Sport and Disordered Eating

In this study, Levit et al. (2018) examined the links between exercise addiction, disordered eating behaviors, anxiety, and depression, in a population of 100 amateur and competitive athletes practicing both individual and group sports (mean age 28.3 years, males = 67). Participants submitted an Exercise Addiction Inventory, Eating Attitudes Test, Body Shape Questionnaire, Spielberger State-Trait Anxiety Inventory, and Beck Depression Inventory (BDI). Analysis of the results revealed that exercise addiction was substantially associated with BDI scores, in addition to disordered eating behaviors, but not with trait or state anxiety. Participants who practiced individual sports reported a modestly higher depression score compared to their peers who practiced group sports, however, there was no significant difference in depression between amateur and competitive athletes. Furthermore, disordered eating behaviors were substantially related to exercise addiction scores, and it was revealed that body shape contributed to the relationship between disordered eating and exercise addiction. The authors comment that their study sheds light on the links between exercise addiction and depression, in addition to the role of disordered eating behaviors in the variability seen in exercise addiction, which ultimately is in agreement with published evidence on the negative relationship between eating disorders and exercise addiction. [NPID: Abnormal eating attitudes, anxiety, depression, exercise addiction]

In this study, Vardar et al. (2007) examined the prevalence of disordered eating behaviors in a population of young female athletes (aged 15-25 years, n = 243), and evaluated the levels of anxiety these athletes experience relative to the presence or absence of disordered eating, using the Eating Attitudes Test (EAT-40) and State-Trait Anxiety Inventory. Analysis of the results demonstrated that 16.7% of the athletes suffered from disordered eating behaviors, and that these athletes scored significantly higher on their state and trait anxiety compared to their peers who did not suffer from disordered eating behaviors. No differences were seen in EAT-40 results due to the type of sport the athletes participated in. The authors thus conclude that disordered eating behaviors correlate with higher levels of state and trait anxiety in young athletes. [NPID: Adolescent, anxiety, eating disorders, personality Inventory, sports]

Eating disorders (EDs) and disordered-eating behaviors (DEBs) increase the chance of death and affect physical health, mental health, and quality of life. The athlete population is especially at risk, owing to the increasing prevalence of EDs and DEBs in this vulnerable group. In this study by Conviser et al. (2018), the authors look at the challenges faced in ameliorating EDs and DEBs seen in athletes using a multidisciplinary care approach, one of which is the critical need for efficient and frequent communication channels among multidisciplinary treatment team (MDTT) members. The authors recommend that certain members would be qualified to join the MDTT, such as coaches, trainers, physical therapists, and certified fitness professionals, and that these individuals should receive ED education and sensitivity training. Addressing ED and DEBs would require the addition of other critical components, for example, evidence-based psychotherapeutics, emotional regulatory interventions, compassionate care, and accurate continuous monitoring of the athletes. Finally, the authors highlight the need for establishing and agreeing upon indicators for safe return to play and mindful adjustment of physical activity levels during periods of ED recovery to help maintain health, avoid injuries or relapses, and facilitate returning to sport participation. [NPID: Athletes, eating disorder, disordered-eating behaviors, multidisciplinary team]

Derangements in dietary habits and eating disorders (EDs) are frequently seen in athletes. In this review by Diaz et al. (2018), the authors outline the current evidence on EDs in sports, particularly in football, as the research on EDs in this population remains insufficient. The authors present an overview on EDs in sports, and challenge the classification of certain sports as low vs high-risk for EDs, in addition to the etiology, course, and impact of ED in sports on various socio-cultural, psychosocial, behavioral, and athletic-related factors, including currently observed trends that may worsen the risk of developing EDs. Furthermore, the authors highlight the available recommendations for ED management and prevention, including addressing potential risk factors, and the knowledge gaps that require further work to improve the available methodological, empirical, and conceptual evidence to help advance research and formulate effective intervention modalities. [NPID: Sports, disordered eating, eating disorders, risk factors, prevention, football, athletes]

