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Eating Disorders in Female Athletes
Abstract
Eating disorders can lead to death. The prevalence of subclinical and eating disorders is high among female athletes, and the prevalence of eating disorders is higher among female athletes than nonathletes. Athletes competing in sports where leanness or a specific bodyweight is considered important are more prone to develop eating disorders than athletes competing in sports where these factors are considered less important. It appears necessary to examine true eating disorders, the subclinical disorders and the range of behaviours and attitudes associated with eating disturbances in athletes, to learn how these clinical and subclinical disorders are related. Because of methodological weaknesses in the existing studies, including deficient description of the populations studied and the methods of data collection, the best instrument or interview method is not known. Therefore, more research on athletes and eating disorders is needed. Suggestions of the possible sport specific risk factors associated with the development of eating disorders in athletes exist, but large scale longitudinal studies are needed to learn more about risk factors and the aetiology of eating disorders in athletes at different competitive levels and within different sports. Further studies are required on the short and long term effects of eating disorders on athletes' health and athletic performance.
... Eating disorders are serious mental illnesses and make a significant negative impact on the individual's quality of life (Bratland-Sanda and Sundgot-Borgen, 2012). These disorders are characterized by a preoccupation with food, body weight, and shape that leads to behavior such as starvation, fasting, binge eating, and purging and excessive exercise (Coelho et al., 2014). ...
... According to the Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition (DSM-5), common eating disorders include anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorders (BED), and eating disorders not otherwise specified (EDNOS) (Pope et al., 2015). The higher prevalence of eating disorders seen among female athletes compared to male athletes (Bratland-sanda and Sundgot-borgen, 2012). Research in Norway showed that prevalence of eating disorders in female athlete was 20% and in the male athletes is only 8% and the population of non-athletes were 9% (Ismailova and Gazdowska, 2016). ...
... Research in Norway showed that prevalence of eating disorders in female athlete was 20% and in the male athletes is only 8% and the population of non-athletes were 9% (Ismailova and Gazdowska, 2016). Other studies reported that the prevalence of eating behavior disorders varied from 0-19% in male athletes and 6-54% in female athletes (Bratland-sanda and Sundgot-borgen, 2012). ...
Eating disorders in young female athletes is a serious psychological and health disease which could become an early problem on Female Athlete Triad. Eating disorders are influenced by internal and external factors. This study aimed to determine the risk factors for eating disorders in young female athletes. An observational study with a crosssectional design on eighty-six young female athletes was conducted with consecutive sampling method. Subjects in this study were athletes in athletics, weightlifting, volleyball, beach volleyball, swimming, rowing, fencing, Pencak Silat, karate, taekwondo, judo, sepak takraw, table tennis, and boxing. The inclusion criteria of the subject athletes were young female athletes aged 11-21 years registered at the study site, did not consume alcohol, and voluntary. The nutritional status of the subjects was measured by their Body Mass Index for age score. Eating disorder was measured using the Eating Attitude Test-26 questionnaire and Eating Disorder Diagnostic Scale for the type of eating disorders, Rosenberg Self Esteem for Self Confidence, Depression Anxiety Stress Scale-42 for stress level, and Body Shape Questionnaire for body image perception. This study used univariate analysis, bivariate analysis with chi-square and multivariate analysis with logistic regression test. The prevalence of eating disorders risk among the young female athletes in this study was approximately 37.2%, where 9.3% of subjects were bulimia, 5.8% were on the binge of eating disorder, and 22.1% subjects experienced eating disorder not otherwise specified (EDNOS). The multivariate analysis showed that the risk factor of eating disorders in young female athletes was the negative body image perception (p = <0.001; RP:10.5) and stress (p = 0.023; RP:3.5). Nutritional status, self-confidence, and type of exercise were not proven as the risk factors of eating disorder among young female athletes. Based on this study, it can be concluded that the negative body image perception and stress are the risk factors of eating disorders among young female athletes.
... Therefore the three conditions were renamed to (a) menstrual function, (b) bone mineral density, and (c) energy availability, to more appropriately depict the entire spectrum, which may vary from excellent health to sickness in each component [37]. Each one of the triad components may exist independently, but it seems that the emphasis on weight loss and low energy intake may initiate a cycle where all three diseases occur in sequence [43]. "Female Athlete Triad" is particularly harmful during adolescence, as the achievement of maximum bone mass density, as well as the development and maturation of the reproductive system, take place at this age [14,48]. ...
... Although the "Female Athlete Triad" is a syndrome that concerns only females, there is growing evidence that male athletes (especially from weight-class sports), may also experience the underlying causes of low energy availability, as they engage in unhealthy weight control behaviors [42,73,74]. These practices also cause low bone mineral density in males [93], as long as other health and performance consequences of disordered eating [43,53,73]. In 2014, the "International Olympic Committee" (IOC), considering the fact that male athletes are also affected by disordered eating and low energy availability, introduced the term of "Relative Energy Deficiency in Sport" (RED-S) [41]. ...
In their attempt to achieve the optimum weight or body shape for their activity, athletes frequently use harmful weight-control practices that may lead to the development of disordered eating or eating disorders. These practices are linked to several medical and mental consequences that may be more serious in adolescent athletes, as their bodies must meet both intensive growth demands and training requirements at the same time. Among other consequences, adolescent athletes may be at nutritional risk, due to their high nutrient needs and unhealthy eating behaviors. A literature review was conducted to examine the main nutritional risks and malnutrition issues faced by adolescent athletes that present disordered eating attitudes or eating disorders. Most studies refer to adult elite athletes, however research on adolescent athletes also indicates that the most common nutritional risks that may arise due to disordered eating include energy, macronutrient and micronutrient deficiencies, dehydration and electrolyte imbalances and changes in body composition that may lead to menstrual abnormalities, and decreased bone mass density. Educational programs and early detection of disordered eating and eating disorders are crucial to avoid the emergence and ensure timely management of nutrition-related problems in the vulnerable group of adolescent athletes.
... An unexpected finding of this study was the surprisingly low priority that most coaches ascribed to ED information compared to nutrition information, with many coaches stating that solid knowledge of nutrition and weight regulation precluded the need for increasing athletes' knowledge about ED. This was especially puzzling given that most coaches accurately acknowledged the complex nature of ED and cited multiple factors that contribute to the development of ED, which mirrors prior findings [29]. Indeed, no coach cited lack of sufficient nutrition knowledge as a risk factor for ED. ...
... It is important to note that these normative dietary practices, while not constituting ED by themselves, are nonetheless harmful. The toll these practices take, and their possible links to the development of ED, have been discussed elsewhere[28][29][30]. ...
This study investigates elite coaches' attitudes toward eating disorders (ED), knowledge about ED, and early intervention skills when confronted with possible ED in their female athletes. We interviewed 18 coaches in Sweden responsible for athletes representing national teams in the three sports categories most at risk for ED: Aesthetic, weight class, and endurance. The interviews revealed that, although most coaches knew athletes with ED, they did not perceive ED as a problem in their sport. The majority of coaches cited difficulties in identifying ED symptoms, especially symptoms associated with bulimia nervosa. Coaches also described several barriers in approaching the athletes, including the athletes' denial of ED, lack of female colleagues on the team and the lack of easily accessible resources for treatment referral on both the national sports federation and the club levels. This study reveals that elite coaches have insufficient capacity to identify ED and conduct early intervention, resulting in delayed treatment.
... Ohne Behandlung können sowohl Anorexie als auch Bulimie tödlich enden,. Die Mortalitätsrate liegt bei 5-18% (Sundgot-Borgen 1994, Feiereis 1997. Es gibt eine gewisse familiäre Disposition. ...
... Essstörungen treten aber auch in allen anderen Sportarten auf. Sieht man auf eine prozentuale Verteilung von Essstörungen im Sport, liegen die ästhetischen Sportarten mit 35% an der Spitze, aber auch Budosportarten (25%) und Ausdauersportarten (20%) zeigen eine große Zahl an anorektischen und bulimischen Patienten (Helge 2001, Sundgot-Borgen 1994, Leon 1991 ...
... At the same time, there are reasons to question whether participation in competitive sports lays tremendous stress on competition and achievement in a way that does not promote mental health. Participation in sports, and body focus, has, in some studies, been shown to increase the likelihood of developing mental health problems such as eating disorders (16,17), although the association is debated (18). ...
... On the other hand, the SDQ has low sensitivity in predicting some psychiatric symptoms, such as eating disorders (37), which could be an overrepresented diagnosis in competitive sports (16,38). ...
Healthy diet was measured using nine questions on how often the respondents consumed different healthy and unhealthy food products/groups (vegetables, fruit, whole-grain bread, milk/yoghurt, potatoes, sweets, coke/soda, hamburger/french fries, and chips). Response options to these questions were as follows: rarely or never; less than once a week; several times a week; daily; several times a day. Each question was dichotomized into 0 (never or rarely – less than once a week) or 1 (several times a week or more). Vegetables, fruit, whole-grain bread, milk/yoghurt and potatoes were added together to form a healthy diet variable, such that only the response “several times a week or more” qualified as a yes.
All analyses were performed using SPSS, version 23.0. Hierarchical logistic regressions were used to investigate the association between sports participation and mental health problems in terms of SDQ total symptom score, impact on daily life, and the four mental health subscales. Background variables included in the analysis as controls – such as age, gender, and perceived economic situation – were entered in step 1. Sports participation was entered as a categorical variable in step 2. The three mediators were entered in step 3. In some of the analyses they were entered individually, whereas in others they were entered simultaneously. Mediation (of weekly exercise, healthy diet, and number of friends) was determined by examining significant changes in the relationship between sports participation and mental health problems after the inclusion of the proposed mediator. The mediating role of weekly exercise, healthy diet, and number of friends was examined by entering all mediators either individually or simultaneously in the PROCESS module in SPSS (28), model 4. Mediation was tested for significance for the direct pathway in addition to the indirect pathways using the bootstrap method and Sobel test.
The total symptom score and its impact on daily life were significantly lower among those participating in team sports (p < .005) (see Table 4). Weekly exercise, healthy diet, and number of friends were then included individually to investigate whether the associations changed upon addition of the mediators. Despite a decline in significance in the association between participation in either noncompetitive or competitive sports and total symptom score in those participating in team sports, the three regressions remained significant (p < .001), indicating only a partial mediation of all three factors. The results of the mediation analysis indicated a significant direct and indirect relationship between participation in either noncompetitive or competitive sports and total symptom score for all three mediators. There was a weaker association between sports participation and impact on daily life than was seen for total symptom scores. The mediation analysis confirmed the significance of both the direct and the indirect pathways for all three mediators indicating only a partial mediation; however, the differences in odds ratios before and after inclusion of the mediators were quite small. For those participating in noncompetitive sports, there was a nonsignificant direct association when weekly exercise or number of friends was included, indicating full mediation.
... Stawia to pod zna kiem za py ta nia świa do me za spo ka janie zwięk szo nych po trzeb or ga ni zmu oraz stwa rza wa run ki do wy stę po wa nia nie do bo rów ener ge tycznych. Ob ser wa cje tę po twier dza wie le pu bli ka cji na te mat za bu rzeń odży wia nia u spor tow ców [18,19,20,21,22,23]. Zwięk szo na czę stość wy stę po wa nia anemii wśród ba da nych ko biet rów nież mo że być potwier dze niem wy stę po wa nia nie pra wi dło wo ści w diecie spor t sme nek. ...
... This is the reason of questioning the fact that they consciously meet their increased caloric intake demands and the reason of frequent energy deficits among this population. These observations are confirmed by nu merous publications on eating disorders among athle tes [18,19,20,21,22,23]. The increased preva len ce of anemia among the studied sample of female athletes may also confirm the dietary abnormalities in female athlete population. ...
