Sport and eating disorders - understanding and managing the risks

Effect of Social Media on Diet, Lifestyle, and Performance of Athletes: A Review of Current Evidence

PURPOSE OF REVIEW

Social media (SM) plays an important role in providing diet and health advice to athletes, but it also carries with it a risk of credibility in the information sought for and received. The objective of this review is to assess the knowledge gap on how SM influences dietary and lifestyle practices in athletes.

RECENT FINDINGS

For this, relevant literature was searched in three leading databases with appropriate keywords, which were subjected to proper scrutiny that led to inclusion of 22 articles (original research papers, reviews, viewpoints, and commentaries). The current era of digitalization has seen an over-reliance on internet and SM for nutrition and lifestyle advice for an athlete. SM has become a powerful tool in athlete's choice of food, nutrition information, healthy living, and performance, with merits and demerits. Their role in choosing dietary supplements and particular food types (e.g., ketogenic diet), body image, self-esteem and eating disorders, and in lifestyle and performance are discussed. SM should be used with caution and should not be used alone as a source of information for nutrition related pieces of advise by athletes. Any food type and supplements trending in SM should be discussed with a sports nutritionist before consumption. SM influencers having a big follower base may not always be disseminating the right knowledge on food and nutrition, thus caution should be exercised. For optimal benefit to the athlete, SM information should be in alignment with recommendations provided by sports nutrition and coaches.

Body Weight Satisfaction, Comments, Nutrition and Injury Risk in 489 Adolescent Elite Athletes

Exposure to critical body weight comments in youth athletes could lead to decreased self-esteem, affect body image, and increase the risk of eating disorders and cause depressive symptoms. The aim was to explore differences between sex, body mass index, sports type, with regards to body weight satisfaction, exposure to critical body weight comments from their coach and nutrition status in adolescent elite athletes. A questionnaire about body weight, critical body weight comments and nutrition was distributed to 489 adolescent elite athletes and injury prevalence was monitored across 20 weeks. The results showed that almost one in four athletes (n=116, 24%) was not satisfied with their weight and 12% (n=59) had received critical body weight comments from their coach. Of the athletes who were unsatisfied with their body weight (n=116), 47% wanted to lose weight (n=55). A significant (p<0.05) higher proportion of ice hockey players and swimmers used nutritional supplements, were unsatisfied with their body weight, and were more exposed to critical body weight comments compared to athletes from other sports. Adolescent elite athletes as young as 15-16 years old are exposed to critical body weight comments from their coach and experience challenges with body weight satisfaction that is partly dependent on the sport-specific context.

A Review of Mental Health Issues in High-Performance and Elite-Level Cycling

Despite the public health benefits of cycling in the general population, mental health issues may be evident in high-performance and elite-level competitive domains. With prominent riders disclosing their experiences with psychiatric symptoms, distinctive socioenvironmental factors could exacerbate psychopathological vulnerabilities. This suggests a need for greater mental health awareness amongst stakeholders, supplemented by actions from international and national federations and regulators. To synthesise relevant observations about psychiatric concerns in high-performance and elite-level cycling, we conducted a keyword search of articles in APA PsycINFO, PubMed, and Scopus based on specified exclusion criteria. Thirteen papers were identified that examined mental health issues in high-performance and/or elite-level cycling per classifications from the World Health Organization's International Classification of Diseases 11th Revision. A large proportion of articles illustrated eating disorder symptomatology, but others discussed attention deficit/hyperactivity disorder, anxiety disorder, depression, sleep wake disorders, and substance use disorder. Existing literature underlines important considerations for all stakeholders within the cycling community around mental health initiatives and care provisions, which are currently lacking across the sport. Such programmes could incorporate consensus statements, psychiatric screening, psychoeducation, stigma-reducing policies, and athlete advocacy. These can help mitigate socioenvironmental risk factors and prioritise athlete wellbeing over performance-centred motivations.

Integration of yoga within exercise and sports science as a preventive and management strategy for musculoskeletal injuries/disorders and mental disorders - A review of the literature

OBJECTIVES

Exercise-induced musculoskeletal injuries/disorders and associated mental disorders are prevalent among athletes. The main objective of this review is to analyze the prospects of Yoga practices as a preventive and management strategy for musculoskeletal injuries/disorders and associated mental disorders often encountered in exercise and sports activities.

METHODS

A review of the literature was performed using electronic databases such as MEDLINE/PubMed and google scholar published between January 1991 and December 2021 which yielded 88 research articles. The keywords used were yoga OR exercise AND musculoskeletal injuries OR disorders, yoga OR exercise AND mental disorders, yoga AND sports injuries, yoga AND stress, yoga OR exercise AND oxidative stress, yoga OR exercise AND inflammation, yoga OR exercise AND diet.

