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Athletes and Dancers
Abstract
IntroductionDefinitionsPrevalence of Eating DisordersEating Disorders among AthletesEating Disorders among DancersRisk Factors for the Development of Eating DisordersMedical IssuesIdentifying Athletes with Eating DisordersTreatmentPrognosisPrevention of Eating DisordersConclusion
References
... On the basis of the importance athletes tend to ascribe to coaches (23), successful prevention programs in the athletic setting may be particularly dependent on the commitment and support from their coaches and ''significant others'' (34). Therefore, to create supportive environments, coaches (employees of the Elite Sport High Schools) were also included in the intervention. ...
To examine the effect of a 1-yr school-based intervention program to prevent the development of new cases of eating disorders (ED) and symptoms associated with ED among adolescent female and male elite athletes.
All 16 Norwegian Elite Sport High Schools were included (intervention group [n = 9] and control group [n = 7]). In total, 465 (93.8%) first-year student athletes were followed during high school (2008-2011, three school years). The athletes completed the Eating Disorder Inventory 2 and questions related to ED before (pretest), immediately after (posttest 1), and 9 months after the intervention (posttest 2). Clinical interviews (Eating Disorder Examination) were conducted after the pretest (all with symptoms [n = 115, 97%] and a random sample without symptoms [n = 116, 97%]), and at posttest 2, all athletes were interviewed (n = 463, 99.6%).
Among females, there were no new cases of ED in the intervention schools, while 13% at the control schools had developed and fulfilled the DSM-IV criteria for ED not otherwise specified (n = 7) or bulimia nervosa (n = 1), P = 0.001. The risk of reporting symptoms was lower in the intervention than in the control schools at posttest 1 (odds ratio [OR] = 0.45, 95% confidence interval [CI] = 0.23-0.89). This effect was attenuated by posttest 2 (OR = 0.57, 95% CI = 0.29-1.09). The intervention showed a relative risk reduction for current dieting (OR = 0.10, 95% CI = 0.02-0.54) and three or more weight loss attempts (OR = 0.47, 95% CI = 0.25-0.90). Among males, there was one new case of ED at posttest 2 (control school) and no difference in the risk of reporting symptoms between groups at posttest 1 or 2.
A 1-yr intervention program can prevent new cases of ED and symptoms associated with ED in adolescent female elite athletes.
... Incidences and experiences of disordered eating attitudes, anorexia nervosa, bulimia and sense of control and achievement in maintaining low weight are well documented in dance (Schnitt and Schnitt 1986;Nixon 1989;Buckroyd 1995Buckroyd , 1996Abraham 1996aAbraham , 1996bBrinson and Dick 1996;Haight 1998;Wolman 1999;Benn and Waters 2001;Robson 2002;Yannakoulia, Sitara, and Matalas 2002;Ravaldi et al. 2003;Sundgot-Borgen, Skarderud, and Rodgers 2003;Koutedakis and Yamurtas 2004;Piran 2005;Ringham et al. 2006). Indeed several studies of eating disorders and weight controlling behaviour amongst adult ballet dancers and ballet students have been undertaken in the last 20 years but none exist which have explored the social world of ballet and how this shapes child and adolescent ballet dancers' perceptions and understandings of their bodies over a period of time nor the lived experiences of child and adolescent dancers' and how they construct, negotiate and embody social and cultural knowledge and meanings whilst in the process of becoming a ballet dancer in a non-residential elite ballet school context. ...
This paper explores what is perceived and believed to be an ideal ballet body by young ballet dancers. Such bodily belief becomes, in Pierre Bourdieu's terms, a core part of a ballet dancer's habitus. A four year longitudinal, ethnographic, empirical study of the experiences of 12 young ballet dancers, six boys and six girls, aged between 10 and 15 years at the start of the study, examined processes of bodily construction and ‘becoming' a ballet dancer in non-residential ballet schooling. Data was generated via a multi-method approach although only individual and focus group interview data are used here. Findings suggest that the 12 young ballet dancers' attempted to replicate and position themselves within what is perceived and believed to be an ideal ballet body shape and size. Ballet is a social practice which shapes the activity of the young dancer but is also shaped by that young dancer through a process of incorporation of the social into the body. The ballet dancer's body and habitus is produced and maintained as the young ballet dancers' accepted their bodies as an aesthetic project. It is argued that there is a strong connection between the size, shape and aesthetic of the ballet body and identity.
