, to participate in a semi-structured interview. More than 25 h of interview data was transcribed verbatim and subject to a reflexive thematic analysis. We constructed 4 major themes to describe athlete experiences: 1) A legacy of body-conscious culture 2) The struggle for "normal", 3) Loss of body as loss of self, 4) Towards new meanings and identities. Athletes explained how the body surveillance culture of elite sport echoed into their post-sport lives. An Olympian identity was considered an embodied identity, so body changes represented a loss of the self. Adjusting to regular eating and exercise routines was deemed challenging, with minimal access to guidance and support. Accepting the inevitability of physical changes in retirement and finding new meanings and identities, were deemed effective coping strategies. Athletes' insights can support sport psychologists and elite sport organisations to devise strategies and policies to facilitate adaptation to body changes post-retirement from sport.

Excessive health behaviors in sports: links of orthorexia nervosa and exercise addiction with well-being, exercise activity in sports categories, and gender effects

Background and aims

Orthorexia nervosa (OrNe), the obsessive fixation on healthy eating, and exercise addiction (ExAdd) have been discussed as correlated excessive health behaviors with potential mental health implications. The role of gender-and sports-specific differences remains unclear. This study aimed to investigate the links of ExAdd, OrNe, and the non-pathological interest in healthy eating (healthy orthorexia; HeOr) with well-being and exercise activity in various sports, considering gender effects.

Methods

Data from two cross-sectional online surveys were combined (N = 1,064, 73.5% women, age = 28.23 ± 11.09), measuring ExAdd (Exercise Addiction Inventory Revised), OrNe and HeOr (Teruel Orthorexia Scale), well-being (WHO-5 Well-Being Index), exercise activity and sports (Physical Activity, Exercise, and Sport Questionnaire).

Results

Well-being correlated with OrNe among women (r = -0.291) and not meaningfully with ExAdd and HeOr among men. Gender differences were not significant, except for the higher correlation of ExAdd with exercise activity in resistance and fitness sports among men. Regression analyses revealed that exercise activity, especially in health, resistance and fitness sports, was linked to HeOr, but not to OrNe. ExAdd was associated with exercise activity in endurance, resistance and fitness, ball and team, antigravitation, technical, aesthetic sports, and martial arts.

Discussion

Men's well-being may slightly benefit from ExAdd and an interest in healthy eating, while obsessive healthy eating may reduce women's well-being. Although exercise activity is associated with ExAdd in a wide variety of sports, it does not explain the link between ExAdd and OrNe. Preventive measures should consider gender-specific risks in excessive health behaviors.

The associations between calorie tracking, body image dissatisfaction, eating disorders, and menstrual cycle characteristics in resistance-trained athletes

BACKGROUND

While body image dissatisfaction (BID) and eating disorders (EDs) are relatively common in athletes (ranging from 11% to 67% of athletes, depending on the sport) [1], they are also prevalent in weight-class restricted sports (a common format in strength sports), and among physique athletes [2]. These athletes manipulate their nutrition to reach aesthetic or body weight standards and, in that process, may undergo prolonged periods of low energy availability. Low energy availability, defined as consuming insufficient energy for one's lean mass and exercise activity, can lead to Relative Energy Deficiency in sport (REDs), a syndrome that can impact menstrual cycle (MC) symptoms (and many other aspects of physiology and psychology) [3]. There has not been an investigation into the relationships between these resistance-trained (RT) athletes' nutritional habits, MC-related symptoms, BIDs, and EDs.

METHODS

A survey was implemented to explore the dieting habits, MC characteristics, BID, and EDs in RT females.

RESULTS

64.6% (n = 469) of participants reported tracking calories, with a slightly higher percentage of competitive athletes tracking calories 71.8% (n = 181) than recreational-level athletes. Competitive athletes were significantly more likely to track calories than recreational-level athletes (p = 0.003). When asked what the primary purpose of calorie restriction was, most participants selected weight loss for aesthetic purposes 58.8% (n = 356). Competitive athletes were less likely to select weight loss for aesthetic purposes 35.7% (n = 77), but weight loss for the purpose of a weight class-based sport was higher at 43.5% (n = 94). There were no significant associations between BID and MC characteristics or most MC symptoms and limited associations between EDs and MC characteristics and symptoms.

CONCLUSION

RT athletes exhibited a higher prevalence of calorie tracking than the general population. Competitive RT athletes were less likely to calorie restrict for aesthetic purposes than non-athletes, but more likely to calorie restrict for the purpose of weight-class-based sports. There were limited significant associations between BID and MC characteristics or MC symptoms, as well as between EDs and MC characteristics. However, there was a significant association between amenorrhea and EDs, which aligns with previous research in this area. Both BID and EDs were significantly associated with MC-based mental health effects; this is likely due to the interconnected nature of mental health concerns, such as EDs with depression and anxiety.

Young athletes' mental well-being is associated with smartphone social networking application usage and moderated by performance level and app type

Smartphones and social media have become an integral part of human daily life and they influence mental well-being. These accounts have been researched in the general population, but not in athletes. This is critical given enhanced physical and emotional stressors in athletes versus non-athletes. Therefore, we here studied intra- and interindividual relationships of four social media sites (WhatsApp, TikTok, Instagram, and Snapchat) with mood, stress, recovery, and sleep using log-based media usage tracking as an objective measure in 53 competitive athletes aged 12-27 years. Multilevel modeling revealed that intraindividual TikTok usage negatively predicted sleep (β = -0.10, p = 0.040) and recovery (β = -0.15, p < 0.002), and positively predicted stress (β = 0.12, p = 0.018). Interindividual Instagram usage predicted feelings of calmness (β = 0.27, p = 0.029) and valence (β = 0.20, p = 0.043). Intriguingly, competition level moderated the usage outcomes of all four apps: Athletes on low performance levels showed lower mental well-being when using social media longer, yet in national and international athletes the strength of these relationships was weaker or even reversed. Our study unravels social media usage associations with mental well-being to vary as a function of performance level and provides findings on intra- and interindividual effects of critical importance to inform future population-tailored and expedient interventions.

