Prevalence of disordered eating and pathogenic weight control behaviors among NCAA division I female collegiate gymnasts and swimmers

Sleep, Diet Quality, and Lipid Profile Assessment in NCAA Division I Acrobatics and Tumbling Student-Athletes: A Cross-Sectional Study

OBJECTIVE

Acrobatics and Tumbling (A&T), an emerging National Collegiate Athletics Association (NCAA) sport, involves athletes with rigorous training backgrounds, usually extending from youth through early adulthood. This study examines the sleep health, diet quality, and lipid profile of A&T athletes clustered by their performance position.

METHODS

Forty-two A&T athletes, clustered as tops (n = 19; age = 19.6 ± 1.0 years; body mass index [BMI] = 22.3 ± 1.7 kg/m2) and bases (n = 23; age = 19.6 ± 1.3 years; BMI = 25.7 ± 2.5 kg/m2), completed preseason sleep and diet quality (Rapid Eating Assessment for Participants-Shortened [REAP-S]) surveys. Fasting blood samples were collected for lipid analysis. Body composition was assessed via dual-energy X-ray absorptiometry.

RESULTS

Most athletes (71.4%; base n = 14, top n = 16) reported insufficient sleep (≤7 hours) and "good" sleep quality (90.4%, n = 38; base n = 18, top n = 20). Average REAP-S score was 29.24 ± 3.74. Approximately 31% (n = 13) displayed at least one undesirable lipid concentration according to medical guidelines for normal levels (total cholesterol [TC] < 200 mg/dL, triglycerides [TG] < 150 mg/dL, high-density lipoprotein cholesterol [HDL-C] > 40 mg/dL, low-density lipoprotein cholesterol [LDL-C] < 130 mg/dL). Approximately 20% exhibited elevated TC (top n = 4, base n = 4), 12.5% had elevated TG (base n = 5), 2.5% showed low HDL-C (base n = 1), and 10% presented elevated LDL-C (top n = 2, base n = 2).

CONCLUSIONS

Most athletes experienced suboptimal sleep (≤7 hours/night) and 31% displayed at least one undesirable lipid concentration (elevated TC, TG, or LDL-C or reduced HDL-C). Tailoring interventions with sports dietitians is recommended, focused on increasing monounsaturated and polyunsaturated fat intake while reducing saturated fat consumption. These interventions could mitigate cardiovascular risks, improve recovery, and possibly enhance athletic performance.

A systematic review, meta-analysis, and meta-regression of the prevalence of self-reported disordered eating and associated factors among athletes worldwide

BACKGROUND

The purpose of this meta-analysis was to provide a pooled prevalence estimate of self-reported disordered eating (SRDE) in athletes based on the available literature, and to identify risk factors for their occurrence.

METHODS

Across ten academic databases, an electronic search was conducted from inception to 7th January 2024. The proportion of athletes scoring at or above predetermined cutoffs on validated self-reporting screening measures was used to identify disordered eating (DE). Subgroup analysis per country, per culture, and per research measure were also conducted. Age, body mass index (BMI), and sex were considered as associated/correlated factors.

RESULTS

The mean prevalence of SRDE among 70,957 athletes in 177 studies (132 publications) was 19.23% (17.04%; 21.62%), I2 = 97.4%, τ2 = 0.8990, Cochran's Q p value = 0. Australia had the highest percentage of SRDE athletes with a mean of 57.1% (36.0%-75.8%), while Iceland had the lowest, with a mean of 4.9% (1.2%-17.7%). The SRDE prevalence in Eastern countries was higher than in Western countries with 29.1% versus 18.5%. Anaerobic sports had almost double the prevalence of SRDE 37.9% (27.0%-50.2%) compared to aerobic sports 19.6% (15.2%-25%). Gymnastics sports had the highest SRDE prevalence rate, with 41.5% (30.4%-53.6%) while outdoor sports showed the lowest at 15.4% (11.6%-20.2%). Among various tools used to assess SRDE, the three-factor eating questionnaire yielded the highest SRDE rate 73.0% (60.1%-82.8%). Meta-regression analyses showed that female sex, older age, and higher BMI (all p < 0.01) are associated with higher prevalence rates of SRDE.

CONCLUSION

The outcome of this review suggests that factors specific to the sport affect eating behaviors throughout an athlete's life. As a result, one in five athletes run the risk of developing an eating disorder. Culture-specific and sport-specific diagnostic tools need to be developed and increased attention paid to nutritional deficiencies in athletes.

A systematic review of interventions targeting modifiable factors that impact dietary intake in athletes

Appropriate dietary intake has been found to positively impact athletes' performance, body composition and recovery from exercise. Strategies to optimise dietary intake often involve targeting one or more of the many factors that are known to influence dietary intake. This review aims to investigate the types and effectiveness of interventions used to impact modifiable factors of dietary intake in athletes. MEDLINE, CINAHL, SPORTDiscus and Web of Science were searched from inception to May 2022 for intervention studies that measured dietary intake with a quantitative tool and explored at least one factor thought to influence the dietary intake of adult athletes. Study quality was assessed using the ADA Quality Criteria Checklist: Primary Research. Twenty-four studies were included. The most common interventions focused on nutrition education (n 10), macronutrient adjustment (n 7) and physical activity (n 5). The three most common factors thought to influence dietary intake addressed were nutrition knowledge (n 12), hunger and appetite (n 8), and body composition (n 4). Significant changes in dietary intake were found in sixteen studies, with nutrition education interventions returning significant results in the largest proportion of studies (n 8). Study quality within this review was mostly average (n 4 < 50 %, n 19 50-80 %, n 1 > 80 %). As studies included were published between 1992 and 2021, interventions and factors explored in older studies may require up-to-date research to investigate possible differences in results due to time-related confounders.

Dietary Intake and Menstrual Health among Acrobatics and Tumbling NCAA Division I Student-Athletes

OBJECTIVE

Acrobatics & Tumbling (A&T) is an emerging sport in the National Collegiate Athletic Association that lacks research regarding the dietary intake and health of A&T student-athletes (A&Tsa). This study assessed the dietary intake adequacy, estimated energy availability (EA), self-reported menstrual health, and body composition of A&Tsa.

METHODS

Twenty-four female A&Tsa participated during week 8 of the preseason (11 top: Age= 20.1 ± 0.9 years; BMI= 22.1 ± 1.7 kg/m2; 13 base: Age= 19.5 ± 1.3 years; BMI= 26.2 ± 2.7 kg/m2). Total energy intake (TEI) and macronutrient intakes were assessed via a paper-based 3-day dietary recall. Resting Metabolic Rate [RMR = 500 + 22 * fat-free mass (FFM)] and energy availability [EA = (TEI - exercise energy expenditure)/FFM)] were estimated; and LEAF-Q assessed menstrual health. Body composition was measured using Dual-Energy X-Ray Absorptiometry. Macronutrient intakes and EA were compared to sports nutrition recommendations (carbohydrate: 6-10 g/kg; protein: 1.2-2.0 g/kg) and the Acceptable Macronutrient Distribution Range (carbohydrate: 45-65%; protein: 10-35%; fat: 20-35%).