RESULTS

The moderate and regular exercises are beneficial to health. However, high intensity and overtraining physical activities lead to immune suppression, oxidative stress, muscle damage/fatigue, coronary risk, psychiatric disorders and so on due to enormous strain on various physiological functions. Yoga seems to undermine these adverse activities through up-regulating the functions of the parasympathetic nervous system (PNS) and down-regulating the activities of hypothalamohypophysial axis (HPA) which are conducive to healing, recovery, regeneration, reduction in stress, relaxation of mind, better cognitive functions, promotion of mental health, reduction in inflammation and oxidative stress, and so on.

CONCLUSION

Literature suggests that Yoga should be integrated within exercise and sports sciences mainly to prevent & manage musculoskeletal injuries/disorders and associated mental disorders.

Sports psychiatry: a desideratum on sports arena!

The emerging field of sports psychiatry has been developing steadily in recent years. This is not just a health concern but is likely to impact sporting performance and achievement significantly. An overview of sports psychiatry is provided. Psychiatric disorders of all varieties can and do present in sporting populations. Sports psychiatry keeps evolving to drive forward the importance of good mental health in sport as in life.

Anorexic Readiness Syndrome in Elite Female Acrobatic Gymnasts-International Study

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

Eating disorder risks and awareness among female elite cyclists: an anonymous survey

Background

Eating disorders (EDs) are an increasingly recognized concern in professional sports. Previous studies suggests that both female gender and endurance sports put athletes at risk. Female elite cyclists are hence of specific interest. The present study aimed at evaluating the distribution of the individual risk of ED in this group. Further the association between individual risk and both the awareness for the topic ED and the deviation from “normal” weight was depicted.

Methods

Female cyclists registered with the Union Cycliste Internationale were contacted via email or facebook and asked to complete a survey comprising age, weight, the Eating-Attitude-Test (EAT-26), and questions regarding ED awareness. The observed distribution of the EAT-26 score was compared to results from previous studies in normal subjects and athletes. The distribution of the ED awareness was described and ED awareness was correlated with the EAT-26 score. Both the deviation from ideal weight and the body mass index (BMI) were correlated with the EAT-26 score.

Results

Of the 409 registered athletes 386 could be contacted, 122 completed the questionnaire. Age ranged from 20-44yrs, BMI from 17.0 to 24.6 kg/m². In the EAT-26, 39 cyclists (32.0%) scored above 20 points indicating a potential benefit from clinical evaluation, 34 cyclists (27.9%) scored 10–19 points suggesting disordered eating. Sixteen athletes (13.2%) had been treated for an ED. About 70% of athletes had been pressured to lose weight. The mean EAT-26 score was above the average observed in normal female populations. It was also above the average observed in many female athlete populations, but lower than in other leanness focussed sports. More than 80%of athletes perceived elite cyclists at risk for developing ED. Increased ED awareness and deviation from the ideal weight were associated with higher EAT-26 scores, but not the body mass index.

Conclusion

Female cyclists are at risk of developing ED and they are aware of this risk. To improve their health and well-being, increased efforts to support elite cyclists and their teams in preventive activities and early detection are crucial.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13102-022-00563-6.

The association between sport nutrition knowledge, nutritional intake, energy availability, and training characteristics with the risk of an eating disorder amongst highly trained competitive road cyclists

Purpose

To determine the association between sport nutrition knowledge, nutritional intake, energy availability, and training characteristics with the risk of an eating disorder amongst highly trained competitive cyclists.

Methods

Using an observational cohort study design, 36 male cyclists (age = 23.1 ± 3.9 years) provided information on personal characteristics, training history and functional threshold power. The cyclists completed the sports nutrition knowledge questionnaire (SNKQ) and brief eating disorder in athletes questionnaire (BEDA-Q) before submitting a three-day food diary to quantify energy and macronutrient intake, and calculate energy availability.

Results

The estimated lean body mass, years training, weekly on-bike training and functional threshold power were 57.6 ± 3.9 kg, 5.9 ± 3.0 years, 16.4 ± 3.2 h and 355 ± 33 W, respectively. The mean score for the SNKQ was 60.0 ± 8.4% whilst the BEDA-Q score was 4.3 ± 4.1 AU. Training and rest day energy availability was 16 ± 18 kcal·kg eLBM−1 and 44 ± 14 kcal·kg eLBM−1, respectively. Associations between SNKQ with energy intake (r = 0.13, P = 0.553) and availability (r = 0.21, P = 0.345) were trivial to small. There was a large, negative association between SNKQ and BEDA-Q (r = –0.55, P = 0.006) suggesting that for every correct answer on the SNKQ, the BEDA-Q score reduced by 0.3 AU. All other association with the BEDA-Q were trivial to small (r = –0.29–0.27, all P > 0.05).

Conclusion

The results indicate that sport nutrition knowledge and energy intake was insufficient to match their training demand on training days. The large, negative association between SNKQ and BEDA-Q suggests that those highly trained cyclists with less sport nutrition knowledge may be at a greater risk of an eating disorder.