Making a Splash: A Closer Look at Early Specialization in Competitive Diving

ABSTRACT

This review article explores the multifaceted aspects of early specialization in diving, focusing on its implications for injury prevalence, performance, and mental health. It highlights the increasing trend of early specialization driven by ambitions for collegiate and Olympic success, despite recommendations advocating for diversification. Divers are at risk for acute and overuse injuries, particularly during high-velocity water entries; however, data on injury patterns, especially among elite divers and early specializers, remains scarce. Recent data suggest a correlation between early specialization and reduced rates of certain injuries among youth divers, but distinguishing between acute and overuse injuries is crucial. Additionally, early specialization may pose mental health risks, with divers facing pressures related to performance, body image, and parental expectations. This article underscores the need for tailored guidelines to mitigate injury risks and promote holistic well-being among youth divers, recognizing the complex interplay between physical and psychological factors in sports specialization.

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.

Prevalence of Disordered Eating Risk Attitudes in Youth Elite Male and Female Football Players

Objectives: Examine the prevalence of risk behaviors for the development of eating disorders in academy footballers of the Liga MX, compare sociodemographic data and highlight the participants' perceptions regarding the influence of the sports environment and external pressure on their relationship with food and their bodies. Methods: A cross-sectional study was carried out with 536 footballers (331 men and 205 women) in the categories U14, U16, U18 men and U15, U19 women of Liga MX with prior consent from their clubs and strict confidentiality measures. The data were collected via Google Forms using the Eating Attitudes Test (EAT-26). Results: Of the participants, 13.4% met or exceeded the cut-off point on the EAT-26. The highest prevalence was observed in the Female U19 category. The reflections indicated that the sports environment and external pressure affect the relationship with food and bodies in a significant proportion of participants. Conclusions: The study highlights a high prevalence of risk behaviors for eating disorders in Liga MX football players, with a higher incidence in the female categories, also evidencing a multifactorial etiology.

Do Swedish rock-climbers exhibit more eating disorder and body dissatisfaction symptoms than non-climbers? A cross-sectional study

OBJECTIVES

The inclusion of rock-climbing in the Olympic Games has increased participation in the sport and attention to athletes' health. In sports where the importance of low body weight is considerate, there is an increased risk of developing eating disorders (EDs). There is sparse research on EDs among rock-climbers. The primary aim was to map ED symptoms among rock-climbers compared with controls. The secondary aim was to analyze differences in body dissatisfaction. Comparisons between rock-climbing levels and sexes were performed.

DESIGN

This is a cross-sectional study in a larger prospective longitudinal study series, CLIMB: Climber's Longitudinal attitudes towards Injury, Mental health and Body image, using baseline data.

PARTICIPANTS

Swedish rock-climbers, at an advanced and elite level according to the International Rock Climbing Research Association, participated. Participants were at least 13 years old. 183 rock-climbers partook with a mean age of 29.5 (SD=9.1) with two participants under 15 years old. 180 controls partook with a mean age of 29.0 (SD=8.9). There were no control participants under 15 years of age.

PRIMARY AND SECONDARY OUTCOME MEASURES

Data was gathered through a self-report questionnaire collecting the primary outcome measure, ED symptoms (Eating Disorders Examination Questionnaire (EDE-Q) V.6.0) and the secondary outcome measure, body dissatisfaction (Body Shape Questionnaire-8C).

RESULTS

There were no differences between rock-climbers and controls regarding ED symptoms. Symptoms were higher among female rock-climbers (26%) than male (5.8%). Regarding body dissatisfaction, the control group reported higher levels compared with rock-climbers. At least a mild concern was observed in 13.3% of male rock-climbers, compared with 47.4% of females.

CONCLUSIONS

Although there was no difference in the EDE-Q V.6.0 between rock-climbers and controls, females reported significantly more symptoms than men. Regarding body dissatisfaction, female rock-climbers exhibited higher levels of dissatisfaction than males. Further, higher levels of dissatisfaction were reported in controls, especially in men, where symptoms were three times higher than rock-climbers.

TRIAL REGISTRATION NUMBER

NCT05587270.

Eating disorder risk assessment and sociocultural attitudes toward body image among Polish and Turkish professional female football players

Introduction

Football requires high physical fitness and often involves maintaining a specific physique, leading to harmful eating behaviors due to internal and external pressures. Cultural norms influence the prevalence and types of eating disorders (ED), with differences in eating habits, beauty standards, and socio-cultural pressures affecting ED development. This study assesses ED risk and analyzes socio-cultural attitudes toward body image among Polish and Turkish female football players.

Methods

The study was conducted from April to June 2024 and included 103 professional female football players aged 18–35 from Polish (n = 49) and Turkish (n = 54) clubs. Data were collected using the CAWI method via Google Forms. Participants completed EAT-26 and SATAQ-3 questionnaires, assessing ED risk and socio-cultural attitudes toward body image.

Results

40.8% of participants were at risk for ED. No differences in ED prevalence were found between groups of different nationalities. Polish footballers at risk of ED scored higher on the Internalization-Pressure and Information subscales and the overall SATAQ-3 score. A weak but significant positive correlation was found between SATAQ-3 and EAT-26 scores.

Discussion

The study finds no nationality-based differences in ED prevalence among professional female football players, but ED is widespread, affecting about 40% of players. Nutritional status impacts ED risk, with higher risk among underweight and overweight players. Polish players are more influenced by socio-cultural standards of body image promoted by mass media. The study underscores the need for regular screening and psychological support.

Association of LEAF-Q and EDE-QS scores with cholesterol levels in Finnish female athletes

Objective

Low energy availability (LEA) is common in athletes. Disturbances in sex hormone levels due to insufficient energy availability have been suggested to influence cholesterol metabolism and impact the overall risk for cardiovascular disease. We assessed the relationship between Low Energy Availability in Females Questionnaire (LEAF-Q) and Eating Disorder Examination Questionnaire Short (EDE-QS) scores with cholesterol levels in a cross-sectional study of female athletes.

Method

Finnish national- to international-level female athletes self-reported physiological symptoms of LEA, including menstrual disturbances, using the LEAF-Q (n=176) and eating disorder symptoms using the EDE-QS (n=294). Serum cholesterol concentrations (mmol/L) were determined from venous blood samples. We analysed the relationship between the different variables using Pearson's r and linear regression. We also studied separately participants representing lean sports, that is, sports that emphasise leanness (LEAF-Q, n=60; EDE-QS, n=80).

