{"id":6855,"date":"2020-02-14T06:30:00","date_gmt":"2020-02-14T12:30:00","guid":{"rendered":"http:\/\/thesportjournal.org\/?p=6855"},"modified":"2020-01-31T09:34:14","modified_gmt":"2020-01-31T15:34:14","slug":"disordered-eating-and-compulsive-exercise-in-collegiate-athletes-applications-for-sport-and-research","status":"publish","type":"post","link":"https:\/\/thesportjournal.org\/article\/disordered-eating-and-compulsive-exercise-in-collegiate-athletes-applications-for-sport-and-research\/","title":{"rendered":"Disordered Eating and Compulsive Exercise in Collegiate Athletes: Applications for Sport and Research"},"content":{"rendered":"\n

Authors:<\/strong> Ksenia Power, M.S., Sara Kovacs, Ph.D., Lois Butcher-Poffley, Ph.D., Jingwei Wu, Ph.D., and David Sarwer, Ph.D.<\/p>\n\n\n\n

Corresponding Author:<\/strong>
Ksenia Power, PhD Candidate
1800 N. Broad Street, Pearson Hall, 242
Philadelphia PA, 19122
tug82764@temple.edu
267-766-8938<\/p>\n\n\n\n

Ksenia Power is a Doctoral Candidate and an Instructor of Record in\nthe Department of Kinesiology at Temple University, majoring in Psychology of\nHuman Movement.  She is also a Volunteer\nAssistant Women\u2019s Tennis Coach at Temple University. <\/p>\n\n\n\n

Disordered Eating and Compulsive\nExercise in Collegiate Athletes: Applications for Sport and Research<\/strong><\/h3>\n\n\n\n

ABSTRACT<\/strong><\/p>\n\n\n\n

Over the last\nthree decades, a large body of research has examined the issue of eating\ndisorders, both formal diagnoses and subclinical features, as well as\ncompensatory behaviors in National Collegiate Athletic Association (NCAA)\nathletes. In general, this literature suggests that large numbers of\nstudent-athletes engage in disordered eating and compensatory behaviors;\nsmaller percentages have symptoms that reach the threshold of formal diagnoses.\nIncreased symptoms are associated with reduced athletic and academic\nperformance, both of which may impact psychosocial functioning later in\nadulthood. Unfortunately, a number of methodological shortcomings across this\nbody of research (e.g., studies with insufficient sample sizes, inappropriate\ncomparison groups, and suboptimal or biased psychometric measures) limit the\nconfidence that can be placed in these findings, underscoring the need for a\nnew generation of studies. This paper provides an overview of this literature,\nfocusing on issues of gender differences, sport type, and age. It also\nhighlights the relationship between disordered eating and compulsive exercise,\na compensatory behavior that is highly prevalent among collegiate\nathletes.  The health and athletic\nperformance consequences of eating disorders in conjunction with compulsive\nexercise are also discussed.  In\naddition, a focus on more recently recognized eating disorders, such as binge\neating disorder and the night eating syndrome is underscored.  Future work in this area needs to include the\nmost methodologically rigorous measures available in order to aid most\nappropriately coaches and athletic trainers in promptly\nidentifying at-risk athletes and to inform future prevention and treatment\nefforts.<\/p>\n\n\n\n\n\n\n\n

Key words:<\/strong> eating disorder, disordered eating, compulsive exercise<\/p>\n\n\n\n

INTRODUCTION<\/strong><\/p>\n\n\n\n

Over the past decade, a number of studies have examined the\nsymptoms of disordered eating among National Collegiate Athletic Association\n(NCAA) athletes (9,12,13,24,30).\n Up to 84% of collegiate athletesreported\nengaging in maladaptive eating and weight control behaviors, such as binge\neating, excessive exercise, strict dieting, fasting, self-induced vomiting, and\nthe use of weight loss supplements (12,13,24). \nSubclinical symptoms or those that reach diagnostic criteria may\ncontribute to poor physical and mental health, as well as suboptimal athletic\nand academic performance (29). <\/p>\n\n\n\n

The substantial physical demands of being a student-athlete are believed to contribute to the development of eating pathology and compensatory behaviors (32).\u00a0 In season, student-athletes are restricted to 20 hours of weekly on-and-off the court\/field physical workload, including the time spent in competition (1<\/em>).\u00a0However, the 20-hour rule if frequently violated, which results in excessive hours of physical activity and subsequent overtraining (39).\u00a0 For instance, Division I football, baseball, and basketball players reported the highest weekly in-season athletic commitments, averaging nearly 40 hours per week (39).\u00a0 In all other sports, the weekly times spent in training and competition averaged 32 hours (39).\u00a0 The combination of disordered eating and physical overtraining may further produce significant health impairments, such as low energy availability, muscle weakness, acquisition of overuse injuries, mineral bone deficiency, cardiac complications, impaired immune function, malnutrition, dehydration, fatigue, amenorrhea, and osteoporosis (5,15).\u00a0 Some of these conditions are sustained after the athlete has moved on from organized competition (29,44).\u00a0 Physical overtraining and inadequate nutrition can also negatively impact an athlete\u2019s mood, contributing to poor academic and athletic performance (29,44,45). <\/p>\n\n\n\n

