Eating disorders in athletes: Overview of prevalence,risk factors and recommendations for prevention and treatment

Abstract

The prevalence of disordered eating and eating disorders vary from 0–19% in male athletes and 6–45% in female athletes. The objective of this paper is to present an overview of eating disorders in adolescent and adult athletes including: (1) prevalence data; (2) suggested sport- and gender-specific risk factors and (3) importance of early detection, management and prevention of eating disorders. Additionally, this paper presents suggestions for future research which includes: (1) the need for knowledge regarding possible gender-specific risk factors and sport- and gender-specific prevention programmes for eating disorders in sports; (2) suggestions for long-term follow-up for female and male athletes with eating disorders and (3) exploration of a possible male athlete triad.     

Prevalence of disordered eating in elite female athletes in team sports in Greece

ABSTRACT

The purpose of the study was to assess (a) the prevalence of disordered eating (DE) in elite female team sports players compared to non-athletes and (b) to compare DE prevalence in elite female players in basketball, volleyball and water polo. One hundred and seventy-five females were recruited (age 23.10?±?5.4, BMI 21.85?±?2.3?kg/m²), 53 were elite basketball players, 42 were elite volleyball players, 34 were elite water polo players and 46 were non-athletes. Participants completed the Eating Disorders Questionnaire (EDE-Q) and a physical activity questionnaire. The EDE-Q incorporates 36 statements which relate to the occurrence and frequency of key behaviours of eating disorders, under the following four subscales: Restraint, eating concern, shape concern and weight concern and a global score of disordered eating. No differences were found in the EDE-Q subscale score and global score between athletes and non-athletes. Only 6.2% of the total number of participants exhibited DE using the global score >2.3. Water polo players had significantly higher scores in the ‘eating concern’ subscale and in the frequency of key behavioural features of DE such as binge eating episodes and objective and subjective bulimic episodes, compared to volleyball and basketball players. In conclusion, team sport elite female players do not exhibit greater prevalence of DE compared to non-athletes. Water polo, a sport that emphasises leanness and control of body weight for international distinctions, is associated with a higher tendency to exhibit DE, when compared to other team sports.     

Eating psychopathology as a risk factor for depressive symptoms in a sample of British athletes

Abstract

Within the clinical literature it is accepted that there is a strong connection between eating disorders and depression; however the nature of the casual relationship is somewhat unclear. Therefore the aim of the present study was to determine the prospective relationship between eating psychopathology and depressive symptoms among competitive British athletes. A total of 122 athletes completed the Eating Disorder Examination Questionnaire and the depression subscale of the Symptom Checklist-90R over a 6-month period. Partial correlations revealed that when controlling for baseline eating psychopathology, athletes’ baseline depressive symptoms was not related to their eating psychopathology 6 months later. However, when controlling for baseline depressive symptoms, athletes’ initial eating psychopathology was positively and significantly related to depressive symptoms 6 months later. Subsequent hierarchical multiple regression analyses revealed athletes’ initial levels of eating psychopathology significantly predicted depressive symptoms 6 months later. The current findings support the assertion that elevated eating psychopathology serves as a potential risk factor for the development of depression in athletes. Thus, National Governing Bodies, athletic clubs, sport organisations and universities need to recognise and be aware that exposure to the factors that increase the risk of eating disorders inadvertently serves to increase athletes’ vulnerability for depression.     

Food attitudes in female athletes: Association with menstrualcycle length

Abstract

The aim of this study was to examine the relationship between indicators of risk of disordered eating, body image and varied menstrual cycle lengths. Altogether, 151 female athletes were invited from 16 sports and 70 female non-athletic controls were recruited from a university lecture class. The participants completed several surveys, including demographics, menstrual cycle history, physical activity, Eating Disorder Inventory (EDI) and the Three Factor Eating Questionnaire (TFEQ). Selected EDI subscales were summed to reflect eating disorder risk and body image. Menstrual cyclicity was based on self-reported cycle length for the last 6 months (normal cycles = 26–32 days, irregular cycles = <26 or >32 days). Athletes overall had more irregular cycles (29.1%) than the non-athletes (15.7%) (P < 0.05). There were significant differences in scores for eating disorder risk, body dissatisfaction, drive for thinness, cognitive restraint (TFEQ) and disinhibition (TFEQ), only when athletes were divided based on menstrual cyclicity (i.e. irregularly cycling athletes had higher scores than athletes with normal menstrual cycle lengths). No differences in these scores were found between non-athletes with normal or irregular menstrual cycle lengths. In conclusion, irregularly short or long menstrual cycle length is associated with subtle indications of higher risk of disordered eating in female athletes.     