Eating disorders among adolescent girls are a public health concern. Adolescent girls that participate in aesthetic sport, such as dance, are of particular concern as they experience the highest rates of clinical eating disorders. The purpose of this study is to explore the experiences of young girls in the world of competitive dance and examine how these experiences shape their relationship with the body; feminist poststructural discourse analysis was employed to critically explore this relationship. Interviews were conducted across Canada with twelve young girls in competitive dance (14–18 years of age) to better understand how the dominant discourses in the world of competitive dance constitute the beliefs, values and practices about body and body image. Environment, parents, coaches, and peers emerged as the largest influencers in shaping the young dancers’ relationship with their body. These influencers were found to generate and perpetuate body image discourses that reinforce the ideal dancer’s body and negative body image.
The aim of the study was to investigate if and how body image, taken from a contextual perspective, contributes to the eating disorder history. This qualitative study investigated the process of eating disorder development in eight elite women athletes in at-risk sports. The results showed that the relationship between eating disorder symptomatology and the sports environment was clearly recognized by the elite women athletes. Contextual body image, more specifically negative body-evaluations and upward body comparisons, appeared as an important factor in the development of eating disorders, particularly in the athletic context. It became clear that the two aesthetic and two endurance athletes as well as the two weight-class athletes in rowing described quite negative body evaluations in the context of sport, while some of them also recognized an impact of body image experiences in daily life. However, for both judokas, their eating disorder had nothing to do with their body image but was attributed to the weight-classes in their sport and accompanying weight making. Several unique trajectories and individual eating disorder histories were distinguished which confirms the value of taking a qualitative approach in investigating eating disorders in sport. We also discovered links between what the athletes had reported as contributors to their eating disorder history and how they told their stories by combining content analysis and narrative inquiry. Furthermore, the present study also highlights several critical aspects for prevention and treatment that should support sport federations and clinical sport psychologists in taking appropriate actions to deal more effectively with eating disorders in athletes.
Eating disorders occur at the same rate in boys and girls before puberty. From puberty, a marked gender difference is noted in prevalence but partial syndromes are less gendered and some eating disorder symptoms are alarmingly prevalent among both adolescent males and females. The gender disparity in prevalence is disproportionate to the lack of attention that males have received in the literature. In thinking about gender issues, it appears more useful to develop an understanding of how males experience eating disorders, rather than continue to think about why so few do. There is a strong developmental component to eating disorders, with subtle differences in symptom expression between the genders raising interesting questions around the role of psychosexual, sociocultural, and biogenetic factors. Females may experience a more protracted course of illness than males and, if confirmed, more work is needed to disentangle what factors may convey protection for either gender, and how these may translate to treatment interventions for both. In general, a review of gender issues in eating disorder reveals more questions than answers.
Many athletes struggle with disordered eating or eating disorders (ED) as they attempt to conform to demands or competition regulations that might be ill-suited to their physique. In this situation, participation in sports may lead to an array of health concerns that may adversely affect the athlete’s short and long-term health at a variety of performance levels and sports. The peak onset of ED is adolescence, when most athletic participation and competition takes place and athletes begin to focus on a particularly sport. For athletes, the biological changes occurring during adolescence might affect not only attitudes toward weight and shape, but also performance. To prevent the medical and psychological consequences related to ED, early intervention and identification is important.
Aims: The overall aim of this thesis was to examine the effect of a one-year school-based intervention program to prevent the development of new cases of ED and symptoms associated with ED among adolescent male and female elite athletes (Paper II). An educational program was developed for coaches and included as a separate part of the intervention program. In Paper III, we examine the effect of the education program on the coaches’ knowledge about nutrition, weight regulation, and ED. In Paper I, we investigate the prevalence of ED among adolescent elite athletes compared to non-athletic controls. Finally, we wanted to design and validate a brief screening questionnaire with the ability to discriminate between athletes with and without an ED (Paper IV).