Results

LEA symptoms were common; 72 (41%) of 176 participants scored ≥8 points in the LEAF-Q, which is indicative of a high risk of problematic LEA. A one-point increase in LEAF-Q score was associated with a small, non-significant increase in low-density lipoprotein (LDL) cholesterol level (beta=0.024, 95% CI -0.0011 to 0.049, p=0.061). Higher EDE-QS scores were associated with higher LDL cholesterol levels (beta=0.028, 95% CI 0.0098 to 0.046, p=0.0029). These associations were somewhat stronger among athletes representing lean sports (LEAF-Q and LDL: beta=0.043, 95% CI 0.0041 to 0.08, p=0.031; EDE-QS and LDL: beta=0.036, 95% CI 0.0041 to 0.068, p=0.028).

Conclusion

In this study, LEAF-Q and EDE-QS were associated with higher LDL cholesterol levels among athletes representing lean sports.

Actions speak louder than coaches: Eating disorder behaviour among student-athletes

The objective of the current study was to examine the prevalence of eating disorder behaviours among student-athletes at a small, non-NCAA (Canadian) university, while evaluating the influence of gender, type of sport, and perceived social support. Two hundred participants (130 female, 70 male) completed an online survey that assessed participants eating disorder behaviours (EAT-26), behaviours consistent with the Adonis Complex (ACQ) and perceived social support (modified MPSS). The results revealed significant differences in eating disorder behaviour between female and male athletes, with females scoring significantly higher; yet no differences were found between how female and male athletes scored on the Adonis Complex Questionnaire. Significant differences were found between lean-sport and non-lean sport athletes, with lean sport athletes exhibiting more eating disorder behaviours. Furthermore, non-lean sport male athletes were found to score significantly higher than lean-sport male athletes for the Adonis Complex. Perceived social support was found to be negatively correlated to eating disorder behaviours and when considering gender and type of sport, accounted for unique variance in eating disorder behaviour. These results suggest that student-athletes are susceptible to negative mental health outcomes, even within the context of a smaller (and non-NCAA) university context, and eating behaviours vary among athlete and sport type. The results highlight the importance of continued research in this area and of having support systems in place for student-athletes and increasing awareness of athletic staff and coaches as to the seriousness and prevalence of eating disorder behaviours.

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.

An Umbrella Review of Body Image Concerns, Disordered Eating, and Eating Disorders in Elite Athletes

Background/Objectives: Several systematic reviews and meta-analyses have been conducted to date indicating a high prevalence of disordered eating in elite athletes and associated risk factors. However, the substantial time burden associated with locating and comparing these reviews, which are varied in methodology and sampling focus, may be a barrier for informing policy and best practice as well as directing future research. This umbrella review aimed to provide a summary of evidence across published reviews regarding the prevalence and risk factors for disordered eating (including body image concerns and eating disorders) in elite athletes. Methods: Five databases (CINAHL, PsycINFO, MEDLINE, Scopus, and SPORTDiscus) were systematically searched for peer-reviewed systematic reviews and meta-analyses that met the following inclusion criteria: (1) investigated prevalence and risk factors for disordered eating, (2) included a sample of elite athletes, and (3) available in English. The included studies underwent data extraction and risk of bias assessment using the AMSTAR 2. Results: The initial search identified 1828 articles that were screened for title and abstract and then full text, leaving 24 systematic reviews (including 10 meta-analyses). Disordered eating was prevalent across elite athletes, including males and females and across sport type. Elite athletes were at elevated risk for disordered eating and eating disorders but at lower risk for body image concerns versus non-athlete controls. Several risk factors were identified, including female gender, competing in lean sports, and experiencing career changes. Few reviews or meta-analyses examined perceived pressures within the sporting environment, and most had substantial risk of bias concerns. Conclusions: Elite athletes are at risk for the spectrum of disordered eating, and all should be considered for primary prevention and screening. Further research is needed regarding sport-specific versus general pressures and mediators of risk to better inform interventions.

Determinants of menstrual dysfunction in the female athlete triad: A cross-sectional study in Italian athletes

BACKGROUND

In 1992 the American College of Sports Medicine first described the Female Athlete Triad. The Triad is a metabolic injury involving three distinct clinical traits: low energy availability, with possible eating disorder, low bone mineral density and menstrual dysfunction (MD). Although the estimated prevalence of the Triad is low (1.2 %), single factors are common in female athletes, at all competitive levels and ages. Even though the Triad was described over two decades ago, the interrelation of the three diagnostics components is still debated: additional evidence is required to improve the multidisciplinary treatment approach for this complex condition. MD is one of the first signs of energy impairment. The present study aims at investigating MD determinants and predictors in female athletes, to allow an early diagnosis of the Triad and to implement adequate preventive strategies.

MATERIALS AND METHODS

An original structured questionnaire was composed to detect the presence of MD risk factors. Included participants were active female athletes within reproductive age range (15-40 years old). Anthropometric parameters and training-related factors, possibly affecting the regularity of the menstrual cycle, were investigated.

RESULTS

Respondents were 288 female athletes. Among them, 73.3 % were under 25 years of age; 6.6 % resulted underweight; 30.6 % reported to follow a meal plan/diet and 13.9 % declared to be a smoker. Lean sports were practiced by 30.6 % of responders. Body-weight congruence was detected in in 79.9 % of participants, whereas overestimation of body image was found in 16.3 % of athletes. Irregular menstrual cycle, a possible MD predictor, was present in 33.0 % of athletes, with 41.1 % practicing some lean sport (p = 0.007). Also, overestimation of body image suggested an increased risk of menstrual irregularity (p = 0.001). BMI <18.5 or BMI >30 could also act as risk factor, although significance was not fully obtained (p = 0.053). Overall, practice of lean sports and overestimation of body image appeared good determinants of increased menstrual irregularity (AOR 2.02 and 3.83, respectively).

