Are female athletes at increased risk for disordered eating and its complications?

Disordered eating behavior (DE) and eating disorders (EDs) are of great concern because of their associations with physical and mental health risks and, in the case of athletes, impaired performance. The syndrome originally known as the Female Athlete Triad, which focused on the interaction of energy availability, reproductive function, and bone health in female athletes, has recently been expanded to recognize that Relative Energy Deficiency in Sport (RED-S) has a broader range of negative effects on body systems with functional impairments in both male and female athletes. Athletes in leanness-demanding sports have an increased risk for RED-S and for developing EDs/DE. Special risk factors in aquatic sports related to weight and body composition management include the wearing of skimpy and tight-fitting bathing suits, and in the case of diving and synchronized swimming, the involvement of subjective judgments of performance. The reported prevalence of DE and EDs in athletic populations, including athletes from aquatic sports, ranges from 18 to 45% in female athletes and from 0 to 28% in male athletes. To prevent EDs, aquatic athletes should practice healthy eating behavior at all periods of development pathway, and coaches and members of the athletes’ health care team should be able to recognize early symptoms indicating risk for energy deficiency, DE, and EDs. Coaches and leaders must accept that DE/EDs can be a problem in aquatic disciplines and that openness regarding this challenge is important.

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A Qualitative Exploration of Sport and Social Pressures on Elite Athletes in Relation to Disordered Eating

Frontiers in Psychology ◽

10.3389/fpsyg.2021.633490 ◽

2021 ◽

Vol 12 ◽

Author(s):

Hannah Stoyel ◽

Russell Delderfield ◽

Vaithehy Shanmuganathan-Felton ◽

Alex Stoyel ◽

Lucy Serpell

Keyword(s):

Disordered Eating ◽

Eating Behaviors ◽

Female Athletes ◽

Complex Interaction ◽

Structured Interviews ◽

Disordered Eating Behaviors ◽

Increased Risk ◽

Social Messages ◽

Societal Expectations ◽

Qualitative Exploration

Introduction: Athletes are at increased risk of disordered eating compared to non-athletes. Inspired by previous investigation into quantitative work on an etiological model of disordered eating in athletes, the current study aimed to explore a problematic aspect of the model: athletes' lived experiences of social and sport pressures in relation to the onset of disordered eating and differing eating behaviors.Methods: Nine (N = 9) male and female athletes representing a range of endurance sports took part in semi-structured interviews. Thematic analysis was utilized.Analysis: Analysis revealed two main themes each with two corresponding subthemes (1) Conflating physical appearance and sporting ability with the subthemes of (1a) social comparison in a sporting world and (1b) societal notions of “the athlete body” and (2) Living as an athlete with the corresponding subthemes of (2a) discipline and sacrifice and (2b) the balancing act.Discussion: It is the complex interaction between societal expectations as lived out in social messages and comparisons, and sport pressures that contributes to the development of disordered eating behaviors. These findings suggest that prevention and treatment of disordered eating in athletes can be applied from those already established in non-sporting realm.

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Examining the Relationship between Exercise Dependence, Disordered Eating, and Low Energy Availability

Nutrients ◽

10.3390/nu13082601 ◽

2021 ◽

Vol 13 (8) ◽

pp. 2601

Author(s):

Megan A. Kuikman ◽

Margo Mountjoy ◽

Jamie F. Burr

Keyword(s):

