Relationships Between Disordered Eating, Body Dissatisfaction, and Low Energy Availability in Women Collegiate Athletes.

ABSTRACTBackgroundCollegiate women athletes face unique challenges regarding nutrition, body image, and athletic performance, which increase their risk for low energy availability (LEA). This risk may be further compounded if there are underlying disordered eating (DE) and body dissatisfaction (BID) behaviors. Therefore, the objective was to examine the prevalence of and relationships between LEA, ED risk and behaviors, and BID among women collegiate athletes from a variety of sports.MethodsNational Collegiate Athletic Association women athletes (n = 115) participated from the following sports: basketball (n = 11), cross country (n = 23), lacrosse (n = 33), soccer (n = 18), volleyball (n = 8), and wrestling (n = 22). Athletes completed the low energy availability for females questionnaire (LEAF-Q), eating attitudes test (EAT-26), muscularity-oriented eating test (MOET), and body dissatisfaction items from the eating disorder examination questionnaire (EDE-Q) to assess LEA risk, DE behaviors, and BID, respectively. A Kruskal–Wallis H test assessed differences in LEAF-Q and EAT-26 scores by sport, and a Mann–Whitney U test determined differences in EAT-26, MOET, BID, and BMI by LEA status. Pearson correlation coefficients and linear regression analysis were used to examine relationships between LEA risk, ED risk, DE behaviors, and BID (p < 0.05).ResultsA total of 64% athletes were considered at risk for LEA with the highest prevalence observed in volleyball (100%) followed by wrestling (68%), cross country (57%), and soccer (56%). There was no difference in LEA risk across sport (p = 0.067), but risk of ED was highest in volleyball (12.5%) and wrestling (23%). Further, 81% and 84% athletes reported dissatisfaction with their body weight and shape, respectively. No differences were observed in EAT-26 (p = 0.131), MOET (p = 0.051), BID (p = 0.077), or BMI (p = 0.332) according to LEA risk. Very strong positive relationships existed between MOET and EAT-26 (p < 0.001, r = 0.760), MOET and BID (p < 0.001, r = 0.723), and EAT-26 and BID (p < 0.001, r = 0.707). Moderate positive relationships existed between MOET and BMI (p < 0.001, r = 0.329), EAT-26 and BMI (p < 0.05, r = 0.318), and BID and BMI (p < 0.001, r = 0.414). BID positively predicted EAT-26 (p < 0.001, R2 = 0.49) and MOET (p < 0.001, R2 = 0.50) scores.ConclusionA high prevalence of LEA and BID was observed across collegiate women’s sports, with DE behaviors strongly linked to body image concerns. Despite a high LEA risk among athletes, clinical eating disorder risk remained low, suggesting that undereating may often be unintentional. It is recommended educational interventions directed at proper nutritional practices be developed and improvements in physical and psychological well-being be focused on to enhance athletic performance and optimize health-related quality of life.

There have been several published studies on the prevalence of low energy availability (LEA) risk amongst North American and European endurance athletes. Yet the prevalence and risk factors amongst rugby league players are less well understood. This study assessed the prevalence of low energy availability risk, eating disorder risk, and food security amongst players from a female National Rugby League squad in Australia. Players from one Australian professional rugby league club volunteered to participate in the study. An online questionnaire was conducted to determine the prevalence of low energy availability (Low Energy Availability in Females Questionnaire [LEAF-Q]), eating disorder risk (Eating Disorders Inventory [EDI-3]), and food security. Differences between those "at risk" and "not at risk" based on their total LEAF-Q score were determined. Of the 28 players, 64% (N.=18) were at risk of LEA. Raw scores for the EDI-3 subscales, body dissatisfaction (P=0.043), bulimia (P=0.002), composite score (P=0.038), were significantly higher for those at risk and not at risk of LEA. Forty percent of players had some level of food insecurity. The results suggest LEA risk is similar to other populations and those at risk of LEA are more likely to have an elevated clinical risk of eating disorders. Food security is also an issue in this population and could contribute to LEA risk for some. Future research is needed amongst team sports athletes to understand interplay between eating disorder risk and food insecurity with LEA risk.