Some collegiate athletes suffering from disordered eating are known to engage in compulsive exercise as a strategy to compensate for excessive caloric intake (33).\u00a0 Compulsive exercise, beyond sport-required training, places student-athletes at a high-risk for physical overtraining, overuse injuries, and subsequent diminished performance (12, 53).\u00a0 In addition, this compensatory behavior often occurs as a symptom of eating psychopathology (21, 33).\u00a0 Particularly worrisome is the finding that maladaptive eating with simultaneous engagement in compulsive exercise can often remain undetected in athletes and contribute to the progression of an eating disorder (36, 45). \u00a0Like subclinical eating disorders, formal eating disorders can endure into adulthood and have a continued, negative impact on physical and psychosocial health (56). Unfortunately, most of these athletes experience eating disorder symptoms in isolation, as these behaviors often are missed by the coaching and athletic training staff (62,63). Thus, further studies are necessary for identifying eating disordered athletes (9,25,29).\u00a0 <\/p>\n\n\n\n

Disordered Eating Symptoms and Eating\nDisorder Diagnoses <\/strong><\/p>\n\n\n\n

According to the Diagnostic and Statistical Manual (DSM-V) of the\nAmerican Psychiatric Association (2013), eating disorders are characterized by\nsevere alterations in an individual\u2019s eating habits that are linked to\nphysiological changes. Individuals with eating disorders become\npre-occupied with food, body weight, and physical appearance.  Common eating disorders that occur in\ncollegiate athletes are Anorexia Nervosa (AN) and Bulimia Nervosa (BN) (4,10,12,\n24, 42).  For instance, in a mixed-sport\nsample of Division I collegiate athletes, 5.1% of all women scored in the\nclinical range for either Anorexia Nervosa or Bulimia Nervosa (49). Similar\nrates of clinical eating disorders were reported in a sample of 414 NCAA\nDivision I athletes (6.3%), with Bulimia Nervosa being the most frequent one\n(4). <\/p>\n\n\n\n

According to the American Psychiatric Association (2013), Anorexia\nNervosa (AN)is characterized by\npersistent restriction of caloric intake, resulting in significantly low body\nweight (below the minimal norm considering an individual\u2019s age, height, weight,\nand developmental trajectory).  It also\nmanifests through an intense fear of gaining weight and severe disturbances in\none\u2019s perceptions of his or her own body weight and shape (i.e., refusal to\nrecognize the seriousness of one\u2019s low body weight).  Bulimia Nervosa (BN) is characterized by the\nfollowing symptoms: (a) recurrent episodes of binge eating; (b) recurrent\nengagement in detrimental compensatory behaviors in order to prevent weight\ngain; (c) the binge eating and compensatory behaviors must occur at least once\na week for three consecutive months; and (d) an individual\u2019s body and shape\nbecome vital parts in his or her self-evaluation (3). Binge Eating Disorder\n(BED)includes the following\nsymptoms: (a) recurrent engagement in episodes of binge eating; (b) occurrence\nof binge eating episodes, on average, at least once a week for three\nconsecutive months; (c) manifestation of distress related to binge eating; and\n(d) disassociation with the recurrent use of compensatory behaviors as in\nBulimia Nervosa or Anorexia Nervosa (3). \nOther Specified Feeding or Eating Disorder (OSFED) can be applied to\ncases, when a person engages in eating behaviors that cause clinically\nsignificant distress or impaired functioning, but does not meet full criteria for\nan eating disorder (3).  Lastly, Night\nEating Syndrome is characterized by recurring episodes of eating after\nawakening from sleep or by immoderate food consumption following the evening\nmeal (3).<\/p>\n\n\n\n

The Prevalence of\nEating Disorders in Athletes <\/strong><\/p>\n\n\n\n

Although disordered eating and exercise behaviors have been\nhighlighted as significant issues among collegiate athletes, the percentage of athletes who meet full\ndiagnostic criteria for clinical or subclinical eating disorders vary greatly,\nfrom 1.1% to 49.2% across studies (4,10,12,24,30,42).  For instance, Greenleaf et al. (2009) found\nthat, in a group of female collegiate athletes, 2% met the criteria for an\neating disorder diagnosis and another 25.5% exhibited subclinical symptoms of\nan eating disorder (e.g., binge eating, self-induced vomiting, and excessive\ndieting).  Similarly, in Petrie et al.\u2019s\n(2008) study, 19.2% of collegiate athletes reported maladaptive eating\nbehaviors.  Sanford-Martens et al. (2005)\ndetected slightly lower rates of subclinical eating problems (14.5%).  <\/p>\n\n\n\n

In Anderson and Petrie\u2019s (2012)\nstudy among female collegiate athletes, 26.8% of women reported disordered\neating behaviors. Approximately 40% of the athletes engaged in at least two\nhours of daily physical activity, suggesting that many may be using this high\nlevel of activity as a compensatory strategy in response to binge eating.  Up to 28% of athletes reported dieting or\nfasting at least two times over the past year (4).  Kato and colleagues (2011) reported the\nhighest rates of disordered eating in a sample of NCAA Division I and III\nathletes, ranging from 40.4% to 49.2%. \nIn addition, 30.7% of all athletes reported body dissatisfaction, weight\npreoccupation, and bulimic tendencies.  Wide-ranging rates of clinical and subclinical eating\ndisorders in collegiate athletes call for additional research on eating\ndisorders and associated symptoms, including compulsive exercise (9,29).  Although previous studies provided useful\nprevalence data (4,12,24,30,42), new studies could potentially yield more accurate\nand consistent results of unhealthy eating and weight control behaviors in\ncollegiate athletes. <\/p>\n\n\n\n