Methods: First-year students (athletes) and their coaches at all the Norwegian Elite Sport High Schools (n=16) and first-year students (controls) at two randomly selected regular high schools participated in the three school year project period (2008 to 2011). In phase I (pretest) of the study all the schools were included and the students were screened for symptoms associated with ED and ED. In phase II, the Elite Sport High Schools were stratified (by size) and randomized to the intervention (n=9) or control group (n=7). The intervention group received the intervention program. Data from the athletes and their coaches at phase I and II, and data from the controls at phase I are included in this thesis.
Paper I: In this cross-sectional study we used a two-tiered approach: self-reported questionnaire (part I) and clinical interview (part II). The questionnaire, including the Eating Disorder Inventory 2 (EDI-2) and questions related to ED, was completed by 611 athletes (90%) and 355 controls (84%). Subjects reporting symptoms associated with ED were classified as “at risk” for ED. In part II, all at-risk athletes (n=153), a random sample not at risk for ED (n=153), and a random sample of 50% of the controls classified as at risk (n=91) and not at risk (n=88) were invited to the clinical interview (Eating Disorder Examination) to screen for ED.
Paper II: The 611 athletes participating in Paper I formed the basis of this randomized controlled trial (RCT). After the pretest (Paper I) all athletes (and coaches, Paper III) from each school were randomized to the same treatment arm (intervention or control). A final sample of 465 (93.8%) athletes was followed during high school. The athletes completed the questionnaire screening at pretest (Paper I), pottest 1 (after the intervention) and posttest 2 (9-months after intervention). Clinical interviews were conducted after pretest and at posttest 2 (one-year after intervention).
Paper III: In this part of the RCT 76 coaches (93.8%) employed at and working with the first-year students at the Elite Sport High Schools were followed during the project period. At pretest and posttest (9-months after intervention) the coaches completed a questionnaire including questions concerning nutrition, weight-regulation, and ED.
Paper IV: We conducted this prospective cross-sectional study in three phases. Phase I consist of data from the screening at pretest among the female athletes (Paper I). Based on the questionnaire screening we extracted items with good predictive abilities for an ED-diagnosis to the Brief ED in Athletes Questionnaire (BEDA-Q) version 1 and version 2. Version 1 consisted of 7-items from the EDI-Body dissatisfaction, EDI-Drive for thinness, and questions regarding dieting. In version 2, two items from the EDI-Perfectionism subscale were added. In phase II, the external predictive validity of version 1 was tested involving 54 age-matched elite athletes from an external dataset. In phase III, the predictive ability of posttest assessments was determined among athletes with no ED at pretest (n=53, 100%).
Main results: 1) No new cases of ED in athletes at the intervention schools one-year after the intervention program, while 13% of the females and one male at the control schools developed ED. 2) Coaches at the intervention schools had higher scores on total knowledge, weight-regulation and ED compared to coaches at the control schools after intervention. The intervention also showed positive effects on the coaches’ subjective evaluation of their ED knowledge. 3) Higher prevalence of ED in adolescent elite athletes than controls (although more controls than athletes reported symptoms associated with ED. 4) BEDA-Q version 2 showed higher discriminative accuracy than version 1 in distinguishing athletes with and without an ED, and higher diagnostic accuracy in predicting new cases of ED than version 1.
Conclusions: A one-year school-based intervention program can prevent new cases of ED and symptoms associated with ED in adolescent female elite athletes. The intervention part targeting the coaches with strategies of identification, management and prevention of ED produced significant effect of at least 9-months. It is confirmed that the prevalence of ED is higher among adolescent elite athletes than controls and higher in female than male adolescent elite athletes. Finally, BEDA-Q containing 9-items reveal promising psychometric and predictive features to distinguish between adolescent female elite athletes with and without ED.
