Body dissatisfaction, ideals, and identity in the development of disordered eating among adolescent ballet dancers

OBJECTIVE

Little is known about how female adolescent ballet dancers-a group at high-risk for the development of body dissatisfaction and eating disorders-construct body ideals, and how their social identities interact with body ideals to confer risk for disordered eating. Using a novel body figure behavioral task, this study investigated (1) whether degree of body dissatisfaction corresponded to severity of disordered eating thoughts and behaviors, and (2) how ballet identity corresponded with ideal body figure size among adolescent ballet dancers.

METHODS

Participants were 188 female ballet dancers ages 13-18 years who completed self-report measures of study constructs and the behavioral task.

RESULTS

Linear regression models indicated that more severe body dissatisfaction was positively associated with increased disordered eating thoughts and behaviors (p < .19), except for muscle building (p = .32). We also found that identifying more strongly as a ballet dancer was correlated with having a smaller ideal body size (p = .017).

CONCLUSION

Findings from this study suggest desire to achieve smaller body sizes is correlated with more severe disordered eating endorsement and stronger ballet identity. Instructors and clinicians may consider assessing the extent to which individuals identify as a ballet dancer as a risk factor for disordered eating and encourage adolescent dancers to build and nurture other identities beyond ballet.

PUBLIC SIGNIFICANCE

Eating disorders are debilitating conditions that can lead to malnutrition, social isolation, and even premature death. Though disordered eating thoughts and behaviors can affect anyone, adolescents in physically demanding and body image-driven activities including ballet dance are particularly vulnerable. Investigating how factors like body dissatisfaction and strength of identity are associated with disordered eating among high-risk groups is crucial for developing effective prevention and intervention methods that minimize harm.

Analysis of Serum Ferritin Levels in a Group of Elite Ballet Dancers

INTRODUCTION

Iron plays a significant role in energy production. However, it is not uncommon for athletes to be diagnosed with iron deficiency (ID), suggesting a correlation between performance and iron regulation. As a result, the International Olympic Committee has recommended iron screenings during health evaluations for elite athletes. Furthermore, athletes participating in esthetic sports are at increased risk for suboptimal iron intake due to disordered eating. Therefore, the purpose of this study was to investigate the distribution of serum ferritin (SF) in a cohort of elite ballet dancers and determine associations between vitamin D, anthropometric measures, stress injury, and dietary preferences.

METHODS

Electronic health records of 40 elite ballet dancers (22 female, 18 male), age 19 to 38 years old, from the 2020 to 2021 pre-participation physical screening were examined. Chi squared comparisons were calculated to evaluate the association between SF and additional variables (ie, gender, age, height, weight, body mass index, vitamin D, stress injury history, and dietary preferences). SF values were compared to published normal and athletic population data.

RESULTS

58.97% of participants displayed normal or above SF values (>50 ng/ml), while 41.02% displayed minimal (<50 ng/ml) to depleted (<0.12/ng/ml) SF values. Approximately, 68% of the female dancers were ID and did not meet the minimal value needed for athletes. Females were more likely to have lower SF distributions (x² [4] = 15.6377, P = .004) compared to male dancers. Additionally, dancers who reported dietary preferences (ie, vegetarian) were more likely to display lower SF distributions (x²[4] = 13.3366, P = .010).

CONCLUSION

Over half of the female elite ballet dancers were ID which is consistent with current research. Females were at a significant higher risk compared to male dancers who reported dietary preferences. These findings suggest iron screenings should be considered in elite dancer populations.

"My job is to keep my body healthy": biopedagogies, beauty and institutional greed in professional ballet

CONTEXT

The ballet institution is known for its aesthetic and performative standards. In professional dancers' everyday lives, self-improvement and body awareness entwine with striving for artistic excellence. In this context, 'health' has primarily been explored in relation to eating disorders, pain, and injuries.

AIM

This paper explores dancers' health practices, namely how they are shaped by the ballet institution and how they relate to broader health discourses.

METHODOLOGY

A reflexive thematic analysis was conducted upon interviews with nine dancers (each interviewed twice) using a theoretical framework based on the concepts of greedy institutions and biopedagogies.

ANALYSES

Two themes were developed: What it takes to be an 'insider' of the ballet institution and Learning to develop an acute embodied self-awareness. Dancers described ballet as a 'lifestyle' rather than a 'job'; practices of self-care defined by continuous self and body work were framed as necessary to meet the demands of this lifestyle. Participants 'played with' institutional and societal norms, often resisting docile bodies promoted within the ballet institution.

CONCLUSION

Dancers' constructions of health and the art of ballet as not fitting neatly into 'good' nor 'bad' make room to consider the tensions between adopting and resisting dominant health discourses in this institution.