Health Consequences of Eating Disorders<\/strong><\/p>\n\n\n\n

While each eating\ndisorder has its distinct signs, symptoms, and health effects, the most\nfrequent signs and symptoms of disordered eating and compensatory behaviors\ninclude: sudden weight loss, gain, or fluctuation; hypothermia (i.e., a\ndangerously low body temperature); and fatigue (29).  Oral and dental problems caused by pathogenic\nweight control behaviors are dental erosion or caries, perimolysis (i.e., a\ndental condition linked to frequent regurgitation), and recurrent sore throats\n(64).  Dermatological issues, such as\nhair loss, brittle nails, skin discoloration, and poor skin healing; also arise\nin individuals suffering from an eating disorder (54).  Disordered eating behaviors also severely\naffect an individual\u2019s endocrine system by resulting in irregular menstrual\ncycles or a complete absence of menstruation (i.e., amenorrhea), which could\npotentially lead to infertility (55). \nFurthermore, prolonged misuse of laxatives, diuretics, enemas, and diet\npills, as well as self-induced vomiting lead to various gastrointestinal\nproblems, such as abdominal pain, early satiety and delayed gastric emptying,\nconstipation, hematemesis (i.e., the vomiting of blood), and hemorrhoids (40).  The resulting damages of disordered eating on\nthe cardiorespiratory system include, but are not limited to, chest pains,\nhypotension (i.e., low blood pressure), arrhythmia (i.e., irregular heart\nbeat), bradycardia (i.e., an extremely low heart rate), and shortness of breath\n(11). <\/p>\n\n\n\n

Another\nconsequence of maladaptive eating and compensatory behaviors is the Female\nAthlete Triad, which is characterized by energy deficiency, menstrual\nirregularities, and low bone mass that occur as a consequence of malnutrition\nand disordered eating (40).  Low bone\nmineral density can result in injuries, stress fractures, and potential\nosteoporosis (55). This may be especially hazardous for competitive athletes\nwho are generally at higher risks for overuse injuries due to their continuous\nengagement in high amounts of intense physical training (61).  For instance, disordered eating, amenorrhea,\nand low bone mineral density were associated with musculoskeletal injuries in\ninterscholastic female athletes (46).  Finally, neuropsychiatric symptoms, including\nmemory loss or lack of concentration, insomnia, increased anxiety, depression,\nseizures, obsessive-compulsive behavior, and suicidal ideation can be seen in\npersons with eating disorders (50).  Up to a third of athletes at-risk for an eating disorder\ntend to engage in multiple pathogenic behaviors, as opposed to a single\nbehavior such as restrictive eating (41). \n<\/p>\n\n\n\n

Consequences of Eating Disorders on Athletic Performance<\/strong><\/p>\n\n\n\n

Disordered eating\ncan have an effect on athletic performance (18).  In aesthetic (e.g.,\ngymnastics, swimming, diving), endurance (e.g., cross-country), and\nweight-classsports (e.g., wrestling, rowing), it\nis believed that leanness leads to enhanced performance (9).  However, many athletes\nachieve low weight through disordered eating and compensatory behaviors, which\ncan significantly decrease athletic performance (18,29).  Specifically, long-term disordered eating\nimpairs the main components of muscular fitness (i.e., aerobic fitness, musculoskeletal\nfitness, motor fitness, and flexibility), thus resulting in poor athletic\nperformance (18).  In addition, the\nhealth consequences of restricted caloric intake, such as loss of fat, lean\nbody mass, electrolyte imbalances, and dehydration, can contribute to\ndiminished performance (29).  In a study\namong junior elite female swimmers, Van Heest and colleagues (2014) found that\nfemale athletes who restricted caloric intake and increased energy expenditure\nin training frequently suffered from ovarian suppression (i.e., lack of\nestrogen production).  Female athletes\nwho trained in the presence of low energy availability and ovarian suppression\nexhibited significant declines in their swim velocity (59). <\/p>\n\n\n\n

A similar study of high school athletes found a negative\nrelationship between disordered eating and athletic performance (56).  Among a large sample of high school athletes,\n35.4% were found to suffer from disordered eating, 18.8% reported menstrual\nirregularities, while 65.6% reported suffering a sports-related musculoskeletal\ninjury during the ongoing season.  Athletes\nexhibiting disordered eating behaviors were twice as likely to sustain a\nsports-related injury during a competitive season, as compared to the athletes\nreporting healthy eating behaviors. \nMoreover, the inability to train and compete due to an injury further\nresults in decreased athlete performance upon the athlete\u2019s return to play (56).\n<\/p>\n\n\n\n

In addition to physical consequences on sport performance,\ndisordered eating may contribute to other psychosocial issues (18).  In particular, obsessive concern about weight\nand body image, as well as continuous eating restriction have been associated\nwith mood disorders, which may impact athletic but also academic performance\n(27).  Furthermore, overvaluation of\nshape, weight and eating control, anxiety, and depression that often coexist in\nathletes at-risk for an eating disorder, are capable of decreasing athletes\u2019\nmotivation to train and compete.  The\nresulting poor performance may further increase the pressure experienced by\nathletes to train more intensely and adhere to even more rigid dieting for\nweight loss (18).  Disordered eating\nbehaviors in competitive athletes may not only severely undermine an athlete\u2019s\nhealth, but may also produce deterioration in sport performance (18).     <\/p>\n\n\n\n