Bipolar disorder and eating disorders in sport: a case of comorbidity and review of treatment principles in an elite athlete

OBJECTIVES

There is overlap between the typical age of onset of bipolar disorder (BD) and the age of peak athletic success. Additionally, eating disorders (EDs) are prevalent psychiatric disorders in athletes. Despite the relevance of both disorders in this population, there remains a need for treatment guidelines, especially when present as comorbidities given the complex interplay between them.

METHODS

This report provides background information and utilizes a case report to explore the presentation and treatment of BD comorbid with an ED in an athlete. It specifically highlights the case of an elite female long-distance runner utilizing a multidisciplinary approach specific to the patient's unique needs as an athlete.

RESULTS

Treatment of this elite athlete utilized strategic pharmacotherapy taking into consideration her training and competition cycles. At 16 week follow-up, the patient was psychiatrically stable, experienced improvement in her running and felt confident in choosing to stay on medication and continue her running career.

CONCLUSION

It is important for providers who work with high-level athletes to provide treatment choices that allow athletes to safely and successfully continue their sport while adequately treating their mental illness. Treatment guidelines that increasingly take into consideration complex psychiatric comorbidities and nuanced pharmacologic approaches are needed in order to advance the field of sports psychiatry.

Eating disorders in sport. Update and proposal for an integrated approach

Eating disorders are a group of conditions which have a huge impact on the health and performance of athletes. The aetiology of eating disorders is multifactorial, being influenced by genetic and environmental factors, but also involving psychological factors and factors specific to the practising of sport. Eating disorders are highly prevalent in sport, particularly in disciplines involving endurance, those that have weight-categories or those where low weight is a competitive advantage and aesthetics are important. Athletes with eating disorders need to be assessed and receive early, comprehensive treatment. Close monitoring of nutritional status is vital, especially with female athletes. Prevention is crucial and plays an invaluable role in this type of disorder, but represents a significant challenge for all professionals who look after athletes. Priority needs to be given to implementing structured nutrition training programmes for the athlete and their entourage to help prevent eating disorders.

Training and physiological characteristics of American and Japanese female track and field athletes

BACKGROUND

Intensive training without appropriate recovery can predispose athletes to injury. Balancing these two facets-training and recovery-is crucial for keeping athletes at their highest possible performance level while lowering their risk of training-related injury. Cultural differences may also affect athletes' training and daily routines, but research investigating the effects of cultural background on female track and field athletes is lacking.

METHODS

In total, 49 Japanese and 28 American track and field athletes competing at the national level were included in this study. Their body composition was evaluated and Eating Attitudes Test (EAT-26) and a survey regarding training schedules, recovery practices, and performance levels were conducted.

RESULTS

Compared with the Japanese athletes, the American athletes had significantly higher height, weight, and body mass index measurements, although their performance levels did not differ. Japanese athletes trained for significantly longer hours both on school days and non-school days and spent significantly fewer days per week on weight training. The Japanese athletes slept, on average, for 1 hour less per day than the American athletes, and their EAT-26 scores were significantly higher than those of the American athletes (both p < 0.01). The number of days off per week was positively correlated with performance, but training hours on school days and fat mass percentage were negatively correlated with performance (p < 0.05). Further, days off per week and nationality were correlated with EAT-26 scores (both p < 0.05).

CONCLUSIONS

The American and Japanese athletes performed similarly, but the Japanese athletes were achieving their performance level with less sleep, longer training hours, and a higher risk of developing an eating disorder.

Findings from a web content analysis of resources targeting sporting coaches aimed at educating or upskilling on eating disorders and disordered eating in athletes

BACKGROUND

Eating disorders (ED) and disordered eating (DE) are highly prevalent in athletes. Coaches can play a role in the prevention of EDs and DE behaviours and are well placed to support athletes with an ED. However, coaches feel under-qualified and lack time and resources for supporting athletes and it is unclear the quality of training and resources available to upskill coaches in this space. Therefore, a web-based content analysis was undertaken to determine the type and source of online education resources currently available to coaches to help identify, prevent, manage and refer on for ED/DE behaviours.

METHODS

Three major search engines were searched using a combination of the following terms: (1) DE or ED resource and (2) coaches or sport. Included websites were specific for DE/EDs in athletes; targeted at coaches or sporting organisations; written in the English language; and published by a reputable site.

RESULTS

Twenty four out of 600 websites met inclusion criteria. The main reasons for exclusion were irreputable sites and websites not targeting coaches. The majority of included webpages were from professional bodies (n = 17) and targeted coaches (n = 24) and sporting organisations (n = 15), with an average quality rating of 4.2 out of 6. All websites provided educational resources but none provided official training. The most common topics discussed on these websites was ED/DE signs and symptoms (n = 17), and the effects of ED/DE on performance, mental and physical health (n = 11).