The Footprint, Stabilometric, Pedobarographic Parameters of Professional Ballet Dancers

This work aims to assess footprint parameters in a group of professional ballet dancers and to determine the correlation between the aforementioned parameters and lateralization, stabilometric parameters, pedobarographic parameters and work environment conditions. A group subjected to tests consisted of 44 elite professional ballet dancers and the reference group was composed of 44 students. The test of balance and thrust under feet involved 30 s-long free standing with open eyes on a podographic platform. The research-related analysis was concerned with footprint parameters (foot length and width, Clarke angle, and Weissflog index), stabilometric parameters (path length and ellipse field, mean value of the velocity and deflection of the displacement of the center of the foot pressure on the ground) and pedobarographic parameters (percentage thrust on the right, left foot as well as the front and rear part the foot). Statistically significant differences between the groups were observed in relation to the stabilometric parameters, the percentage pressure of the left forefoot and the right heel, as well as the value of the Clarke angle (p ≤ 0.05). The longitudinal arch of the foot and the width of the foot in ballet dancers are not dependent on the total and professional career duration and weekly training volume.

Female Athlete Body Project Intervention with Professional Dancers: A Pilot Trial

As aesthetic athletes, professional dancers have increased vulnerability for eating disorders (EDs), with three times higher risk than non-dancers. Among ballet dancers, generalized risk for EDs associated with internalization of western cultural female beauty ideals is compounded by idealization of a ballet-specific body ideal, a combination that confers unique vulnerability for eating pathology. Empirical support has been established for an athlete-specific intervention promoting body acceptance and reduced eating pathology among general populations of young-adult women and female collegiate athletes; the current study adapted this intervention for pilot implementation among professional ballet dancers. Participants from two elite ballet companies (N = 19) were randomized to a control and intervention condition. All participants self-reported eating pathology and related variables pre- and post-intervention, and at six-week follow-up. Post-intervention, participants receiving the intervention demonstrated reductions in body dissatisfaction, p = .005, r = -.63, dietary restraint, p = .008, r = -.59, and eating pathology, p = .007, r = -.60, as compared to control group counterparts; significant differences were retained at follow-up. Results provide preliminary evidence that this intervention has the potential to provide a feasible and acceptable means of ED prevention in female professional ballet dancers. Barriers to feasibility are identified and discussed.

Kettlebell Training for Female Ballet Dancers: Effects on Lower Limb Power and Body Balance

The aim of the present study was to evaluate the effects of 5 month kettlebell-based training on jumping performance, balance, blood pressure and heart rate in female classical ballet dancers. It was a clinical trial study with 23 female dancers (age = 21.74 ± 3.1 years; body height = 168.22 ± 5.12 cm; body mass = 53.69 ± 5.91 kg) took part in the study. Participants were divided into two groups: a kettlebell group (n = 13), that followed a commercial kettlebell training protocol named the “Simple & Sinister protocol”, and a traditional dance training control group (n = 10). In the kettlebell group, kettlebell training completely replaced the jump and balance section of dance classes. Both groups performed balance and jumping tests before and after the training period. Blood pressure and the heart rate were also measured. The kettlebell group showed significant improvements in the balance tests (antero-posterior and medio-lateral oscillation) with both legs and eyes open as well as in all types of jump exercises (unrotated: +39.13%, p < 0.005; with a turnout: +53.15%, p < 0.005), while maximum and minimum blood pressure and the heart rate decreased significantly (max: -7.90%, p < 0.05; min: -9.86%, p < 0.05; Heart rate: -17.07%, p < 0.01). The results for the control group were non-significant for any variable. Comparison between groups showed significant differences for all variables analyzed, with greater improvements for the kettlebell group. Our results suggest that specific kettlebell training could be effective in improving jump performance and balance in classical dancers to a significantly greater degree compared to classical dance training.

Effect of Kinesio® Taping on Ankle Complex Motion and Stiffness and Jump Landing Time to Stabilization in Female Ballet Dancers

Ankle sprain is the most commonly diagnosed injury experienced by ballet dancers with few studies investigating preventive support measures such as Kinesio taping. The need exists to examine the mechanical support characteristics of Kinesio taping and effect of application on ankle motion and performance. This may be important to understanding the mechanical mechanisms attributed to Kinesio ankle taping and justify its use in the prevention and treatment of jump landing injuries in ballet dancers. This study compared Kinesio taping with and without tension and no tape (control) on active and passive measures of ankle complex motion in healthy ballet dancers. A secondary objective was to examine the effect of Kinesio taping on balance using time to stabilization. Participants performed three ballet jumps with single-leg landings on a force plate across three ankle support conditions consisting of Kinesio taping, sham-Kinesio taping, and no tape. Sagittal and frontal plane motion and load-displacement of the ankle complex for each support condition were obtained using an ankle arthrometer. Kinesio taping with tension significantly restricted inversion-eversion rotation and increased inversion stiffness of the ankle complex (p < 0.05). No significant differences were found among the three ankle support conditions for jump landing time to stabilization (p > 0.05). Arthrometric results indicate Kinesio taping significantly restricted ankle complex motion in the frontal plane that is associated with lateral ankle sprain. Objective information on the nature of Kinesio taping support can assist sports medicine practitioners when recommending ankle support to athletes.