RESULTS

TEI was 1753 ± 467 kcal (top) and 1980 ± 473.8 kcal (base). A total of 20.8% of A&Tsa failed to meet RMR with TEI, with a higher prevalence in the top (-266 ± 219.2 kcal, n = 3) vs. base (-414.3 ± 534.4 kcal, n = 2) A&Tsa. Top and base A&Tsa had both low EA (28.8 ± 13.4 kcals·FFM-1; 23.8 ± 9.5 kcals·FFM-1) and inadequate carbohydrate intake averages (4.2 ± 1.3 g/kg; 3.5 ± 1.1 g/kg, p < 0.001), respectively. A total of 17% of A&Tsa reported secondary amenorrhea, with a higher prevalence in the top (27.3%, n = 3) vs. the base (7.7%, n = 1).

CONCLUSION

TEI and carbohydrate intake of the majority of A&Tsa were below recommendations. Sports dietitians should encourage and educate A&Tsa about following an adequate diet that meets energy and sports-specific macronutrient needs.

Eating Disorder Risk and Pathogenic Behaviors Among Collegiate Student-Athletes

CONTEXT

Eating disorders (EDs) are a cluster of behavioral conditions characterized by uneasy thoughts and behaviors that grow into severe or persistent eating disturbances. The demands on student-athletes may create mental and physical stressors that increase the likelihood of EDs and disordered eating.

OBJECTIVE

To examine the ED risk through eating attitudes and behaviors in male and female student-athletes and across various sport types (endurance, aesthetic, power, ball or team, or technical sports).

DESIGN

Cross-sectional study.

SETTING

Collegiate athletics.

PATIENTS OR OTHER PARTICIPANTS

National Collegiate Athletic Association Division I and II student-athletes (n = 2054; males = 631; females = 1423) from 40 institutions.

MAIN OUTCOME MEASURE(S)

Participants completed a web-based demographic survey and the Eating Attitudes Test-26 (EAT-26). Multiple χ2 analyses examined participants classified as at risk for EDs. Independent-samples t tests and a 1-way analyses of variance compared sex and sport type across EAT-26 totals and subscale (Dieting, Bulimia, and Oral Control) scores.

RESULTS

Overall, 25.3% (n = 520/2054) of student-athletes were classified as at risk for EDs. Differences were found between sex and ED risk (χ21,2054 = 32.9, P ≤ .01; 17.3% [n = 109/631] males, 28.9% [n = 411/1423] females) and across ED risk and sport type (χ24,2054 = 13.4, P = .01). When examining females only, we observed differences across ED risk and sport type (χ24,1423 = 13.4, P ≤ .01). No differences were evident across ED risk and sport type for males. Differences were seen between sex and binge eating (χ21,2054 = 6.8, P = .009), sex and diet pill use (χ21,2054 = 19.6, P ≤ .01), and sport type and diet pill use (χ24,2054= 12.2, P = .016), excessive exercise (χ24,2054 = 32.1, P ≤ .01), and losing more than 20 lb (9 kg) in the last 6 months (χ24,2054 = 10.2, P ≤ .037).

CONCLUSIONS

Student-athletes in the collegiate setting are at risk for EDs. Medical professionals, such as athletic trainers, need to be educated on the potential risk factors that may lead to EDs. Protocols for prevention, screening and recognition, and referral should be developed for student-athletes at risk for EDs.

A mixed method approach to evaluating eating-related psychopathologies in collegiate student-athletes

OBJECTIVE

To examine the presence of body image concerns, drive for muscularity, and disordered eating behaviors in collegiate student-athletes.

PARTICIPANTS

One hundred and one NCAA Division I student-athletes participated in Phase I; 15 of these also participated in Phase II.

METHODS

This study employed a mixed method, sequential explanatory design. Participants first completed survey measures assessing body image concern, drive for muscularity, and eating behaviors. These results influenced open-ended, semi-structured interviews, which were thematically analyzed.

RESULTS

Body image and disordered eating behaviors were of greater concern than drive for muscularity. Student-athletes reported engaging in eating behaviors as opposed to not eating, yet these eating behaviors trended toward disordered behaviors such as obsessive "healthy eating" or orthorexia.

CONCLUSIONS

This study took a novel methodological approach to examining student-athlete body image and eating behaviors. Results emphasize the need for further support and education for student-athletes around body image and eating behaviors.

Eating disorder risk in adolescent and adult female athletes: the role of body satisfaction, sport type, BMI, level of competition, and training background

BACKGROUND

Eating disorders negatively influence athletes' health and performance. To achieve a high level of performance and conform to cultural expectations regarding an athletic body type, female athletes often restrict their diets, which can lead to eating disorders. In addition to factors related to the sports environment, adolescent athletes are subject to changes caused by the maturation process. Therefore, the same factors may have different effects on eating disorder risk among adolescent and adult athletes. This study examined the relationship between eating disorder risk, specific aspects of the sports environment (sport type, level of competition [national and international], and training background), and individual aspects (body satisfaction and body mass index) in two groups of athletes: adolescents and adults.

METHODS

The sample included 241 highly trained female athletes aged 12-30 years (M = 20.68, SD = 4.45) recruited from different sports clubs in Poland. The subgroup of adolescents consisted of 82 athletes, while the number of adult athletes was 159. The Eating Attitudes Test questionnaire was used to assess the eating disorder risk among the athletes. Body satisfaction was measured using the Feelings and Attitudes Toward Body Scale incorporated into the Body Investment Scale.

RESULTS

Eating disorder risk was prevalent among 14.6% of the adolescent and 6.9% of the adult athletes. Significant associations between eating disorder risk and the studied variables were noted only among adolescent athletes. Univariate logistic regression analysis revealed that the occurrence of eating disorder risk was associated with participation in lean non-aesthetic sports (OR = 11.50, 95% CI: 3.58-37.09). Moreover, eating disorder risk was associated with athletes' lower body satisfaction (OR = 0.80, 95% CI: 0.70-0.92). Body mass index was not included in the final regression model.

CONCLUSIONS

The study indicated that eating disorder risk in adolescent female athletes was related to sport type and body satisfaction. The findings showed that, in adolescent athletes, eating disorder risk was the most associated with practicing lean non-aesthetic sports. Coaches and athletes should be aware that eating disorder risk increases among individuals with a lower body image.

