Robin Halioua’s research while affiliated with University of Zurich and other places

Purpose The purpose was to evaluate the individual and combined use of the Low Energy Availability in Females Questionnaire (LEAF-Q) and the Brief Eating Disorder in Athletes Questionnaire (BEDA-Q) to detect clinical indicators associated with Relative Energy Deficiency in Sport (REDs). Methods In this cross-sectional study, 50 female endurance athletes training ≥4x/week completed the LEAF-Q and BEDA-Q and were assessed for presence of selected REDs indicators. Athletes meeting the criteria for mild or more severe REDs severity/risk according to the International Olympic Committee REDs Clinical Assessment Tool Version 2 (IOC REDs CAT2) were classified as REDs cases. Diagnostic properties of the German versions of the LEAF-Q and BEDA-Q were assessed at different cut-offs using receiver operating characteristics calculations. Results Fourteen (28%) athletes were classified as REDs cases. The LEAF-Q had a sensitivity of 79% and a specificity of 50%, with a positive predictive value (PPV) of 38% and negative predictive value (NPV) of 86%. For detection of disordered eating behaviour/eating disorder (DE/ED), the BEDA-Q showed a sensitivity and specificity of 71% and 76%, respectively, with a PPV of 68% and NPV of 79%. Out of 14 REDs cases, nine (64%) scored positive in the LEAF-Q and BEDA-Q. Two athletes (14%) scored positive only in the LEAF-Q and one athlete scored positive only in the BEDA-Q. Two REDs cases remained undetected by both questionnaires. Conclusions Among German female endurance athletes, the LEAF-Q and BEDA-Q are good screening tools to detect REDs cases with mild or more severe severity/risk as classified according to the IOC REDs CAT2. Further clinical assessments should be initiated when athletes score positive in at least one of the questionnaires.

Objective This cross-sectional study aimed to investigate the role of low energy availability (LEA) in the interplay between depression and disordered eating/eating disorders (DE/EDs) among female athletes. The International Olympic Committee consensus statement on Relative Energy Deficiency in Sport (REDs) identified depression as both an outcome of LEA and a secondary risk factor for REDs. However, the direct link between LEA and depression has yet to be fully established. Methods We assessed 57 female athletes participating in weight-sensitive sports at different levels of competition training at least four times a week. Assessment was conducted using laboratory analyses, clinical interviews and the Patient Health Questionnaire-9 questionnaire. Participants were recruited through various channels, including German sports clubs, Olympic training centres, social media platforms and the distribution of flyers at competitions. Indicators of LEA were defined if at least two of the following three physiological indicators were present: menstrual disturbances, suppressed resting metabolic rate and suppressed thyroid hormones. Logistic and linear regression analysis were used to examine the relationship between LEA, depression and DE/ED. Results The lifetime prevalence of depressive disorders was 29.6%. 19% of the participants were diagnosed with an ED, and an additional 22.6% exhibited DE.LEA was not significantly associated with either lifetime prevalence of depressive disorders or current depressive symptoms. However, a significant association was found between depression and DE/ED in terms of both lifetime prevalence and current depressive symptoms. DE/ED increased the probability of lifetime prevalence of depressive disorders by 34% (19%–49%) compared with normal eating behaviour. Conclusion We found no evidence that LEA is an independent factor for depression in female athletes. Its association with LEA and REDs appears to occur primarily in the presence of DE/ED.

Relative energy deficiency in sports (RED-S) is centered by chronic low energy availability (LEA), with a bidirectional causative relationship with mental health. Aside the well-established link between eating disorders and LEA, exercise addiction (ExA) has been proposed as another independent LEA risk factor. The aim of this investigation was to assess the relationship between LEA, eating disorders, ExA and biomarkers indicative of LEA in a sample of female endurance athletes. In a cross-sectional study, 23 athletes (27 ± 6 yrs, BMI 20.6 ± 2.0 kg/m2) who train ≥ 4 times/week completed the Low Energy in Females Questionnaire (LEAF-Q), the Brief Eating Disorder in Athletes Questionnaire (BEDA-Q), and an expanded version of the Exercise Addiction Inventory (EAI). Biomarkers of LEA included a reduction in resting metabolic rate, defined as a ratio of measured and predicted RMR < 0.9 and reduced circulating concentrations of triiodothyronine (T3). According to the LEAF scores, 52% of all athletes were at risk of LEA. Athletes at risk for LEA demonstrated a higher risk for eating disorders (42% vs. 9%) and exercise addiction (ExA; 25% vs. 0%), which was predominantly (67%) categorized as secondary ExA. Overall, EAI scores were increased in athletes at risk for LEA (22.4 ± 3.7 vs 18.9 ± 2.7, p=0.014), and more of those athletes reported to train despite pain or injury (42% vs. 18%). Additionally, athletes at risk for LEA were more likely to have suppressed RMR and low T3 (42% vs 36% and 17% vs. 9% respectively). EAI scores were not associated with LEA biomarkers. Our findings indicate that the inclusion of exercise addiction could complement the LEAF-Q when screening athletes for LEA. Given that mental health and LEA are bidirectional, early detection of compromised mental health could aid in prevention of chronic LEA and RED-S. Acknowledgements: This study was funded by the Robert-Enke-Foundation.