Eating Disorders by Gender<\/strong><\/p>\n\n\n\n

A number of studies have found\nhigher rates of maladaptive eating habits in female athletes compared to male\nathletes (9,10,24,31).  For\nexample, in a sample of 800 NCAA Division I student-athletes, 19% of women and 12% of men\nreported unhealthy eating habits (10). \nKrebs et al. (2019) also found a higher rate of eating disorders in collegiate female\nathletes than males.  Specifically, three\ntimes as many female distance runners screened positively for an eating\ndisorder as compared to male (46% and 14%, respectively).  In another study, 26% of student-athletes\nscored in the clinical range for an eating disorder, with five times more\nfemales (84%) than males (16%) reporting disordered eating behaviors (37).  <\/p>\n\n\n\n

The main explanation for this tendency is\nthat female athletes are more subjected to socio-cultural pressure to diet and\nbe thin, while male athletes tend to be more concerned with physical fitness and\nmasculinity (51).  Thus, fewer male athletes\ncontemplate dieting as compared to female athletes, which represents a risk\nfactor for the development of eating disordered in females (51).  Nevertheless, disordered eating has been\nsignificantly increasing among male athletes (22,12,42,52).  For instance, certain male athletes,\nspecifically wrestlers, rowers, and long-distance runners, are more likely to\nengage in pathogenic weight control behaviors than female athletes in general\ndue to an increased focus on physical appearance and weight (22,26).  <\/p>\n\n\n\n

Hinton and colleagues (2004)\nexamined dietary intake and eating behaviors in 345 NCAA Division I\nstudent-athletes.  They found that more\nmale athletes than female athletes exhibited having inadequate nutrient intake.  Specifically, only 10% of male athletes, as\ncompared to 19% of female athletes, consumed the recommended minimum of\ncarbohydrates per each kilogram of their body weight, while 19% of males and\n32% of females consumed the minimum recommended amount of protein.  Moreover, male athletes were more likely to\nexceed the Dietary Guidelines for fat, saturated fat, sodium, and cholesterol\nintakes, as compared to female athletes (26). \n<\/p>\n\n\n\n

In contrast to female athletes,\nwho indicated restricting their nutrient intakes for weight gain prevention,\nmale athletes reported using dietary supplements (other than vitamins) for\nweight reduction (26).  Also,\napproximately 6% of male athletes indicated restricting their fluid\nintake.  These findings can potentially\nbe understood in the context of men\u2019s preoccupation with muscularity, resulting\nin a focus on diet, nutritional supplements, and excessive exercise (10). Hinton\net al.\u2019s (2004) study findings suggest that male athletes, just as female\nathletes, undergo psychological problems of body dissatisfaction and low self-esteem,\nwhich leads to the onset of eating pathologies. \nIn regards to sport-specific factors, male athletes are equally\npressured to diet and exercise compulsively in order to maintain low body\nweight and produce successful athletic results (14). <\/p>\n\n\n\n

In summary, a\nsubstantial body of literature shows that rates of eating disorders and\ndisordered eating symptoms among collegiate athletes range widely, 0-19% in\nmale athletes and 6-45% in female athletes (9,29,31,34).  While the occurrence of clinical eating disorders is more prevalent in\nfemale athletes than male athletes, male athletes, in sports such as wrestling,\nrowing, and cross country, are at greater risk for pathological weight control\nbehaviors (26,49,52).  Such findings highlight inconsistencies in the eating\ndisorder area and emphasize the need for additional research on the prevalence\nof eating disorders among both male and female athletes.  <\/p>\n\n\n\n

Eating\nDisorders by Sport<\/strong><\/p>\n\n\n\n

A number of studies\nhave determined that the sport type in which an athlete participates can serve\nas a risk-factor for the development of disordered eating (4,22,48,52).  In eating disorder research, sports have been\ncategorized according to the level of pressure an athlete faces to maintain a\nlow body weight for aesthetic reasons and\/or performance enhancement (14).  <\/strong>Across several studies (4,22,29,42),the\nfollowing categories have been described: aesthetic or lean sports (e.g.,\ngymnastics, figure skating, swimming, diving, track and field), endurance\nsports (e.g., cross country, cycling), technical sports (e.g., tennis, golf,\nbaseball, softball), ball game sports (e.g., soccer, volleyball, basketball,\nfootball), weight-class sports (e.g., wrestling, rowing), and\nanti-gravitational sports (e.g., skiing, pole vault jumping).   <\/strong><\/p>\n\n\n\n

Higher rates of\neating disorders in aesthetic, endurance, and weight-class sports have been consistently\nreported (9,29,57).  For example, Thiemann et al.\n(2015) found a greater frequency of maladaptive eating in aesthetic sports\n(17%) than in ball-game sports (3%).  In\nSundgot-Borgen and Torstveit\u2019s (2004) study on elite athletes, 42% of women in\naesthetic sports had subclinical and clinical eating disorders (e.g.,\ngymnastics, figure skating, diving), 24% in endurance sports (e.g.,\nlong-distance running, cycling, swimming), 17% in technical sports (e.g., golf,\ntennis), and 16% in ball game sports (e.g., soccer, volleyball,\nbasketball).  Among male athletes, 9% of\neating disorders were seen in men participating in endurance sports and 5% in\nball-game sports (52).  There are three possible explanations of\nhigher rates of eating disorders in aesthetic, endurance, and weight-class\nsports.  First, in endurance sports, such\nas cross-country, weight higher than an athlete\u2019s optimum performance weight is\nlinked to decreased performance (14). \nSecond, in weight category sports, such as wrestling, athletes are\npressured to meet a specific weight requirement just to qualify for a\ncompetition (9).  Third, in aesthetic\nsports, such as gymnastics, athletes\u2019 physical appearance is a part of an\naesthetic evaluation, which pressures athletes to attain a certain body\ncomposition (14). <\/p>\n\n\n\n