A FOUR-YEAR CYCLE COMPARISON OF THE NUTRITIONAL AND CARDIOVASCULAR HEALTH STATUS OF AN ELITE-LEVEL FEMALE ARTISTIC GYMNAST: CASE STUDY REPORT FROM SLOVENIA

Regular monitoring of body composition, nutrition, health, and motor skills are crucial for further training process planning and performance progress. With the same protocol and methods, we evaluated a four-year change (2018 vs. 2022) in the nutritional and cardiovascular health status of the currently most successful elite-level adult female artistic gymnast in Slovenia. Detailed body composition and dietary intake were assessed using dual-energy X-ray absorptiometry and a standardized food questionnaire FFQ. The blood lipids and safety factors, blood pressure, and serum micronutrients (e.g., B12, 25-hydroxyvitamin D (25(OH)D), potassium, calcium, phosphorus, magnesium, and iron) status were measured. The four-year comparison showed an improved body composition status: decreased body fat mass/percentage, android fat percentage, and android/gynoid ratio, while other anthropometrical and body composition parameters remained essentially unchanged. We also measured an improvement of some and worsening of other cardiovascular health serum variables (i.e., decreased total cholesterol but increased low-density lipoprotein cholesterol and S-glucose), most likely due to the differences in assessed dietary intake (i.e., lower total fat, mono- and polyunsaturated fatty acid intake but higher cholesterol intake and still high free sugar and saturated fat intake, despite higher fiber). Notably, nutrient intakes that are generally of concern (fiber (borderline low intake), eicosapentaenoic omega-3 fatty acids and docosahexaenoic omega-3 fatty acids, vitamin B12 and D, calcium (borderline low intake), iron, and zinc) were within recommended ranges. However, the athlete’s vitamin E and potassium intakes were not adequate. Furthermore, in 2018, the athlete did not consume dietary supplements, while she now regularly uses several dietary supplements, including enriched plant-based protein powder, isolated vitamin B12, C, D, and iron. Moreover, the athlete had significantly lower than recommended serum levels of 25(OH)D, probably due to insufficient regular intake of vitamin D in the form of a dietary supplement (1000 IU/d). Moreover, from the micronutrient serum, phosphorus, and iron levels that deviated from the reference values in the 2018 study, in the current study, they were found to be within referenced ranges (i.e., iron status was markedly improved). This kind of screening toolbox, using valid, sensitive, and affordable methods and with rapid organizational implementation, may be a viable format for regular monitoring.

The body satisfaction and psychological well-being of retired women athletes: A long-term qualitative analysis of bodies in motion

We conducted a qualitative evaluation of Bodies in Motion (BIM), a dissonance, mindful self-compassion-based program that addresses the unique experiences and needs of female athletes with respect to their bodies and their well-being. Using semi-structured interviews, 12 collegiate female athletes (retired 2 - 6 years) reflected and provided feedback on the enduring impact of BIM on their body image, relationship to food and exercise, and overall psychological well-being. Through thematic analysis, we found that these retired athletes, extending from their initial program learning, reported increased awareness of sport and societal messages and their impact on body image, shifted perspectives in their view of themselves and their bodies, and used learned skills to manage body image in their lives. Further, with the passage of time, athletes emphasized how what they had learned in BIM remained essential as they navigated challenging life transitions, such as their retirement from collegiate sports. Our findings indicate that the benefits female athletes report accruing in the immediate aftermath of BIM remain with them, even growing and becoming more salient as they continue to reflect on the program and its impact on their body awareness and how they navigate their lives as women and former athletes.

Prevalence of Female and Male Athlete Triad Risk Factors in Ultramarathon Runners

OBJECTIVE

To identify the prevalence of male and female athlete triad risk factors in ultramarathon runners and explore associations between sex hormones and bone mineral density (BMD).

DESIGN

Multiyear cross-sectional study.

SETTING

One hundred-mile ultramarathon.

PARTICIPANTS

Competing runners were recruited in 2018 and 2019.

ASSESSMENT OF RISK FACTORS

Participants completed a survey assessing eating behaviors, menstrual history, and injury history; dual-energy x-ray absorptiometry for BMD; and laboratory evaluation of sex hormones, vitamin D, and ferritin (2019 cohort only).

MAIN OUTCOME MEASURE

A Triad Cumulative Risk Assessment Score was calculated for each participant.

RESULTS

One hundred twenty-three runners participated (83 males and 40 females, mean age 46.2 and 41.8 years, respectively). 44.5% of men and 62.5% of women had elevated risk for disordered eating. 37.5% of women reported a history of bone stress injury (BSI) and 16.7% had BMD Z scores <-1.0. 20.5% of men had a history of BSI and 30.1% had Z-scores <-1.0. Low body mass index (BMI) (<18.5 kg/m 2 ) was seen in 15% of women and no men. The Triad Cumulative Risk Assessment classified 61.1% of women and 29.2% of men as moderate risk and 5.6% of both men and women as high risk.

CONCLUSIONS

Our study is the first to measure BMD in both male and female ultramarathon runners. Our male population had a higher prevalence of low BMD than the general population; females were more likely to report history of BSI. Risk of disordered eating was elevated among our participants but was not associated with either low BMD or low BMI.

Extreme weight control behaviors among adolescent athletes: Links with weight-related maltreatment from parents and coaches and sport ethic norms

The use of extreme weight-control behaviors is prevalent among adolescent athletes and may result from individual and sport-specific factors. Weight-related maltreatment from coaches and parents, and conformity to sport ethic norms have recently been linked to the use of extreme weight-control behaviors. This study aims to investigate the role of sport ethic norms and weight-related maltreatment from coaches and parents in the use of extreme weight-control behaviors among adolescent athletes. A sample of 999 French-Canadian athletes aged 14-17 years competing in a variety of sports completed an online survey assessing extreme weight-control behaviors, weight-related maltreatment from coaches and parents, and conformity to sport ethic norms. A total of 16.9% of the adolescent athletes reported having adopted extreme weight-control behaviors during their athletic careers. Extreme weight-control behaviors were significantly more prevalent among girls (19.75% vs 9.7% in boys) and weight-class-sport athletes (44%). In addition, 7.4% of the sample experienced at least one type of weight-related maltreatment by coaches or parents. Sex, weight-related neglect by coaches and parents, and weight-related psychological violence by coaches explained 24.4% of extreme weight-control behaviors variance. Indeed, participants who engaged in extreme weight-control behaviors experienced significantly more violence than the other participants did. In contrast, no differences were observed between people who engaged in extreme weight-control behaviors and those who did not due to conformity to sport ethic norms.

Evaluating a motivational and psycho-educational self-help intervention for athletes with mild eating disorder symptoms: A mixed methods feasibility study

Objective

The primary aim was to assess the feasibility of undertaking a study evaluating the novel Motivational and Psycho‐Educational Self‐Help Programme for Athletes with Mild Eating Disorder Symptoms (MOPED‐A). A mixed‐methods approach was adopted to explore the feasibility of recruiting and retaining participants, and to evaluate the acceptability of measures, procedures and the intervention. A secondary aim was to explore the potential efficacy of MOPED‐A in reducing athletes' eating disorder symptoms.

