Peer Recognition of Disordered Eating Behaviors: Implications for Improving Awareness through Health Education

Investigating coaches’ recognition of symptoms of eating disorders in track athletes

Objective

To determine the extent to which athletics coaches can identify evidence of an eating disorder in track athletes and what treatment advice they would provide.

Methods

Vignettes depicting athletes portraying symptoms consistent with anorexia nervosa (AN) and bulimia nervosa (BN) were developed and used to survey 185 UK and Irish athletics coaches (and a community sample of 105 non-coaches) regarding their ability to recognise and respond to symptoms of an eating disorder.

Results

Coaches were no more likely than the community sample to correctly identify an eating disorder but were more likely to suggest professional treatment for an athlete experiencing symptoms of AN (OR 1.82, 95% CI 1.02 to 3.29). For both eating disorders, higher levels of mental health literacy (AN: OR 1.06, 95% CI 1.02 to 1.11, BN: OR 1.08, 95% CI 1.04 to 1.14) and more years of coaching experience (AN: OR 1.12, 95% CI 1.03 to 1.24, BN: OR 1.07, 95% CI 1.01 to 1.16) also increased the likelihood of suggesting professional help. When considering the whole sample, participants were more likely to correctly identify an eating disorder (OR 4.67, 95% CI 2.66 to 8.20) and suggest professional treatment for AN than BN (OR 1.76, CI 1.04 to 2.97). Further, symptoms of AN were more likely to be correctly identified in female than male athletes (OR 2.26, 95% CI 1.28 to 4.06).

Conclusions

Although coaches were more likely than community members to recommend professional treatment to an athlete exhibiting symptoms of an eating disorder, they were no more likely to correctly identify an eating disorder in the first instance. Further work is required to enhance coaches’ capacity to identify symptoms of eating disorders to ensure athletes receive appropriate interventions.

Association between the recognition of muscle mass and exercise habits or eating behaviors in female college students

This study aimed to examine the association between muscle mass and perception of body shape, desired body shape, physical strength, exercise habits, and eating behaviors. Height, weight, and body composition in 270 female university students were measured. The questionnaire on body shape perception, desired body shape, dieting experience, current, and past exercise habits, exercise preference, and eating behaviors were administered. The analysis of covariance with body fat mass as the covariate found that the skeletal muscle index (SMI) was different among each group on each of body perception or desired body shape (all, p < 0.001). In the post hoc test on body shape perception, the SMI in “obese” was significantly more than that in “slim” (p < 0.001) and “normal” (p < 0.001). In the desired body shape, the SMI in “become thin” was more than that in “maintain as current shape” (p < 0.001). Further, a significant difference was found among the categories of diet experience, with body fat mass as the covariate. In the post hoc test, the SMI in “yes” was more than that in “no” (p < 0.001). These results indicate that not only body fat mass but skeletal muscle mass drives young females’ desire for thinness even with exercise advantages.

College student attitudes and strategies for intervention with a hypothetical peer exhibiting disordered eating

OBJECTIVE

The present study assesses stigma, attitudes, and strategies of college students in intervening with peers demonstrating disordered eating behaviors.

METHOD

Four hundred and eighty nine college students (384 women) completed questionnaires that assessed eating disorder symptoms and bystander attitudes adapted for disordered eating. Participants read one of three vignettes of a 20-year-old hypothetical peer displaying symptoms of disordered eating aligned with bulimia nervosa, anorexia nervosa, or binge-eating disorder; participants then described whether the vignette subject had a problem, what the problem was, and strategies for intervention. Relationships among eating disorder history, bystander attitudes, demographics, and intention to intervene in disordered eating were assessed using descriptive and regressive analyses; peer intervention strategies were organized and evaluated for frequencies of responses.

RESULTS

Demographics (female-identification) and familiarity with disordered eating were associated with likelihood to intervene in disordered eating. Most students recognized that the peer had a problem, but fewer than half believed the problem was disordered eating; nearly a quarter (22%) of the students stated that they would be uncomfortable talking to a peer about disordered eating. The majority of students cited vague or nonproblem-related intervention strategies (62%), followed by emotion-focused strategies (22.5%), or body and behavior-focused strategies (15%).

DISCUSSION

College students, particularly women and those with previous exposure to eating disorders, are likely to intervene peers disordered eating. However, students tend to use vague or body-focused intervention strategies. Bystander intervention training that provides rationale and rehearsal for supportive communication strategies is needed to address students' lack of intervention skills, particularly among men.