 <\/strong>While the prevalence of\ndisordered eating in sports that emphasize leanness is high, the reported rates\nof eating disorders vary by sport (48,53,57). \nFor instance, in a sample of 414 NCAA Division I female athletes\ncompeting in gymnastics and swimming\/diving, 108 (26%) scored in the\nsubclinical range for an eating disorder (4). \nIn addition, 26 athletes (6.1% of gymnasts and 6.7% of swimmers\/divers)\nwere classified as having an eating disorder. \nOut of 26 athletes in the eating disorder group, 20 athletes were\nidentified as having subthreshold Bulimia Nervosa, 4 with Non-bingeing Bulimia,\nand 2 with Binge Eating Disorder (4).<\/p>\n\n\n\n

In contrast to Anderson and\nPetrie\u2019s (2012) findings, Carter and Rudd (2005) detected lower rates of\ndisordered eating considering the sport type. \nIn a mixed-gender sample of 800 NCAA Division I athletes, Carter and\nRudd (2005) found 9.2% of non-lean sport athletes and 17.5% of lean-sport\nathletes exhibiting subclinical features for an eating disorder.  Additionally, 6.1% of athletes in lean sports\nsuffered from \u201cchronic dieting,\u201d as compared to 2.5% of athletes in non-lean\nsports.  Such high rates of disordered\neating in gymnasts and swimmers\/divers support the notion that athletes\ncompeting in lean and aesthetic sports are pressured to possess ideal body\nweight for reaching optimal performance. \nThus, lean- and aesthetic-sport athletes are exposed to higher risks for\ndeveloping an eating disorder than athletes competing in sports that do not\noverly emphasize body weight and physical appearance (4,10).  Furthermore, Glazer (2008) found that athletes\nparticipating in lean sports averaged significantly higher on the Eating\nAttitudes Test (EAT) and the Social Physique Anxiety Scale (SPAS), suggesting\ngreater disordered eating and physique anxiety, as compared to athletes\nparticipating in non-physique-salient sports. \nGlazer\u2019s (2008) findings support the notion of increased prevalence of\neating disorders in sports that emphasize leanness (e.g., gymnastics, long\ndistance running).  Participation in non\nphysique-salient sports (e.g., basketball, softball, soccer) may be a\nprotective factor for the development of disordered eating (22).  <\/p>\n\n\n\n

Although some studies have linked\nthe sport team classification to disordered eating levels (4,10,48), other\nstudies found no support for this relationship (24,42,49).  For example, despite the high frequency of\npathogenic eating in a sample of collegiate athletes (19.2%), no association\nwas found between sport team classification and eating disorder status in\nPetrie et al.\u2019s (2008) study.  Similarly,\nGreenleaf et al. (2009) found no differences in the frequency of maladaptive\neating behaviors across sport type. These results corroborated previous\nfindings from Sanford-Martens and colleagues\u2019 (2005) study, which also found no\ndifferences in eating disorder symptoms across sport types.  These findings suggest that sport type may\nnot be an influential factor in the development of maladaptive eating habits in\ncompetitive athletes (49). <\/p>\n\n\n\n

To conclude, some\nstudies suggested that lean-sport athletes (such as gymnasts, runners,\nswimmers, cyclists, and wrestlers) are more prone to developing an eating\ndisorder than non-lean sport athletes, who do not overly emphasize body weight\nand physical appearance as part of their sport (4,10).  However, other studies failed to establish\nthe relationship between athletes\u2019 sport classification and their propensity\nfor unhealthy eating behaviors (24, 42). \nThis observation calls for the need to broaden researchers\u2019 perspectives\non identification of at-risk athletes (9). \nFuture studies may provide a clearer pattern between the sport type and\ndisordered eating in collegiate athletes.<\/p>\n\n\n\n

Eating Disorders and Age<\/strong><\/p>\n\n\n\n

While a great number of studies\non the prevalence of eating disorders among athletes have reported their ages\nas a demographic variable (22,34,36,47,52), only a few studies assessed the\ndirect link between disordered eating and college athletes\u2019 age (23,24,42).  For instance, in Petrie et al.\u2019s (2008)\nstudy, disordered eating group status (symptomatic vs. asymptomatic) was not\nrelated to age, indicating that symptomatic athletes may be found among all\ndifferent ages (42).  Similarly,\nGreenleaf et al. (2009) found no differences in athletes\u2019 eating disorder\nstatus (i.e., symptomatic vs. eating disordered) based on their age.  These findings suggest that the age variable\nmay not be an influential factor on collegiate athletes\u2019 disordered eating\nsymptomology (24).  Similarly, in a\nsample of 290 elite athletes between 14 and 30 years of age, Gomes et al.\n(2011) assessed the relationship between unhealthy eating behaviors and\nage.  No association was found between\nathletes\u2019 age and each subscale of the Eating Disorder Examination\nQuestionnaire (EDE-Q, 20).  Thus, the\nfindings indicate that athletes across different ages may be equally at-risk\nfor developing maladaptive eating habits (23, 42). <\/p>\n\n\n\n