Method

Thirty‐five athletes were recruited. Participation involved completing MOPED‐A over a 6‐week period and completing self‐report measures at baseline (T1), post‐intervention (T2) and 4‐week follow‐up (T3). A subsample (n = 15) completed an interview at T2.

Results

Retention was good throughout the study (n = 28; 80%). Quantitative and qualitative feedback suggested the format, delivery, content and dosage of MOPED‐A were acceptable. Athletes valued that the intervention was tailored to them, and this facilitated both participation and completion. Over a third of participants reported disclosing their eating difficulties and deciding to seek further support. Large reductions in eating disorder symptoms were detected at T2 and sustained at T3.

Conclusions

The MOPED‐A intervention can be feasibly implemented, is acceptable to participants, and demonstrates potential for reducing symptoms in athletes. A larger, controlled trial is warranted.

Participant recruitment to the study was feasible, and an acceptable proportion of participants were retained throughout the study.

This is the first study to show that the format and delivery of a self‐help intervention is acceptable to athletes with mild eating disorder symptoms, and that athletes valued the intervention being tailored to them which facilitated participation and completion.

The intervention demonstrates potential for reducing athletes' eating disorder symptoms.

Weight Pressures and Eating Disorder Symptoms among Adolescent Female Gymnasts of Different Performance Levels in Greece

This study examined the weight pressures within the gymnastics environment and explored associations between these pressures and eating disorder (ED) symptoms in adolescent female gymnasts. One hundred and forty-seven competitive gymnasts and 122 recreational-level gymnasts (11–17 years old) completed the Eating Attitudes Test (EAT-26), the Weight-Pressures in Sport-Females (WPS-F), the Social Desirability Scale (SDS) and provided information on their training. It was found that 16.3% of competitive gymnasts and 7.4% of non-competitive gymnasts scored ≥20 in EAT-26, indicating disordered eating behavior. Competitive gymnasts scored higher than non-competitive in the total score of EAT-26 (p = 0.027), as well as in the total score of WPS-F, the sport and coaches weight pressures sub-scale and the appearance and performance weight pressures sub-scale (p < 0.001). Multiple regression analyses indicated that sport and coaches weight pressures, appearance and performance weight pressures and body mass index accounted for 30.3% of the variance of EAT-26 in competitive gymnasts, while the appearance and performance weight pressures sub-scale accounted for 16.3% of the variance of EAT-26 in non-competitive gymnasts. Sport and coaches weight pressures are associated with ED in competitive gymnasts, while body appearance and performance demands correlate with ED in female gymnasts irrespective of competitive level.

Development and Initial Evaluation of the Athlete Eating Psychopathology Observation Questionnaire for Sport Professionals

Eating psychopathology symptoms are common in athletes; however, it is unknown which symptoms are detected and to what extent by sport professionals. This study aimed to develop and evaluate a self-report questionnaire to explore which features of eating psychopathology in athletes are detected by sport professionals, and how observation of these symptoms might vary. Thirty-one questions were developed and 232 sport professionals (56% male) participated in the study. Exploratory Factor Analysis revealed a 20-item, five-factor solution (Negative Affect, Dieting Practices, Fear of Eating in Social Contexts, Bingeing and Purging, and Compulsive Exercise). Participants most frequently reported observing athletes’ dieting practices, while symptoms of a fear of eating in social contexts were observed least frequently. This study has developed and preliminarily tested the Athlete Eating Psychopathology Observation Questionnaire (AEPOQ), which now requires further validation. The findings provide important directions for education initiatives with sport professionals regarding identification of eating psychopathology symptoms.

An Uneven Playing Field: Athlete Injury, Illness, Load, and Daily Training Environment in the Year Before the FINA (Aquatics) World Championships, 2017

OBJECTIVE

To assess athlete's training environment and health problems before the FINA World Championships (WC) (2017) and to analyze the differences between the 6 disciplines, gender, and countries with different medal rankings during the championships.

DESIGN

Retrospective anonymous questionnaire.

SETTING

FINA WC 2017.

PARTICIPANTS

Registered aquatic athletes (swimmers, divers, high divers, water polo players, artistic swimmers, open water swimmers).

MAIN OUTCOME MEASURES

The outcome measures included the following: training and competition load, availability of support staff, performance of injury prevention exercises, and prevalence of health problems. The independent variables included gender, aquatic discipline, and country group based on medal ranking.

RESULTS

In the 12 months preceding the Championships, 67% of the athletes reported physical complaints and 41% trained or competed with a diagnosed injury. Only half of the athletes reported that injury prevention exercises were always (29.9%) or often (23.4%) a regular part of their daily training. In the daily training environment, support staff (excluding coach) was not available or available only if the athlete pays in 28.4% (specialized trainer) to 58.9% (sport scientist) of cases. About one-quarter of the athletes rated the support offered by their National Team program as poor or very poor. There were discrepancies in training loads and support staff among the 6 aquatic disciplines. Availability of support staff, athlete's satisfaction with their training environment/support, and regular use of injury prevention exercises were higher in countries that ranked higher in the medal list.

CONCLUSIONS

Injury prevention strategies should be promoted in aquatic sports, with prospective surveillance for the early identification of physical complaints. The facilitation of access to sport-specific experts could improve athlete's health and performance, especially in countries with low medal ranking.

Sports Nutrition: Diets, Selection Factors, Recommendations

An athlete’s diet is influenced by external and internal factors that can reduce or exacerbate exercise-induced food intolerance/allergy symptoms. This review highlights many factors that influence food choices. However, it is important to remember that these food choices are dynamic, and their effectiveness varies with the time, location, and environmental factors in which the athlete chooses the food. Therefore, before training and competition, athletes should follow the recommendations of physicians and nutritionists. It is important to study and understand the nutritional strategies and trends that athletes use before and during training or competitions. This will identify future clinical trials that can be conducted to identify specific foods that athletes can consume to minimize negative symptoms associated with their consumption and optimize training outcomes.

Understanding risk factors for disordered eating symptomatology in athletes: A prospective study

Disordered eating and eating disorders have huge impact on athletic health and performance. Understanding risk factors for disordered eating development is paramount to protecting the health and performance of these athletes. This project tested a model longitudinally to test whether body dissatisfaction (mediated by negative affect) and societal pressures (mediated by internalisation) predicted bulimic symptomatology at 1 year. The study recruited 1017 male and female athletes in a range of sports at three time points over a year. Cross-lag meditation modelling in MPLUS was utilised to test the hypothesised model. Results indicated that societal pressures mediated by general internalisation led to bulimic symptomatology and that gender and sport type do moderate the relationships. However, measurement issues indicate that scales not originally created for athletes may not reliably measure athletes' experience. This research highlights how understanding how to better assess risk factors and disordered eating related concepts in athletes is a key next step. The study is unique in its longitudinal design and in its sampling of a wide range of sports in both male and female athletes.