CONCLUSIONS

Menstrual irregularity in female athletes can be considered an early predictor of MD: risk is further increased in athletes of lean sports and reporting an overestimation of self-perceived body image. Screenings and awareness programs should specifically address female athletes, because of their vulnerable-group profile. In order to define a standardized at-risk profile for Triad onset and sequelae likelihood, evaluation of menstrual regularity should especially be considered, in conjunction with the assessment of other indicators of energy availability (e.g. TEE, lean and fat mass, BMC). Testing for sport-derived stress and disordered eating attitudes is also recommended. Preventive strategy should involve the proactive engagement of sport clubs and periodic competitive sport medical assessment.

"Male athletes play well to feel good, and female athletes feel good to play well": Attitudes, beliefs, and practices pertaining to perceived sex-related differences in communication and interpersonal approach of strength and conditioning coaches in international women's rugby union

Effective communication and rapport building with athletes are key tenets of coaching. As the majority of empirical evidence to date has adopted an androcentric view of strength and conditioning, a potential knowledge gap exists regarding sex-related differences in physical preparation and coaching approaches. Therefore, this study explored the attitudes, beliefs and practices of strength and conditioning coaches (n = 8; M/F, 6/2) in elite level (international) women's rugby union using semi-structured interviews (mean ±standard deviation duration 59 ± 15 min). The interviews explored differences in coaching practices for elite female rugby players compared to males, with a specific focus on the interpersonal aspects of the athlete-coach relationship. Reflexive thematic analysis was used to generate a rich qualitative dataset. The analysis resulted in the identification of higher order themes: athlete engagement, and interpersonal approach. The coaches in this study consistently perceived important differences between male and female players in factors related to engagement and interpersonal approach. Coaches adopted differing coaching practices for male and female athletes. This study provides important contextual evidence for the understanding of differences in the interpersonal relationships of female rugby players compared to male athletes from the perspective of elite-level strength coaches.

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.

Social media behaviors and body type ideals predict weight loss and food tracking behaviors among recreational climbers

Introduction

Elite and recreational climbers may be at risk for disordered eating, low energy availability (LEA), and increased injury as a result. Social media use among athlete and non-athletes can lead to body image disturbances resulting in unhealthy weight loss practices exacerbating LEA and injury risk. Therefore, the objective of this study was to examine relationships between social comparative behaviors on social media, body type ideals and outcomes, and health behaviors among adult recreational climbers.

Methods

Participants (n = 324) were adult recreational climbers from the U.S. (29.30 ± 9.99 years old and 50% female). Participants answered a 66-item questionnaire comprised of demographics, climbing characteristics, social media behaviors, body type ideals, training and nutrition-seeking behaviors, and weight and food tracking behaviors.

Results

Most participants (78.7%) indicated strength-to-weight ratio was important for climbing performance. Many participants perceived they could perform better at rock climbing if their body proportions were different (59.3%). These body type ideals were found to be significant predictors of performing weight loss and food-tracking behaviors (all p < 0.001). Higher amounts of social comparative behaviors on social media and social physique anxiety independently and significantly predicted attempting weight loss to improve climbing ability (p < 0.001 and p = 0.001 respectively). Those who followed climbing influencers, used Instagram frequently for training and nutrition information, perceived they could perform better at rock climbing if their body proportions were different, or were female and college-aged had significantly higher mean social comparative behavior scores (all p < 0.01).

Discussion

This study expands on prior work with elite climbers by providing a possible explanation for how climbing-related body type ideals and certain social media behaviors can perpetuate negative body image and compensatory behaviors among a general climbing population. Because unhealthy weight management behaviors can lead to injury and health disturbances, broad education programming and social media campaigns should be developed to shift body ideals and nutrition behaviors among recreational climbers.

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).

Testing general sociocultural and coach-related appearance pressures as the factors associated with disordered eating in competitive female athletes participating in various sports

The aim of the present study was to test the sociocultural Petrie and Greenleaf's (2007) model of disordered eating (DE) in competitive female athletes. Specifically, we tested a model of general sociocultural and coach-related pressures towards body weight and appearance of female athletes as the factors associated with athletes' DE through the mediators such as internalization of appearance ideals and overweight preoccupation. 515 athletes participated in this study. The mean age of the sample was 19.0 ± 5.9 years. Athletes were provided with study measures on general sociocultural and coach-related appearance and body weight pressures, internalization of appearance ideals, overweight preoccupation and DE. Path analyses showed that general sociocultural pressures were associated with DE directly and through internalization of appearance ideals and overweight preoccupation. Pressures from coaches were associated with DE through overweight preoccupation and through the internalization of appearance ideals and overweight preoccupation. The models were invariant across body weight sensitivity in sports and age groups. These results inform DE prevention for female athletes. It is important to increase resistance to sociocultural pressures and pressures from coaches in DE prevention programmes for female competitive athletes of all ages and participating in sports irrespective of sports group (weight-sensitive or less weight-sensitive).

Cross-sectional and longitudinal associations between higher weight and eating disorder risk among collegiate athletes

OBJECTIVES

To examine whether higher weight status is associated with increased eating disorder risk in athletes.

DESIGN

Study 1 used cross-sectional (N = 942) and longitudinal (N = 483) data collected over a five-year period from Division I athletes at a Midwestern university. Study 2 used cross-sectional data from athletes competing at various levels at universities across the United States (N = 825).

METHODS

Weight and height were measured in Study 1 and self-reported in Study 2; higher weight was defined as body mass index ≥ 25 kg/m2. Eating disorder risk was assessed with preliminary (Study 1) and final (Study 2) versions of the Eating Disorders Screen for Athletes. Study 1 examined weight status in relation to both concurrent and one-year changes in Eating Disorder Screen for Athletes score. Study 2 examined weight status in relation to both the Eating Disorders Screen for Athletes score and elevated eating disorder risk using the established Eating Disorders Screen for Athletes cut-off. All models adjusted for gender and sport type; Study 2 additionally adjusted for race/ethnicity, age, and competition level.

RESULTS

Across studies, higher weight status was significantly associated with increased eating disorder risk among athletes. This association was observed both cross-sectionally and longitudinally, and the prevelence of elevated eating disorder risk was 43 % greater among athletes with higher weight status than among those without higher weight status.

CONCLUSIONS

Despite existing stereotypes that eating disorders tend to occur with low weight status, findings highlight the importance of screening all athletes for eating disorders, regardless of their weight status.

