Pathogenic weight‐control methods and self‐reported eating disorders in female elite athletes and controls

Norwegian University of Sport and Physical Education, Oslo, Norway
Scandinavian Journal of Medicine and Science in Sports (Impact Factor: 3.17). 01/2007; 3(3):150 - 155. DOI: 10.1111/j.1600-0838.1993.tb00379.x

ABSTRACT To determine the use of pathogenic weight-control methods and prevalence of self-reported eating disorders (ED) among female elite athletes and non-athletic controls, the Eating Disorder Inventory (EDI) and a self-developed questionnaire were administered to the total population of Norwegian female elite athletes (n=603) and age- and home community-matched controls (n=522). The response rate in both athletes and controls was 86%; 97% of the athletes and 90% of the controls had body mass index (BMI) values within or below the optimal level (20–25). Athletes had a significantly lower mean BMI 20.8 (95% confidence interval (CI), 20.7–20.9) than controls 21.5 (95% CI 21.3–21.7). A similar fraction of the athletes (31%) and controls (27%) were dieting. Most athletes dieted to enhance performance (73%); most controls dieted to improve appearance (83%). Significantly more athletes (11%) than controls (7%) used pathogenic weight-control methods. Athletes competing in aesthetic and endurance sports were the leanest groups, and athletes competing in aesthetics, endurance- and weight-dependent sports most frequently reported the use of the more severe pathogenic weight-control methods. A similar fraction of athletes (22%) and controls (26%) were classified as being at risk of developing ED based on the subscale scores of the EDI. However, a higher fraction of athletes in aesthetics-, endurance-, and weight-dependent sports than athletes in technical sports, ballgames, power sports and non-athletic controls were classified as being at risk of developing ED. In contrast to previous reports, our results demonstrated that a number of athletes also competing in sports where the participants are considered less weight-conscious were using pathogenic weight-control methods (technical 10% and ballgames 8%). A similar percentage of athletes (12%) and controls (11%) actually reported having an ED.