... Compared to male athletes, female athletes are more likely to engage in compulsive exercising and pathological weight-loss methods such as abuse of laxatives or diets pills, selfinduced vomiting, and fasting with the goal to achieving top sporting performance and superior physical condition (12). Data indicate that although the prevalence of clinical eating disorders ranges from 0 to 8% among professional and college female athletes (49), many of them are "at risk" for eating disorders which places them at risk for menstrual irregularity, bone injuries, cardiovascular problems, depression, lower athletic performance, social isolation, and poorer quality of life (32). ...
... DE and eating disorders among female athletes often go unnoticed and it is therefore difficult to estimate their real prevalence. Research has indicated that the reported lifetime prevalence of anorexia nervosa and bulimia nervosa in female athletes ranges from 0.5 to 3.7% and from 1.1 to 4.2%, respectively (49). Furthermore, disordered eating, which is characterized by abnormal eating behaviors but does include all the diagnostic criteria for eating disorders, has a lifetime prevalence rate ranging from 0 to 27% (18). ...
THIS ARTICLE PROVIDES AN OVERVIEW OF CURRENT LITERATURE RELATED TO NUTRITIONAL CONSIDERATIONS FOR THE FEMALE ATHLETE. THE PREVALENCE OF THE FEMALE ATHLETE TRIAD, EATING DISORDERS, AND BODY IMAGE ISSUES AMONG FEMALE ATHLETES WILL BE REVIEWED. FURTHERMORE, DETRIMENTS IN HEALTH AND/OR SPORTS PERFORMANCE FROM LACK OF PROPER NUTRITION WILL BE DISCUSSED. RECOMMENDATIONS FOR APPROPRIATE NUTRITIONAL GUIDELINES TO SAFELY DECREASE BODY FAT, INCREASE MUSCLE MASS, AND IMPROVE OVERALL SPORTS PERFORMANCE WILL BE ADDRESSED. CONSIDERATIONS WHEN PROVIDING BODY COMPOSITION ADVICE FOR THE FEMALE ATHLETE ARE REVIEWED.
... Hausenblas & Carron, 1999;Sundgot-Borgen & Torstveit, 2004). This effect is particularly well established among lean sport participants (Sundgot-Borgen, 1993, 1994a, 1994b. However, other research has reported no difference between athletes and non-athletes (e.g. ...
... club, county, regional, national, etc.). To ensure consistency with previous research that has studied eating disorders in sport, the type of sport was then categorised into lean sports or non-lean sports (Sundgot-Borgen, 1993, 1994a, 1994b. The lean sports included sports that were aesthetic (e.g. ...
The sport literature has produced equivocal results as to whether sport participation is a protective or risk factor for disordered eating. One mechanism by which it could be a risk factor is the increased drive or compulsion to exercise. This study compared the levels of disordered eating and compulsive exercise between adolescent sport and non-sport participants. A sample of 417 male and female adolescents, aged 14-16 years old, was recruited from UK secondary schools. Participants completed questionnaire packs that included: the Eating Disorder Inventory; a measure of exercise behaviour; and the Compulsive Exercise Test (CET). Non-sport participants reported significantly greater body dissatisfaction than sport participants, and this was true for boys and girls. Significant group differences were also reported for many of the CET scales, with sport participants generally reporting greater levels of compulsive exercise than non-sport participants. Implications of these results are discussed. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.
... the wide range for the latter group is due to inconsistent criteria for defining De and the lack of standardized assessment tools for this population (Bonci et al., 2008). regarding clinical-level eD diagnoses-the end of the behaviour continuum-the lifetime prevalence of Bn and An in female athletes range from 1.1% to 4.2% and 0.5% to 3.7%, respectively (Sundgot-Borgen, 1994). ...
... moreover, given the large amount of time and effort that athletes dedicate to their respective sport (e.g., trainings, practices, etc.), it is especially important to identity sports-related predictors of De, in order to prevent the onset of symptoms and the progression of the disease to its clinical phase. many eD correlates have been suggested (Sundgot-Borgen, 1994); however, in classifying correlates as predictors, a causal relationship must be demonstrated (Kazdin, Kraemer, Kessler, Kupfer, & Offors, 1997). Because cross-sectional investigations only quantify the association be-tween the exposure of a variable and an outcome, these studies are susceptible to the reverse causality phenomenon and disqualify causal interpretation. ...
Despite the large role of oral communication in day-to-day interactions, attitude researchers within social psychology have focused predominantly on the impact of written messages on the persuasive process while largely neglecting to investigate the role played by voice. In the following we discuss two competing perspectives, each of which suggests various ways in which different emotional qualities of voice may influence the success of an affectively-based persuasive appeal. We summarize findings from novel research investigating this question and suggest several potential directions for future study.
... SungotBorgen [18] [24]. ...
Abhängig von der Sportart hat Leistungssport geschlechtsspezifische Auswirkungen auf die hormonelle Entwicklung und das Wachstum
von jugendlichen Athleten. Bei gewichtsassoziierten Sportarten wie Kunstturnen, Eiskunstlaufen und Ballett treten Störungen
des normalen Pubertätsverlaufs und des Wachstums besonders bei Mädchen auf. Der Begriff „Athletinnentrias“ beschreibt einen
Symptomkomplex aus einer Essstörung mit niedriger Nahrungsaufnahme, Amenorrhö und einer Osteoporose. Trainingsbeginn, Belastungs-
und Leistungsspitzen sind bei Jungen und Mädchen in den einzelnen Sportarten unterschiedlich verteilt und haben – abhängig
von der Art des Sports – unterschiedlich stark ausgeprägte Auswirkungen auf den Hormonhaushalt.
In sport disciplines in which lean body mass is required for better performance, such as gymnastics, figure skating, and ballet,
disturbances of pubertal development and growth of young athletes may be present, occurring in females more often than in
males. The term “female athlete triad” describes the combination of amenorrhea, osteoporosis, and an eating disorder with
low caloric intake. The start of high-intensity training, the training load, and the age of peak performance vary not only
from sport to sport but also between girls and boys. Therefore, the impact of high-intensity training on growth and pubertal
development differs depending on the nature of the sport.
... A possible explanation is that female athletes face sociocultural and physiologic limitations that may prevent them from performing high training loads. Physical appearance alterations that go against canons of beauty (25), the greater tendency to suffer from eating disorders (64), or the perception of athletic identity exclusivity (12) might be preventing some athletes from expressing their full sporting potential. Moreover, a predominance of male coaches, who are less able to empathize with such sex-related issues, may be exacerbating the phenomenon (25). ...
Limited data for elite male and female triathletes exist in the academic literature. This comparative study examined the training loads and physiologic performance data, for the general preparatory period(s) within the training years 2021–2024, as a function of both sex and competition level, in 33 top triathletes. 23 male and 10 female international- or national-level elite athletes took part in the study. The individual athlete’s training data were collected for an average period of 18 weeks, at the outset and end of which cardiorespiratory and lactate testing was performed. The nonparametric Mann–Whitney U test was performed to detect statistical differences. Running speed at maximum oxygen uptake (SVO2max) was the test-related variable that showed the greatest differences with performance tier in male (p 5 0.001; effect size [ES]: 2.07) and female athletes (p 5 0.031; ES: 1.74). Training volume was higher in the international athletes (p: 0.001; ES: 1.52). Moreover, mean weekly training load was significantly positively correlated with physiologic performance in the running and cycling tests, especially with SVO2max (r: 0.651; p: 0.05). However, the extent of physiologic performance improvements that occurred during this period did not differ statistically between groups in any variable. It is important, therefore, that the professional level of an athlete is considered when the coach(es) decide what is his/her most appropriate, assimilable, training load. Both SVO2max and the ability to assimilate high training loads seem to be important variables to take into account in the triathlon talent detection process.
... In the literature, individual sports women represent a high-risk category for DEAB (Uriegas et al., 2023) and DEAB appear particularly among endurance athletes (e.g., middle-distance, marathon and trail runners, and triathletes) (Nattiv et al., 2007;Neumark-Sztainer et al., 2007;Sundgot-Borgen and Torstveit, 2004). Indeed, some authors report that in endurance sports: (a) low body weight may play a role in movement efficiency and speed (Scoffier-Mériaux and D' Arripe-Longueville, 2012;Smolak et al., 2000;Sundgot-Borgen, 1994;Sundgot-Borgen and Torstveit, 2004); (b) thinness is associated with sporting performance (Currie, 2010); (c) endurance athletes achieve generally the desired body type through disordered eating attitudes that can lead to eating disorders (Smolak et al., 2000). The studies that have been conducted so far have identified certain variables that can be used to determine whether an athlete's eating habits lie on the dysfunctional side of the continuum. ...
Background
Research on sport psychology suggests that athletes are at risk of developing dysfunctional eating attitudes and behaviors (DEAB), however the origins of these behaviors remain largely unexplored. The present study aims to identify factors (i.e., personality traits, anxiety levels, eating attitudes and behaviors, the internalization of sport thinness norms, and resilience) associated with the development of DEAB among female endurance athletes, in training and competition.
Method
A longitudinal follow-up study was conducted among 14 elite female athletes who were tested daily, weekly, and quarterly over 12 months in 2022, for a total of 545 measures. Participants completed questionnaires assessing personality traits, anxiety levels, eating attitudes and behaviors, the internalization of sport thinness norms, and resilience. Descriptive statistics were calculated for all study data, and odds ratios were conducted to compare the variance of psychological factors and sporting factors depending on the level of DEAB and the sport period. Significance was set at p < 0.05.
Results
Overall, 28% of our sample of athletes were identified with DEAB. Among those with DEAB, scores for agreeableness, anxiety, and competitive anxiety were significantly higher, while scores for resilience were significantly lower than those without DEAB. During the competitive season, scores for self-regulatory eating attitudes and the internalization of thinness norms were significantly higher than during the training period.
Conclusion
Our results suggest a greater probability of DEAB among athletes who exhibit the trait of agreeableness, experience anxiety during competition, and lack resilience. The competitive season was also identified as a period conducive for developing DEAB compared with the training period. Based on these results our study suggests preventive measures that can be implemented with athletes displaying these traits, with a particular emphasis during the competitive phase.
... The present study failed to observe any differences in other aspects of ON symptomatology (e.g., EHQ-Problems, EHQ-Feelings) and ED risk (e. g., EAT-26 scores for dieting, bulimia and oral) between athlete groups. A potential explanation for this may be due to the self-reported nature of disordered eating behaviours, as it has been previously found that elite athletes tend to under-report symptoms of EDs (Sundgot-Borgen 1994;Torstveit, Rosenvinge, & Sundgot-Borgen, 2008). Moreover, it is common for athletes, regardless of level, to maintain control over their diet, therefore detecting ON behaviours may prove to be difficult, as symptoms may be concealed by an athlete's motivation to consume a healthy diet for performance gains (Segura-García et al., 2012). ...
... Although we hypothesized that we would find differences in clinical features and personality traits between the ED-A and ED-NA groups, when analyzing the data, no relevant statistical differences were found. These findings were in line with previous results [47,48] and suggest that, due to the clinical similarities between the athlete and non-athlete groups, similar clinical approaches may be appropriate. ...
Eating disorders (ED) have frequently been described among athletes. However, their specific features and therapy responses are lacking in the literature. The aims of this article were to compare clinical, psychopathological and personality traits between ED patients who were professional athletes (ED-A) with those who were not (ED-NA) and to explore differences in response to treatment. The sample comprised n = 104 patients with ED (n = 52 ED-A and n = 52 matched ED-NA) diagnosed according to DSM-5 criteria. Evaluation consisted of a semi-structured face-to-face clinical interview conducted by expert clinicians and a psychometric battery. Treatment outcome was evaluated when the treatment program ended. ED-A patients showed less body dissatisfaction and psychological distress. No differences were found in treatment outcome among the groups. Within the ED-A group, those participants who performed individual sport activities and aesthetic sports presented higher eating psychopathology, more general psychopathology, differential personality traits and poor therapy outcome. Individual and aesthetic sports presented more severity and worse prognosis. Although usual treatment for ED might be similarly effective in ED-A and ED-NA, it might be important to develop preventive and early detection programs involving sports physicians and psychologists, coaches and family throughout the entire athletic career and afterwards.