'E koekoe te Tūī, e ketekete te Kākā, e kuku te Kererū, The Tūī chatters, the Kākā cackles, and the Kererū coos': Insights into explanatory factors, treatment experiences and recovery for Māori with eating disorders - A qualitative study

BACKGROUND

Eating disorders are as common in Māori, the Indigenous people of Aotearoa-New Zealand, as they are in non-Māori; however, research has focused on the experiences of non-Māori. This paper will describe explanatory factors, treatment experiences and what helps with recovery for Māori.

METHODS

Kaupapa Māori research methodology informed the methods and analysis. Fifteen semi-structured interviews comprised thirteen Māori participants with eating disorders (anorexia nervosa, bulimia nervosa and binge eating disorder) and two whānau (support network) members. A thematic analysis was undertaken by a first cycle of coding that used deductive structural coding to identify data describing participants' perceived causes of eating disorders, their experience of treatment and recovery. A second cycle of coding used inductive analysis with descriptive and pattern coding.

RESULTS

Three overarching themes were antecedents (cumulative exposure), treatment (a system of complexities) and recovery (resource empowerment). Antecedents comprised cumulative exposure to body and sporting ideals and adversity as causal factors of eating disorders. In the treatment theme, a system of complexities critiqued rural settings for generalised mental health services, allocation of Māori cultural support, the economic burden of treatment, culturally incongruent treatment (methods, values) and a weight-focused discharge criterion. Recovery (resource empowerment) found appropriate health information, self-determination and connection to Māori culture and whānau aspirations helped with recovery.

CONCLUSION

The diversity of birdcalls reminds us of the individuality of eating disorders. Health practitioners are reminded that just as the Tūī, Kākā and Kererū possess their own unique birdcalls, so do Māori with eating disorders and their whānau have their own experiences, needs and required treatment responses.

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.

Disordered eating is not associated with musculoskeletal injury in university athletes

TAKE HOME MESSAGE

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

Nutritional counseling in athletes: a systematic review

Many studies report poor adherence to sports nutrition guidelines, but there is a lack of research on the effectiveness of nutrition education and behavior change interventions in athletes. Some studies among athletes demonstrate that nutrition education (NE), often wrongly confused with nutritional counseling (NC), alone is insufficient to result in behavior change. For this reason, a clear distinction between NC and NE is of paramount importance, both in terms of definition and application. NE is considered a formal process to improve a client's knowledge about food and physical activity. NC is a supportive process delivered by a qualified professional who guides the client(s) to set priorities, establish goals, and create individualized action plans to facilitate behavior change. NC and NE can be delivered both to individuals and groups. To our knowledge, the efficacy of NC provided to athletes has not been comprehensively reviewed. The aim of this study was to investigate the current evidence on the use and efficacy of nutritional counseling within athletes. A systematic literature review was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method. The search was carried out in: PubMed, Scopus, Web of Science, Science Direct, Cochrane Library between November 2022 and February 2023. Inclusion criteria: recreational and elite athletes; all ages; all genders; NC strategies. The risk of bias was assessed using the RoB 2.0 Cochrane tool. The quality of evidence checking was tested with the Mixed Methods Appraisal Tool system. From 2,438 records identified, 10 studies were included in this review, with athletes representing different levels of competition and type of sports. The most commonly applied behavior change theory was Cognitive Behavioral Theory. NC was delivered mainly by nutrition experts. The duration of the intervention ranged from 3 weeks to 5 years. Regarding the quality of the studies, the majority of articles reached more than 3 stars and lack of adequate randomization was the domain contributing to high risk of bias. NC interventions induced positive changes in nutrition knowledge and dietary intake consequently supporting individual performance. There is evidence of a positive behavioral impact when applying NC to athletes, with positive effects of NC also in athletes with eating disorders. Additional studies of sufficient rigor (i.e., randomized controlled trials) are needed to demonstrate the benefits of NC in athletes.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42022374502.

Eating Disorder Risk and Pathogenic Behaviors Among Collegiate Student-Athletes

CONTEXT

Eating disorders (EDs) are a cluster of behavioral conditions characterized by uneasy thoughts and behaviors that grow into severe or persistent eating disturbances. The demands on student-athletes may create mental and physical stressors that increase the likelihood of EDs and disordered eating.

OBJECTIVE

To examine the ED risk through eating attitudes and behaviors in male and female student-athletes and across various sport types (endurance, aesthetic, power, ball or team, or technical sports).

DESIGN

Cross-sectional study.

SETTING

Collegiate athletics.

PATIENTS OR OTHER PARTICIPANTS

National Collegiate Athletic Association Division I and II student-athletes (n = 2054; males = 631; females = 1423) from 40 institutions.

MAIN OUTCOME MEASURE(S)

Participants completed a web-based demographic survey and the Eating Attitudes Test-26 (EAT-26). Multiple χ2 analyses examined participants classified as at risk for EDs. Independent-samples t tests and a 1-way analyses of variance compared sex and sport type across EAT-26 totals and subscale (Dieting, Bulimia, and Oral Control) scores.

RESULTS

Overall, 25.3% (n = 520/2054) of student-athletes were classified as at risk for EDs. Differences were found between sex and ED risk (χ21,2054 = 32.9, P ≤ .01; 17.3% [n = 109/631] males, 28.9% [n = 411/1423] females) and across ED risk and sport type (χ24,2054 = 13.4, P = .01). When examining females only, we observed differences across ED risk and sport type (χ24,1423 = 13.4, P ≤ .01). No differences were evident across ED risk and sport type for males. Differences were seen between sex and binge eating (χ21,2054 = 6.8, P = .009), sex and diet pill use (χ21,2054 = 19.6, P ≤ .01), and sport type and diet pill use (χ24,2054= 12.2, P = .016), excessive exercise (χ24,2054 = 32.1, P ≤ .01), and losing more than 20 lb (9 kg) in the last 6 months (χ24,2054 = 10.2, P ≤ .037).

CONCLUSIONS

Student-athletes in the collegiate setting are at risk for EDs. Medical professionals, such as athletic trainers, need to be educated on the potential risk factors that may lead to EDs. Protocols for prevention, screening and recognition, and referral should be developed for student-athletes at risk for EDs.