Autonomy,eating disorders and elite gymnastics: ethical and conceptual issues

Participation in elite sport, and in particular those sports with special demands in terms of weight and shape, is associated with a higher risk for eating disorders such as anorexia nervosa [Sundgot-Borgen, J., & Torstveit, M. K. (2010). Aspects of disordered eating continuum in elite high intensity sports. Scandinavian Journal of Medicine and Science in Sports, 20, 112–121]. We report upon research exploring eating attitudes and behaviours within elite gymnastics. The study comprised 42 semi-structured interviews with gymnasts and support staff—34 gymnasts and 9 staff/support staff. The majority of those interviewed were acrobatic gymnasts (22; 16 males and 6 females) with 7 rhythmic gymnasts (all female) and 5 tumblers (all female). The mean age of those gymnasts interviewed was 17.4. A difficulty in precisely delineating extreme eating patterns (disordered eating) from having an eating disorder was noted. Within an elite sports context behaviours thought to be pathological in a more general setting might be fairly commonplace and even functional to the athlete's performance. The extent to which the athlete consents to these patterns of behaviour is problematic given their age and development. We argue that conceptualising consent as ‘authority to be cared for by a trustworthy coach’, more felicitously applies to the child/adolescent elite sporting context, helping us understand not only the focus of the elite gymnast, but also their relationship with the coach and the coaches' responsibilities.     

Defining and categorizing emotional abuse in sport

Abstract

In this study, we used a qualitative research design to explore athletes’ experiences of emotional abuse in sport. Semi-structured interviews were conducted with 14 retired, elite female swimmers, and data were analysed inductively using open, axial, and selective coding procedures. Findings revealed that emotionally abusive behaviours of the coach occurred in three ways: through physical behaviours, verbal behaviours, and the denial of attention and support. Based on our findings, a definition of emotional abuse in sport is proposed. This definition of emotional abuse is the first definition derived from the experiences of emotional abuse within an athletic environment. It encapsulates previous definitions of emotional abuse, types of emotionally abusive behaviours, and outcomes of these behaviours. The need for an athlete protection initiative in sport is discussed and recommendations are made for future research.     

"女运动员三联征"的研究现状及其能量平衡调节机制

“女运动员三联征”包括了相互联系的三个征象，即进食障碍、闭经和早发骨质疏松。这三种症状在女运动员经常同时出现，尤其易发生在那些从事美学和生理学上依赖低体脂或低体重取得成功的项目的运动员中，是影响女运动员健康和竞技状态的重要因素。女运动员三联征与机体能量不平衡有关。从机体能量平衡调节的角度综述女运动员三联征的发生机制。     

Athletic identity and disordered eating in obligatory and non-obligatory runners

Abstract

Athletic identity is the extent to which an individual identifies with being an athlete. Strong “running” role identity may contribute to increased restrictive dieting behaviours, potentially placing such individuals at risk for eating disorders. In this study, we examined differences in eating and exercise behaviours/attitudes and athletic identity in obligatory versus non-obligatory runners. Male and female participants completed a battery of questionnaires including the Eating Disorder Inventory, Obligatory Exercise Questionnaire (OEQ), and Athletic Identity Measurement Scale (AIMS). OEQ scores ≥50 were indicative of obligatory exercise. The non-obligatory runners (n = 82) and obligatory runners (n = 91) were compared on the various measures. Obligatory runners scored significantly higher (P < 0.002) on all of the eating attitudes/disorder measures, and the AIMS (P ≤ 0.006). Scores on the AIMS were correlated with all disordered eating measures (P < 0.05). Exercising to maintain identification with the running role may be associated with pathological eating and training practices.     