The focus of this 2021 literature review was the nutritional problems faced by adolescent athletes with disordered eating or eating disorders. Athletes often use harmful weight-control practices that may contribute to the development of eating disorders or disordered eating. These medical and mental implications may be more serious among adolescent athletes since their bodies need to meet training requirements in addition to intensive growth demands. Consequently, these young athletes may be at nutritional risk, having high nutrient needs and adopting unhealthy eating behaviors. This literature review aimed to uncover the nutritional risks and malnutrition problems faced by adolescent athletes with disordered eating/eating disorders. The most common nutritional risks possibly induced by disordered eating were dehydration, electrolyte imbalances, deficiencies (in energy, macronutrients, and micronutrients), decreased bone mass density, and potentially harmful changes in body composition. To avoid nutrition-related issues, education programs are essential. Early detection is also paramount to ensure the timely management of nutritional problems, particularly in vulnerable groups such as adolescent athletes. [NPID: nutrition, nutritional deficiency, malnutrition, adolescents, athletes, sports, disordered eating, eating disorders]

In this 2018 study, a survey was conducted to determine the prevalence of disordered eating among male athletes and non-athletes. All 186 male participants were aged between 18 and 26 years. The aim of this project was to divide the male athletes into types and levels of sports participation and identify any factors that may contribute to their disordered eating attitudes and behaviors. Sport types included “lean” and “non-lean” sports, while athletic participation was grouped into one of: recreational athletes; low- competitive level; high-competitive level. There were no significant differences in average eating disorder scores (indicated by the Eating Disorder Examination Questionnaire survey) between athletes and non-athletes, nor between the groups varying in sports type and competitive level. Excessive exercising was higher among the athletes than the non-athletes (23.1% vs. 12.5%), and incidences of binge eating disorders were higher in the non-athletes than the athletes (~50% vs. 42%). A considerably greater percentage of athletes competing in “lean” sports reported excessive exercising, compared with athletes involved in “non-lean” sports. Additionally, those competing at high levels of competition were more likely to show greater dietary restraint than those low-level competition athletes, and recreational athletes. This study concluded that the incidence of disordered eating patterns and pathological weight control behaviors was not different in male athletes, compared with the non-athletic population. But it cannot be said that sport type and participation level pose a greater risk for eating disorders in male athletes. [NPID: eating disorder, disordered eating, sports, competition level, non-athletes, athletes, diet restriction, male athletes, weight control behaviors]

The purpose of this 2020 study was to investigate the eating habits and possible presence of eating disorders among female university athletes. Although the diagnostic methods are advancing and the amount of research on female athletes is rising, these sports athletes are experiencing more musculoskeletal injuries and health issues than before. In this research study, 77 university student female athletes were assessed on eating disorders through a questionnaire. Strength/power athletes were found to skip meals more often and use nutritional supplements. Overall, the eating disorder prevalence rate was 32.5% among all the participants. Longer weekly exercise duration was moderately associated with higher eating disorder scores. To conclude, eating disorders and disordered eating were highly prevalent among the 77 female college athletes. As well as encouraging athletes to adjust their eating habits, another necessity is informing athletes and their trainers about this issue. The diagnosis and treatment process of eating disorders should include a multidisciplinary team consisting of physicians, dieticians, nurses, psychologists, and coaches. [NPID: athletes, sports, disordered eating, eating disorder, female athletes, students, diet, eating habits, sports injuries]

This 2021 study analyzed the eating attitudes, behaviors, and beliefs of female bodybuilding athletes. A non-athlete group was also included to provide comparisons. The authors aim to address the limited research conducted on female bodybuilding athletes. Female athletes participating in sports that emphasize aesthetics are said to be possibly more prone to developing eating disorders and disordered eating than non-athletes, males, and those athletes involved in sports with less emphasis on leanness. Although there was a difference in body mass between the female bodybuilders and non-athletes, there were no significant discrepancies in age, stature, or body mass index between the two groups. The data also revealed that considerably more athletes were deemed to be “at risk” of an eating disorder, compared with non-athletes. A separate questionnaire for the athletes indicated high preoccupation with body mass, and negative self-perception. These bodybuilding athletes often engage in exercise to alter their body mass. To conclude, female bodybuilding athletes exhibit behaviors linked with disordered eating and eating disorders. Compared to non-athletes, they were more likely to be concerned with nutrient intake, exercise, and changing their appearance. [NPID: athletes, sports, disordered eating, eating disorders, bodybuilding, female athletes, perception]