Pettersen et al. (2016) further\nexamined the prevalence of disordered eating in 225 Norwegian athletes in the\nage groups of 17, 18, and 19+ years old. \nIn total, 18.7% of the athletes exhibited symptoms of disordered\neating.  Age was not a significant\npredictor of athletes\u2019 maladaptive eating patterns.  As Pettersen et al. (2016) explain, the peak\nrisk for the development of an eating disorder occurs between childhood and\nearly adolescence.  However, the majority\nof the sample athletes were in their later adolescence and early adulthood,\nwhich may explain why age was unrelated to disordered eating symptoms.\nSpecifically, adult athletes have acquired higher levels of confidence and\nself-esteem than athletes in their early adolescence, which could serve as a\nprotective mechanism against the development of eating pathologies (43).<\/p>\n\n\n\n

In summary, some studies suggest\nthat the prevalence of maladaptive eating behaviors (e.g., fasting,\nself-induced vomiting, using laxatives and diuretics, binging followed by\nexercise, etc.) is higher in the college-aged athletes, as compared to\ncompetitive adolescent athletes (29, 30, 43). \nNevertheless, a substantial body of literature indicates that\ncompetitive adolescent athletes experience severe eating disorder symptoms as\ndo collegiate athletes (9, 29, 43). Additionally, the studies focusing\nspecifically on the impact of age, failed to establish a significant\nassociation between age and athletes\u2019 eating disorder status (24, 42 ,43).  Thus, additional studies are necessary to\nestablish a clearer association between athletes\u2019 age and pathogenic\neating.  <\/p>\n\n\n\n

CONCLUSIONS<\/strong><\/p>\n\n\n\n

Collegiate student-athletes\nrepresent a unique population of young adults who, because of the demands on\ntheir time associated with their sport, may be at particular risk for\ndisordered eating and compulsive exercise (32).  Specifically,\nmany collegiate athletes appear to use excessive exercise as a compensatory\nbehavior to control their body weight (4, 12, 36, 42, 48).  Compulsive exercise, in combination with the\nsport-required training, place student-athletes at a high-risk for overuse\ninjuries, and physical exhaustion, which can further impede athletic\nperformance (12, 53).  Therefore, there\nis a need to further examine disordered eating and compulsive exercise patterns\namong collegiate student-athletes in order to draw athletic staff\u2019s, coaches\u2019,\nand athletes\u2019 attention to the deleterious health effects of these disordered\nbehaviors.    <\/p>\n\n\n\n

APPLICATIONS IN SPORT<\/strong><\/p>\n\n\n\n

The roles of athletic trainers, administration, and coaches\nare paramount in recognizing detrimental eating and exercise patterns in\nathletes and providing them with the necessary professional assistance (14).  First, expanding athletes\u2019 knowledge about\nproper nutrition habits, maladaptive eating behaviors and their health\nconsequences, and learning how to address the issue of disordered eating, are\npivotal steps in primary prevention (40). \nThere is a need to inform athletes that dietary restriction and purging\nbehaviors for attainment of the desired body weight may lead to decreased\nathletic performance and adverse health consequences.  Structured educational programs have shown to\nreduce the impact of risk factors of disordered eating (6, 17, 19).  For instance, Becker et al. (2012) observed a\nsignificant reduction in bulimic symptoms just after 1 year following a\npeer-led educational intervention for athletes. \nIn addition, the researchers found an increase in the number of athletes\nseeking medical assistance due to the concern that they may suffer from the\nFemale Athlete Triad symptoms (6). \nThrough educational programs, athletes, parents, and coaches can also\nlearn that menstrual dysfunction occurs as a result of low energy availability\ndue to deliberate dietary restriction, rather than a positive adaptation to\nhigh-intensity sport participation (17). \n<\/p>\n\n\n\n

Changing perspectives on competitive sport participation\nfor athletes and coaches could be another strategy for eating disorder\nprevention.  Specifically, the way in\nwhich athletes evaluate their maladaptive eating and exercise habits can foster\nmaintenance of an eating disorder (44,58). \nFor instance, Thompson and Sherman (2010) found that athletes tend to\nunderreport their eating disorder symptoms due to the misconception that\ndietary restriction and excessive exercise will result in enhanced sport\nperformance.  Athletes and coaches often\nreinforce maladaptive behaviors (i.e., dietary restriction, excessive exercise)\nbecause they believe that certain aspects of sport participation, such as\nmental toughness and continuous engagement in intense training, are pivotal in\nreaching optimal performance (44).  As a\nresult, athletes may perceive compulsive exercise as a demonstration of high\ncommitment to their sport, rather than a symptom of an eating disorder (16,28).  In addition, athletes and coaches falsely\nbelieve that weight loss achieved through food restriction and excessive\nexercise will imminently lead to increased performance (16).  Thus, due to perfectionistic and\nresult-oriented views of athletic participation, eating disorder symptoms are\noften overlooked and underreported (28). \nConsequently, an emphasis of educational programs should be placed on\nprompt recognition of maladaptive eating and exercise habits to prevent the\ndevelopment of a clinical eating disorder. <\/p>\n\n\n\n