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    ABSTRACT: The aims of this study were to analyze the psychometric properties of the Spanish version of the Three-Factor Eating Questionnaire-R18 (TFEQ-SP), as well as determine its validity by evaluating the relationship of the TFEQ-SP with different parameters related to body mass index, weight perception, perception of physical fitness, self-esteem, and food intake, as well as with weight control-related variables. A total of 281 participants (aged 18.38 ± 6.31) were studied. The factor analysis yielded three factors: cognitive restraint (CR), uncontrolled eating (UE), and emotional eating (EE). The internal consistency of the TFEQSP was determined by means of Cronbach’s α coefficient, with values ranging between 0.75 and 0.87. Higher scores on CR were found in women (p < 0.5), overweight/obese participants (p < 0.001), participants with lower self-esteem (p < 0.05), participants who overestimated their weight (p < 0.001), participants who weighed themselves frequently (p < 0.001) and those who were about to go on a diet (p < 0.001). Higher EE scores were found in participants with lower self-esteem scores (p < 0.05), among participants with a poorer perception of their physical fitness (p < 0.01) and when participants were about to diet (p < 0.05). Higher scores on UE were observed in case of poorer perception of physical fitness (p < 0.05). The validation study of the TFEQ-SP meets the requirements for measuring the three different facets of eating behavior: CR, UE, and EE.
    Nutrients 12/2014; 6:5619-5635. DOI:10.3390/nu6125619 · 3.15 Impact Factor
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    ABSTRACT: Many athletes struggle with disordered eating or eating disorders (ED) as they attempt to conform to demands or competition regulations that might be ill-suited to their physique. In this situation, participation in sports may lead to an array of health concerns that may adversely affect the athlete’s short and long-term health at a variety of performance levels and sports. The peak onset of ED is adolescence, when most athletic participation and competition takes place and athletes begin to focus on a particularly sport. For athletes, the biological changes occurring during adolescence might affect not only attitudes toward weight and shape, but also performance. To prevent the medical and psychological consequences related to ED, early intervention and identification is important. Aims: The overall aim of this thesis was to examine the effect of a one-year school-based intervention program to prevent the development of new cases of ED and symptoms associated with ED among adolescent male and female elite athletes (Paper II). An educational program was developed for coaches and included as a separate part of the intervention program. In Paper III, we examine the effect of the education program on the coaches’ knowledge about nutrition, weight regulation, and ED. In Paper I, we investigate the prevalence of ED among adolescent elite athletes compared to non-athletic controls. Finally, we wanted to design and validate a brief screening questionnaire with the ability to discriminate between athletes with and without an ED (Paper IV). Methods: First-year students (athletes) and their coaches at all the Norwegian Elite Sport High Schools (n=16) and first-year students (controls) at two randomly selected regular high schools participated in the three school year project period (2008 to 2011). In phase I (pretest) of the study all the schools were included and the students were screened for symptoms associated with ED and ED. In phase II, the Elite Sport High Schools were stratified (by size) and randomized to the intervention (n=9) or control group (n=7). The intervention group received the intervention program. Data from the athletes and their coaches at phase I and II, and data from the controls at phase I are included in this thesis. Paper I: In this cross-sectional study we used a two-tiered approach: self-reported questionnaire (part I) and clinical interview (part II). The questionnaire, including the Eating Disorder Inventory 2 (EDI-2) and questions related to ED, was completed by 611 athletes (90%) and 355 controls (84%). Subjects reporting symptoms associated with ED were classified as “at risk” for ED. In part II, all at-risk athletes (n=153), a random sample not at risk for ED (n=153), and a random sample of 50% of the controls classified as at risk (n=91) and not at risk (n=88) were invited to the clinical interview (Eating Disorder Examination) to screen for ED. Paper II: The 611 athletes participating in Paper I formed the basis of this randomized controlled trial (RCT). After the pretest (Paper I) all athletes (and coaches, Paper III) from each school were randomized to the same treatment arm (intervention or control). A final sample of 465 (93.8%) athletes was followed during high school. The athletes completed the questionnaire screening at pretest (Paper I), pottest 1 (after the intervention) and posttest 2 (9-months after intervention). Clinical interviews were conducted after pretest and at posttest 2 (one-year after intervention). Paper III: In this part of the RCT 76 coaches (93.8%) employed at and working with the first-year students at the Elite Sport High Schools were followed during the project period. At pretest and posttest (9-months after intervention) the coaches completed a questionnaire including questions concerning nutrition, weight-regulation, and ED. Paper IV: We conducted this prospective cross-sectional study in three phases. Phase I consist of data from the screening at pretest among the female athletes (Paper I). Based on the questionnaire screening we extracted items with good predictive abilities for an ED-diagnosis to the Brief ED in Athletes Questionnaire (BEDA-Q) version 1 and version 2. Version 1 consisted of 7-items from the EDI-Body dissatisfaction, EDI-Drive for thinness, and questions regarding dieting. In version 2, two items from the EDI-Perfectionism subscale were added. In phase II, the external predictive validity of version 1 was tested involving 54 age-matched elite athletes from an external dataset. In phase III, the predictive ability of posttest assessments was determined among athletes with no ED at pretest (n=53, 100%). Main results: 1) No new cases of ED in athletes at the intervention schools one-year after the intervention program, while 13% of the females and one male at the control schools developed ED. 2) Coaches at the intervention schools had higher scores on total knowledge, weight-regulation and ED compared to coaches at the control schools after intervention. The intervention also showed positive effects on the coaches’ subjective evaluation of their ED knowledge. 3) Higher prevalence of ED in adolescent elite athletes than controls (although more controls than athletes reported symptoms associated with ED. 4) BEDA-Q version 2 showed higher discriminative accuracy than version 1 in distinguishing athletes with and without an ED, and higher diagnostic accuracy in predicting new cases of ED than version 1. Conclusions: A one-year school-based intervention program can prevent new cases of ED and symptoms associated with ED in adolescent female elite athletes. The intervention part targeting the coaches with strategies of identification, management and prevention of ED produced significant effect of at least 9-months. It is confirmed that the prevalence of ED is higher among adolescent elite athletes than controls and higher in female than male adolescent elite athletes. Finally, BEDA-Q containing 9-items reveal promising psychometric and predictive features to distinguish between adolescent female elite athletes with and without ED. Key words: athletes, coaches, eating disorders, prevalence, prevention, screening, instrument, intervention
    02/2015, Degree: PhD
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    ABSTRACT: The increase in cases of eating disorders, particularly among sportsmen and women, has taken on worrying pro-portions over recent years. Male and female athletes com-peting in sports that require the careful control of body weight and link slight builds with high performance (as is often the case in artistic events) are a high risk group for developing eating disorders. The aim of this study was to present the various types of eating disorder and their fre-quency in the world of sport. It also focused on the root causes of eating disorders, the effect they have on the body and, moreover, measures for their prevention and treatment. In this regard, the experiences of five former competitive rhythmic gymnasts, with years of experience in the sport and medals to their names, were carefully stud-ied. An in-depth phenomenological study was conducted using open, semi-structured interviews in order to explore and understand the ways in which these individuals relat-ed to food and nutrition during their time as athletes. The results showed that the sportswomen taking part in the survey ran the risk of suffering from eating disorders for two main reasons. First, they displayed behaviours and personality traits common to people with eating disorders. And second, they submitted to the limitation or complete cessation of their food intake forced upon them by their environment (by coaches, parents, etc.).
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