CONCLUSION

Few reputable online resources were identified in the current review. There is a need for more comprehensive education and training resources aimed at coaches and athletic organisations to help prevent, identify, manage and refer on for ED/DE behaviours.

A systematic review of instruments for the assessment of eating disorders among adults

PURPOSE OF REVIEW

The availability of psychometrically sound assessment instruments for assessing eating disorder symptomatology is crucial for both clinical practice and research. The purpose of the current review is to provide the reader with a list of psychometrically validated assessments for adults that are available within the field of eating disorders. Eating disorder interviews and self-report questionnaires were identified using online literature searches, reviewing previous review articles, and via research and/or clinical experience of the authors. The focus of the review was on (1) standard assessments that were frequently used in eating disorder research (such as the Eating Disorder Examination and Eating Attitudes Test), and (2) newer assessments that were developed over the past 5 years. Information compiled on each instrument included the purpose of the assessment, scores that can be derived, psychometric information, translations in other languages, and availability for use in research and clinical settings.

RECENT FINDINGS

Several recent trends in assessment instruments were identified including updates based upon Diagnostic and Statistical Manual criteria, briefer assessments, assessments for specific populations, and assessment of specific clinical features observed in people with eating disorders.

SUMMARY

The current review provides eating disorder clinicians and researchers a guide for making informed decisions about the selection of eating disorder assessments.

Eating disorders in sport. Update and proposal for an integrated approach

Eating disorders are a group of conditions which have a huge impact on the health and performance of athletes. The aetiology of eating disorders is multifactorial, being influenced by genetic and environmental factors, but also involving psychological factors and factors specific to the practising of sport. Eating disorders are highly prevalent in sport, particularly in disciplines involving endurance, those that have weight-categories or those where low weight is a competitive advantage and aesthetics are important. Athletes with eating disorders need to be assessed and receive early, comprehensive treatment. Close monitoring of nutritional status is vital, especially with female athletes. Prevention is crucial and plays an invaluable role in this type of disorder, but represents a significant challenge for all professionals who look after athletes. Priority needs to be given to implementing structured nutrition training programmes for the athlete and their entourage to help prevent eating disorders.

Comparing eating disorder characteristics and treatment in self-identified competitive athletes and non-athletes from the National Eating Disorders Association online screening tool

OBJECTIVE

We compared eating disorder (ED) characteristics and treatment seeking behaviors between self-identified competitive athletes and non-athletes in a large, community-based sample.

METHOD

During the 2018 National Eating Disorders Awareness Week, 23,920 respondents, 14.7% of whom identified as competitive athletes, completed the National Eating Disorders Association online screen. Data were collected on demographics, disordered eating behaviors, probable ED diagnosis/risk, treatment history, and intent to seek treatment.

RESULTS

The sample was predominantly White (81.8%), female (90.3%), and between 13 and 24 years (82.6%). Over 86% met criteria for an ED/subthreshold ED, and of those, only 2.5% were in treatment. Suicidal ideation was reported in over half of the sample. Athletes reported a significantly greater likelihood of engaging in and more frequent excessive exercise episodes than non-athletes. Athletes also reported a significantly lower likelihood of engaging in and less frequent binge-eating episodes compared with non-athletes. Athletes were more likely to screen positive for an ED/subthreshold ED than non-athletes, but percentages across all probable ED diagnoses were similar. No significant differences between athletes and non-athletes emerged on treatment history or intention to seek treatment post-screen (less than 30%).

DISCUSSION

Although the distribution of probable ED diagnoses was similar in athletes and non-athletes, symptom profiles related to disordered eating behavior engagement and frequency may differ. Athletes may be less likely to seek treatment due to stigma, accessibility, and sport-specific barriers. Future work should directly connect survey respondents to tailored treatment tools and increase motivation to seek treatment.

Body composition and eating behaviour in non-professional adolescent female dancers

BACKGROUND

Dance is one of the most practiced sports in women's childhood and adolescence. It is often difficult for dancers to maintain a normal body composition without changing their eating habits, despite the presence of high intensity training. The study aims to investigate, through nutritional habits and body composition, the impact of this sports regime in the prepubertal period.

METHODS

Two groups of 10 adolescent dancers of classic and modern style were evaluated in terms of anthropometric parameters and hydration. Lifestyle, eating habits, adherence to Mediterranean diet, characteristics of menstrual cycle and risk stratification of Athletes' Triad Syndrome were evaluated through questionnaires. The data were reinterpreted based on the presence or absence of menarche.

RESULTS

The average BMI value was within the normal range (17.9 ± 2.2 kg/m2) in both groups. No significant differences emerged for anthropometric parameters and body composition between the two groups with the exclusion of the suprailiac fold which was significantly lower in G2 (classical: 0.1 ± 0.1 mm) compared to G1 (modern: 11.0 ± 6.6 mm) p < 0.001. Instead, differences observed (p < 0.05) was related to the presence or absence of the menstrual cycle. Despite the poor adherence to the Mediterranean diet, there was no evidence of risk of developing eating disorders or Athletes' Triad Syndrome.