The purpose of this 2019 study was to investigate if there are psychosocial factors that contribute to risk of eating disorders in sports athletes, with a particular focus on soccer players. Recent studies have indicated that footballers and other athletes involved in “low-risk” sports are just as susceptible to developing eating disorders as athletes from sports that emphasize weight and body appearance. The athlete’s eating habits questionnaire (CHAD) was administered to a total of 357 athletes, including footballers. The results showed that 10.9% of athletes scored 100 points or more on the CHAD, implying that a large number of athletes are either at risk of developing or already suffer from eating disorders. The data also demonstrated that a higher proportion of footballers (11.4%) scored 100 points or higher on the CHAD. Based on athletes’ beliefs, attitudes, and behaviors, the footballers were rated to be at moderate risk of eating disorders. Traditionally, different sports are classified as either high- or low- risk, but the findings of this study are conflicting with this way of sports grouping. The authors believe that the type of sports the athlete participates in may not be the most important factor in eating disorder risk. Athletes, including footballers, may have a heightened risk for EDs when they have certain combinations of dysfunctional beliefs, attitudes and behaviors. [NPID: footballers, soccer, athletes, sports, disordered eating, eating disorders, psychosocial]

In this 2020 study, a sample of Puerto Rican high school athletes were assessed on their risk of developing eating disorders. Student athletes are thought to face multiple social and cultural pressures that can exponentially increase the chances of developing eating disorders. Influential factors may include high expectations of coaches, teammates, and friends, which can cause the young athletes to feel desperate in meeting the high demands of their sport. The author also checks if risk of eating disorders can be affected by factors such as self-esteem and body image of the student-athlete. Thirty-six Puerto-Rican high school student-athletes took part in a sociodemographic questionnaire, as well as several tests on eating attitudes, self-esteem, and body appreciation. The data analysis models did not indicate any correlation between body image, self-esteem, and eating disorder risk. These students were not likely to develop eating disorders given that they possessed a normal body image and a favorable level of self-esteem. While these results are positive, a larger group of student-athletes can be examined to back up the evidence. [NPID: high school, athletes, student athletes, eating disorders, body image, self-esteem, Puerto Rico]

This 2019 article takes a closer look at former elite sportspeople, examining their eating behaviors and body dissatisfaction. Retiring from professional sports may influence significant identity, body, and lifestyle changes, which is why a literature review was conducted to investigate. Buckley et al. searched for relevant articles in six different databases. Among the 16 articles that were identified, three main themes arose. These included body dissatisfaction and grief, disordered eating, and long-term influence of sporting culture. It was determined that maladaptive and compensatory behaviors can arise from sustained athletic identity, body grief, lack of education, and contradictory body ideals. A lack of body acceptance may lead to maladaptive behaviors related to food, exercise, and body arising in this transitory period. This review brings up the need for sporting organizations and health professionals to acknowledge the significant changes in eating and body attitudes that individuals go through post-retirement. [NPID: athletes, body image, diet, dietary behaviors, retirement, retired athletes]

This 2020 study compared the incidences of eating disorders among female athletes with non-athletes. Eating disorders are said to cause certain events that can influence sports performance. An aim of this article was to identify personality characteristics that can contribute to the risk of developing eating disorders. The eating disorder prevalence of 80 adolescent female athletes was compared to a group of 40 non-athletes. The SCOFF questionnaire was used to examine the presence of disordered eating and certain psychological aspects pertinent to eating disorder status/disordered eating symptoms. One of the most notable results was the higher SCOFF questionnaire score in the non-athletes compared with the athletes. These non-athlete female adolescents may display more disturbed eating behaviors and thoughts than athletic female adolescents and could possibly be at greater risk of developing clinical eating disorders. [NPID: disordered eating, eating disorder, athletes, adolescents, eating behavior, sports performance, sports]