Nutritional Risks among Adolescent Athletes with Disordered Eating

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.

Body Composition, Training Volume/Pattern and Injury Status of Slovenian Adolescent Female High-Performance Gymnasts

Body composition (BC), training volume/pattern, and injury status are a few important factors affecting training quality and sport performance in female artistic gymnastics. We aimed to examine BC status, training volume/pattern, and injury status during the first competition period. Our cross-sectional study included 17 female gymnasts (age: 17.4 ± 4.1 years, body height: 159.8 ± 6.2 cm, and body weight: 54.8 ± 5.3 kg) who were high performance at the international and national level. The BC (measured by dual-energy X-ray absorptiometry) parameters included body height and mass, body fat percentage (BF %), lean body mass (LBM), body mass index (BMI), total bone mineral density (BMD total), and total bone mineral content (BMC total). Training volume and pattern were assessed via an author-developed questionnaire, while injury status (i.e., anatomical location, symmetry and rate of injuries) was assessed via a modified questionnaire on overuse injuries used in sports injury epidemiology studies with elite-level athletes. Body composition parameters were as follows: the BMI was 21.5 ± 1.4 kg/m², BF % was 21.9 ± 4.7%, LBM was 41.2 ± 3.4 kg, BMD total was 1.22 ± 0.08 g/cm², and BMC total was 2486 ± 344 g. Furthermore, the average weekly volume of training was 23.5 ± 1.4 h, with the highest training volume occurring on Monday and Tuesday and high variability within gymnasts. Our study also revealed that the most frequently injured joints that had the most negative impact on training volume, sport performance and pain status were the ankles and low back, followed by the knees and shoulders. This kind of yearly screening method is warranted to allow more definitive conclusions to be made on adjusted training and preventive strategies.

Eating disorder diagnosis and the female athlete: A longitudinal analysis from college sport to retirement

OBJECTIVES

Female athletes experience eating disorders (EDs) at clinical, and subclinical, levels; most studies have determined point-prevalence rates through cross-sectional methodologies. To date, few studies have examined the long-term stability of EDs in female athletes; none extend into retirement.

DESIGN

A longitudinal investigation of ED classification (i.e., Clinical ED, Subclinical ED, Healthy) and weight control behaviors (e.g., vomiting, laxative use) from when athletes actively competed (T1) into their retirement (T2).

METHODS

Participants included U.S. female athletes (N=193) who were collegiate competitors (T1) and eventually were retired from their collegiate sports six years later (T2).

RESULTS

At T2, athletes were classified as Healthy (69.9%), Subclinical ED (26.9%), and Clinical ED (3.1%). Overall percentage of Subclinical EDs increased from 18.7% (T1) to 26.9% (T2); 52.8% of T1 Subclinical ED athletes continued to meet criteria for either Subclinical or Clinical ED at T2. Of the 13 Clinical ED athletes at T1, six (46.2%) continued to meet criteria for either a subclinical or clinical ED at T2. Though exercising (2+ hours/day; n=8, 4.1%) and dieting/fasting (4+ times/year; n=14, 7.3%) were the most frequently used weight control behaviors at T2, rates were substantially lower than at T1.

CONCLUSIONS

Retirement does not result in immediate remittance of eating concerns among female athletes; many continue or develop Subclinical and Clinical ED symptoms. Thus, addressing healthy body image and nutrition when athletes are competing is imperative to assist prevention and intervention efforts that may alleviate ED symptoms as athletes transition from sport.

Nutritional Status and Cardiovascular Health in Female Adolescent Elite-Level Artistic Gymnasts and Swimmers: A Cross-Sectional Study of 31 Athletes

OBJECTIVE

Nutritional status is important for health and competitive achievement. This area remains understudied among elite-level female athletes and is appropriate for research. We examined nutritional status and cardiovascular health markers of two groups of female athletes of the same age and competition period, involved in weight-bearing and a non-weight-bearing sport: gymnasts (n = 17) and swimmers (n = 14); mean age 17.4 and 16.6 years.

METHODS

Body composition and dietary intake were assessed by bioelectrical impedance and Food Frequency Questionnaire. The concentrations of serum micronutrients (B12, 25-hydroxyvitamin D (25 (OH) D), calcium, magnesium, phosphorus, potassium, and iron), blood lipids, and blood pressure (BP) were measured. Setting and Participants. A cross-sectional study of 31 athletes from Slovenia.

RESULTS

Gymnasts had higher body mass index (21.5 vs. 20.1 kg/m2, p=0.043) and lower fat free mass (42.4 vs. 46.6 kg, p=0.024) than swimmers and comparable body fat percentage (22.5 vs. 22.8%). Both groups had low intake of carbohydrates, fibre, polyunsaturated fats, protein (only gymnasts), and micronutrients (11/13 micronutrients gymnasts and 4/13 swimmers) and high intake of free sugars and saturated fats. Both groups also had significantly lower-than-recommended serum levels of 25 (OH) D. All cardiovascular risk factors were within recommended ranges. Gymnasts had higher LDL cholesterol (2.7 vs. 2.2 mmol/L, p < 0.011), and swimmers had higher systolic BP (126 vs. 107 mmHg, p < 0.001).

CONCLUSIONS

Dietary intake especially in gymnasts was suboptimal, which may reflect in anthropometric and cardiovascular marker differences between gymnasts and swimmers.

National Collegiate Athletic Association Athletic Departments’ Mental Health Screening Practices: Who, What, When, and How

College student athletes face unique, sport-related stressors that may lead to, or exacerbate, mental health (MH) concerns and symptoms. Although the National Collegiate Athletic Association has identified MH screening as a best practice, minimal data exist regarding contemporary screening practices. We explored National Collegiate Athletic Association Division I (DI), Division II (DII), and Division III (DIII) athletic departments’ current MH screening practices (N = 264). Compared with DII/DIII (53%), a greater percentage of Division I (89%) conducted formal MH screening. At DII/DIII institutions, athletic trainers were more likely to both administer and review screeners than any other sports medicine professional; sport psychologists primarily oversaw these tasks at DI schools. DI, compared with DII/DIII, institutions were more likely to have had a student athlete attempt suicide (62% vs. 40%) and participate in inpatient treatment (69% vs. 43%). There is a clear need for the National Collegiate Athletic Association to continue to promote policies that support MH screening and to create mechanisms in which it can monitor institutional involvement.