Disordered Eating ◽

Female Athletes ◽

Signs And Symptoms ◽

Low Energy ◽

Exercise Dependence ◽

Energy Availability ◽

Recreational Athletes ◽

Bone Stress ◽

Increased Risk ◽

Low Energy Availability

Both dietary and exercise behaviors need to be considered when examining underlying causes of low energy availability (LEA). The study assessed if exercise dependence is independently related to the risk of LEA with consideration of disordered eating and athlete calibre. Via survey response, female (n = 642) and male (n = 257) athletes were categorized by risk of: disordered eating, exercise dependence, disordered eating and exercise dependence, or if not presenting with disordered eating or exercise dependence as controls. Compared to female controls, the likelihood of being at risk of LEA was 2.5 times for female athletes with disordered eating and >5.5 times with combined disordered eating and exercise dependence. Male athletes with disordered eating, with or without exercise dependence, were more likely to report signs and symptoms compared to male controls-including suppression of morning erections (OR = 3.4; p < 0.0001), increased gas and bloating (OR = 4.0–5.2; p < 0.002) and were more likely to report a previous bone stress fracture (OR = 2.4; p = 0.01) and ≥22 missed training days due to overload injuries (OR = 5.7; p = 0.02). For both males and females, in the absence of disordered eating, athletes with exercise dependence were not at an increased risk of LEA or associated health outcomes. Compared to recreational athletes, female and male international caliber and male national calibre athletes were less likely to be classified with disordered eating.

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Eating and Weight Disorders in the Female Athlete

International Journal of Sport Nutrition ◽

10.1123/ijsn.1.2.104 ◽

1991 ◽

Vol 1 (2) ◽

pp. 104-117 ◽

Cited By ~ 42

Author(s):

Jack H. Wilmore

Keyword(s):

Eating Disorders ◽

Disordered Eating ◽

Bone Mineral ◽

Female Athlete ◽

Female Athletes ◽

Special Populations ◽

Menstrual Dysfunction ◽

Secondary Amenorrhea ◽

Clinical Criteria ◽

Increased Risk

This paper presents an overview of eating disorders, including definitions, clinical criteria for appropriate diagnosis, and a discussion of the potential for increased risk for eating disorders in special populations of female athletes. This is followed by a discussion of the prevalence of eating disorders in normal and athletic populations. From this discussion, it seems clear that female athletes in endurance or appearance sports are at an increased risk for disordered eating. Finally, the paper focuses on related disorders—a triad associating eating disorders, menstrual dysfunction, and bone mineral disorders. It is clear that secondary amenorrhea is associated with malnutrition and disordered eating. Further, bone mineral disorders are related to menstrual dysfunction. Disordered eating may represent the initiating factor of this triad.

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The Role of Disordered Eating in Type 2 Diabetes: A Pilot Study

American Journal of Lifestyle Medicine ◽

10.1177/15598276211002459 ◽

2021 ◽

pp. 155982762110024

Author(s):

Alyssa M. Vela ◽

Brooke Palmer ◽

Virginia Gil-Rivas ◽

Fary Cachelin

Keyword(s):

Physical Activity ◽

Type 2 Diabetes ◽

Disordered Eating ◽

Lifestyle Intervention ◽

Eating Behaviors ◽

Diabetes Management ◽

Behavioral Therapy ◽

Exercise Stress ◽

Increased Risk

Rates of type 2 diabetes mellitus continue to rise around the world, largely due to lifestyle factors such as poor diet, overeating, and lack of physical activity. Diet and eating is often the most challenging aspect of management and, when disordered, has been associated with increased risk for diabetes-related complications. Thus, there is a clear need for accessible and evidence-based interventions that address the complex lifestyle behaviors that influence diabetes management. The current study sought to assess the efficacy and acceptability of a pilot lifestyle intervention for women with type 2 diabetes and disordered eating. The intervention followed a cognitive behavioral therapy guided-self-help (CBTgsh) model and included several pillars of lifestyle medicine, including: diet, exercise, stress, and relationships. Ten women completed the 12-week intervention that provided social support, encouraged physical activity, and addressed eating behaviors and cognitions. Results indicate the lifestyle intervention was a feasible treatment for disordered eating behaviors among women with type 2 diabetes and was also associated with improved diabetes-related quality of life. The intervention was also acceptable to participants who reported satisfaction with the program. The current CBTgsh lifestyle intervention is a promising treatment option to reduce disordered eating and improve diabetes management.