... Interestingly, female Wushu Sanda athletes took a higher number of days before the competition to lose weight (25.4 ± 18.46 days) when compared to male Wushu Sanda athletes (16.8 ± 17.32 days). Female athletes tend to be more concerned about their weight and body shapes [17], and it may justify why female athletes started losing weight earlier than male athletes. However, previous studies show that RWL may not be influenced by gender since this practice is transient, and both genders use to lose weight just for competing in CS [18,19]. ...
... However, recent attempts to include AN and BN in worldwide quantification burdens have shown that impairment and mortality are caused by such disorders [6]. Weight and EDs are not uncommon and can be physically and mentally long-term [7]. An increasing compilation of literature has shown its correlation with poorer quality of life, the major burden of illness, and an elevated risk of stress, misuse of drugs, and suicide. ...
Details
It is no surprise that eating disorders (EDs) are increasing all over the planet. With the emergence of global westernization, development in technology, and societal changes, nearly all regions of the globe have been influenced by the concept of a perfect body image and height. EDs are a considerable public concern, a bewilderment for psychologists and a challenge for physicians. The primary EDs include anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). AN is an ED that is psychological and possibly life-threatening. Usually, people with AN experience an exceedingly low body weight due to their height and body shape. The highest rate of occurrence is between 14 and 17 years of age. BN is an extreme, lifethreatening, neurological ED in which you have binge eating cycles. You may not have any sense of balance in your diet throughout these binges. The weight-control engagement of patients with AN and BN results in various physiological shifts. EDs can control your lives and can be quite hard to cope with. Yet you will develop a better understanding of who you are by therapy, return to healthy eating and exercise, and undo any of the severe complications of AN. Investigation into EDs has yielded valuable new information over the past few decades, notably involving the psychological features and care of patients. The purpose of this study/review is to expand the knowledge of the people about these EDs, their global burden, diagnostic criteria, risk factors, medical complications, management, and the newly added avoidant/restrictive food intake disorder.
... As anticipated, there is a strong two-way link between EA and eating disorders [38]. Eating disorders are often accompanied by excessive levels of exercise; on the other hand, individuals affected by EA are often excessively concerned about their body image, weight, and strict dietary control [15, [44][45][46]. Around 39-48% of people with eating disorders also suffer from EA [44,47]. ...
In a society that strives for appearance, fitness is increasingly viewed as a means to reach a certain aesthetic ideal, rather than a way to improve health and physical performance. Every day millions of posts appear on social media promoting a visual representation of apparently fit, healthy and 'perfect' bodies. Combining personal accounts, clinical cases, and scientific research, this book explores how such new trends in society can lead to the development of exercise addiction and body image disorders. It explains how such a concern with physical appearance can act as a precursor or be symptomatic of other conditions, such as eating disorders, mood disorders, and the use of performance and image enhancing drugs. It highlights throughout the importance of raising awareness amongst health professionals, including psychiatrists, psychologists, mental health nurses, social workers and primary care physicians, of this growing challenge to prevent harm and improve treatment.
... Such findings are also present in athlete populations where qualitative evidence has suggested that negative verbal commentary from significant others (e.g., coach, teammates, parents) in the form of feedback or messages made about the athletes' physical appearance were highly influential in the development or worsening of their clinical eating disorder (Arthur-Cameselle & Quatromoni, 2011;Muscat, 2001). Indeed, up to 19% of athletes reported that receiving a critical weight/shape comment was a contributor to the onset of their disordered eating (Sundgot-Borgen, 1994). However, studies have typically limited their focus to the experiences of young, female, lean sport athletes, where the prevalence of receiving a critical weight/shape comment is very high (e.g., 73% in a dance population; Goodwin et al., 2014). ...
Critical comments from parents or coaches about weight or shape have been associated with athletes' body dissatisfaction and disordered eating. However, research is yet to explore how critical comments from an athlete's teammates may impact on eating and exercise psychopathology. This study aimed to (1) explore whether athletes who reported receiving a teammate critical comment have higher eating/exercise psychopathology and poorer psychological wellbeing versus matched athletes who have not, (2) determine whether gender differences exist in the perceived severity of critical comments and (3) evaluate the moderating role of gender when establishing the relative importance of explicit teammate critical comments versus implicit teammate influences (e.g., modelling) on eating/exercise psychopathology. Athletes (N = 646, Mage=23 years, n = 391 female) completed a survey exploring explicit/implicit teammate influences , psychological wellbeing (self-esteem, anxiety, depression) and eating/exercise psychopathology. Athletes receiving a teammate critical comment (n = 323) had significantly higher eating/exercise psychopathology, anxiety, and lower self-esteem compared to those who had not (n = 323). Females (n = 196) perceived the severity of the comment to be significantly worse than males (n = 127). Explicit critical comments had a greater influence on athletes' eating/exercise psychopathology versus implicit teammate influences. Disordered eating/compulsive exercise prevention efforts with athlete populations should highlight the detrimental impact that athletes' comments can have on teammates' wellbeing and body satisfaction.
... Although female runners and aesthetic athletes do not have experience extreme energy restriction associated with RWL, they may continue to experience have long-term adverse effects on menstruation and bone health. Weight-categorized female athletes may be seemingly less likely to develop menstrual disorders and low BMD, but dietary restrictions associated with RWL may induce ED in adolescent female athletes (43). Therefore, although RWL practices in juniors may not directly affect low BMD, the development of ED and anorexia nervosa due to repeated RWL may lead to chronic low EA; thus, there may be some delay in menarche or physical growth during puberty caused by RWL. ...
... ). Les entraîneurs sportifs portent une part de responsabilité par rapport au risque de TCA, car des remarques humiliantes répétitives liées au poids de l'athlète, des pratiques punitives en cas de prise de poids, et la pression autour de l'alimentation pour contrôler le poids, sont des éléments favorisant l'émergence d'un TCA (e.g., Vust & Ambresin, 2015). SelonSundgot-Borgen (1994), l'AA regroupe l'ensemble des comportements alimentaires subcliniques présents chez des sportifs pour lesquels un trouble réel du comportement alimentaire n'est pas défini, mais qui utilisent au moins une méthode de contrôle pondéral tel que le jeûne, les vomissements provoqués, ou la prise de laxatifs ou de diurétiques. Certains sports sont plus à risque que d'autres de mener au développement de l'AA, Bien que la DM soit répertoriée depuis 1993(Pope et al.), elle est encore caractérisée comme une « nouvelle pathologie », car elle était peu connue jusqu'à présent, mais celle-ci se développe de plus en plus, et cela principalement chez les hommes (e.g.,Cuadrado et al., 2018 pathologie importante et elle a longtemps été appelée « anorexie inversée » de par les similitudes entre les deux troubles(Pope et al., 1993). ...
Bien que la recherche de prise de masse musculaire soit reliée à de nombreux comportements déviants tels que les troubles du comportement alimentaire (TCA), les types de motivation et les variables sociocognitives sous-jacentes restent à ce jour peu identifiés. Cette thèse a pour objectif principal d’appliquer le modèle trans-contextuel de la motivation (Hagger & Chatzisarantis, 2009), intègrant la théorie de l’auto-détermination (Deci & Ryan, 2000) et la théorie du comportement planifié (Ajzen & Madden, 1986), pour rendre compte de la séquence motivationnelle sous-tendant les comportements de prise de masse musculaire des bodybuilders masculins, et les comportements alimentaires des sportifs pratiquant des disciplines sportives à risque telles que le bodybuilding et la course à pied. Cinq études composent ce travail doctoral. L’étude 1 est une revue de la littérature anglophone relative à la recherche de prise de masse musculaire et à la dysmorphie musculaire chez les bodybuilders. L’étude 2 a pour objet de développer et valider un questionnaire mesurant la recherche de prise de masse musculaire chez les sportifs masculins francophones, intitulé le DMS-FR. Les études 3 et 4 appliquent le modèle trans-contextuel de la motivation au contexte des comportements de prise de masse musculaire chez les bodybuilders masculins, et au contexte des comportements alimentaires de sportifs masculins pratiquant le bodybuilding ou la course à pied. L’étude 5 explore de manière qualitative d’autres facteurs psychosociaux susceptibles d’expliquer la dynamique de développement des TCA en fonction du niveau d’engagement compétitif des bodybuilders. Les principaux résultats montrent que différents types de motivation pour le sport (autodéterminée et contrôlée) sont reliés positivement aux comportements de prise de masse musculaire chez les bodybuilders masculins, et aux comportements alimentaires des bodybuilders et des coureurs masculins, de manière directe, et par le biais des variables de la théorie du comportement planifié. Cette thèse supporte l’importance d’appréhender les mécanismes psychosociaux explicatifs des déviances alimentaires chez les bodybuilders masculins dans la perspective de pouvoir développer des outils de prévention.
... leanness is believed to enhance performance(Davis & Cowles, 1989;Sundgot-Borgen & ...
... Prevalence rates for disordered eating attitudes and behaviours are elevated among athletic populations, with estimates between 14 and 45% (Martinsen, Bratland-Sanda, Eriksson, & Sundgot-Borgen, 2010;Petrie, Greenleaf, Reel, & Carter, 2008). Disordered eating is a significant risk factor for the development of clinically significant eating disorders (ED) in athletes (Sundgot-Borgen, 1994). While few studies have established ED prevalence in athletes, in one large-scale study, 20% of female athletes and 8% of male athletes were established as having an ED (primarily BN or OSFED) via clinical interview (Sundgot-Borgen & Torstveit, 2004). ...
Background: It has been well documented that athletes are at an increased risk of developing disordered eatingattitudes and behaviours. Over the last two decades, researchers have focused their attention on how teammatesmay influence athletes’ eating attitudes and behaviours.
Objective:To systematically review the literature relating to teammate influences on athletes’ eating attitudes and behaviours.
Method: A systematic literature search of the SPORTDiscus, PsycINFO and MEDLINE databases was conducted.Qualitative and quantitative studies were included if they met the following inclusion criteria: (1) examined therelationship between teammate influence and eating attitudes and/or behaviours; (2) sampled actively trainingathletes; (3) written in English; and (4) published in a peer-reviewed academic journal.
Results:Twenty-four studies were included (n= 13 quantitative,n= 11 qualitative). Included studies werefound to be of good or reasonable quality. Mechanisms of influence were categorised as (1) Teammate support(e.g., supportive teammate friendships, promotion of healthy eating practices, vigilance against disorderedeating), and (2) Teammate pressure (e.g., conflicting teammate friendships, critical comments and appearanceconversations, maladaptive team norms, and competitive comparisons).
Conclusion:Teammates are an important source of influence on athlete eating attitudes and behaviours andthese influences can be protective against, or engender an increased risk for, disordered eating. Additional,prospective research is required to enhance understanding of the mechanisms of teammate influences and toinform the development of interventions to reduce disordered eating among athletes.
... These practices typically have the aim of promoting athletes to have an optimal body weight and composition, thereby maximising performance (Dosil, 2008;Papathomas & Lavallee, 2006;Plateau, McDermott, Arcelus, & Meyer, 2014). Within this context of routine monitoring of athletes' bodies, pressures to diet and modify the body are customary (Martinsen, Bratland-Sanda, Eriksson, & Sundgot-Borgen, 2010;Sundgot-Borgen, 1994). Such regulatory practices, which function to control what athletes eat (Lang, 2015) and produce athletes as individuals who need to engage in bodily self-surveillance (Chapman, 1997;McMahon & Dinan-Thompson, 2011), come to be normalised in elite sport settings (McMahon & Penney, 2013b). ...