CONCLUSIONS

The training of classical and modern dance does not seem to have any negative impact on the body composition especially in pre-pubertal age. The onset of the menarche determines the major modification of the body composition.

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

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

Self-confidence and Disordered Eating amongst Martial Artists: A Cross-sectional Study

Background: Extreme dieting is a well-known phenomenon in combat sports, and still, little research has explored the link between extreme dieting and confidence levels among martial artists. Methods: In this cross-sectional study, extreme dieting and sport-specific self-confidence among 111 Swedish athletes practicing mixed martial arts (MMA) or Brazilian jiu-jitsu (BJJ) were examined. Athletes completed an online survey containing the Eating Disorder Examination questionnaire (EDE-Q) and the Trait Sport-Confidence inventory (TSCI). Results: The results showed that MMA athletes dieted in more extreme ways than BJJ athletes, primarily via restricted eating. They also had higher sport-specific self-confidence, which was positively correlated with weight loss. BJJ athletes used less restrictive eating than MMA athletes, but those who did diet in extreme ways experienced lower self-confidence compared to MMA athletes. Conclusions: The results are consistent with previous studies showing rapid weight loss in MMA athletes and suggest that some martial artists are at a particular risk of extreme dieting and possible sequelae. There is a link between self-confidence and weight loss, but it seems to allude to a comprehensive explanation and is in need of further research.

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

Background

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

Objective

Scoping review of ED and DE in male elite athletes.

Methods

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

Results

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

Discussion

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

Conclusion

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

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

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

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

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

Development and Validation of the Eating Disorders Screen for Athletes (EDSA): A Brief Screening Tool for Male and Female Athletes

OBJECTIVES

To develop and validate the Eating Disorders Screen for Athletes (EDSA), a brief eating disorders screening tool for use in both male and female athletes.

METHODS

Data from Division I athletes at a Midwestern university (N=434) were used to conduct exploratory factor analysis (EFA) by gender. Data from athletes competing at various levels at universities across the United States (N=862) were then used to conduct confirmatory factor analysis (CFA) and receiver operator characteristic (ROC) curve analysis by gender. Athletes from a range of lean and non-lean sports were included. Gender-specific empirically derived cut-offs on the Eating Disorder Examination-Questionnaire were used to classify high eating disorder risk for ROC curve analysis. Measurement invariance by gender, level of competition, and sport type was also examined.

RESULTS

A six-item, one-factor structure for the EDSA was supported by EFA and CFA in both genders, and internal consistency was good for both male (α=. 80) and female athletes (α=.86). ROC curve analyses indicated that the EDSA was highly accurate in predicting eating disorder risk status and identified a score of 3.33 as the optimal cut-off for both male (sensitivity=.96, specificity=.80) and female athletes (sensitivity=.96, specificity=.64). Results also supported strong measurement invariance for the EDSA by gender, level of competition (Division I versus club), and sport type (lean versus non-lean).

CONCLUSIONS

The EDSA shows promise as a brief screening tool to identify male and female athletes at risk for eating disorders.

Promoting a Healthy Lifestyle through Mindfulness in University Students: A Randomized Controlled Trial

The present study explored the effects of a second-generation mindfulness-based intervention known as flow meditation (Meditación-Fluir) in the improvement of healthy life behaviors. A sample of university students (n = 51) in Spain were randomly assigned to a seven-week mindfulness treatment or a waiting list control group. Results showed that compared to the control group, individuals in the mindfulness group demonstrated significant improvements across all outcome measures including healthy eating habits (balanced diet, intake rate, snacking between meals, decrease in consumption by negative emotional states, increased consumption by negative emotional states, amount of consumption, meal times, consumption of low-fat products), tobacco, alcohol, and cannabis consumption, and resting habits. There were differences between males and females in some of these variables and a better effect of the treatment was evident in the females of the experimental group when compared to the males. The flow meditation program shows promise for fostering a healthy lifestyle, thus decreasing behaviors related to maladaptive eating, tobacco, alcohol, and cannabis consumption as well as negative rest habits in university students. This mindfulness program could significantly contribute to the treatment of eating disorders and addictions, wherein negative emotional states and impulsivity are central features of the condition.