Mental Health in Ultra-Endurance Runners: A Systematic Review

BACKGROUND

Among ultra-endurance runners (UER), the mental, behavioral, and physical demands of training/competition can result in maladaptive outcomes. Mental health issues are common in athletes and can impact psychology, physical health, and performance.

OBJECTIVE

To synthesize information regarding the incidence/prevalence and factors associated with mental health issues among UER.

METHODS

Systematic searches were performed in PubMed, SPORTDiscus, Scopus, Cochrane databases, CINAHL, Web of Science, and Medline Ovid using key terms related to UER (e.g., trail running, road running) and psychological issues (e.g., exercise addiction, depression). Inclusion criteria included original articles published in peer-reviewed journals in English, using qualitative or quantitative approaches. We considered papers reporting incidence/prevalence and associated factors with mental health outcomes in UER of both sexes, all ages, and levels of competition (e.g., elite, nonprofessional runners). The Joanna Briggs Institute Analytical Cross-Sectional Studies critical appraisal tool was used for quality assessment.

RESULTS

A total of 282 studies were identified, and 11 studies were included in the final selection. A total of 3670 UER were included in the studies. The prevalence of mental health issues among UER ranged between 32.0% and 62.5% for eating disorders, from 11.5% to 18.2% for exercise addiction, 18.6% for depressive symptoms, and 24.5% for sleep disturbance. Exercise addiction was not related to weekly volume, but a strong relationship with exercise in an unstructured space, age, and body mass index was shown.

CONCLUSION

Mental health issues among UER are common, especially eating disorders, exercise addiction, sleep disturbances, and depressive symptoms. Further high-quality studies are needed to examine underlying factors and find preventative strategies to protect UER.

REGISTRATION

The protocol of this systematic review was registered at the PROSPERO-CRD42022338743.

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

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

Contraception, female cycle disorders and injuries in Swiss female elite athletes-a cross sectional study

Aim: The national Olympic committee of Switzerland has conducted an online survey among female elite athletes with a focus on cycle disorders, contraception, and injuries in 2021. Methods: A total of 1,092 female elite athletes from 107 different sports were asked to answer the questionnaire. A descriptive analysis was carried out to determine location parameters and create frequency tables. Results: The questionnaire was completed by 408 athletes (37.4%) from 92 different sports. 43.4% participated in a lean sport. 57.1% reported no injuries, 32.6% one injury, and 10.2% two or more injuries per year. A considerable proportion reported being affected by primary amenorrhoea (10.8%). Primary amenorrhoea occurred significantly more often in female athletes with a BMI lower than 21.7 kg/m2 (15.2%) than in athletes with a BMI above 21.7 kg/m2 (7.4%, p = 0.021). Considering contraception, 25.8% of female athletes were currently using an oral contraceptive pill. The proportion of female athletes not using contraception at all or using non-hormonal contraceptive methods was high at 54.4%. In lean sports, significantly more athletes used no or non-hormonal contraceptives (p < 0.05). Conclusion: Among top Swiss female athletes, a considerable proportion used non-hormonal or no contraceptives. This trend was more evident in lean sports. Delayed menarche and cycle irregularities were common among female athletes, especially among athletes with high training volumes as well as a BMI below 21.7 kg/m2. This orienting survey underlines the importance of specialized gynecological care for elite female athletes.

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.

Digital media and mental health in adolescent athletes

Although digital media are increasingly important for adolescent athletes, few studies explore their influence on mental health in this population. This study aimed to examine this relationship in 591 German adolescent athletes (aged 12-19 years) from 42 different sports. Longer daily social media usage was connected to increased negative affect and dysfunctional eating patterns. Similar results were found for cognitive-behavioral symptoms of excessive media usage and mental health. Structural equation modeling revealed these relationships were mediated by social comparison and quality of sleep. Higher athletic performance level was related to increased social comparison, but not to quality of sleep, negative affect, and dysfunctional eating. The negative relationship between excessive media usage and sleep was stronger in competitive and elite than in recreational athletes. Results imply digital media should receive attention when aiming to improve mental health in athletes. Relevant targets for future intervention could be social comparison and sleep.

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 association between sport type and eating/body image concerns in high school students: a cross-sectional observational study

PURPOSE

Disordered eating and body image concerns are increasingly common among adolescents, possibly representing the underpinning of eating disorders (EDs). This cross-sectional observational study aimed at investigating the relationship between various patterns of sports involvement or inactivity, and the abovementioned psychopathological dimensions.

METHODS

All adolescents attending their 3rd-5th Italian grade in a single high school reported their sociodemographic and anthropometric data, their weekly sports involvement, and filled the Eating Disorders Examination Questionnaire 6.0 (EDE-Q), the Body Uneasiness Test, and the Muscle Dysmorphia Disorder Inventory (for boys). Comparisons were performed considering sex, weekly hours of activity, and different sports type (none, individual, or team sports).

RESULTS

Of 744 enrolled students, 522 (70.2%) completed the survey. Girls showed higher underweight rates, preference for inactivity or individual sports, and higher psychometric scores compared to boys. Among girls, no differences were found based on time spent exercising or sports type. Inactive boys displayed worse weight- and shape-based psychopathology, higher body uneasiness, and higher appearance intolerance compared to those who devoted more time to exercise. Among boys, individual and team sports were associated with lower EDE-Q scores compared to inactivity, whereas body uneasiness and appearance intolerance were lower only in team sports.

CONCLUSIONS

The study confirms the presence of remarkable sex differences in eating and body concerns of adolescents. Among boys, sports involvement is tied to lower ED psychopathology, and preference for team sports may be associated with reduced concerns. Wider longitudinal studies on will clarify the direction and specificity of these findings.

LEVEL OF EVIDENCE

Level V-Cross-sectional observational study.

12-months of increased dietary intake does not exacerbate disordered eating-related attitudes, stress, or depressive symptoms in women with exercise-associated menstrual disturbances: The REFUEL randomized controlled trial

Disordered eating-related attitudes are a leading cause of energy deficiency and menstrual disturbances in exercising women. Although treatment recommendations include psychological counseling with increases in dietary intake, a key concern is whether increased dietary intake may exacerbate negative eating behaviors.