Objective
To examine the discursive practices surrounding athletes’ bodies with a particular focus on a) how food, the body and agency around eating and exercising practices are constructed, as well as b) how dominant discourses and narratives are deployed.
Method
A case study design was used, examining interactions from three female athletes with a sport psychologist regarding their body composition. The psychology sessions took place within an elite sport setting. Recordings from three initial psychology sessions were recorded. Analysis drew on a synthesis of discursive psychology and conversation analysis.
Results
Competing depictions of food and the body were drawn on by the athletes and the psychologist in order to either reproduce or resist taken for granted notions about a need to reduce body composition to improve performance. Discursive tensions were evident in talk around female athletes’ bodies, with a performance narrative functioning to regulate athletes’ bodies, at the same time that athletes oriented to a dominant notion of the thin female body. Food was also variously constructed in moral terms and as a neutral energy source. Throughout the sessions, individual agency for the body and for resolving the ‘problem’ of body composition was reproduced, with broader discursive and institutional practices overlooked.
Conclusion
This study provides an in insight into how talk around the body and eating practices takes place within one institutional context occurring within an elite sport setting. In particular, this study highlights how potentially problematic discourses and practices are privileged and reproduced or resisted. Shifting the focus to technique rather than body modification and nutrition may be beneficial for athletes’ wellbeing. Further implications for practice are discussed.
... In the study of Çağlar in [13], the body attractiveness level of male athletes in the handball category was determined as 17.08, while their physical competence level was determined as 17.49. Sundot-Borgen [14] stated that skinny athletes had greater body dissatisfaction than those who are not skinny. In the study of Aşçı in [15], the body dissatisfaction level of young male national basketball players was determined as 3.89. ...
This study aims to the comparison of body image satisfaction levels of athletes in individual and team sports. The sample of the study was selected by 34 athletes engaged in athletics, 52 athletes engaged in boxing, 45 athletes engaged in wrestling, 37 athletes engaged in weightlifting, 36 athletes engaged in handball, 35 athletes engaged in rowing, 41 athletes engaged in taekwondo, 36 athletes engaged in swimming, 31 athletes engaged in water polo, 35 athletes engaged in volleyball and 42 athletes engaged in bodybuilding and all these athletes already ranked among the top three athletes in Turkish Championships. The scales were applied to athletes included in sample in 2017. In the study, “Body Image Scale” which was validated, trusted, and adapted to Turkish language by Hovardaoğlu (1986) was used as data collection tool. For analyses of data, Portable IBM SPSS Statistics v20 software package was used. Paired sample t-test and descriptive statistical analysis were applied in the analysis of the data. According to the statistical analysis results, it was determined that body image satisfaction level of athletes engaged in wrestling is higher than other athletes.
... Det er isaer de aestetiske idraetsgrene (35%), som står i fokus, men også andre vaegtafhaengige idraetsgrene, som f.eks. budo (25%), boksning eller udholdenhedsidraetter (20%), rummer anorektiske eller bulimiske patienter (Helge 2001, Sundgot-Borgen 1994, Leon 1991. ...
Smerte anses som udtryk for en forstyrret kommunikation mellem symptom, udøver og behandlingen.
Erfaringerne fra en undersøgelse med udøvere fra tre landshold (fægtning, judo og fodbold) danner baggrund for bogen.
... Regarding athletes of esthetic sports (i.e., sports in which success in competitions is based on the scores that judges assign to an esthetic/artistic bodily performance; Sundgot-Borgen 1994; Thompson and Sherman, 2011), it is plausible that they could be at risk for EXD because they primarily are at risk of developing eating disorders (Hausenblas and Carron 1999;Warschburger 2011, 2013;Sundgot-Borgen 1994). Research highlighted that weight concerns and eating disorders are often associated with EXD (Cook et al., 2015) and with excessive and compulsive exercise (Meyer et al., 2011;Shroff et al. 2006). ...
Relatively few studies directly compared the prevalence of exercise dependence (EXD) in different sports. Different conceptualizations and measures of EXD limit the possibility of comparing results from different studies. In this study, we measured the prevalence of EXD and its correlation with drive for thinness (DT) in four different categories of sports and exercise. Participants were 427 people engaging in endurance sports, esthetic sports, team sports, or fitness activities. The Exercise Dependence Scale was adopted to measure EXD; the Drive for Thinness scale was used to measure DT and to distinguish between primary and secondary EXD. Results suggested that none of the considered sport categories seems to be more at risk for EXD than the other ones. A correlation between EXD and DT was found in the fitness group, suggesting, together with previous literature, that EXD could be related to the reward a person strives to achieve trough exercising.
... However, several investigators have suggested that female athletes are at increased risk of developing an eating disorder (Ashley et al., 1996;Beals & Manore, 1994;Casper, Michaels, & Simon, 1997;Gamet & Rosen, l99l;Sundgot-Borgen, 1994a). ...
This study is an examination of eating behaviors and body image concerns among 587 female collegiate athletes from nine colleges/universities representing 14 different sports. Measures included the Eating Disorders Inventory-2 (EDI-2), the Eating Attitudes Test (EAT-26), and a questionnaire gathering general demographic information, reasons for dieting and/or using other methods of weight control, as well as information about expressed concerns from others regarding the respondents weight. Three sport groups were hypothesized to be at increased risk: athletes whose performance is subjectively scored; athletes who compete in a sport where a low body weight is considered advantageous; and athletes who must wear body conrevealing clothing. Chi-Square and Logistic Regression analyses revealed no association between these sport groups and the presence of a subclinical eating disorder (SED). Additional analyses determined no statistical association between student-athletes competing at the National Collegiate Athletic Association Division I level (versus Division II or III level) or student-athletes who were scholarship recipients (versus non-scholarship recipients) and the presence of SED. Student-athletes who have heard expressed concerns from others regarding their body weight were significantly more likely to report the presence of SED (p < .0001). Therefore, special care should be taken with all student-athletes when discussing body weight.
... En varias investigaciones se ha determinado que algunas poblaciones en riesgo para desarrollar un trastorno de la conducta alimentaria, ya sea clínicamente completo o en una forma así llamada parcial o subclínica, se encuentran principalmente entre aquellos sujetos que otorgan una especial trascendencia al peso y la silueta corporal [1][2][3][4][5][6] . El modelaje, la actuación, la danza y el deporte son actividades -profesiones, ocupaciones o entretenciones-que, potencialmente podrían favorecer el terreno para la manifestación de una patología alimentaria en ambos sexos y en cualquiera de sus modalidades. ...
Background: People who work out could have an excessive concern for diet and body weight and thus be more prone to have eating disorders. Aim: To compare psychological and behavioral traits between subjects with clinically relevant eating disorders and subjects that work out regularly. Subjects and methods: The Eating Attitudes Test (EAT-40) and the eight items of the Eating Disorders Inventory were administered to 151 patients that fulfilled the DSM-IV diagnostic criteria for eating disorders and to 396 subjects who work out regularly in gymnasiums (136 males). Results: Eighteen percent of subjects that worked out (5 males and 67 females) scored within the pathological range in the EAT-40. These subjects were classified as having a subclinical eating disorder. When comparing the EDI scores of these subjects with those of patients with clinically relevant eating disorders, they had a similar Drive for thinness (p= 0.413), Body dissatisfaction (p= 0.365), Maturity fears (p= 0.190) and Perfectionism (p= 0.907). Females had similar Interpersonal distrust (p= 0.709) scores. Males had similar Maturity fears (p= 0.119), Perfectionism (p= 0.253) and Interpersonal distrust (p= 0.767) scores. Conclusions: Subjects that work out regularly and have subclinical eating disorders, display similar drive for thinness, body dissatisfaction, immaturity and perfectionism traits, than patients suffering from clinically relevant eating disorders.
... Competitive athletes were chosen because it is proposed that in competitive sport rather than recreational sport the greatest pressures to succeed may exist. As competition level increases, athletes encounter more intense training and greater pressures to maintain a specific weight (Sundgot-Borgen, 1994), thus making competitive athletes more susceptible to drive for thinness. Female athletes were recruited to increase homogeneity. ...
This study investigated relationships between trait emotional intelligence, pre-race emotions, and post-race emotions among a sample of 93 competitive 10-mile runners. Participants completed emotional intelligence and pre-race emotion scales approximately one hour before starting a 10-mile race, repeating completion of the emotion scales within one hour of finishing. Results indicated emotional intelligence correlated significantly with higher pleasant emotion and lower unpleasant emotion before and after racing. Path analysis results revealed emotional intelligence predicted both pre and post-race emotion. Results lend support to the notion that emotional intelligence is associated with emotional well-being. Future research should investigate emotional intelligence and its relationship with strategies used by athletes to regulate emotion before, during, and after competition.
The aim of this study was to examine dimensions of body-esteem, Body Mass Index, and their relations with eating disorder symptoms among 42 elite adolescent athletes engaged in competitive synchronized swimming (M = 15.4 yr., SD = 1.2) and to compare them with 40 athletes in sports with no emphasis on leanness (M = 16.5 yr., SD = .93), and 50 nonathlete college female students (M = 16.3 yr., SD = 1.1). They completed the Body-esteem Scale and the Eating Attitudes Test, and the Body Mass Index was computed. Analysis showed synchronized swimmers reported greater negative feelings about their appearance than the two other groups and low perceptions of how others evaluate their physical appearance. Participants did not differ on the EAT-26. Regression analyses showed that Body Mass Index and Body-esteem Appearance accounted for 38% of the variance in log-transformed Dieting scores of synchronized swimmers. Results are discussed in relation to the literature.
and further examine if these techniques help to empower women or if they perpetuate sexist ideology like many postfeminist films—this B.A.The thesis aims to include findings about the effects of hyper-masculine spaces, such as sports, and sociocultural issues, on the female athlete identity. Additionally, discussing some critical issues of the media representation that female athletes receive or do not, by being underrepresented and misrepresented. Using documentary series/films such as HBO’s Being Serena as an example of a new era of storytelling that empowered women to narrate their own stories and be viewed as multifaceted people. Defying gender norms and the boxes that society aims to limit them to while still using their voice to advocate for the causes they feel passionate about. Female athletes often stand on the front line of social issues, and the way they are portrayed in documentary films can shed light on their personal life and effectively show them as what they are, leaders and heroes to generations to come.
This research will serve as an argument for the proper representation of female athletes for better visibility in media.
While the relationships between media and eating disorders and disordered eating patterns incollege-aged women have been extensively studied (e.g., Bissel, 2004; Grabe & Hyde 2009;Harper & Tiggeman, 2008; Yamamiya, Cash, Melnyk, Posavac, & Posavac, 2005), fewerstudies have been conducted with female athletes. More specifically, limited studies havefocused on the relationship between social media and eating behaviors of athletesparticipating in aesthetic sporting events, even though the highest rates of disordered eatingpatterns occur in sports where female athletes are scored on judges’ opinions (Hausenblas &Carron, 1999; Smolak, Murnen, & Ruble, 2000; Sundgot-Borgen, 1994), and where leanness,thinness, and aesthetic skills and aspects are emphasized (Byrne & McLean, 2002; DiBartolo& Shaffer, 2002). Thus, the current study sought to understand the links among collegegymnasts’ perceptions of body image, disordered eating behaviors, and perceptions ofathletes’ body images presented on social media. Furthermore, the study also explored howcriticism presented on social media relates to disordered eating symptomatology. The studywas conducted via an online survey system by 72 18-25-year-old females who were currentlycompeting or recently competed in club or collegiate gymnastics. Results found significantcorrelations between the severity of critical comments about physical appearance, emotionalreaction to criticism about physical appearance, and disordered eating behavior in instanceswhere the comments were not made on social media, but no correlation was found betweenseverity, emotional reaction, and disordered eating behaviors for comments made on socialmedia.