This study investigated the association between the risk of low energy availability, disordered eating, and anxiety in collegiate female athletes. Female athletes (n = 115) completed questionnaires that assessed disordered eating (Disordered Eating Screen for Athletes, DESA-6; and the Eating Disorder Examination Questionnaire Short, EDE-QS), anxiety (Generalized Anxiety Disorder-7) and the risk of low energy availability (Low Energy Availability in Females Questionnaire; LEAF-Q). The athletes were 19.9 ± 0.1 years old and presented with no anxiety (14.8%), mild (33.0%), moderate (24.3%), and severe (27.8%) anxiety. The EDE-QS scores revealed that 22.6% of the participants had a high risk of an eating disorder, while the DESA-6 scores revealed that 31.3% of the participants scored positive for a risk of disordered eating. The LEAF-Q total scores revealed that 68.7% of the participants were at risk of low energy availability. Increased GAD-7 scores were associated (p < 0.001) with measures of disordered eating (EDE-QS and DESA-6) and the risk of low energy availability (LEAF-Q total score). Non-parametric partial correlations demonstrated that anxiety (increased GAD-7 scores) correlated with the risk of low energy availability (increased LEAF-Q total scores) while controlling for eating disorder scores (EDE-QS) (r (112) = 0.353, p < 0.001), or while controlling for the risk of disordered eating (DESA-6 scores) (r (112) = 0.349, p < 0.001). In female collegiate athletes, both disordered eating and the risk of low energy availability were positively associated with increased anxiety.

Low energy availability (LEA) is a state of inadequate energy reserves that results from a negative energy balance. This condition can lead to severe health risks such as amenorrhea and osteoporosis. Various causes for LEA, such as eating disorders and exercise addiction, have been reported in the literature. However, data in Saudi Arabia are lacking. This cross-sectional study measures the prevalence of LEA, eating disorders, and exercise addiction among adult females in Saudi Arabia and identifies possible associated risk factors. The sample comprised 119 female athletes who filled out an online survey adapted from the LEA in Females Questionnaire, the Eating Disorder Examination Questionnaire, and the Exercise Addiction Inventory. Participants showed a high prevalence of LEA (66.4%), eating disorder (33.6%), and exercise addiction (10.1%), confirming the association between normal weight and LEA in females living in Saudi Arabia (p < 0.00). With an increasing number of females in the country interested in following a healthy lifestyle, there is a need to raise the awareness of the population on the issues of LEA, eating disorders, and exercise addiction and their effects on the body by developing educational programs about energy intake and healthy physical activity routines.

Low energy availability [(energy intake – exercise expenditure)/kg lean body mass], a component of the Female Athlete Triad, has been associated with menstrual disturbances and low bone mass. No studies have examined the energy availability of athletes across a season. The purpose of this study was to assess the prevalence of, and what contributes to, low energy availability in Division I female soccer players across a season. Nineteen participants aged 18–21 years (mean [Vdot]O2max: 57.0 ± 1.0 mL · kg−1 · min−1) were studied during the pre, mid, and post season. Mean energy availability was overall lowest at mid season, and lower at mid than post season (35.2 ± 3.7 vs. 44.5 ± 3.7 kcal · kg−1 lean body mass, P = 0.009). Low energy availability (<30 kcal · kg−1 lean body mass) was observed in 5/19 (26.3%), 5/15 (33.3%), and 2/17 (11.8%) of participants during the pre, mid, and post season. Dietary energy intake was lower mid (P = 0.008) and post season (P = 0.022) than it was pre season (pre: 2794 ± 233 kcal · day−1; mid: 2208 ± 156 kcal · day−1; post: 2161 ± 143 kcal · day−1). Exercise energy expenditure decreased significantly (P ≤ 0.001) over time (pre: 819 ± 57 kcal · day−1; mid: 642 ± 26 kcal · day−1; post: 159 ± 28 kcal · day−1). Low energy availability was due to lower dietary energy intake at lunch during pre season (P = 0.014) and during lunch and dinner during mid season (P ≤ 0.030). Energy availability was inversely related to body dissatisfaction (r = −0.62, P = 0.017) and drive for thinness (r = −0.55, P = 0.041) during mid season. Although most Division I female soccer players are not at risk for low energy availability, a concerning proportion exhibited low energy availability at pre or mid season. Further studies are needed to explore strategies to prevent and monitor low energy availability in these athletes.