Furthermore, despite the availability of various eating\ndisorder prevention strategies, Vaughan\net al. (2004) found that only 1 in 4 (27%) of athletic trainers feel confident\nin identifying an athlete with an eating disorder.  In addition, only 38% of athletic trainers\nfeel confident in asking an athlete about disordered eating behavior (60).  Although educational programs and counseling\nservices have been created for collegiate student-athletes, proactive steps on\nbehalf of the university athletic staff are necessary for early identification\nand prevention of eating disorders (8,35). \nPrompt detection of unhealthy eating behaviors through screening\nprotocols has been associated with more effective treatment outcomes (8,57).  <\/p>\n\n\n\n

For instance, the Preparticipation Physical Examination\n(PPE) monograph, created by the American Medical Society for Sports Medicine\n(AMSSM) and the American College of Sports Medicine (ACSM), can serve as an\neffective screening tool for identification of disordered eating behaviors in\nathletes (7).  This instrument assesses\nwhether athletes suffer from body weight pre-occupation, restrict their caloric\nintake, use nutritional supplements for weight loss, and undergo pressure to\nlose weight by outside sources (7).  The\nFemale Athlete Triad Coalition developed an 11-question screening tool that\ncould be successfully employed as a part of the Pre-participation Physical\nExamination (17).  This measure evaluates\na female athlete\u2019s pre-occupation with body weight, dietary restriction,\nmenstrual dysfunction, bone injuries, and low bone mineral density.  Consequently, simultaneous use of these\nscreening tools could play a key role in identifying at-risk athletes and\nproviding immediate treatment prior to competitive season.  <\/strong>By\nutilizing screening protocols, coaches and athletic trainers can ensure that\nstudent-athletes have rewarding collegiate experiences.  In addition, this method can protect athletes\nagainst the development of eating disorders that otherwise may\nendure into adulthood, impacting their physical and psychosocial health long-term\n(18,27). <\/p>\n\n\n\n

Directions for\nFuture Research<\/strong><\/p>\n\n\n\n

Further studies investigating the patterns of disordered\neating in conjunction with compulsive exercise in collegiate athletes are\nnecessary for several reasons.  First, it\nis pivotal to provide athletes, coaches, athletic trainers, and athletic\nadministrators with accurate information about the severity of maladaptive\neating and exercise in collegiate athletes. \nSecond, various socio-cultural and sport-specific pressures have been\nidentified as potential risk factors for the onset of eating disorders in\nathletes, which allows researchers to examine the links between these risk\nfactors and the development of disordered eating behaviors (14,18,51).  While numerous studies have investigated\nthese issues in great depth, wide gaps still exist in the literature due to\ninconsistent prevalence rates of eating disorders based on athletes\u2019 gender,\nage, and sport type (9,29).  In addition, certain studies yielded\ncontradictory results and failed to establish the relationships among athletes\u2019 sport classification, age, and their\npropensity for unhealthy eating behaviors (23,24,42).<\/p>\n\n\n\n

To date, there is a scarcity of literature focusing on more recently recognized eating disorders, such as Binge Eating Disorder and the Night Eating Syndrome (4,12).\u00a0 Studies investigating the prevalence of clinical eating disorders in collegiate athletes reported rare instances of BED and the NES, ranging from 0 to 0.5% (4,10,12,24,42).\u00a0 The low rates of BEDs can be explained by the difficulty to disassociate the recurrent use of compensatory behaviors, which are distinct symptoms of AN and BN only (3).\u00a0 In the majority of clinical cases, athletes\u2019 disordered eating occurs in conjunction with pathogenic weight control behaviors (12), which results in higher rates of AN and BN, and significantly lower rates of BED diagnoses.\u00a0 <\/p>\n\n\n\n

In addition, a\ngreat number of studies in eating disorder research used the Questionnaire for\nEating Disorder Diagnoses (Q-EDD; 38) due to its high psychometric properties\n(4,10,12,24,42,49).  Based on the DSM-IV\n(2) diagnostic criteria for eating disorders, the Q-EDD mainly assesses the\nsymptoms of AN, BN, and BED, thus omitting questions related to the symptoms of\nthe NES, an eating disorder that was later added the DSM-V (3). Consequently,\nquestions exploring the NED symptoms, such as the frequency of recurring\nepisodes of eating after awakening from sleep and the episodes of immoderate\nfood consumption following the evening meal, should be added to the more recent\neating disorder measures. <\/p>\n\n\n\n

Considering limitations of the previously discussed studies of eating disorders in athletes, the following methodological recommendations could help future researchers to gain a better understanding of the nature and distribution of eating disorders.\u00a0 First, samples should include a large number of NCAA athletes to provide more reliable and valid results, and to ensure generalizability of the study findings.\u00a0 Second, athlete samples representative of each sport should be selected for accurate and valid comparisons by sport type.\u00a0 One way to achieve this goal is to categorize sports by their types (e.g., lean vs. non-lean, weight-class vs. non-weight-class) and recruit approximately an equal number of athletes for each sport category.\u00a0 <\/p>\n\n\n\n

In regards to gender comparison, sufficient samples of both\nfemale and male athletes competing at the collegiate level need to be recruited\nto more accurately address the issue of gender differences in eating\ndisorders.  Although male athletes\ngenerally have a lower prevalence of eating disorders than female athletes, an\nincreasingly large body of literature indicates that disordered eating among\nmale athletes is on the rise (12,22,42,52).\n Moreover, male athletes in certain\nsports are more likely to engage in compensatory behaviors than female athletes\n(26).  This conclusion could not be drawn\nif the study focused solely on one gender. \nThus, excluding one gender from the\ninvestigation may result in biased reporting of the disordered eating problem\nand inaccurate conclusions about its prevalence rates across both genders.  <\/p>\n\n\n\n