Eating disorders (ED) are serious mental disorders, which can have serious health consequences and high mortality rates. Due to facing unique risk factors female athletes have increased susceptibility for ED. Female athletes are also at risk for subclinical conditions such as the Female Athlete Triad. There is a dearth of studies on preventing and identifying ED in female athletes and the role and responsibility of the sports coach is unclear. This study aimed to address the questions of whether female athletes are at increased risk for ED, what interventions currently show promise and what is the role of the sports coach in the intervention process. The study was based on a systematic review of relevant literature retrieved through PubMed and Sports Discus databases.
Despite heterogeneity in prevalence studies, findings suggest that female athletes are at higher risk than male athletes and non-athletes and those in elite level sports or sports categorised as lean, aesthetic, endurance and weight-class are at increased risk for clinical and subclinical ED. Risk-factors unique to the sports environment such as weight pressures, competitive thinness and revealing uniforms, may lead to increased risk in female athletes. Despite a dearth of studies on interventions for ED in sport, findings suggest that primary prevention programs based on educating athletes such as ATHENA show most promise in prevention. Secondary prevention should focus on early identification using athlete-specific screening tools. Symptom checklists and pre-participation examinations can also assist coaches in early identification. Psychotherapy interventions such as CBT have had the best results for treatment.
Sports coaches’ play a critical role in, early identification, referral, management and prevention of ED in female athletes. However, current findings suggest that many coaches lack knowledge about ED and require education to be able to intervene successfully in female athletes with ED. Inappropriate coaching behaviours have also been found to act as an additional risk-factor for ED. Recommendations for sports coaches in N.I. are provided to assist them in successful intervention, management and return to play of female athletes with ED.
Key words: Eating Disorders, Sports, Coaches, Female Athlete Triad, Prevention.
Eating disorders are a widespread problem for college female athletes. This article builds on this research by collecting survey data from female college track and field athletes at 30 universities. Results find that the division level is not a significant driver of eating disorders. Another significant finding comes from breaking out the pressures into its team-related and social causes. Results find that team-related pressures lead to more vomiting behavior, while social pressures impact dieting. Previous studies which aggregate pressures, rely on one eating disorder, or focus on a single university for their sampling may not reflect these complex relationships. Even after controlling for individual factors, competition level, and team nutritionists, the pressures still impact these athletes. This suggests a need for additional screenings and counselors to address pressures occurring both on and off the track. While difficult to achieve, there needs to be a change in team cultures across all divisions.
JEL Classifications: I1, Z2
This study investigated social physique anxiety (SPA), disturbed eating attitudes and behaviors (DEAB), and perceived pressure for thin body by the "significant others" (coach, parents, peers, experts) in 41 female rhythmic gymnastics (RG) and 49 aerobic gymnastics (AG) athletes at competitive level. Moreover, the potential impact of gymnasts' BMI was examined and controlled. Results showed that BMI associated with gymnasts' SPA, DEAB and perceived pressure, so its effect was controlled. There were no significant differences between RG and AG regarding SPA and DEAB, whereas AG athletes had higher parental pressure for thin body than RG athletes. When RG and AG data were merged, a high percentage (40%) of gymnasts presenting DEAB was revealed. Gymnasts with DEAB had significantly higher SPA and perceived pressure for thin body than those with normal eating attitudes and behaviors. These results underline the need for interventions involving "significant others" and aiming at DEAB prevention in female gymnasts.
Abstract Ultrasound (US) provides the most accurate technique for thickness measurements of subcutaneous adipose tissue (SAT) layers. This US method was recently standardised using eight sites to capture SAT patterning and allows distinguishing between fat and embedded fibrous structures. These eight sites chosen for fat patterning studies do not represent the mean SAT thickness measured all over the body that is necessary for determining subcutaneous fat mass. This was obtained by SAT measurements at 216 sites distributed randomly all over the body. Ten participants with BMI below 28.5kgm−2 and SAT means (from eight sites) ranging from 3 mm to 10 mm were selected. The means from eight sites overestimated the means obtained from 216 sites (i.e. 2160 US measurements in the ten participants); the calibration factor of 0.65 corrects this; standard deviation (SD) was 0.05, i.e. 8%. The SD of the calibration factor transforms linearly when estimating the error range of the whole body’s SAT volume (body surface area times the calibrated mean SAT thickness). The SAT masses ranged from 3.2 to 12.4 kg in this group. The standard deviations resulting from solely the calibration factor uncertainty were ±0.3 and ±1.0 kg, respectively. For these examples, the SAT percentages were 4.9(±0.4)% and 13.3(±1.0)%.
The objective of this study was to define the prevalence of the female athlete triad, i.e., the simultaneous occurrence of disordered eating, amenorrhea, and osteoporosis, in military women. A total of 423 active duty female soldiers participated in a three-part prospective, cross-sectional study. Part 1 entailed completing the Eating Disorder Inventory and a clinical interview with those women “at risk” for an eating disorder. Part 2 consisted of a clinical evaluation and laboratory studies of any woman with menstrual irregularities. Part 3 evaluated the bone mineral density of all women meeting the inclusion criteria for parts 1 and 2 using dual-energy X-ray absorptiometry. Of the 423 active duty women who participated in the study, no subject exhibited the full female athlete triad. Thirty-three women (8%) had an eating disorder and 109 women (26%) were at risk for an eating disorder. Our results suggest that the female athlete triad is not a clinically significant problem for the Army.
The number of women participating in sports has increased dramatically in the past few decades. This rise in sports participation promotes numerous mental and physical benefits to the female athlete. However, clinical experience and research reports provide evidence of a health sequela, the “Female Athlete Triad,” developing as a result of inadequate dietary intake relative to exercise expenditure among a subset of athletes. The Female Athlete Triad (Triad) is an interrelated disorder of low energy availability, menstrual dysfunction, and reduced bone mineral density, and has been studied in various populations of athletic girls and women. In addition, current evidence suggests that athletes with Triad can experience other detrimental effects, including musculoskeletal, cardiovascular, gastrointestinal, renal, and neuropsychiatric symptoms. Female athletes participating in sports emphasizing leanness are at increased risk of developing the Triad. Factors that may account for this increased risk include an increased pressure to meet specific weight or body shape requirements of sport, the perceived benefit of a low body weight or thin frame in optimizing performance, and an increased susceptibility to sociocultural demands. These factors can lead to harmful dieting and subsequent energy deficit with likely health repercussions. Alternatively, some leanness sport athletes, such as those in endurance sports, may also develop an energy deficit inadvertently as a result of a high training volume and lack of awareness of their energy and nutritional needs. The specific risk biotypes considered in this chapter include endurance sports (e.g., runners, triathletes, cyclists, and swimmers), aesthetic sports (e.g., figure skating and gymnastics), weight-class sports (e.g., lightweight rowing and wrestling), and others. The involvement of a multidisciplinary team including sport medicine physicians, athletic trainers, dietitians, sports psychologists, among others, is required for the treatment of the Triad. The management comprises non-pharmacological and pharmacological approaches in some cases. However, the most effective way to avoid long-term consequences is early detection and prevention of this condition, especially in higher risk populations.
Chez une patiente sportive, comme chez une nonsportive, le motif de la consultation peut être évident: «c’est une consultation systématique, de dépistage, pour voir si tout va bien…». Parfois ce sont des métrorragies, une aménorrhée, une demande de contraception, une grossesse qui tarde à venir… Parfois le véritable motif de consultation est masqué ou pas exprimé d’emblée: le médecin ne doit pas hésiter à reprendre au cours de la consultation cette notion de «but de la visite».
A palatable flavor is known to enhance fluid intake during exercise; however, a fear of excessive kilojoule intake may deter female athletes from consuming a sports drink during training sessions. In order to examine this issue, we monitored fluid balance during 9 separate training sessions undertaken by junior elite female netball players (n=9), female basketball players (n=7), and male basketball players (n=8). The beverages tested were water, a regular carbohydrate-electrolyte beverage (6.8% CHO, 18.7 mmol/L Na, 3.0 mmol/L K, 1130 kJ/L), and an identical tasting, low kilojoule electrolyte beverage (1% CHO, 18.7 mmol/L Na, 3.0 mmol/L K, 170 kJ/L). Each subject received each of the 3 drinks at 3 separate training sessions, in a randomized, balanced order. Subjects were aware of the beverage provided. Change in body mass over the training session was used to estimate body fluid change, while voluntary fluid intake was determined from the change in weight of drink bottles used in each session. The overall fluid balance on drinks classified as regular, low kilojoule, and water was -11.3 ml/h (95%CI -99.6 to 77.0), -29.5 ml/h (95%CI -101.4 to 42.5) and -156.4 ml/h (95%CI-215.1 to -97.6), respectively. The results indicate that, overall, better fluid balance was achieved using either of the flavored drinks compared to water. These data confirm that flavored drinks enhance fluid balance in afield situation, and suggest that the energy content of the drink is relatively unimportant in determining voluntary fluid intake.
An energy deficiency is the result of inadequate energy intake relative to high energy expenditure. Often observed with the development of an energy deficiency is a high drive for thinness, dietary restraint, and weight and shape concerns in association with eating behaviors. At a basic physiologic level, a chronic energy deficiency promotes compensatory mechanisms to conserve fuel for vital physiologic function. Alterations have been documented in resting energy expenditure (REE) and metabolic hormones. Observed metabolic alterations include nutritionally acquired growth hormone resistance and reduced insulin-like growth factor-1 (IGF-1) concentrations; hypercortisolemia; increased ghrelin, peptide YY, and adiponectin; and decreased leptin, triiodothyronine, and kisspeptin. The cumulative effect of the energetic and metabolic alterations is a suppression of the hypothalamic-pituitary-ovarian axis. Gonadotropin releasing hormone secretion is decreased with consequent suppression of luteinizing hormone and follicle stimulating hormone release. Alterations in hypothalamic-pituitary secretion alters the production of estrogen and progesterone resulting in subclinical or clinical menstrual dysfunction.
Aim:
Rhythmic gymnasts are often believed to be a population at risk of malnutrition because of their tendency to keep a low weight and a lean appearance for better athletic performance, and because they start intensive training at a very young age. The purpose of this study was to evaluate in adolescent elite gymnasts the effects of physical activity on body composition and cardiac morphology and function.
Methods:
Sixteen national level rhythmic gymnasts and 16 control adolescent female underwent anthropometric measurements, bioelectric impedance and echocardiography to assess body composition and cardiac morphology and function.
Results:
As compared to controls, gymnasts had lower body mass index (16.9±1.1 vs. 18.7±1.0, P<0.001), fatty mass (14.2±4.5 vs. 15.8±2.9 %, P<0.05) and greater fat-free mass (84.0±4.7 vs. 80.5±5.0 %, P<0.05), left ventricular end-diastolic dimension (4.7±0.4 vs. 4.4±0.3 cm) and left ventricular mass, as absolute (132.8±21.2 vs. 112.5±22.8 g, P<0.01) and indexed (44.5±9.3 vs. 36.1±8.2 g/m2.7, P<0.01). Left ventricular mass was directly related to fat-free mass as absolute (r=0.37, P<0.05) and indexed (r=0.43, P<0.02).
Conclusion:
Body composition analysis showed a lower percentage of body fat in the gymnasts, together with a higher percentage of fat-free mass. Echocardiographic findings indicate that elite rhythmic gymnastics present left ventricular remodeling as training-induced cardiac adaptation. Intensive training, dietary attitude and evident leanness of rhythmic gymnasts are not associated with cardiac abnormalities, as it is the case of pathological leanness.