Diet Quality, Carotenoid Status, and Body Composition in NCAA Division I Athletes

Objectives: In this paper, we examined diet quality and associations between changes in skin carotenoids and body composition among selected NCAA Division I athletes. Methods: Athletes from women's (rowing, swimming, gymnastics) and men's (swimming, wrestling) teams at a large Midwest university (N = 129) completed one online food frequency questionnaire and 2 in-person visits, once in-season and once out-of-season, to assess skin carotenoids and body composition. Diet quality was assessed via Healthy Eating Index-2015 (HEI). Carotenoids were measured via resonance Raman spectroscopy and body composition via dual-energy x-ray absorptiometry. ANOVA and Pearson correlations were used to test differences between teams and determine association between changes from in-season to out-of-season. Results: Mean HEI score for all athletes was 71.0. Women's rowing reported the highest diet quality (73.5), men's wrestling lowest (56.5). Skin carotenoids decreased for all teams, except men's wrestling, from in-season to out-of-season. Body fat percentage increased for women and decreased for men. There was a moderate inverse association between changes in skin carotenoids and body fat percentage (r = -.334, p = .001). Conclusions: Suboptimal diet quality coupled with decreases in skin carotenoids and increases in body fat percentage from in-season to out-of-season may justify dietitian-led interventions year-round to improve dietary patterns in collegiate athletes.

Risk of eating disorder in Colombian women who go to the gym

Background: Mental health in gyms has not been a topic of study in Colombia. Social stereotypes of beauty and dissatisfaction with body image make women a population prone to excessive exercise. This research analyzes the risk of eating disorder in women who attend gyms (comparing ages), its relationship with the frequency of physical exercise and the use of diet to improve physical appearance. Methods: 519 women with ages between 15 and 50 years participated. The EAT-26 Eating Attitude Test was used, a standardized procedure to estimate the frequency of physical exercise and a brief socio-demographic survey. Results: The percentages of women with risk (46.8%) of TBI and without risk (53.2%) are similar, the factor scores and the total of the EAT-26 only show significant differences in the age range 15 -19 and 20-24, no significant correlations were found between the factors and the total score of the EAT-26 and the measure of the frequency of physical exercise, and there is an association between the risk of eating disorders and diet to improve the physical image. Conclusion: The percentage of women at risk for eating disorders is higher than those reported for high school students, university students, and athletes. A very high percentage of gym users would be compromising their mental health in some way, considering the frequency values of physical exercise.

Eating Disorders in Male Athletes

CONTEXT

Eating disorders (EDs) in male athletes are potentially debilitating disorders with significant medical, psychological, and athletic performance consequences.

EVIDENCE ACQUISITION

Searches were performed across PubMed, EBSCOhost, and PSYCinfo from 1990 to 2019. Keywords searched were eating disorder, male, athlete, anorexia nervosa, bulimia nervosa, muscularity, muscle dysmorphia, and sports. Search results included articles written in the English language and encompassed reviews, empirical studies, and theoretical articles.

STUDY DESIGN

Clinical review.

LEVEL OF EVIDENCE

Level 3.

RESULTS

EDs among male athletes may lead to serious negative outcomes, including increased susceptibility to injury, inconsistent performance, problematic recovery, muscle deficiencies, impairment of optimal athletic functioning, and medical, social, and emotional problems. Male athletes with EDs may be more difficult to identify and diagnose for a variety of reasons related to differential presentation of symptoms, secretiveness or shame around behaviors, and sex-related stigma.

CONCLUSION

Professionals working closely with athletes are uniquely positioned to identify and screen those who may require further evaluation and treatment.

Mindfulness in Eating Is Inversely Related to Binge Eating and Mood Disturbances in University Students in Health-Related Disciplines

The purpose of the study was to investigate the relationship between mindful eating, disordered eating and mood in university students in health-related disciplines. A total of 221 university students participated in the study; 102 students studied sport and exercise science (SS), 54 students pharmacy sciences (PS), and 65 students health sciences (HS). Participants completed the Binge Eating Scale (BES), the Mindful Eating Questionnaire (MEQ), and the Profile of Mood State questionnaire (POMS). 41% of the students were classified as binge eaters and 57% were above the POMS threshold of depression. Binge eaters were found to have significantly lower MEQ score and significantly higher total mood disturbance scores (TMD) compared to non-binge eaters (p < 0.01). Students with a high depression score exhibited no differences in the MEQ score but a significantly higher BES score compared to non-depressed students (p < 0.01). Gender differences were found in the MEQ with females exhibiting significantly higher scores in the MEQ score and in all MEQ subscales compared to males, with the exception of the emotional subscale that females were noted to have a lower score compared to males (p < 0.01). The MEQ score was inversely related to the BES score (r = −0.30, p < 0.01) and TMD (r = −0.21, p < 0.05). The MEQ score was a significant negative predictor of the variance of the binge eating behavior of the students (B = −3.17, p < 0.001). In conclusion, mindfulness in eating is inversely related to the binge eating behavior and mood state of university students studying health-related subjects and is a significant negative predictor of disordered eating behavior in this high risk population.

[Exercise-risks and side effects]

Physical activity and exercise is widely connected with positive effects on human health. However, exercise may also pose as a risk factor for health under specific circumstances. Primarily, the risks connected with exercise are physical risks, but also psychological risks may appear, especially when exercise is conducted excessively. Psychological risks include eating disorders, illegal and legal substance use and exercise dependence. The aims of the present article are to focus on potential risks and side effects of exercise and physical activity and to put the risks in the context of the positive effects of exercise on health.