Key words: athletes, coaches, eating disorders, prevalence, prevention, screening, instrument, intervention
Purpose:
It has been suggested that programs regarding early identification and prevention of eating disorders (ED) among athletes are unlikely to succeed without their coaches' endorsement and participation. Therefore, we developed a 1-yr intervention aiming to prevent the development of ED among adolescent elite athletes by targeting athletes and their coaches. The separate part of the intervention targeting the coaches was designed to provide knowledge and strategies regarding healthy nutrition, eating behavior, and ED (symptoms, identification, management, and prevention). In this trial, we examined the effect of the educational program on the coaches' knowledge and management index in three content areas (nutrition, weight regulation, and ED). We also examined their subjective evaluation of their ED knowledge.
Methods:
All Norwegian Elite Sport High Schools were included (intervention group (n = 9) and control group (n = 7)). Seventy-six coaches employed at and coaching first year student athletes at the different schools were followed for three school years (2008-2011). At pretest and posttest (9 months after intervention), they completed a questionnaire regarding nutrition, weight regulation, and ED.
Results:
Intervention coaches had higher knowledge index scores than control coaches for weight regulation (6.2 ± 1.7 vs. 4.8 ± 1.3, P < 0.001), ED (including recognition and management) (19.3 ± 4.4 vs. 16.5 ± 5.0, P = 0.004), and total knowledge (weight regulation, ED, and nutrition) (35.0 ± 7.2 vs. 31.6 ± 8.0, P = 0.021) at posttest. Moreover, the coaches likelihood of describing knowledge of ED as "somewhat good" or better was seven times higher for intervention than control coaches at posttest (OR = 7.1, 95% CI, 2.2-23.2, P = 0.001).
Conclusion:
Intervention coaches had higher index scores on total knowledge, weight regulation, and ED (including recognition and management) than control coaches. The intervention also was successful in producing effects on the coaches' subjective evaluation of their ED knowledge.
This is the first study developed in Portugal which investigates specific characteristics of dance and gymnastics environments that make them high-risk contexts for the development of eating disorders. Four focus groups were conducted with thirteen ballet students from a professional dance school and nine gymnasts from a gymnastics club (aged 12 to 17 years old), which were subjected to an inductive-deductive analysis procedure. Specific risk and protective factors were identified. Among their respective sources of influence, teachers and coaches are those who exert a stronger influence upon young athletes. We also explored some themes related to the influence of peers, parents, and environmental characteristics, which could have an important role on the development or prevention of disordered eating.
Thirty-two professional female ballet dancers were studied by means of a gynecological questionnaire to determine the prevalence of menstrual dysfunction. 37% had a history of amenorrhea (p<.01 compared with control). 47% had a history of menstrual dysfunction manifested by delayed menarche, amenorrhea, or oligomenorrhea (p<.001) compared with controls). Menstrual dysfunction was related to both strenuous physical exercise and diminished body weight, and it was reversible, often disappearing with significant weight gain or intervals of less intense exercise. 13 women had pituitary hormone levels measured before and after exercise, and both were within the normal range.
This clinical review of psychiatry and sport examines the place of sport and physical activity in health and psychopathology. Athleticism as a psychological state, the place of physical activity in anorexia nervosa and the role of the psychiatrist in treating the psychiatrically impaired athlete are discussed.
This article outlines main goals and implementation strategies of the Norwegian school-based model for the prevention of eating disorders. Initially, the model focused on the integration of information about eating disorders and attitudinal change. Secondary prevention strategies were also employed in the model. They included information about eating disorders for teachers and health-care professionals, as well as guidelines to facilitate the provision of adequate levels of care to students. In view of our critical reconsiderations, we outline new directions for prevention.
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.
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.
Surveys suggest that 8 to 41% of athletes may struggle with binge/purge and bulimic eating behaviors. Many of these athletes with bulimia struggle alone, receiving no professional help for recovery. This article offers effective counseling strategies for nutrition professionals who want to help bulimic athletes. Through a case study of a triathlete who binges, and then purges through compulsive exercise, a nutrition care plan is discussed that addresses the food and weight concerns commonly expressed by athletes with bulimia. The priorities of the care plan are to reduce preoccupation with weight, establish a pattern of regular eating, and address the underlying causes of the binges. The case demonstrates that nutrition counseling is only one part of the treatment program, and emphasizes the importance of developing a team of health professionals to assist athletes with bulimia.