The purpose of this study was to examine the prevalence of disordered eating patterns (DEP) and menstrual irregularities in Chinese female athletes (n=881) and nonathletic controls (n=147), by using Eating Attitudes Test-26 (EAT-26) and written questionnaires. The athletes were divided into the following 6 categories : technical, endurance I (leanness is considered important for athletic performance) and II (leanness is less important), aesthetic, ball-game and power sports. The prevalence of DEP in the athletes estimated by EAT-26 was low (technical 1.5%, endurance I 3.3%, endurance II 1.6%, aesthetic 3.0%, ball-game 3.0% and power sports 0.9%), and didn't significantly differ from that in nonathletic controls (0.7%). Amenorrheic athletes were not observed in endurance I and II, aesthetic, or ball-game sports and very low prevalence rates for amenorrhea were found in the athletes in technical (0.5%) and power sports (0.4%). These figures represent no significant differences between athletes and nonathletes in the prevalence rates of amenorrhea. It was suggested that a low prevalence of DEP in Chinese athletes stems from low socioculturally- and socioeconomically-imposed desires to be thin and low requirements for weight loss to improve athletic performance. Also, the present data suggest that the low incidence of amenorrhea in Chinese athletes is partly associated with the low prevalence of DEP.
In this study the sociological and philosophical concept of the sport ethic has been utilized to explain the meaning of extreme and overconforming athlete behaviors which manifest themselves as athletic preparation. The study discloses, through the life history of a rhythmic gymnast, how the meanings and values of what it means to be an athlete were transmitted through the day-to-day discourse of athlete practice. By focusing on the dietary preoccupations of gymnasts involved in international competition, it was possible to demonstrate how modern sport preparation is not only distorted but also paradoxical, serving to push the body beyond its limits while insisting on its preservation.
Synopsis
Data on the development of a 40-item measure of the symptoms in anorexia nervosa are reported. The scale (EAT) is presented in a 6-point, forced choice, self-report format which is easily administered and scored. The EAT was validated using 2 groups of female anorexia nervosa patients ( N = 32 and 33) and female control subjects ( N = 34 and 59). Total EAT score was significantly correlated with criterion group membership( r = 0·87, P < 0·001), suggesting a high level of concurrent validity. There was very little overlap in the frequency distributions of the 2 groups and only 7% of the normal controls scored as high as the lowest anorexic patient. Female obese and male subjects also scored significantly lower on the EAT than anorexics. Recovered anorexic patients scored in the normal range on the test, suggesting that the EAT is sensitive to clinical remission.
The guiding principles and operating procedures of the Eating Disorders Work Group are described. Provisional diagnostic criteria for the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders for anorexia nervosa and bulimia nervosa are listed, together with an explanation of how and why they differ from the revised 3rd edition (American Psychiatric Association, 1987). Consideration of a possible new diagnosis is noted.
In the past decade much has been learned about the clinical features, diagnosis and understanding of people with anorexia nervosa and bulimia nervosa. In order to provide the next level of improvement in our care for these patients, our understanding of certain problems must be addressed by empirical research. Areas which require further study include the definition of high risk groups, the refinement of diagnoses, understanding factors which result in chronicity, determining the complications of chronicity and comparative evaluations of different treatments. These five areas are outlined in this article. Populations at risk for anorexia nervosa and bulimia nervosa may be those who must be thin and achieve according to career choice, those with a particular family and personal psychiatric history; obesity and chronic medical illnesses may be further risks. Improved diagnostic understanding has occurred by the differentiation of bulimic from restricting subtypes of anorexia nervosa. Further work must determine the relationship between the bulimic subtype of anorexia nervosa and bulimia in normal weight women and to further clarify the relationship between eating disorders and affective disorders. A number of factors may result in a chronic illness. These have been described on a variety of levels. The consequences of starvation in altering an individual's thinking, feeling and behaviour do play a role. It is not clear what factors at a neurochemical level contribute to this. Elevated endogenous opiates decreased noradrenergic function and decreased serotonin may be important. Information about the chronic complications is required for clinicians to understand the broad range of difficulties that may develop over time so that clinicians may use this information in planning treatment strategies.(ABSTRACT TRUNCATED AT 250 WORDS)
Nine male marathon runners were exercised to exhaustion to determine the effects of a 27-h fast on endurance performance. Each subject completed two exercise tests at the same treadmill speed (set at 70% maximal O2 uptake), one following a 27-h fast and one 3 h after a preexercise meal, in random order. Fasting caused a 44.7 +/- 5.8% (SE) decrease in endurance performance (P less than 0.01). Blood, muscle, psychological, and ventilatory data were examined to determine the cause of the decreased performance. Fasting caused significant increases in O2 uptake (9.3 +/- 2.0%), heart rate (8.4 +/- 2.4%), and rating of perceived exertion, ventilation, and psychological fatigue, evident within the first 60 min of exercise. There were no differences in plasma glucose or epinephrine levels. Muscle glycogen degraded at the same rate (0.482 +/- 0.146 vs. 0.470 +/- 0.281 mumol.g-1.min-1 in the nonfasted and fasted tests, respectively) despite lower respiratory exchange ratio and elevated free fatty acid levels, which may partially explain the elevated O2 uptake. Lactate, insulin, and norepinephrine were all increased in the fasted test (P less than 0.05). The increase in norepinephrine (r = 0.79, P less than 0.01), the diameter of type I muscle fibers (r = 0.70, P less than 0.05), and ending insulin levels (r = -0.88, P less than 0.01) were correlated with endurance time in the fasted state. Fatigue in endurance running for 27-h fasted humans appears to be related to a combination of physiological, psychological, metabolic, and hormonal changes.
Study of 955 9- to 18-year-olds at a competitive swimming camp revealed that many subjects had misperceptions about their body weights, particularly girls; swimmers' decisions to lose or gain weight were based on their perceptions more than on their actual weight; and others' opinions strongly influenced swimmers' opinions of their own weight. (Author/MT)
The responses of 137 coaches representing 153 teams in the Big Ten Conference indicate a recognized need for more information about nutrition, a need that apparently is not being met very satisfactorily by traditional methods of communicating knowledge, including a number of excellent review articles. Prescribing nutritional supplements with little or no assessment of the athlete's nutritional status (for example, the use of protein supplements in 22 teams respresenting 11 different sports), belief in steak and other high protein foods by some coaches as essential to the precompetition meal, use of high carbohydrate diets by a number of sports requiring limited endurance capacity, and the subjective appraisal of optimum body weight are practices that underscore the need for more effective communication between coaches and the scientific community. Nevertheless, the fact that coaches recognize their need for more information on nutrition is a healthy sign for better communication in the future - and for better care of athletes.
In brief: Research has indicated that 4% to 19% of female college students have eating disorders such as anorexia nervosa, anorexia athletica, or bulimia. To determine the extent to which preoccupation with weight and tendencies toward eating disorders are problems among female athletes, we analyzed the responses to a questionnaire completed by 168 college women-101 nonathletes, 35 athletes whose sports emphasize leanness, and 32 athletes whose sports do not emphasize leanness. The results showed that 6% of the nonathletes, 20% of the athletes in sports that emphasize leanness, and 10% of all the athletes were either exceptionally preoccupied with weight or had tendencies toward eating disorders.
Athletes have gone to extraordinary lengths to reduce their body fat stores in an effort to improve performance. To identify athletes who need help, a questionnaire was administered to 182 female collegiate athletes. Results showed that 32% practiced at least one of the weight-control behaviors defined as pathogenic, which include self-induced vomiting; binges more than twice weekly; and the use of laxatives, diet pills, and/or diuretics. A number of steps are suggested to alert coaches, trainers, and team physicians to the high-risk athlete who requires special attention or treatment to correct this disorder.
Studies show that adult ballerinas practice poor nutrition habits, but little research has been done on adolescent dancers. The authors analyzed the diet composition of 92 female ballet dancers aged 12 to 17 enrolled in six professional schools. Three-day histories were used to compile data, and a dietitian worked with the dancers to ensure accuracy in record keeping. The results showed poor nutrition habits and low calorie and nutrition intake. Sixty percent routinely took vitamin or mineral supplements, but not properly. Unfortunately, the dancers' desire to maintain a sylphlike, willowy body makes them unwilling to consume the number of calories required for a health diet. A nutrition class in the dance school curriculum would help increase their knowledge and improve their dietary habits.
In brief: This study examined the effects of nutrition education (through individual counseling) on the body composition and diet patterns of 39 female college athletes. Anthropometric and diet data were collected before and after the playing season. Ten of the athletes received individual nutrition counseling during the season and comprised group 1; the other 29 made up group 2. Neither group met the recommended dietary allowance for energy before or after the season, but group 1 significantly lowered fat and cholesterol levels and increased carbohydrate and fiber intakes. The findings suggest that individual counseling is effective in improving the diet quality of female athletes.
In brief: A total of 348 coaches, 179 athletic trainers, and 2,977 athletes in high school and college settings answered questionnaires about their nutrition knowledge and practices. Certified athletic trainers had the best nutrition backgrounds, and they believed they should take primary responsibility for athletes' nutrition. Coaches and athletic trainers are most concerned about fluid intake, but athletes are most concerned about weight. Most athletes are familiar with and use the basic four food groups, but 44% take vitamin supplements, 13% take mineral supplements, and 9% take protein supplements.
This study examined resting metabolic rate in adolescent wrestlers to test the hypothesis that repeated cycles of weight loss and regain would be associated with reduced energy requirements. Energy restriction lowers resting metabolic rate in normal-weight and obese persons. Repeated cycles of weight loss and regain can increase food efficiency, defined as the degree of weight change per unit of food intake, in animals. Many wrestlers lose weight repeatedly as they "cut weight" for matches. This cycle of weight loss and regain may affect their resting metabolism. Twenty-seven wrestlers were classified as cyclers or noncyclers based on their weight loss history. Resting metabolic rate was measured using indirect calorimetry and body composition was evaluated using six skinfolds. Cyclers and noncyclers did not differ in age, weight, height, surface area, lean body mass, or percent body fat. Cyclers had a significantly lower mean resting metabolic rate than noncyclers (154.6 vs 177.2 kJ/m2/h) (4.6 vs 5.5 kJ per kilogram of lean body mass per hour). There was a 14% difference between the cyclers and the noncyclers in resting energy expenditure (6631.8 vs 7702.8 kJ/d). Weight cycling in wrestlers appears to be associated with a lowered resting metabolic rate.
(JAMA 1988;260:47-50)
To study the methods and extent to which female college gymnasts diet, data were collected from 42 gymnasts aged 17 to 22 years, who represented five teams in a major athletic conference. The survey showed that (1) all the participants were dieting; (2) 26 were using at least one form of pathogenic weight-control behavior; and (3) 21 of the 28 competitors who were told by their coaches that they were too heavy resorted to using pathogenic weight-control behaviors. The authors discuss the implications of the demands of gymnastics and the additional social pressure to maintain exceptional thinness.
This study examined the effects of nutrition education on body composition and diet patterns of 39 female college athletes. The findings, which are discussed, suggest that individual nutrition counseling is effective in improving the diet quality of female athletes. (Author/MT)
Coaches, team physicians, sport psychologists, athletic trainers, sport physical therapists, sport nutritionists, dance trainers, and other sport and medical professionals will find "Helping Athletes With Eating Disorders" a practical and comprehensive guide to effectively managing athletes with eating disorders.
Our goal is to provide you with practical recommendations to enhance the cooperative efforts of sport staff and medical personnel, while keeping foremost the special needs of the athlete with an eating disorder.
In addition to outlining formal treatment, "Helping Athletes With Eating Disorders" addresses daily management issues of helping athletes overcome their disorders. We examine the difficult subjects of eating, weighing, exercise and training, competition, medication, discipline, and personality difficulties. We address such topics as getting athletes into treatment, making referrals, handling injuries, ensuring privacy, and counseling the family.