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Disordered eating patterns in competitive female athletes

International Journal of Eating Disorders ◽

10.1002/1098-108x(199009)9:5<565::aid-eat2260090512>3.0.co;2-n ◽

1990 ◽

Vol 9 (5) ◽

pp. 565-569 ◽

Cited By ~ 52

Author(s):

Beverly J. Warren ◽

Annette L. Stanton ◽

Daniel L. Blessing

Keyword(s):

Disordered Eating ◽

Female Athletes ◽

Eating Patterns ◽

Disordered Eating Patterns

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Female Hyperandrogenism in Elite Sports and the Athletic Triad

Seminars in Reproductive Medicine ◽

10.1055/s-0041-1736337 ◽

2021 ◽

Author(s):

Angelica Lindén Hirschberg

Keyword(s):

Female Athletes ◽

Polycystic Ovary ◽

Disorders Of Sex Development ◽

Normal Female ◽

Menstrual Disorders ◽

Mineral Density ◽

Energy Deficiency ◽

Sex Development ◽

Endocrine Disturbances ◽

Increased Risk

AbstractEssential hyperandrogenism seems to be overrepresented in female elite athletes. This applies to mild forms such as polycystic ovary syndrome, as well as rare differences/disorders of sex development (DSD). The reason is likely a selection bias since there is increasing evidence that androgens are beneficial for athletic performance by potent anabolic effects on muscle mass and bone mass, and stimulation of erythropoiesis. XY DSD may cause a greatly increased production of testosterone in the male range, that is, 10 to 20 times higher than the normal female range. The established regulations concerning the eligibility of female athletes with severe hyperandrogenism to compete in the female classification remain controversial. The most common cause of menstrual disorders in female athletes, however, is probably an acquired functional hypothalamic disturbance due to energy deficiency in relation to energy expenditure, which could lead to low bone mineral density and increased risk of injury. This condition is particularly common in endurance and esthetic sports, where a lean body composition is considered an advantage for physical performance. It is important to carefully evaluate endocrine disturbances and menstrual disorders in athletes since the management should be specific according to the underlying cause.

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Stress Fractures And The Reproductive System In The Female Athlete

10.2310/fm.1513 ◽

2018 ◽

Author(s):

Irfan M Asif ◽

Kimberly Harmon ◽

Mallory Shasteen

Keyword(s):

Femoral Neck ◽

Disordered Eating ◽

Reproductive System ◽

Female Athlete ◽

Female Athletes ◽

Stress Fractures ◽

Female Athlete Triad ◽

Low Back ◽

Mineral Density ◽

Pubic Ramus

Stress fractures are more common in the female athlete. Stress fractures of the pubic ramus and femoral neck are particularly more common in females than in males. Rib stress fractures are an important injury to consider in the female rower, whereas spondylolysis is a common cause of low back pain in female athletes who hyperextend their spines. The higher incidence of stress fractures in females is mainly due to the higher prevalence of disordered eating and subsequent energy imbalance, which leads to detrimental effects on bone. This review discusses stress fractures and unique issues related to exercise and the female reproductive system. This review contains 6 figures, 5 tables and 49 references Key words: amenorrhea, bone mineral density, disordered eating, female athlete triad, femoral neck, pregnancy, pubic ramus, rib, spondylolysis, stress fracture

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Cognitive Mapping: Its Use as an Assessment Tool for Disordered Eating

Women in Sport and Physical Activity Journal ◽

10.1123/wspaj.8.2.63 ◽

1999 ◽

Vol 8 (2) ◽

pp. 63-72

Author(s):

Kristin L. Wiginton ◽

Deborah Rhea

Keyword(s):

Eating Disorders ◽

Disordered Eating ◽

Eating Behaviors ◽

Cognitive Mapping ◽

Female Athletes ◽

Assessment Tool ◽

Mental Representations ◽

Disordered Eating Behaviors ◽

Preventive Practices ◽

The Impact

The incidence of eating disorders among female athletes continues to increase, presenting intervention challenges to athletic trainers. Additionally, a number of female athletes have disordered eating behaviors that do not yet constitute an eating disorder diagnosis, but have similar characteristics to those athletes diagonised with eating disorders. However, each athlete exhibits individual mental representations of disordered eating and the impact of those representations on important aspects of her life. The athletic trainer has the potential to offer comprehensive preventive education when all aspects of the athlete’s own understanding of disordered eating are assessed. Cognitive mapping is an assessment technique that can be used in addition to other preventive practices and can be useful in determining an athlete’s current mental representations of disordered eating.

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