Mental health management of elite athletes during COVID-19: a narrative review and recommendations

Elite athletes suffer many mental health symptoms and disorders at rates equivalent to or exceeding those of the general population. COVID-19 has created new strains on elite athletes, thus potentially increasing their vulnerability to mental health symptoms. This manuscript serves as a narrative review of the impact of the pandemic on management of those symptoms in elite athletes and ensuing recommendations to guide that management. It specifically addresses psychotherapy, pharmacotherapy and higher levels of care. Within the realm of psychotherapy, crisis counselling might be indicated. Individual, couple/family and group psychotherapy modalities all may be helpful during the pandemic, with novel content and means of delivery. Regarding pharmacotherapy for mental health symptoms and disorders, some important aspects of management have changed during the pandemic, particularly for certain classes of medication including stimulants, medications for bipolar and psychotic disorders, antidepressants and medications for substance use disorders. Providers must consider when in-person management (eg, for physical examination, laboratory testing) or higher levels of care (eg, for crisis stabilisation) is necessary, despite potential risk of viral exposure during the pandemic. Management ultimately should continue to follow general principles of quality health care with some flexibility. Finally, the current pandemic provides an important opportunity for research on new methods of providing mental health care for athletes, and consideration for whether these new methods should extend beyond the pandemic.

Risk factors associated with low back pain in competitive female gymnasts: A meta-analytic approach

The aim of this meta-analysis was to aggregate data from studies investigating the risk factors associated with low back pain (LBP) in competitive gymnasts.

Four databases were searched and studies reporting demographics, anthropometrics, functional, psychosocial and gymnastics-practice variables in competitive gymnasts with and without LBP were included. For continuous data, the weighted mean difference (MD) and confidence interval (95% CI) were calculated, while odds or risk ratio (OR, RR) were calculated for dichotomous data.

Meta-analysis of six cross-sectional studies involving 284 competitive female gymnasts revealed that artistic were more likely to report LBP compared to rhythmic gymnasts (RR 1.4, 95% CI 1.04-2.0, Z=2.2, p=0.03). Data pooling revealed that age (MD 1.5 years, 95% CI 0.4-2.5, p=0.005) and body weight (MD 3.5 kg, 95% CI 0.1-6.8, p=0.04) were significantly higher in gymnasts with LBP compared to those without. Subgroup-analyses confirmed these differences in artistic but not in rhythmic gymnasts. Moreover, artistic gymnasts with LBP tended to display longer gymnastics-practice history (p=0.09) compared to those without.

Increased age, body weight and, to a lesser extent, longer gymnastics-practice appear to differentiate artistic gymnasts with LBP from those without; conversely, these potential risk factors seem less relevant for rhythmic gymnasts.

Prevalence of Disordered Eating Among International Sport Lead Rock Climbers

Disordered eating (DE) is characterized as a range of irregular eating patterns or behaviors, which may lead to pathological eating or a clinical eating disorder diagnosis. DE patterns are associated with a variety of negative health outcomes. The prevalence of DE is highest in female athletes who participate in aesthetic or weight dependent sports. Elite rock climbers tend to be strong, small and lean, but the prevalence of DE in rock climbers is unknown. The purpose of the present study was to assess DE prevalence in a large group of international rock climbers and to explore the relationship between sport rock climbing ability and DE. A web-based survey assessed both DE (Eating Attitudes Test-26) and climbing ability based on the International Rock Climbing Research Association's position statement on comparative grading scales. The survey was distributed to international climbing communities; 810 individuals attempted the survey; 604 completed all questions; 498 identified as sport lead climbers. The majority of sport lead climbers were lower grade/intermediate (57.8%), compared to advanced (30.7%) and elite/higher elite (11.4%), and male (76.9%). Forty-three sport lead climbers reported a score of 20 or above on the EAT-26 indicating an 8.6% prevalence of DE in this sample. Male climbers had a DE prevalence of 6.3% (24 of 383) and female climbers more than doubled that with 16.5% (19 of 115). Chi-square analysis revealed that DE was associated with climbing ability level [χ2 (2, n = 498, 8.076, p = 0.02)], and when analyzed by sex, only the female climbers had a significant relationship of DE with climbing ability [χ2 (2, n = 115, 15.640, p = 0.00)]. These findings suggest sport lead rock climbers are not immune to DE and that the risk is elevated in female climbers, particularly at the elite/high elite climbing ability level. Our research indicates further investigations are warranted to determine if and how disordered eating behaviors affect health and performance of adult rock climbers.

Teammate influences, psychological well-being, and athletes' eating and exercise psychopathology: A moderated mediation analysis

OBJECTIVE

Positive and negative influences from teammates (e.g., supportive teammate friendships, modelling of teammates' disordered eating) have been associated with athletes' eating/exercise psychopathology. However, research is yet to explore how an athlete's psychological well-being and gender may impact upon these relationships. This study aimed to explore whether psychological well-being mediates the relationship between teammate influences and eating/exercise psychopathology, and to determine whether gender moderates the significant mediation effects identified.

METHOD

Athletes (N = 195, mean age 18.35 years, n = 110 female, n = 81 lean sport athletes) completed a survey three times over an 8-month period exploring teammate influences, psychological well-being (self-esteem, anxiety, depression) and eating/exercise psychopathology. Mediation and moderated-mediation analyses were conducted.

RESULTS

Higher levels of anxiety significantly mediated the positive relationships between bulimia modelling and teammate pressure with eating and exercise psychopathology. Higher levels of depression significantly mediated the positive relationship between teammate pressure and body dissatisfaction, and the negative relationship between supportive friendships and body dissatisfaction. Higher levels of self-esteem mediated both inverse relationships between supportive friendships and a lower drive for thinness (fully) and body dissatisfaction (partially). Gender did not significantly moderate any mediation relationships.

DISCUSSION

Male and female athletes with poor psychological well-being (i.e., high levels of anxiety or depression) are more susceptible to negative teammate influences, while athletes with good psychological well-being (i.e., high self-esteem) reap the protective benefits of supportive teammate friendships. Understanding the circumstances under which teammates are influential is vital for the development of targeted intervention and prevention strategies to reduce athlete eating and exercise psychopathology.

Teammate influences and relationship quality are associated with eating and exercise psychopathology in athletes

Teammates have a powerful influence on athletes' eating attitudes/behaviours, but less is known about the relative importance of teammate influence mechanisms. The primary aim of this study was to explore the relationships and predictive associations between teammate influences (e.g., modelling of teammates' disordered eating; supportive teammate friendships) and athletes' eating and exercise attitudes and behaviours. A further aim was to identify the presence of any gender differences. Athletes (N = 1172, mean age 24 years, n = 727 female) completed a survey exploring multiple teammate influences, eating and exercise attitudes and behaviours, and psychological wellbeing (anxiety, depression, self-esteem). Many significant relationships were identified between teammate influences and eating/exercise psychopathology. Stepwise regression analysis revealed that a perceived pressure from teammates to lose weight/change shape and perceptions that teammates engaged in disordered eating practices were the best predictors of higher eating and exercise psychopathology. Supportive teammate friendships was the best predictor of lower eating psychopathology and higher levels of healthy exercise behaviours. Encouragement/discouragement to eat healthily were also significant predictors. Teammate influences explained more variance in exercise than eating psychopathology, and total variance explained by teammates was higher for females compared to males. Teammates may have a positive and negative influence on the eating and exercise attitudes/behaviours of athletes; however, gender differences are apparent. Understanding teammate influences on the eating and exercise practices of athletes is important for the development of team-based interventions to reduce or prevent disordered eating and exercise. Future research should explore these relationships longitudinally, considering the role of moderating factors (e.g., sport type, stage of season).