Throughout the book, case examples are provided to explain and illustrate salient aspects of the difficulties facing athletes with eating disorders. The information contained in these cases accurately portrays athletes with eating disorders. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
A biobehavioral model of activity-based anorexia is examined in terms of recent evidence. Strenuous exercise reduces the value of food reinforcement and results in decreased food intake. Reduction of food intake increases the motivational value of physical exercise. This produces an escalation in activity that further suppresses appetite. Cultural practices of diet and exercise initiate this anorexic cycle, and once started the process is resistant to change. These anorexias may be the result of natural selection favoring those organisms that became active in times of food scarcity. Proximate physiological mechanism(s) appear to involve the endogenous opiate system that mediates the relationshp between running and eating. It is argued that classification of human self-starvation should be based on environmental and/or biological conditions that control food regulation. Activity anorexia may be one instance of such a classification that could account for many instances of “an orexia nervosa”.
Fifty-five white and eleven black female dancers in nine regional and national ballet companies in America and Europe (mean age 24.9) were surveyed for eating disorders. The dancers, as a whole, weighed 12% below their ideal weight for height. None of the black American dancers reported anorexia nervosa or bulimia, while 15% of the white American dancers reported anorexia nervosa and 19% reported bulimia. All instances of anorexia nervosa were in national rather than regional companies, making the incidence among whites in the former 22%. Self-reported anorectics scored higher on the EAT-26, had lower weights, exhibited more psychopathology, and a poorer body image than the nonanorectics. In addition, all but one of the self-reported anorectics weighed, or had weighed, less than 20% of ideal weight for height. The bulimics valued their careers less, dieted more, and exercised less frequently than the nonbulimics. Weight did not differ for these two groups. The data suggest that the anorectic dancers differ from dancers with no eating disorders and that sociocultural factors are related to the report of eating disorders. Specifically, level of competition is related to reported anorexia nervosa and ethnicity to anorexia nervosa and bulimia.
The aim of this study was to investigate the effect of weight reduction on maximal oxygen uptake (V̇O2max and running speed in endurance-trained female elite athletes. Seven (the cases) of the 33 subjects reduced a significant amount of body weight (BW) within a period of 2 months. The cases showed a significant decrease in V̇O2max and running speed relative to controls during the weight reduction period (WRP). A considerable loss in BW might have prevented cases from achieving a training-induced increase in V̇O2max and running speed similar to controls during the WRP. Six cases maintained low BW and all 7 improved V̇O2max relative to controls 1 year after the WRP.
While there has been a real and considerable expansion over the past decade and a half in our understanding of the nature and treatment of anorexia nervosa and bulimia, serious gaps in our knowledge still exist. Many aspects of the eating disorders continue to be characterized by seeming paradox or inconsistency. This paper will examine several of these and emphasize how each dictates the need for humility, rather than confident generalization, in our current approaches to these conditions.
The present paper documents the etiological importance of physical activity to self-starvation in animals and suggests similarities between this research area and the literature concerned with some self-starvation in humans. An activity anorexia is proposed that may account for 38% to 75% of anorexia nervosa. An account of excessive locomotor activity is made in terms of schedule-induced behavior. A reciprocally interactive effect of activity and food ingestion is taken to explain self-starvation for animals and activity anorexia in humans. Literature is reviewed which demonstrates that rats and mice self-starve when they are given access to a running wheel and placed on food restriction. In this paradigm, these animals become excessively active and paradoxically reduce food consumption when compared with control subjects. This evidence and related findings are shown to be consistent with a phylogenetically based model of anorexia. Sociocultural factors are hypothesized to set and maintain the conditions that produce activity anorexia in humans.
In an effort to identify risk for disordered eating patterns in competitive female athletes, the present study compared a sample of NCAA Division I female athletes (n = 74) to a college female nonathlete control group (n = 52). Measures included the Eating Disorders Inventory (EDI) (Garner, Olmsted, & Polivy, 1983), the Eating Attitudes Test (EAT) (Garner & Garfinkel, 1979), and body mass. Findings indicated that none of these highly trained athletes had scores indicative of the constellation of disturbances in eating patterns and personality attributes seen in anorexia nervosa or bulimia. Rather, results suggested that the typical college female athlete falls into the normal range with regard to body mass and eating patterns. The competitive female cross-country runner actually may be at slightly less risk for body dissatisfaction than her nonathlete counterpart, whereas the gymnast may be at somewhat greater risk for weight preoccupation.
Thesis (M.S.)--Loma Linda University, 1986. Includes bibliographical references (leaves 28-32). Photocopy of typescript.
This paper presents an overview of eating disorders, including definitions, clinical criteria for appropriate diagnosis, and a discussion of the potential for increased risk for eating disorders in special populations of female athletes. This is followed by a discussion of the prevalence of eating disorders in normal and athletic populations. From this discussion, it seems clear that female athletes in endurance or appearance sports are at an increased risk for disordered eating. Finally, the paper focuses on related disorders--a triad associating eating disorders, menstrual dysfunction, and bone mineral disorders. It is clear that secondary amenorrhea is associated with malnutrition and disordered eating. Further, bone mineral disorders are related to menstrual dysfunction. Disordered eating may represent the initiating factor of this triad.
To assess current weight loss practices in wrestlers, 63 college wrestlers and 368 high school wrestlers completed a questionnaire that examined the frequency and magnitude of weight loss, weight control methods, emotions associated with weight loss, dieting patterns, and preoccupation with food. Clear patterns emerged showing frequent, rapid, and large weight loss and regain cycles. Of the college wrestlers, 41% reported weight fluctuations of 5.0-9.1 kg each week of the season. For the high school wrestlers, 23% lost 2.7-4.5 kg weekly. In the college cohort, 35% lost 0.5-4.5 kg over 100 times in their life, and 22% had lost 5.0-9.1 kg between 21 and 50 times in their life. Of the high school wrestlers, 42% had already lost 5.0-9.1 kg 1-5 times in their life. A variety of aggressive methods wer used to lose weight including dehydration, food restriction, fasting, and, for a few, vomiting, laxatives, and diuretics. "Making weight" was associated with fatigue, anger, and anxiety. Thirty to forty percent of the wrestlers, at both the high school and college level, reported being preoccupied with food and eating out of control after a match. The tradition of "making weight" still appears to be integral to wrestling. The potential physiological, psychological, and health consequences of these practices merit further attention.
Since 1958 we have conducted a prospective study of anorexia/bulimia nervosa (A/BN) covering a total of 550 patients. This paper presents a new idea of the development of A/BN. For a variety of reasons, a predisposition for developing A/BN is triggered by a minor and non-specific loss of weight. The development of mental symptoms with pathological thoughts and behaviour, and disturbances in the satiety and hunger centres suggest a cerebral dysfunction. Educating patients in pathophysiology enables them to use their intelligence, logical thinking and strong will to evaluate the importance of an adequate supply of nutrients. To date, two studies of the outcome of the disease have been carried out producing similar results: 86% fair results (12% spontaneous recovery), 13% chronic cases and 1% have died.
The effects of weight loss (dehydration) techniques (which mimicked techniques used prior to actual competition) used by intercollegiate wrestlers on selected physiological parameters (strength, anaerobic power, anaerobic capacity, the lactate threshold (LT), and peak aerobic power) were examined in seven intercollegiate wrestlers. During the 36 h weight loss period, subjects lost 3.3 kg (4.9% body weight), all of which occurred during the 12 h prior to weigh-in, using exercise in a rubberized sweat suit. Weight loss resulted in a reduction in upper body but not lower body strength measures (peak torque and average work per repetition). Anaerobic power and anaerobic capacity were significantly reduced in a dehydrated state (81.4 kgm.s-1, normal weight; 63.9 kgm.s-1, weight loss; 1984.3 kgm.40 s-1, normal weight; 1791.4 kgm.40 s-1, weight loss). Analyses of treadmill data revealed the following: 1) velocity was decreased at LT (4.4%) and peak (6.5%) during weight loss (P less than 0.05); 2) VO2 peak was significantly reduced with weight loss (6.7%, P less than 0.05); 3) treadmill time to exhaustion was significantly reduced in the weight loss state (12.4%) (35.7 min, normal weight; 31.3 min, weight loss). It was concluded that typical wrestling weight loss techniques result in deleterious effects on strength, anaerobic power, anaerobic capacity, the lactate threshold, and aerobic power.
Two groups of female athletes, one in sports that provide an advantage to those with a thin body build (TB) and one in sports that demand a normal build (NB), completed a comprehensive inventory that examined eating disorder indicators, weight and diet concerns, and personality factors. They were compared with a group (CG) of similarly-aged university student females who were not engaged in sport beyond the recreational level. The data showed that the TB group, even though they were thin, had greater weight and diet concerns, and were emotionally more labile and dissatisfied than the NB group. The paper also briefly discusses the notions of psychosocial and activity models of eating problems.
Forty-nine dancers from four national ballet companies in America (N = 32) and the People's Republic of China (N = 17) were surveyed (mean age, 24.6 +/- 4.18) from highly and moderately selective dance companies. The less selected American dancers reported significantly more eating problems (46% vs 11%; P less than 0.05), anorectic behaviors (2.77 vs 1.11; P less than 0.05), and familial obesity (42% vs 5%; P less than 0.05) than the Americans chosen from a company school. Differences were not found on these variables between the highly selected American and Chinese dancers. All of the groups reported a delay in menarche and weighed approximately 14% below their ideal weight for height. These data suggest that dancers who have survived a stringent process of early selection may be more naturally suited to the thin body image demanded by ballet and so less at risk for the development of eating problems. In addition, delayed menarche is typical of the majority of national dancers and probably is reflective of genetic and environmental factors.
This study examined resting metabolic rate in adolescent wrestlers to test the hypothesis that repeated cycles of weight loss and regain would be associated with reduced energy requirements. Energy restriction lowers resting metabolic rate in normal-weight and obese persons. Repeated cycles of weight loss and regain can increase food efficiency, defined as the degree of weight change per unit of food intake, in animals. Many wrestlers lose weight repeatedly as they "cut weight" for matches. This cycle of weight loss and regain may affect their resting metabolism. Twenty-seven wrestlers were classified as cyclers or non-cyclers based on their weight loss history. Resting metabolic rate was measured using indirect calorimetry and body composition was evaluated using six skinfolds. Cyclers and noncyclers did not differ in age, weight, height, surface area, lean body mass, or percent body fat. Cyclers had a significantly lower mean resting metabolic rate than noncyclers (154.6 vs 177.2 kJ/m2/h) (4.6 vs 5.5 kJ per kilogram of lean body mass per hour). There was a 14% difference between the cyclers and the noncyclers in resting energy expenditure (6631.8 vs 7702.8 kJ/d). Weight cycling in wrestlers appears to be associated with a lowered resting metabolic rate.
Aside from the limits imposed by heredity and the physical improvements associated with training, no factor plays a bigger role in exercise performance than does nutrition. Since the mid-1930s, dietary carbohydrate (CHO) has been known to enhance performance, particularly during prolonged exercise. In these early studies, respiratory gas exchange of oxygen and carbon dioxide exchange was first used to demonstrate that during intense exercise CHO serves as the primary fuel for the muscles. It was also observed that when subjects were fed diets rich in CHO they tended to have greater endurance and to derive more of their energy from CHO during steady-state exercise. The mechanisms underlying this shift toward CHO oxidation and enhanced performance have only recently been examined using the invasive measurements of muscle and liver glycogen and the employment of isotopes. The following review will attempt to show the important role played by endogenous and ingested CHO during muscle performance. Specific attention will be given to the influence of dietary sugar on muscle and liver glycogen storage.