Parental Behavior,Cognitive Appraisal,and Motivation in Young Athletes

Purpose: This study tested two hypotheses relating young athletes’ sports motivations to parental behaviors and cognitive appraisal: (1) young athletes’ motivation in sports is related to their parents’ behavior; and (2) this relationship is mediated by cognitive appraisal, even after controlling for competitive level and sports records. Method: This cross-sectional study included 673 young athletes and it measured the athletes’ perceptions of parental behaviors, cognitive appraisal, and sports motivation. Results: Structural equation modeling confirmed Hypothesis 1–the mother’s behaviors accounted for 15 to 16% of the variance in sports motivation, and the father’s behaviors accounted for 12 to 21% of the variance. The correlation patterns differed according to whether the athletes were evaluating the mother’s or father’s behaviors. Hypothesis 2 also was confirmed, for cognitive appraisal partially mediated the relationship between the perception of parental behaviors and sports motivation (34% of the variance was accounted for by the perception of the mother’s behavior; 30% by the father’s). The mediating model did not vary with competitive level or sports records. Conclusion: Parental behaviors and cognitive appraisal need to be taken into account to understand young athletes’ sports motivations.     

How performance analysis of elite long jumping can inform representative training design through identification of key constraints on competitive behaviours

Abstract

Analysing performance in competitive environments enables identification of key constraints which shape behaviours, supporting designs of more representative training and learning environments. In this study, competitive performance of 244 elite level jumpers (male and female) was analysed to identify the impact of candidate individual, environmental and task constraints on performance outcomes. Findings suggested that key constraints shaping behaviours in long jumping were related to: individuals (e.g. particularly intended performance goals of athletes and their impact on future jump performance); performance environments (e.g. strength and direction of wind) and tasks (e.g. requirement for front foot to be behind foul line at take-off board to avoid a foul jump). Results revealed the interconnectedness of competitive performance, highlighting that each jump should not be viewed as a behaviour in isolation, but rather as part of a complex system of connected performance events which contribute to achievement of competitive outcomes. These findings highlight the potential nature of the contribution of performance analysis in competitive performance contexts. They suggest how practitioners could design better training tasks, based on key ecological constraints of competition, to provide athletes with opportunities to explore and exploit functional intentions and movement solutions high in contextual specificity.     

Food attitudes in female athletes: association with menstrual cycle length

The aim of this study was to examine the relationship between indicators of risk of disordered eating, body image and varied menstrual cycle lengths. Altogether, 151 female athletes were invited from 16 sports and 70 female non-athletic controls were recruited from a university lecture class. The participants completed several surveys, including demographics, menstrual cycle history, physical activity, Eating Disorder Inventory (EDI) and the Three Factor Eating Questionnaire (TFEQ). Selected EDI subscales were summed to reflect eating disorder risk and body image. Menstrual cyclicity was based on self-reported cycle length for the last 6 months (normal cycles = 26-32 days, irregular cycles < or =26 or >32 days). Athletes overall had more irregular cycles (29.1%) than the non-athletes (15.7%) (P < 0.05). There were significant differences in scores for eating disorder risk, body dissatisfaction, drive for thinness, cognitive restraint (TFEQ) and disinhibition (TFEQ), only when athletes were divided based on menstrual cyclicity (i.e. irregularly cycling athletes had higher scores than athletes with normal menstrual cycle lengths). No differences in these scores were found between non-athletes with normal or irregular menstrual cycle lengths. In conclusion, irregularly short or long menstrual cycle length is associated with subtle indications of higher risk of disordered eating in female athletes.     

Examining the impact of the Respect in Sport Parent Program on the psychosocial experiences of minor hockey athletes

ABSTRACT

Models of positive youth development suggest that athletes may be influenced by parent education programmes; however, there is little research examining the impact of such programmes on athlete outcomes. This study examined the impact of the Respect in Sport Parent Program on athlete outcomes among minor hockey players over three years. This study consisted of cross-sectional and longitudinal online surveys measuring athletes’ positive and negative developmental experiences, prosocial and antisocial behaviours, parental support and pressure, and sport enjoyment and commitment. Athletes completed at least one online survey during the study period (N = 366; 84.2% males; 14–19 years of age; M = 15.4 years), and 83 athletes completed multiple surveys for longitudinal analyses. Cross-sectional results comparing athletes in leagues adopting the programme at different time points indicated significant differences in prosocial behaviours towards teammates. Multilevel longitudinal analyses revealed improvements in athletes’ antisocial behaviours towards opponents, initiative, goal setting, and cognitive skills over time, regardless of whether they were in a league that implemented the programme. However, athletes in leagues that implemented the programme during the study reported greater improvements in antisocial behaviours towards opponents, and there were trends with respect to improved personal and social skills. These findings provide suggestions to improve the delivery and impact of parent education programmes in youth sport.     