The Association of Body Image With Anthropometric Measures and Eating Disorders Among Students From University Sports Teams

Background and aims: Body image is defined as a complex concept involving a person’s thoughts, feelings, and attitudes about his/her body. The body image dissatisfaction may expose the individuals, specifically athletes, to eating disorders (EDs). The aim of this study is to assess the association of body image score with EDs and anthropometric measures in students from university sports teams. Methods: This cross-sectional study was carried out on 225 students from sports teams of Qazvin University in 2014. The samples were selected by the census method. The Multidimensional BodySelf Relations Questionnaire (MBSRQ), eating attitudes test (EAT-26) questionnaire, and demographic information questionnaire were used for collecting data. Anthropometric characteristics were also measured. The data were analyzed in SPSS software version 22.0. Results: The result of the study showed that the association of body image score with age (P=0.012, OR=0.80, CI=0.179, 1.437) and waist-to-height ratio (WHtR) (P=0.013, OR=-52.14, CI=-93.20, -11.08) was positively significant. Although the mean body image score was lower in students with EDs, it was not statistically significant. In addition, there was not a significant association between body image score and other variables such as marital status, gender, educational level, body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and hip circumference (HC) (P>0.05). Conclusion: In this study, the body image had a positive significant association with age, and a negative significant one with WHtR. This may indicate that abdominal obesity plays an important role in body image satisfaction among students from the university sports teams.

Eating Behaviour among Disabled Athletes in Malaysia

Background

Nutrition has always been associated with eating behaviour. The eating behaviour can impact not only the normal population but also athletes' population including disabled athletes too. Athletes have a higher tendency to unhealthy eating behaviour due to intense pressure and competitive environment in sports. It is important to identify the types of eating behaviour among disabled athletes to prevent eating disorder that could affect their performance. Thus, this study aims to identify the types of eating behaviour among disabled athletes in Malaysia.

Methods

This study involved 93 disabled athletes in Malaysia. The setting of the study is at National Sports Council, Malaysia. The data obtained are analysed using chi-square test using SPSS.

Results

This study shows that the most common types of eating behaviour among disabled athletes are emotional eating (37.6%), followed by uncontrolled eating (34.3%) and cognitive restraint (28%). Most of the overweight and obese disabled athletes are prone to emotional eating (19.4%) as compared to non-overweight athletes (18.3%).

Conclusion

As a conclusion, recognising the eating behaviour in disabled athletes is important as more effective and innovative interventions and measures can be undertaken to prevent eating disorder which can enhance sports performance.

Adapting a Technology-Based Eating Disorder Model for Athletes

Eating disorders (EDs) are common amongst athletes, yet few receive treatment. Given that athletes have a unique set of risk factors for eating disorders and are faced with additional barriers to treatment, new models outside of face-to-face treatment are necessary to reach the population and provide more affordable, tailored, evidence-based care. One solution is to use digital mental health programs to provide primary or supplemental therapy. Digital programs can provide accessibility and privacy, and recent advancements allow for more personalized online experiences. However, there have been no studies to date that integrate technology-based tools to address the especially high prevalence rates of EDs in athletes. This paper describes how an integrated model that includes online screening linked to guided self-help programs, all adapted specifically for athletes, can be used to provide prevention and intervention of EDs in athletes.

The Athletes' Relationships with Training scale (ART): A self-report measure of unhealthy training behaviors associated with eating disorders

OBJECTIVE

Several studies indicate that eating-disorder (ED) psychopathology is elevated in athletes compared to non-athletes. The assessment of excessive exercise among athletes is a challenge because, compared to non-athletes, athletes are required to train at higher intensities and for longer periods of time. However, individuals participating in competitive sports are still susceptible to unhealthy physical-activity patterns. Most ED assessments were developed and normed in non-athlete samples and, therefore, do not capture the nuances of athletes' training experiences. The purpose of the current study was to develop and validate a clinically useful, self-report measure of unhealthy training behaviors and beliefs in athletes, the Athletes' Relationships with Training Scale (ART).

METHOD

The initial item pool was administered to N = 267 women collegiate athletes who were participating in an ED prevention program study and N = 65 women athletes who were in ED treatment.

RESULTS

Factor analyses indicated the ART had a four-factor structure. Factorial and construct validity of the ART were demonstrated. ART scores significantly predicted health care utilization and differed between athletes with an ED versus athletes without an ED. For athletes in ED treatment, ART scores significantly decreased from treatment admission to discharge.

DISCUSSION

The ART showed evidence of strong psychometric properties and clinical utility. The ART could be helpful for clinicians and athletic trainers to help gauge whether athletes are engaging in unhealthy training practices that may warrant clinical attention and for tracking clinical outcomes in athletes with EDs who are receiving treatment.