OBJECTIVE

To determine the effects of a 12-month nutritional intervention on eating-related attitudes and psychological characteristics in exercising women with oligomenorrhea/amenorrhea (Oligo/Amen).

METHODS

Intent-to-treat analysis of the REFUEL randomized controlled trial (#NCT00392873) in 113 exercising women (age [mean±SEM]:] 21.9 ± 0.4 yrs; BMI: 20.9 ± 0.2 kg/m²). Women were randomized to increase energy intake 20-40% above baseline energy needs (Oligo/Amen+Cal, n = 40) or maintain energy intake (Oligo/Amen Control, n = 36) while maintaining their exercise behaviors. A reference group of ovulatory women (OVref, n = 37) maintained diet and exercise behaviors. Body composition, eating attitudes, stress, and depressive symptoms were assessed at baseline and every 3 months.

RESULTS

At baseline, the Oligo/Amen groups had higher drive for thinness, cognitive restraint, and eating disorder risk than OVref group (p < 0.001). Increased energy intake led to increases in percent body fat and fat mass (p < 0.010), but not psychobehavioral outcomes, in the Oligo/Amen+Cal compared to Oligo/Amen Control group. Independent of group, cognitive restraint decreased (p < 0.001) and resilient coping increased (p < 0.007) over 12-months, while perceived stress (p = 0.143) and depressive symptoms (p = 0.344) were unchanged.

DISCUSSION

Long-term nutritional intervention consisting of modest increases in dietary intake with guidance from a registered dietician and a psychologist increases body and fat mass without increasing disordered eating-related attitudes, stress, or depressive symptoms in exercising women with Oligo/Amen.

Body Composition, Eating Habits, and Disordered Eating Behaviors among Adolescent Classical Ballet Dancers and Controls

Adolescent classical ballet dancers are nutritionally vulnerable, as they try to retain a lean body shape during a life period of high nutritional requirements due to rapid growth. Studies conducted on adult dancers have indicated a high risk for the development of disordered eating behaviors (DEBs), but research on adolescent dancers remains scarce. The aim of the present case-control study was to compare the body composition, dietary habits, and DEBs of female adolescent classical ballet dancers and their non-dancer same-sex peers. Self-reported questionnaires, namely the Eating Attitudes Test-26 (EAT-26) and a 19-item Food Frequency Questionnaire (FFQ), were used for the assessment of habitual diet and DEBs. The assessment of body composition included the measurements of body weight, height, body circumference, and skinfolds and bioelectrical impedance analysis (BIA). The results indicate that the dancers were leaner than the controls, with lower weight, BMIs, and hip and arm circumferences, leaner skinfolds, and less fat mass. No differences were observed between the two groups regarding eating habits and the EAT-26 scores, but almost 1 out of 4 (23.3%) participants scored ≥ 20, indicative of DEBs. Participants with an EAT-26 score ≥ 20 had significantly higher body weight, BMIs, body circumferences, fat mass, and fat-free mass than those with a score < 20. Adolescents must be educated on nutrition and healthy methods to control body weight through evidence-based information and programs, and whenever appropriate, also through individual counseling by the appropriate health professionals.

Study of Different Personalised Dietary Plans on Eating Behaviour, Body Image and Mood in Young Female Professional Handball Players: A Randomised Controlled Trial

Low energy availability may precede or be caused by cognitive disturbances in professional athletes. Related psychological problems include disordered eating patterns, body shape preoccupation, depression or anxiety. The objective of this research was to evaluate the effects of different personalised dietary plans on psychological factors in young professional female handball players with low energy availability. This 12-week randomised clinical trial involved 21 female players aged 22 ± 4 years, 172.0 ± 5.4 cm and 68.4 ± 6.7 kg divided into three groups (FD: free diet; MD: Mediterranean diet; HAD: high antioxidant diet). Eating behaviour (Eating Attitude Test, EAT-26: diet, bulimia and oral control subscales), body image (Body Shape Questionnaire, BSQ) and mood state (Profile of Mode State, POMS: tension, vigour, anger, depression, fatigue) were assessed. All participants showed low energy availability (<30 kcal/lean mass per day). The different plans showed no significant differences between them but significant differences over time within groups for the variables: body image, Tension, Vigour and Depression (p < 0.05). Eating behaviour improved slightly but did not show statistically significant changes. Following an adequate nutritional planning for athletes seems to improve the mood and body perception of young female handball players. A longer intervention period is required to assess the differences between diets and improvement of other parameters.

Elite lean athletes at sports high schools face multiple risks for mental health concerns and are in need of psychosocial support

The combined demands on an adolescence in an elite sports high school can negatively affect mental health (eg, stress, burnout, depression, anxiety). Late adolescence is also when elite-striving athletes typically transition from junior-to-senior level programs. In addition, adolescent elite lean sports athletes have an increased risk of suffering from abnormal eating pathology. The purpose of this study was to investigate the perceived psychosocial needs that young, elite-striving lean sports athletes in sports high schools find essential for their sports careers and transition from junior-to-senior level sports. Eight Swedish elite-striving lean sports athletes (2 men and 6 women; median age 17.0 years, range: 16-18 years) participated in this study and sports represented were athletics (n = 1), gymnastics (n = 3), and wrestling (n = 4). Semi-structured interviews were performed, and data was analyzed by thematic analysis. Results showed integration, both in the present situation and for the future, as an overarching theme perceived as essential for a successful elite sports career over time. Three additional themes were also identified: (a) Psychosocial stress (combined performance demands, diminished social life, sports-related body weight demands, taboo talking about eating disorders, injuries), (b) Protective psychosocial factors (social support and psychological safety, communication and coordination school and sports, self-care/health behaviors), and (c) support needs junior-to-senior transition (career advice and mentorship, individualized support). As a result, elite-striving, lean sports athletes attending sports high schools need additional support to excel in their academic and athletic endeavors. Sports developmental programs continue to provide inadequate support before and during the junior-to-senior level transition. Similarly, despite the continued calls for reducing the stigma of mental health, athletes in sports schools still encounter barriers from coaches and peers, making the subject taboo, particularly surrounding eating pathologies.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

Adolescent girls' participation in sports is associated with lower negative effects of internalization of thin body ideals on self-objectification: findings from a cross-sectional study

PURPOSE

The aim of the present study was to test a partial sociocultural model of integrated tripartite influence and objectification theories in adolescent girls and to assess the moderating role of participation in sport.