Mental health in elite athletes: International Olympic Committee consensus statement (2019)

Mental health symptoms and disorders are common among elite athletes, may have sport related manifestations within this population and impair performance. Mental health cannot be separated from physical health, as evidenced by mental health symptoms and disorders increasing the risk of physical injury and delaying subsequent recovery. There are no evidence or consensus based guidelines for diagnosis and management of mental health symptoms and disorders in elite athletes. Diagnosis must differentiate character traits particular to elite athletes from psychosocial maladaptations.

Management strategies should address all contributors to mental health symptoms and consider biopsychosocial factors relevant to athletes to maximise benefit and minimise harm. Management must involve both treatment of affected individual athletes and optimising environments in which all elite athletes train and compete. To advance a more standardised, evidence based approach to mental health symptoms and disorders in elite athletes, an International Olympic Committee Consensus Work Group critically evaluated the current state of science and provided recommendations.

Bodies in Motion: An empirical evaluation of a program to support positive body image in female collegiate athletes

Female athletes are at risk for eating disorders due to the experience and internalization of pressures regarding various aspects of their bodies, including weight and appearance. Evaluating programs that address psychosocial antecedents and may reduce female athletes' risk is critical. We examined Bodies in Motion, a program based on cognitive dissonance and mindful self-compassion principles that integrates components of social media. Female athletes across nine NCAA athletic departments were assigned to Bodies in Motion (n = 57) or a wait-list control group (n = 40). Athletic department personnel were trained in the standardized program. Data were collected at three time-points - baseline, post-program, and three to four months later. Using Holm's algorithm to control for multiple comparisons, repeated measures ANOVAs showed that, after program completion, Bodies in Motion athletes reported less thin-ideal internalization, as compared to the control athletes, over time. We also observed varying group trajectories in outcome responses upon visual inspection of profile plots. These findings serve as the basis for future research suggestions involving larger sample sizes and prolonged measurement of outcomes.

Evaluation of disordered eating tendencies in young adults

PURPOSE

It was aimed to determine the prevalence of high disordered eating tendencies and its relationship with food addiction, emotional eating and self esteem in participants at 18 and 33 years age group.

METHODS

This study was planned as a cross-sectional study and conducted with 1359 young adult volunteers (M = 386, F = 973) with an average age of 22.4 ± 2.84 years. Eating Attitudes Test-26 (EAT-26), Yale Food Addiction Scale (YFAS), Emotional Appetite Questionnaire (EMAQ) and Rosenberg Self-Esteem Scale (RSES) were used. EAT-26 score above 20 was considered as eating disorders risk cutoff.

RESULTS

Participants with disordered eating tendencies have higher rates (22.4%) of food addiction compared to participants without high disordered eating tendencies (7.2%). There is no difference for EMAQ and YFAS scores; however, there is a significant difference for RSES and EAT-26 scores according to gender. A positive association of EAT-26 with YFAS and EMAQ-negative scores and a negative association of EAT-26 with RSES and EMAQ-positive were found.

DISCUSSION

There is association among EAT-26, YFAS, and Rosenberg Self-Esteem Scale, and Emotional Appetite Questionnaire scores. This study provides information for future studies about high disordered eating tendencies, food addiction and mood that are thought to be important in young adults.

LEVEL OF EVIDENCE

Level V (cross-sectional descriptive study).

Eating disorders and weight control behaviors change over a collegiate sport season

OBJECTIVES

Determine whether the prevalence of eating disorder classifications (i.e., clinical eating disorder, subclinical eating disorder, and asymptomatic) and pathogenic weight control behaviors (e.g., bingeing, vomiting) change over a five-month sport season.

DESIGN

Longitudinal study.

METHODS

Female collegiate gymnasts and swimmers (N=325) completed the Questionnaire for Eating Disorder Diagnoses as well as six items from the Bulimia Test-Revised at Time 1 (two weeks into the beginning of their athletic season) and Time 2 (final two weeks of the athletic season); data collections were separated by five months.

RESULTS

Over the course of the season, 90% of the athletes (18 out of 20) retained a clinical eating disorder diagnosis or moved to the subclinical classification. Of the 83 subclinical athletes at Time 1, 37.3% persisted with that classification and 10.8% developed a clinical eating disorder; the remainder became asymptomatic/healthy eaters by Time 2. The majority of Time 1 asymptomatic athletes (92.3%) remained so at Time 2. Exercise and dieting/fasting were the most frequent forms of weight control behaviors, though each was used less frequently at Time 2 (exercise=35.4%; dieting=9.2%) than at Time 1 (exercise=42.5%; dieting=12.3%).

CONCLUSIONS

Eating disorder classifications, particularly clinical and subclinical, remain stable across a competitive season, supporting the need for early detection and purposeful intervention. Athletes engage in weight control behaviors that may be reinforced in the sport environment (e.g., supplemental exercise), making identification more challenging for sports medicine professionals.

Learning to eat again: Intuitive eating practices among retired female collegiate athletes

The present study used an open-ended survey to collect information about current eating practices and coping strategies among 218 retired female athletes. An inductive and deductive thematic analysis revealed three themes relevant to the intuitive eating framework-permission to eat; recognizing internal hunger and satiety cues; and eating to meet physical and nutritional needs. Athletes described feeling liberated with regards to their eating following retirement from sport, and for some this included an alleviation of disordered eating practices. These changes, however, required an effortful process of recalibration, during which athletes had to relearn and reinterpret their body's physiological signals of hunger and satiety. Additional research is needed to understand just how this process unfolds and how retired athletes can be supported in developing a healthier and more adaptive approach to eating.

Amenorrhea in the Female Athlete: What to Do and When to Worry

Functional hypothalamic amenorrhea is a diagnosis of exclusion that is common in female athletes, particularly those participating in aesthetic sports (ballet, other dance genres, figure skating, and gymnastics) and endurance sports (cross-country running). Although common, it should be considered abnormal even in the high-level elite athlete. Amenorrhea in combination with low energy availability and low bone density is labeled "the Female Athlete Triad." Studies have demonstrated numerous long-term consequences of athletes suffering from all or a portion of this triad, including increased rate of musculoskeletal injuries, stress fractures, abnormal lipid profiles, endothelial dysfunction, potential irreversible bone loss, depression, anxiety, low self- esteem, and increased mortality. This article provides the clinician with the tools to evaluate an athlete with secondary amenorrhea, reviews the recommended treatment options for affected athletes, and discusses when to return to the activity in an effort to facilitate "healthy" participation.