NBC’s televised media portrayal of female athletes in the 2016 Rio Summer Olympic Games: a critical feminist view

Abstract

Mass media play a major role in influencing societal views of female athletes and in shaping the relationship between women and sport. While female athletes historically tend to receive little media coverage, the Olympic Games provide an opportunity to feature sports for both male and female athletes. This paper, guided by critical feminist theory, focuses on televised media’s presentation of female athletes in the 2016 Summer Olympic Games, reporting particularly on the broadcast narrative. Common themes include comparison to male athletes, heterosexualizing female athletes, women as wives and mothers, shaming, and male privilege. The role of production, social media, and female athletes’ perceptions on this presentation are also discussed.     

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.     

The 2012 Olympic Badminton Scandal: Match-Fixing,Code of Conduct Documents,and Women’s Sport

Abstract

At the 2012 Olympic Games, eight badminton players were disqualified from the women’s doubles tournament for intentionally losing matches in the group stage. The incident marks the largest mass disqualification of athletes from multiple countries for match-fixing at the Olympic Games in the twenty-first century. Significantly, it is also the first time that female athletes have been disqualified from a Summer Olympic Games for match-fixing not related to betting or gambling. This essay weaves together two interdependent arguments. First, it is suggested that the incident can be understood through the lens of three separate but interconnected issues: the history of match-fixing, the growth of code of conduct documents in sports, and the regulation of women’s bodies in sports. Second, it is argued that the athletes’ gender is a critical element of the incident. The primary aims of the article are to position the 2012 badminton scandal as a key moment in the history of match-fixing and to suggest that the incident is important for future research and policy creation.     

Athletic identity and disordered eating in obligatory and non-obligatory runners

Athletic identity is the extent to which an individual identifies with being an athlete. Strong "running" role identity may contribute to increased restrictive dieting behaviours, potentially placing such individuals at risk for eating disorders. In this study, we examined differences in eating and exercise behaviours/attitudes and athletic identity in obligatory versus non-obligatory runners. Male and female participants completed a battery of questionnaires including the Eating Disorder Inventory, Obligatory Exercise Questionnaire (OEQ), and Athletic Identity Measurement Scale (AIMS). OEQ scores ≥50 were indicative of obligatory exercise. The non-obligatory runners (n = 82) and obligatory runners (n = 91) were compared on the various measures. Obligatory runners scored significantly higher (P < 0.002) on all of the eating attitudes/disorder measures, and the AIMS (P ≤ 0.006). Scores on the AIMS were correlated with all disordered eating measures (P < 0.05). Exercising to maintain identification with the running role may be associated with pathological eating and training practices.     

Psychological resilience in sport performers: a review of stressors and protective factors

Abstract

Psychological resilience is important in sport because athletes must utilise and optimise a range of mental qualities to withstand the pressures that they experience. In this article, we discuss psychological resilience in sport performers via a review of the stressors athletes encounter and the protective factors that help them withstand these demands. It is hoped that synthesising what is known in these areas will help researchers gain a deeper profundity of resilience in sport, and also provide a rigorous and robust foundation for the development of a sport-specific measure of resilience. With these points in mind, we divided the narrative into two main sections. In the first section, we review the different types of stressors encountered by sport performers under three main categories: competitive, organisational and personal. Based on our recent research examining psychological resilience in Olympics champions, in the second section we discuss the five main families of psychological factors (viz. positive personality, motivation, confidence, focus, perceived social support) that protect the best athletes from the potential negative effect of stressors. It is anticipated that this review will help sport psychology researchers examine the interplay between stressors and protective factors, which will, in turn, focus the analytical lens on the processes underlying psychological resilience in athletes.     

Factors that influence fatigue status in Canadian university swimmers

Abstract

The overall purpose of this two-part study was to examine factors that influenced fatigue status in university level swimmers. Participants were 25 swimmers (14 male, 11 female) from one university swim team. A mixed methods approach was used. Quantitative data were collected using an orthostatic heart rate test and self-report questionnaire at multiple time points throughout a competitive season. Qualitative data were collected via focus groups conducted at the end of the season. Analysis of the quantitative data indicated high levels of accumulated physiological and psychological fatigue that improved with increased recovery. Specifically, heart rate indices, form, feeling, and energy level improved during taper periods and worsened during and immediately after intensive training blocks. Analysis of the qualitative data revealed that one factor (flexible structure of training programme) had a positive influence on athletes’ fatigue while two factors (teammate expectations and balancing school, work, and sleep) had a negative influence on athletes’ fatigue.