Plain English summary Muscle dysmorphia is a mental disorder in which those affected are constantly preoccupied with being insufficiently muscular. Although there is initial evidence that binge eating may play a role in the clinical presentation of muscle dysmorphia (MD), this has not been investigated. In addition, MD has rarely been studied in women. We conducted a study involving 5905 men (n = 422) and women (n = 5483) using self-report questionnaires to examine the association between binge eating and symptoms of MD. We found that symptoms of MD and binge eating are positively associated. According to our model, two-thirds of women and one-quarter of men at-risk for MD exhibit binge eating. Binge eating episodes should therefore form part of the clinical assessment of MD.

Background: Government restrictions during the first COVID-19 lockdown, such as the closure of gyms and fitness centers, drastically limited the training opportunities of bodybuilders and fitness athletes (BoFA) who rely on indoor training facilities. This provided a unique situation to investigate the effect of training limitations on the training patterns, training adaptive strategies and mental health of BoFAs. Objectives: The primary aim of this study was to investigate differences in the training patterns and the mental health of BoFA before and during the first COVID-19 lockdown. The secondary aim was to assess whether BoFA who exhibited features of muscle dysmorphia were affected differently from the group that did not. Methods: A cross-sectional study was conducted with 85 BoFAs by means of an online questionnaire asking about sports activity, intensity, subjective physical performance, and economic status, including primary or secondary occupations before (from memory) and during lockdown, current physical health problems and financial fears, symptoms of depression, sleep disorders, anxiety (trait and state), muscle dysmorphia, coping mechanisms and actions during the first lockdown in Switzerland. Results: Training patterns and mental health of BoFA were influenced by the COVID-19 pandemic and first lockdown. During lockdown, the physical activity on the BoFA dropped significantly from 2.3 ± 0.8 h per day to 1.6 ± 0.9 h per day (p < 0.001), the subjective training intensity decreased significantly from 85.7 ± 13.2% to 58.3 ± 28.3% (p < 0.001) and the subjective performance declined significantly from 83.4 ± 14.3% to 58.2 ± 27.8% (p < 0.001) of maximal performance. In comparison to those without risk for body dysmorphia, participants at risk rated their maximal performance significantly lower and scored significantly higher for depression, sleep disorders and anxiety. Conclusion: This study showed the significant changes on the training patterns of BoFA before and during the first COVID-19 lockdown and poor mental health scores of BoFA during the lockdown itself, with those at risk of muscle dysmorphia scoring statistically worse regarding mental health than those with no risk of muscle dysmorphia. To better understand the particularities of BoFA, further investigation is needed to understand their psychology and in particular the effect of training restrictions on it.

Zusammenfassung. In der klinischen Praxis sind Patient_innen, die stark unzufrieden mit der Beschaffenheit oder dem Aussehen ihres Körpers sind, häufig. Viele versuchen mittels Körperpraktiken, ihren Körper entsprechend den eigenen Idealvorstellungen zu formen. Dabei geht es aber um weit mehr als um blosses Aussehen. Der Körper ist ein zentrales Element der menschlichen Identität. Das Verhältnis, das wir zu unserem Körper haben ist sozial geprägt und widerspiegelt die Fragen danach, wer wir sind und wie wir wahrgenommen werden möchten. Die Bedürfnisse nach Bindung und Kontrolle stellen hierbei zentrale Motive dar: Beim Bindungsbedürfnis dient die Körperpraxis primär der sozialen Anerkennung, sei es, um positiv oder nicht negativ aufzufallen. Beim Kontrollbedürfnis dient der Körper als fügbares Objekt der Selbstermächtigung.

Background Eating disorders (ED) and disordered eating (DE) among male elite athletes share some of the characteristics seen in female elite athletes and the population, but also exhibit some key differences. Objective Scoping review of ED and DE in male elite athletes. Methods In May 2020, a comprehensive systematic literature search was conducted for DE and ED in male elite athletes. Results We identified 80 studies which included 47 uncontrolled, 14 controlled studies, one interventional trial and 18 reviews. Discussion There was a wide range of definitions of DE and a high level of heterogeneity regarding competitive level, age and sport type. In adult male elite athletes, ED prevalence rates up to 32.5% were found, higher than in the general population. Prevalence was not higher in young/adolescent male elite athletes. The most frequently associated factor was competing in weight-sensitive sports. Male elite athletes tended to exhibit less body dissatisfaction than controls and were not always associated with DE. There were no studies looking at the prognosis or reporting an evidence-based approach for the management of DE in male elite athletes. Conclusion Existing literature indicates high prevalence of DE and ED in male elite athletes, with a wide range of aetiopathogenesis. There is a need for longitudinal studies to characterise the pathology and long-term outcomes, as well as develop standardised tools for assessment and treatments.

Among elite athletes disordered eating (DE) behavior as well as eating disorders (ED) are one of the most common mental illnesses. According to Sundgot-Borgen et al. [1] DE can be illustrated by a continuum ranging from performance-oriented eating and exercise behaviors to subclinical EDs and clinical EDs such as Anorexia nervosa (AN) and Bulimia nervosa (BN) along with other medical complications and impairment of performance.

The current ideal of beauty consists of a strong shift towards physical activity and aims to develop a muscular, athletic physique. While the athletic ideal for women has been a product of recent years, the muscular ideal for men has been observed since the 1970s. Increasing pressure to achieve this muscular ideal is associated with both body dissatisfaction and a strong desire to increase muscularity. In extreme terms, the pursuit of a muscular body and its associated behaviours, such as strength training and dieting, may lead to the development of muscle dysmorphia.