Athletes engage in a number of dietary and weight control practices which may influence metabolism, health, and performance. This paper reviews the literature on these factors with special emphasis on athletes who show large, frequent, and rapid fluctuations in weight (wrestlers) and athletes who maintain low weight and low percent body fat (e.g., distance runners, gymnasts, and figure skaters). A theory is presented which relates these weight patterns and the accompanying dietary habits to changes in body composition, metabolism, metabolic activity of adipose tissue, and the distribution of body fat. Changes in these physiological variables may be manifested in enhanced food efficiency (weight as a function of caloric intake) as the body seeks to protect and replenish its energy stores. This may explain the surprisingly low caloric intakes of some athletes. The health status of the athlete is a concern in this regard because there may be changes in fat distribution, risk factors for cardiovascular disease, and hormonal factors associated with reproductive functioning in both females and males. Amenorrhea in female athletes may be mediated at least in part by regional fat distribution; depletion of femoral fat depots (lactational energy reserves) may be the stimulus for cessation or disruption of menses.
Four features of anorexia nervosa—increased level of physical activity, restricted food intake, depressive symptomatology, and episodes of binge-eating (bulimia)—are examined as they unfolded in two men who developed a manifest eating disorder only after they had become serious long-distance runners. Their cases suggest that extreme exercise, such as long-distance running, can serve as a trigger for eliciting anorexia nervosa in persons who are at risk, psychologically and biologically, for developing an eating disorder. A role for endorphins in mediating this clinical sequence is postulated.
The present study was designed to test the clinical hunch that members of high-risk groups, such as athletes, have psychological traits similar to persons with eating disorders. Three groups of adolescent females (eating-disordered, athletes, and students) were studied to determine their menstrual, dieting, and exercise patterns and their self-images. Although the three groups fell on a continuum of anorexic-like behaviors, their self-images were not on a similar continuum. Eating-disordered females had the poorest self-images while athletes were the best adjusted of all three groups. Eating-disordered subjects exhibited extremely low scores on emotional tone and social relationships, suggesting that these dimensions of self-image may be characteristic which clearly distinguish the eating-disordered from so-called high-risk persons.
Ten competitive cyclists were exercised to exhaustion to test the potential of a 24-h fast for increasing endurance. One group (n = 4) was tested at an initial intensity of 86% maximum O2 uptake (VO2max) (HI) and a second group (n = 6) at 79% VO2max (MI). Both groups repeated test rides in fasted and normal-diet conditions. Time to fatigue was designated at two points: fatigue 1 occurred when pedal frequency could not be maintained at the initial percent VO2max; fatigue 2 occurred when pedal frequency could not be maintained at a workload of approximately 65% VO2max. In both HI and MI the 24-h fast had no effect on resting muscle glycogen stores but significantly increased plasma free fatty acid (FFA) levels. Despite the increased FFA availability, time to fatigue was reduced in the fasted groups. Fatigue 1 and 2 times (mean +/- SE) for HI-fasted were 42.0 +/- 6.2 and 170.0 +/- 20.4 min, respectively, compared with those of the HI-normal diet of 115.3 +/- 25.6 and 201.0 +/- 14.8 min. Fatigue 1 and 2 times for MI-fasted were 142.0 +/- 19.6 and 167.5 +/- 10.5 min compared with those of the MI-normal diet of 191.3 +/- 25.0 and 214.3 +/- 18.9 min. The cause of fatigue at fatigue 1 was not readily apparent. Fatigue 2 in all groups seemed to be related to hypoglycemia as well as muscle glycogen depletion.
Anorexia and bulimia are eating disorders affecting a significant number of adolescent and young adult women. The core symptoms of both disorders are similar and include a fear of obesity, body image disturbance, erratic eating patterns, and purging. These symptoms produce significant physical and psychologic complications. Both anorexia and bulimia appear to have a common origin in a fear of obesity and dieting. Anorectics, being "successful" dieters, lose a significant amount of weight; whereas bulimics alternate between binges and purges. Treatment for the eating disorders is gradually evolving as clinical research experience accumulates. For anorexia, hospitalization is indicated when weight falls below 15% of ideal, and most investigators agree that therapy for the core symptoms cannot be undertaken until weight is restored. During the impatient stay, a behavior modification program can effectively organize medical, nutritional, and psychologic support, and offers the quickest and most direct route to weight restoration. The nasogastric tube and total parenteral nutrition are used primarily for those who are severely emaciated or who actively resist standard modes of therapy. Inpatient treatment is most effectively and efficiently rendered in a specialized eating disorder unit. Once weight restoration is progressing, behavior therapy for core symptoms is commenced and continued on an outpatient basis. A variety of behavioral techniques are employed, and they are designed primarily to influence anorectic assumptions and beliefs. Although there may be a brief inpatient stay for initiation of treatment, the bulk of therapy for bulimia occurs on an outpatient basis. The available literature indicates that behavioral techniques and antidepressant medication are effective for the symptoms of bulimia. Early identification of core symptoms of both disorders can lead to an initiation of treatment before the core symptoms become ingrained. A potentially more effective intervention lies in efforts to influence the media. As noted, standards for feminine beauty as portrayed in the media have changed significantly over the past 20 years. An attempt at the primary prevention of eating disorders would include efforts to convince the media to change their standards of femininity from cosmetic slimness to a focus on health and physical fitness. These efforts could stem from professional and lay organizations who have the interest and capability to influence policy.
Features important in the diagnosis of anorexia nervosa were common in a sample of 100 ballet students. Defining a "case" of anorexia nervosa proved difficult. Follow-up one year later showed that seven girls who were designated "possible cases" had continued to dance and were considerably improved in their physical status without medical intervention.
We evaluated 201 children for short stature or delayed puberty or both. Fourteen of them (nine boys and five girls, aged 9 to 17 years) fit a pattern of growth failure due to malnutrition, which was the result of a self-imposed restriction of caloric intake arising from a fear of becoming obese. All 14 patients underwent a complete history, physical examination, diagnostic laboratory evaluation, and psychiatric assessment. They were all below the fifth percentile for weight, and 11 of them were also below the fifth percentile for height. The deficit of weight for height ranged from 5 to 23 per cent. Seven of the older patients also had delayed puberty. All 14 patients had deteriorating linear growth, which was preceded by at least one to two years of inadequate weight gain. They ingested only 32 to 91 per cent of the recommended caloric intake for their age and frequently skipped meals. No gross psychiatric disease or anorexia nervosa was found; on the whole, they were good students with rather compulsive, shy personalities observed in an open-ended interview. The Diagnostic Interview for Children and Adolescents, which was conducted with seven patients, also revealed no psychiatric disease. After nutritional and psychiatric counseling, the patients resumed an adequate caloric intake for their age, and recovery occurred, as demonstrated by increased linear growth and sexual development.
The dominant role of athletic activities in our society and the extent and intensity of sports participation by large number of young people create stresses causing a whole new constellation of health problems, both emotional and physical. One such problem is excessive weight loss and food aversion in athletes. The condition is in many ways similar to primary anorexia nervosa as commonly encountered in young women. The athlete avoiding food and experiencing extreme weight loss is most often a male, however, and does not suffer from severe, deep-seated emotional problems. He is typically a serious and outstanding student athlete fearing failure in meeting expectations of admiring coaches, teammates, and parents. The prognosis is excellent under the treatment by an informed, reassuring physician. The athlete's physician should provide a precise definition of optimum level of fatness for given sports participation. Guidance should be given in such a way that desire level of fatness can be safely achieved, without threatening health and fitness.
This study examined risk factors and triggers for eating disorders in female athletes. Subjects included were all of the elite female athletes in Norway (N = 603), ages 12-35 yr, representing six groups of sports: technical, endurance, aesthetic, weight dependent, ball games, and power sports. The Eating Disorder Inventory was used to classify individuals at risk for eating disorders. Of the 117 athletes defined at risk, 103 were administered a structured clinical interview for eating disorders. A comparison group was also interviewed, consisting of 30 athletes chosen at random from a pool not at risk and matched to the at-risk subjects on age, community of residence, and sport. Ninety-two of the at-risk athletes met criteria for anorexia nervosa, bulimia nervosa, or anorexia athletica. The prevalence of eating disorders was higher in sports emphasizing leanness or a specific weight than in sports where these are less important. Compared with controls, eating disordered athletes began both sports-specific training and dieting earlier, and felt that puberty occurred too early for optimal performance. Trigger factors associated with the onset of eating disorders were prolonged periods of dieting, frequent weight fluctuations, a sudden increase in training volume, and traumatic events such as injury or loss of a coach.
This study assessed the nutrient intake and eating behavior in Norwegian female elite athletes suffering from eating disorders (ED) who met the criteria for anorexia nervosa (AN), anorexia athletica (AA), or bulimia nervosa (BN). The subjects included 7 AN, 43 AA, 42 BN, and 30 controls. Three-day and 24-hr food records were used to assess energy and nutrient intake. Results revealed that a significant number of AN and AA athletes have diets too low in energy and nutrients, the mean intake for energy and CHO being lower than recommended for active females. A significant number did not reach the protein level recommended for athletes. In addition, there were low intakes of several micronutrients, most notably calcium, vitamin D, and iron. The energy and nutritional inadequacy, combined with the use of purging, are of major concern since the athletes in this study were relatively young. It is unknown whether the abnormal eating pattern is a consequence of ED or is typical of top level athletes.
This study examined the prevalence of eating disorders (ED) and the possible difference between ED symptoms and true ED by using questionnaires as compared with an interview and clinical evaluation in Norwegian elite female athletes (n = 522) from 35 sports and nonathletic controls (n = 448). In addition to the 117 athletes classified as "at risk" to develop ED, 90 subjects were randomly chosen, comprising 30 athletic controls, 30 at-risk nonathletes, and 30 nonathletic controls. All were interviewed and clinically examined. A significantly higher number of athletes (18%) than controls (5%) were found to actually suffer from ED, particularly athletes competing in sports in which leanness or a specific weight were considered important. When results from the screening study were compared to those from the interviews and clinical examinations, a significant underreporting of ED among athletes was demonstrated. The athletes also reported the use of other pathogenic methods in the screening study compared to what they reported in the interview. Nonathletes more correctly reported the use of pathogenic methods but overreported the prevalence of ED. Thus the issue of using questionnaires alone or in combination with personal interview/clinical examination merits further investigation.
To present recommendations for the prevention, detection, and comprehensive management of disordered eating (DE) in athletes.
Athletes with DE rarely self-report their symptoms. They tend to deny the condition and are often resistant to referral and treatment. Thus, screenings and interventions must be handled skillfully by knowledgeable professionals to obtain desired outcomes. Certified athletic trainers have the capacity and responsibility to play active roles as integral members of the health care team. Their frequent daily interactions with athletes help to facilitate the level of medical surveillance necessary for early detection, timely referrals, treatment follow-through, and compliance.
These recommendations are intended to provide certified athletic trainers and others participating in the health maintenance and performance enhancement of athletes with specific knowledge and problem-solving skills to better prevent, detect, and manage DE. The individual biological, psychological, sociocultural, and familial factors for each athlete with DE result in widely different responses to intervention strategies, challenging the best that athletics programs have to offer in terms of resources and expertise. The complexity, time intensiveness, and expense of managing DE necessitate an interdisciplinary approach representing medicine, nutrition, mental health, athletic training, and athletics administration in order to facilitate early detection and treatment, make it easier for symptomatic athletes to ask for help, enhance the potential for full recovery, and satisfy medicolegal requirements. Of equal importance is establishing educational initiatives for preventing DE.
Nutrient intake and eating behavior of female elite athletes suffering from anorexia nervosa, anorexia athletica and bulimia nervosa
- J Sundgot-Borgen
- Larsen
Eating disorders: impli-cations for the 1990s An index of symptoms of anorexia ner-vosa
- Garfinkel Pe Garner Dm
- Goldbloom
- Garner
- Dm
- Pe
Garfinkel PE, Garner DM, Goldbloom DS. Eating disorders: impli-cations for the 1990s. Canadian Journal of Psychiatry 32: 624-631, 1987 Garner DM, Garfinkel PE. An index of symptoms of anorexia ner-vosa. Psychological Medicine 9: 273-279, 1979