Is There Any Relationship Between Body Image Perception, Eating Disorders, and Muscle Dysmorphic Disorders in Male Bodybuilders?

Bodybuilding has increasingly become popular between males since male body shape has become a subject of interest in the last decades. Bodybuilders have desired to gain more muscle and paid attention to their body shape. Based on this purpose, they have string rules that include restrictive eating and excessive exercise program. Recent research has demonstrated that desiring more muscular body shape exhibits eating behavior problems and body dissatisfaction issues in bodybuilders. Limited research exists on the relationship between body dissatisfaction and eating disorders in male bodybuilders. The aim of this study was to determine the relationship between body image disturbance and eating disorders in 120 male bodybuilders. The Eating Attitude Test (EAT-40) was used to determine eating disorders, the Muscle Dysmorphia Disorder Inventory was used to determine bigorexia symptoms, and Bodybuilder Image Grid-Original (BIG O) and Scaled (BIG S) forms were used to detect the factors associated with body dissatisfaction. There was a positive relationship between Eating Attitude Test and Muscle Dysmorphia Disorder Inventory total scores. Eating Attitude Test was positively correlated with both fat and muscle dissatisfaction. Our results indicated that eating disorder psychopathology is positively related to body dissatisfaction and body dysmorphic disorders in male bodybuilders.

Service Providers' Attitudes Toward Athletes With Eating Disorders

OBJECTIVE

This study explored the nature and extent of Athlete Support Personnel's (ASP's) attitudes and beliefs toward athletes with symptoms of anorexia nervosa (AN) compared with those with symptoms of depression.

DESIGN

A cross-sectional study with a survey instrument.

SETTING

Sport and Exercise Science Professional Bodies and Associations in the Republic of Ireland, Northern Ireland, and mainland United Kingdom.

PARTICIPANTS

One hundred fifty-two ASP.

MAIN OUTCOME MEASURES

Participants read 2 vignettes describing a fictional female athlete with symptoms of AN or depression after which they completed an on-line survey examining attitudes toward such athletes.

RESULTS

Significant differences in patterns of responses were found between the 2 mental health conditions. The athlete with AN was viewed as significantly more difficult to communicate with F(1,148) = 18.17, P = 0.000, η = 0.11, more likely to be using her disorder to gain attention F(1,148) = 21.69, P = 0.000, η = 0.13, personally responsible for her condition F(1,148) = 10.10, P = 0.00, η = 0.06, and less likely to recover F(1,148) = 23.03, P = 0.000, η = 0.14 than the athlete with depression. Male service providers were more likely to believe that the athletes depicted were attention seeking F(1,148) = 10.69, P = 0.001, η = 0.07 and only had themselves to blame for their mental health condition F(1,148) = 12.97, P = 0.000, η = 0.08.

CONCLUSIONS

Athlete support personnel report stigmatizing attitudes toward athletes with eating disorders such as AN. Male service providers hold greater negative attitudes toward athletes with mental health conditions.

Body Composition, Muscle Quality and Scoliosis in Female Collegiate Gymnasts: A Pilot Study

Research has demonstrated an elevated prevalence of body weight concerns and scoliosis among female gymnasts. The purpose of the current pilot study was to evaluate the utility of ultrasonography and dual-energy X-ray absorptiometry (DXA) as practical imaging modalities to measure body composition and spinal curvature variables that may correlate with performance in female collegiate gymnasts (n=15). DXA was used to evaluate body composition and lateral spinal curvature, utilizing a modified Ferguson method. Echo intensity (EI) and cross-sectional area (CSA) of the vastus lateralis were determined from a panoramic cross-sectional ultrasound image. For returning athletes (n=9), performance scores from the previous season were averaged to quantify performance. The average performance score was correlated with lean mass of the arms (R=0.714; P=0.03) and right leg (R=0.680; P=0.04). Performance was not correlated with total mass, fat mass or body fat percentage (P>0.10). Scoliosis was identified in 3 of 15 scans (20%). Echo intensity and CSA of the vastus lateralis were inversely correlated with each other (R=-0.637, P=0.01), but not with other measures of body composition or performance. Results suggest that limb LBM may be a determinant of gymnastics performance, and DXA may provide important health and performance-related information for female collegiate gymnasts.

Eating disorders in athletes: overview of prevalence, risk factors and recommendations for prevention and treatment

The prevalence of disordered eating and eating disorders vary from 0-19% in male athletes and 6-45% in female athletes. The objective of this paper is to present an overview of eating disorders in adolescent and adult athletes including: (1) prevalence data; (2) suggested sport- and gender-specific risk factors and (3) importance of early detection, management and prevention of eating disorders. Additionally, this paper presents suggestions for future research which includes: (1) the need for knowledge regarding possible gender-specific risk factors and sport- and gender-specific prevention programmes for eating disorders in sports; (2) suggestions for long-term follow-up for female and male athletes with eating disorders and (3) exploration of a possible male athlete triad.