Comparison of disordered eating symptoms and emotion regulation difficulties between female college athletes and non-athletes

The purpose of the study was to compare the prevalence of disordered eating between female college athletes and non-athletes and explore emotion regulation as a potential mediator of the link between participation in athletics and disordered eating symptoms. Data for this cross-sectional study came from 527 college students in a mid-western state of the USA in fall of 2013 (376 non-athletes and 151 athletes). Disordered eating symptoms and emotion regulation were assessed utilizing the Eating Attitudes Test and the Difficulties with Emotion Regulation Scale in a survey-based format. The prevalence of disordered eating was higher in non-athletes (16.5%, vs. 6.6%; X(2)=62.8; p<.05). Non-athletes reported more signs and symptoms of disordered eating than athletes (p<.01). A linear regression approach indicated a statistically significant indirect effect (0.63, CI95=0.18, 1.20) of athletic-status on disordered eating via emotion regulation; however, this effect did not reach practical significance. Our findings show that female athletes in our sample were somewhat protected from disordered eating compared to non-athletes, but the mechanism of this relationship is unclear. A further in-depth examination of other factors, such as self-esteem and body satisfaction, that may have contributed to this finding is warranted utilizing a large sample of female college students and athletes representing a variety of sports.

Disordered eating in male athletes: a meta-analysis

We examined the propensity for male athletes to exhibit symptoms of disordered eating. Using meta-analytic techniques, we examined overall effect size, individual effect sizes for specific sport types, standard of athletic competition and diagnostic tools from 31 studies. When all studies were considered as a homogeneous group, male athletes did not have symptoms of disordered eating that were significantly different from non-athletic controls. However, significant moderator effects emerged for sport type and measurement: (a) wrestling reported a greater incidence of disordered eating; and (b) studies that reported data from the Eating Attitudes Test yielded a significantly greater incidence of disordered eating in male athletes compared to non-athletes. Although some sports seem to present a higher risk of disordered eating compared to others, the effects are weak and heterogeneous. We make suggestions for the development of the research area, which has been severely hampered by the diagnostic tools that have been available for the study of men.

Epidemiology, health-related quality of life and economic burden of binge eating disorder: a systematic literature review

PURPOSE

To perform a systematic review on the epidemiology, the health-related quality of life (HRQoL) and economic burden of binge eating disorder (BED).

METHODS

A systematic literature search of English-language articles was conducted using Medline, Embase, PsycINFO, PsycARTICLES, Academic Search Complete, CINAHL Plus, Business Source Premier and Cochrane Library. Literature search on epidemiology was limited to studies published between 2009 and 2013. Cost data were inflated and converted to 2012 US$ purchasing power parities. All of the included studies were assessed for quality.

RESULTS

Forty-nine articles were included. Data on epidemiology were reported in 31, HRQoL burden in 16, and economic burden in 7 studies. Diagnosis of BED was made using 4th Edition of The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria in 46 studies. Lifetime prevalence of BED was 1.1-1.9% in the general population (DSM-IV). BED was associated with significant impairment in aspects of HRQoL relating to both physical and mental health; the Short Form 36 Physical and Mental Component Summary mean scores varied between 31.1 to 47.3 and 32.0 to 49.8, respectively. Compared to individuals without eating disorder, BED was related to increased healthcare utilization and costs. Annual direct healthcare costs per BED patient ranged between $2,372 and $3,731.

CONCLUSIONS

BED is a serious eating disorder that impairs HRQoL and is related to increased healthcare utilization and healthcare costs. The limited literature warrants further research, especially to better understand the long-term HRQoL and economic burden of BED.

Susceptibility to eating disorders among collegiate female student-athletes

CONTEXT

Research has suggested that the prevalence of young women with eating disorders (EDs) is increasing, but determining the exact prevalence of EDs within the female student-athlete (FS-A) population is difficult. Looking at certain traits may help us to identify their level of susceptibility to developing an ED.

OBJECTIVE

To determine the susceptibility of FS-As to EDs in relation to self-concept, including self-esteem and body image.

DESIGN

Cross-sectional study.

SETTING

Athletic training and health centers at National Collegiate Athletic Association Division I, II, and III institutions via e-mail questionnaire correspondence.

PATIENTS OR OTHER PARTICIPANTS

A total of 439 FS-As from 17 participating institutions completed the questionnaires. The sample was primarily white (83.1%) and underclass (61.8%).

MAIN OUTCOME MEASURE(S)

The questionnaire consisted of 4 parts: 3 subscales of the Eating Disorder Inventory-2, the Rosenberg Self-Esteem Scale, the Body Cathexis Scale, and demographic items.

RESULTS

A total of 6.8% of FS-As were susceptible to anorexia and 1.8% were susceptible to bulimia. The majority of FS-As (61%) reported normal self-esteem levels, whereas 29.4% had high self-esteem. Overall, 64.5% were satisfied and 23% were very satisfied with their body image.

CONCLUSIONS

These results are generally positive in that they suggest FS-As have high levels of self-concept and are at low risk to develop EDs. However, these findings do not mean that all concerns should be dismissed. Although more than 90% of the respondents were not susceptible to an ED, there are still FS-As who may be. Athletic departments should evaluate their FS-As' levels of self-concept so that their susceptibility to EDs can be addressed. The emotional aspect of health care should be included in providing holistic care for student-athletes. Athletic trainers often are the primary health care providers for FS-As, so they should be made aware of this concern.

Weight pressures in sport: examining the factor structure and incremental validity of the weight pressures in sport - females

Due to pressures within the sport environment, such as from coaches, teammates, uniforms and judges, female athletes may develop unhealthy eating practices to lose weight or change their body size/shape to become more competitive and meet societal and sport-related physique ideals. However, up until the development of the Weight Pressures in Sport for Females (WPS-F; Reel, SooHoo, Petrie, Greenleaf, & Carter, 2010) there was no way to quantify sport-specific weight pressures with female athletes. In this study, the psychometric properties of the scale were further examined using a sample of 414 female collegiate athletes. Sample 1 [n=207; M=19.27 years; SD=1.16] and Sample 2 [n=207; M=19.19 years; SD=1.66] participants were of a similar age and were used for exploratory and confirmatory analyses respectively. A two factor structure was confirmed and it was established that the scale was unique from general sociocultural pressures that all women experience, predicting female athletes' internalization, body dissatisfaction, dietary intent, and bulimic symptomatology. Specifically, the following factors, Coach and Sport Pressures about Weight (Factor 1) and Pressures Regarding Appearance and Performance (Factor 2), were found to have strong internal consistency and the emerging reliable and valid WPS-F has practical implications for screening and identifying weight-related sport pressures within female athletes. WPS-F can also serve to educate sport professionals about environmental pressures so that disordered eating and body image disturbances can be prevented.