Assessment of Dietary Intake, Energy Status, and Factors Associated With RED-S in Vocational Female Ballet Students

Elite ballet dancers are at risk of health issues associated with Relative Energy Deficiency in Sport (RED-S). This study determined the nutritional status, estimated energy status, and assessed factors related to RED-S in vocational female ballet students. Using a cross-sectional study design, we measured dietary intake (food diaries and 24 h dietary-recall) and energy expenditure (accelerometry) in vocational female ballet students (n = 20; age: 18.1 ± 1.1 years; body mass index: 19.0 ± 1.6 kg·m²; body fat: 22.8 ± 3.4%) over 7 days, including 5 weekdays (with dance training) and 2 weekend days (without scheduled dance training). Furthermore, we assessed eating behaviors, menstrual function, risk of RED-S (questionnaires), and body composition (dual x-ray absorptiometry). Energy and macronutrient intakes of vocational ballet students were similar during weekdays and weekend days (P > 0.050), whereas total energy expenditure was greater on weekdays than weekend days (P < 0.010; 95% CI: 212, 379). Energy balance was lower on weekdays (-425 ± 465 kcal·day^-1) than weekend days (-6 ± 506 kcal·day^-1, P = 0.015; 95% CI: -748, -92). Exercise energy expenditure was greater on weekdays (393 ± 103 kcal·day^-1) than weekend days (213 ± 129 kcal·day^-1; P < 0.010; 95% CI: 114, 246), but energy availability was similar between time periods (weekdays 38 ± 13 kcal·kg FFM·day^-1; weekend days 44 ± 13 kcal·kg FFM·day^-1; P = 0.110). Overall, 35% of participants had an energy intake <1,800 kcal·day^-1, 44% had reduced energy availability (30-45 kcal·kg FFM·day^-1), and 22% had low energy availability (<30 kcal·kg FFM·day^-1). Menstrual dysfunctions were reported in 40% of participants; 15 and 25% reported oligomenorrhea and secondary amenorrhea, respectively; while 65% were classified at risk of RED-S (based on the Low Energy Availability in Females Questionnaire). All participants had adequate bone health (bone mineral density Z-score: 1.1 ± 0.9 SD), but 20% had <85% expected body weight. The observation of an energy deficit in vocational female ballet students was primarily attributed to an inability to plan energy intake and thereby meet higher energy requirements during ballet training weekdays. Screening for factors associated with RED-S and tailoring education programs to inform energy and nutrition requirements for health and training are recommended in elite young ballet students.

Association between the female athlete triad and endothelial dysfunction in dancers

OBJECTIVE

To determine the prevalence of the 3 components of the female athlete triad [disordered eating, menstrual dysfunction, low bone mineral density (BMD)] and their relationships with brachial artery flow-mediated dilation in professional dancers.

DESIGN

Prospective study.

SETTING

Academic institution in the Midwest.

PARTICIPANTS

Twenty-two professional ballet dancers volunteered for this study.

INTERVENTIONS

The prevalence of the female athlete triad and its relationship to endothelial dysfunction.

MAIN OUTCOME MEASURES

Subjects completed questionnaires to assess disordered eating and menstrual status/history. They also completed a 3-day food record and wore an accelerometer for 3 days to determine energy availability. Serum baseline thyrotropin, prolactin, and hormonal concentrations were obtained. Bone mineral density and body composition were measured with a GE Lunar Prodigy dual-energy X-ray absorptiometry. Endothelial function was determined as flow-mediated vasodilation measured by high-frequency ultrasound in the brachial artery. An increase in brachial diameter <5% to hyperemic flow stimulus was defined a priori as endothelial dysfunction.

RESULTS

Seventeen dancers (77%) had evidence of low/negative energy availability. Thirty-two percent had disordered eating (EDE-Q score). Thirty-six percent had menstrual dysfunction and 14% were currently using hormone contraception. Twenty-three percent had evidence of low bone density (Z-score < -1.0). Sixty-four percent had abnormal brachial artery flow-mediated dilation (<5%). Flow-mediated dilation values were significantly correlated with serum estrogen and whole-body and lumbar BMD. All the 3 components of the triad plus endothelial dysfunction were present in 14% of the subjects.

CONCLUSIONS

Endothelial dysfunction was correlated with reduced BMD, menstrual dysfunction, and low serum estrogen. These findings may have profound implications for cardiovascular and bone health in professional women dancers.