The purpose of this 2020 review was to evaluate the existing literature on the efficacy of the ketogenic diet among athletes. Recently, researchers have been focusing their attention on examining the potential benefits of maintaining a ketogenic diet in improving body composition, physical health, psychological well-being, and performance of athletes. There were 12 articles that met the inclusion criteria and were added to the final scoping review. While adhering to a ketogenic diet can positively influence body weight and fat mass, the diet’s impact on physical health varied. Although the adherence to a ketogenic diet provides benefits to physical health including fat oxidation (the breaking down of fatty acids), this eating habit also negatively affects stool microbiota and iron metabolism. Moreover, this low-carb, high-fat diet had conflicting effects on sporting performance. Athletes reported better well-being after starting the ketogenic diet, but only after the second week. Following a ketogenic diet had both positive and detrimental effects among athletic populations. Additional research is required to back up any concluding statements on the role of the ketogenic diet in athletes. [NPID: athletes, sports, ketogenic diet, review, performance, body composition, physical health, well-being, mental health]

This 2019 study assessed if preparing for fitness sports competitions affects mental health symptoms. The prevalence of mental health issues is high among athletes, but there are limited studies that analyze fitness physique athletes. Being young, female, and competing in aesthetic sports is a high-risk triad for mental health symptoms. Therefore, this study examined fitness physique athletes and another group of females on mental health symptoms such as dietary behavior, perfectionism, body image, and relationship with exercise. Before competition, the athletes showed greater drive to be lean and increased eating restraint, compared with the female group used for reference. Eating restraint was higher and the number of disordered eating symptoms were lower in the athletes at the time of competition. The fitness physique athletes exhibited higher levels of drive for leanness and muscularity, and exercised more for figure toning, in comparison to the female reference group. The differences seen during competition remained even one month after the end of the event. Overall, the athletes managed the dieting aspect, but self-control decreased post-competition. There was a rise in disordered eating and body shape concern after competition. Furthermore, perfectionism was associated with eating restrictions among the fitness physique athletes but related to disordered eating in the female reference group. In this female group, high drive for leanness generally correlated with more disordered eating behavior. [NPID: athletes, fitness, physique, mental health symptoms, diet, behavior, perfectionism, body image, exercise, disordered eating, sports, competition]

The aim of this 2020 review was to discuss the importance of disordered eating in adolescent athletes, particularly focusing on female athletes with disordered eating disorders. The reviewers examined the literature on adolescents who may be affected by both binge eating disorders (BED) and other eating disorders. Relevant articles were identified by searching on PubMed using term variations of “feeding and eating disorders” and “athletes” with “high school”. The search produced 20 studies with relevance to disordered eating in adolescent athletes. Compared to other psychological disorders, there were higher incidences of comorbidities accompanying eating disorders. It was also found that a small percentage of patients with eating disorders seek treatment. Moreover, eating disorders were more prevalent in adolescent elite athletes than non-athletes of both genders (in all sports and levels of competition). More powerful tools for identifying disordered eating behaviors are needed by family practice physicians, nurses, and coaches to use when working with at-risk adolescent athletes. Healthcare professionals as well as school teaching staff ought to be educated and trained to detect disordered eating. [NPID: sports, disordered eating, eating disorders, binge eating disorders, school, athletes, review]

This 1998 article explored the incidence of binge eating among athletes, who are believed to be more susceptible than the general population due to the strict requirements in weight and higher demand for better body shape. This review examines scientific reports with relevance to the development of binge eating disorder in athletes. Williams finds that following extreme and rigid dieting practices and focusing on body weight and composition can be risk factors for binge eating disorder. Regardless of the presence of stressors, controlling calorie intake for an extended time can disrupt hunger and satiety cues, and induce urges to binge eat. It was also discovered that binge eating disorder shares several mechanisms and behavioral traits with drug addiction. The traditional models of binge eating disorder are based on the general population and thus, the current treatments do not address the individual requirements of athletes. Currently, there are no guidelines for binge eating disorder management. Since binge eating disorder in athletes is likely induced by caloric restriction, this information may help coaches and athletes in preventing the onset of the disorder. [NPID: binge eating, binge eating disorder, athletes, weight, performance, calorie restriction, drug addiction]