METHODS

This study is part of a larger research that involved a sample of adolescent girls and boys from the 11^th grade. In the present study, data on 842 girls were analysed. The mean age of the sample was 16.9 ± 0.5 years. The adolescent girls completed online questionnaires assessing internalization of thin body ideals, disordered eating attitudes and behaviours, and self-objectification, as well as various aspects of participation in sports. To assess the primary hypotheses, moderated mediation models were tested.

RESULTS

Self-objectification mediated associations between internalization of thin body ideals and disordered eating attitudes and behaviours in adolescent girls. Participation in an achievement sport moderated the association between internalization of thin body ideals and self-objectification, but not between the latter and disordered eating attitudes and behaviours. Internalization of thin body ideals was not significantly associated with self-objectification in girls participating in achievement sport. The association between internalization of thin body ideals and self-objectification was stronger in adolescent girls not involved in any sports activities than in leisure-time exercisers.

CONCLUSION

It is important to promote involvement in sport for all adolescent girls, since it might help them to decrease the negative effect of internalization of thin body ideals on self-objectification and to value body functions over appearance. Decreasing self-objectification and teaching about body functionality might be an effective strategy in programmes aimed at decreasing disordered eating in adolescent girls participating in achievement sport.

LEVEL OF EVIDENCE

Level of evidence V, cross-sectional descriptive study.

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.

Overweight preoccupation is associated with eating pathology in male collegiate athletes with body dissatisfaction

PURPOSE

This study examined specific aspects of body dissatisfaction and drive for muscularity as correlates of eating pathology and explored sport confidence as a moderator of these associations in male collegiate athletes.

METHOD

Ninety-three male collegiate athletes who endorsed body dissatisfaction and were enrolled in a body dissatisfaction intervention study completed baseline measures of appearance orientation, appearance evaluation, overweight preoccupation, muscularity-oriented attitudes and behaviors, eating pathology symptoms, and sport confidence.

RESULTS

There were significant associations between overweight preoccupation and cognitive restraint, purging, binge eating, and excessive exercise, appearance orientation and cognitive restraint, negative appearance evaluation and restricting, muscularity-oriented attitudes and binge eating, and muscularity-oriented behaviors and excessive exercise. Low-to-moderate sport confidence moderated the association between muscularity-oriented behaviors and purging.

CONCLUSION

Findings highlight a need for interventions targeting drive for muscularity and body dissatisfaction, especially overweight preoccupation, in male collegiate athletes. Findings additionally suggest a need to further examine the utility of sport confidence in prevention and intervention programs targeting eating pathology in larger samples of male athletes.

LEVEL OF EVIDENCE

V, Cross-sectional descriptive study.

Eating disorders risk assessment in men who practice team sports

Introduction

Eating disorders (EDs) are characterized by an overconcern about body weight and shape. Men who practice team sports have been systematically excluded from the high-risk eating disorders groups. This exclusion could be challenged based on misinformation about the prevalence of actual eating disorders within these athletes, with the previous evidence showing significant body image concerns among them and the under-diagnosis risk in populations of men.

Objective

To assess eating disorders risk in Spanish adult men who practice team sports.

Methodology:

An observational study was conducted with 276 athlete men aged between 18 and 55 years: 60.5% were team sports players and 39.5% were athletes of aesthetic, endurance, and weight-category sports. Data were collected via an online form including a general assessment sheet and four validated questionnaires: The Eating Habits Questionnaire for Athletes (CHAD), the Eating Attitudes Test (EAT-40), the Inventory of Eating Disorders (EDI-2), and the Body Shape Questionnaire (BSQ). Data analysis was conducted with the software IBM SPSS 28.0.0.

Results

About 20.36% of team sports players presented a clinical profile compatible with an ED diagnosis. There were no significant differences comparing EDs potential cases between team sports players and athletes playing sports categorized as high EDs risk. There were significant differences when analyzing the existence of EDs between the different groups of age, family pressure, and coach pressure. The U-value of the Mann–Whitney test presented significant differences when assessing the influence of BMI over the development of EDs.

Conclusion

Men who practice team sports may also be a high-risk group for the development of EDs. Being younger than 21 years, having a BMI larger than 25 kg/m², and perceiving high-level pressure from the coach and/or family would be risk factors for EDs in men who practice team sports.

Investigating coaches' recognition of symptoms of eating disorders in track athletes

Objective

To determine the extent to which athletics coaches can identify evidence of an eating disorder in track athletes and what treatment advice they would provide.

Methods

Vignettes depicting athletes portraying symptoms consistent with anorexia nervosa (AN) and bulimia nervosa (BN) were developed and used to survey 185 UK and Irish athletics coaches (and a community sample of 105 non-coaches) regarding their ability to recognise and respond to symptoms of an eating disorder.

Results

Coaches were no more likely than the community sample to correctly identify an eating disorder but were more likely to suggest professional treatment for an athlete experiencing symptoms of AN (OR 1.82, 95% CI 1.02 to 3.29). For both eating disorders, higher levels of mental health literacy (AN: OR 1.06, 95% CI 1.02 to 1.11, BN: OR 1.08, 95% CI 1.04 to 1.14) and more years of coaching experience (AN: OR 1.12, 95% CI 1.03 to 1.24, BN: OR 1.07, 95% CI 1.01 to 1.16) also increased the likelihood of suggesting professional help. When considering the whole sample, participants were more likely to correctly identify an eating disorder (OR 4.67, 95% CI 2.66 to 8.20) and suggest professional treatment for AN than BN (OR 1.76, CI 1.04 to 2.97). Further, symptoms of AN were more likely to be correctly identified in female than male athletes (OR 2.26, 95% CI 1.28 to 4.06).

Conclusions

Although coaches were more likely than community members to recommend professional treatment to an athlete exhibiting symptoms of an eating disorder, they were no more likely to correctly identify an eating disorder in the first instance. Further work is required to enhance coaches' capacity to identify symptoms of eating disorders to ensure athletes receive appropriate interventions.

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.