Lastly, the conditions under which athletes report\ntheir eating behaviors must be assessed prior to data collection.  Athletes tend to underreport their\nmaladaptive eating and compulsive exercise habits due to the fear that their\neating disorder may be discovered by their coaches and potentially affect their\nathletic careers (52).  Consequently,\nathletes must be provided with confidentiality and a pressure-free environment\nin which they can answer instrument questions candidly.  In addition, researchers need to choose\nappropriate measures that have been previously validated in athlete samples to\nsuccessfully discriminate between eating disordered and healthy athletes. <\/p>\n\n\n\n

ACKNOWLEDGMENTS<\/strong><\/p>\n\n\n\n

None <\/p>\n\n\n\n

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    Authors: Ksenia Power, M.S., Sara Kovacs, Ph.D., Lois Butcher-Poffley, Ph.D., […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"jetpack_publicize_message":"","jetpack_is_tweetstorm":false,"jetpack_publicize_feature_enabled":true,"jetpack_social_options":[]},"categories":[898],"tags":[164,1557],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p4btio-1Mz","jetpack-related-posts":[{"id":1832,"url":"https:\/\/thesportjournal.org\/article\/disordered-eating-eating-attitudes-and-reasons-for-exercise-among-male-high-school-cross-country-runners\/","url_meta":{"origin":6855,"position":0},"title":"Disordered Eating, Eating Attitudes, and Reasons for Exercise among Male High School Cross Country Runners","date":"April 28, 2014","format":false,"excerpt":"ABSTRACT PURPOSE: This study investigated the prevalence of disordered eating behaviors among male high school cross country runners. The study identified behaviors and feelings about being an athlete, and determined relationships between motivations to exercise and disordered eating behaviors. METHODS: Sixty-eight male high school cross country runners from 12 high\u2026","rel":"","context":"In "Contemporary Sports Issues"","img":{"alt_text":"Capture1","src":"https:\/\/i0.wp.com\/thesportjournal.org\/wp-content\/uploads\/2014\/04\/Capture11.jpg?resize=350%2C200","width":350,"height":200},"classes":[]},{"id":433,"url":"https:\/\/thesportjournal.org\/article\/body-image-disturbances-in-ncaa-division-i-and-iii-female-athletes\/","url_meta":{"origin":6855,"position":1},"title":"Body Image Disturbances in NCAA Division I and III Female Athletes","date":"September 30, 2011","format":false,"excerpt":"Kato, K., Jevas, S., and Culpepper, D. ### Abstract The purpose of this study was to examine and compare eating characteristics and body image disturbances in female NCAA Division I and III athletes in the mainstream sports of basketball, softball, track\/cross country, volleyball, soccer, tennis, swimming\/diving, and ice hockey. 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The MABQ was developed to measure patterns of addictive behaviors and to ascertain gender differences as well\u2026","rel":"","context":"In "Contemporary Sports Issues"","img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]},{"id":467,"url":"https:\/\/thesportjournal.org\/article\/title-female-athletes-and-eating-disorders\/","url_meta":{"origin":6855,"position":3},"title":"Female Athletes and Eating Disorders","date":"August 30, 2012","format":false,"excerpt":"Abstract Sports should prevent athletes from having eating disorders not develop eating disorders. There is evidence that female athletes are at a risk of developing disordered eating. The purpose of this study was to find how prevalent eating disorders are in female athletes and examine factors that may have a\u2026","rel":"","context":"In "Contemporary Sports Issues"","img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]},{"id":469,"url":"https:\/\/thesportjournal.org\/article\/female-athletes-and-eating-disorders\/","url_meta":{"origin":6855,"position":4},"title":"Female Athletes and Eating Disorders","date":"November 15, 2012","format":false,"excerpt":"Danielle Soubliere and Priscilla N. Gitimu \u00a0 Abstract Sports should prevent athletes from having eating disorders not develop eating disorders. There is evidence that female athletes are at a risk of developing disordered eating. The purpose of this study was to find how prevalent eating disorders are in female athletes\u2026","rel":"","context":"In "Contemporary Sports Issues"","img":{"alt_text":"Figure 1","src":"https:\/\/i0.wp.com\/thesportjournal.org\/wp-content\/uploads\/2012\/11\/Figure1.png?resize=350%2C200","width":350,"height":200},"classes":[]},{"id":2683,"url":"https:\/\/thesportjournal.org\/article\/the-impact-of-eating-disorder-risk-on-sports-anxiety-and-sports-confidence-in-division-iii-female-athletes\/","url_meta":{"origin":6855,"position":5},"title":"The Impact of Eating Disorder Risk on Sports Anxiety and Sports Confidence in Division III Female Athletes","date":"April 1, 2015","format":false,"excerpt":"Submission by JoAnne Barbieri Bullard1, Psy.D.* 1* Instructor, Health and Exercise Science Department, Rowan University, JoAnne Barbieri Bullard is an instructor in the Health and Exercise Science Department at Rowan University. Bullard is also a Doctor of Sport Psychology and Performance and a Certified Strength and Conditioning Specialist. 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