Low energy availability risk and in-season injuries among female adolescent athletes: A prospective cohort study over a school-season.

Adequate energy intake is crucial for athletic performance and recovery. However, many endurance athletes experience Low Energy Availability (LEA), which, if prolonged, can detrimentally impact both health and performance. A total of 55 endurance athletes (23 females; 45 ± 13 years, 1.64 ± 0.06 m, 64.4 ± 11.4 kg and 32 males; 44 ± 13 years, 1.76 ± 0.18 m, 78.8 ± 9.2 kg) underwent physical assessments and completed questionnaires on dietary habits, training loads, and psychological stress. Dual-Energy X-ray Absorptiometry (DEXA) scans measured bone mineral density (BMD) in the lumbar L1-L4 spine, and body composition. Risk of LEA burnout, and psychological strain were assessed using sport-specific questionnaires. Seventy-seven percent of female athletes were identified as at risk of LEA by the LEAF-Q. These females had higher body weight and fat percentage than those at low risk of LEA. Male athletes had a higher prevalence of low lumbar BMD (31%) compared to females, associated with older age, and longer training histories. Although only 9% of female athletes had low-BMD, those affected had a history of amenorrhea and were identified as at risk of LEA by the LEAF-Q. A high proportion of endurance athletes had low-BMD and were at risk of LEA. This underscores the need for targeted nutritional strategies to mitigate the risks associated with LEA and promote overall athlete well-being.

Low energy availability (LEA) and nutrient intake have been well studied in able-bodied athletes, but there is a lack of research examining these issues amongst athletes with spinal cord injury (SCI). To date, there have been no studies that have examined energy availability (EA) amongst this population. Furthermore, athletes with SCI may experience unique challenges around nutrition that may increase their risk of LEA. This review will evaluate the literature and assess whether this population is at risk for LEA. Due to the limited research on this topic, sedentary individuals with SCI and para athletes were also included in this review. Review of the current literature suggests that athletes with SCI may be at an increased risk for LEA. While research examining EA and risk of LEA in athletes with SCI is lacking, the number of athletes with SCI continues to increase; therefore, further research is warranted to assess nutrient and energy needs and their risk to this population.

ObjectivesThis retrospective, cross-sectional study aimed to investigate symptoms of eating disorders (EDs) and low energy availability (LEA) among recreational female runners.MethodsFemales (18–39 years) (n=89) participating in running group sessions organised...

IntroductionCompeting in aesthetic sports increases the risk of low energy availability and associated health impairments. Fitness physique sport is a popular, but understudied aesthetic sport. We evaluated health and symptoms of relative energy deficiency in sport (RED‐s) in female fitness athletes (FA) and female references (FR) during a competitive season.MethodsTotally, 25 FA and 26 FR, mean (SD) age of 28.9 (5.7), were included. Assessments were at baseline (T1), 2‐weeks pre‐competition (T2), and 1‐month post‐competition (T3), by dual‐energy x‐ray absorptiometry scan, indirect calorimetry, diet registration, The Low Energy Availability in Females Questionnaire, The Beck Depression Inventory, and Eating Disorder Examination Questionnaire (EDE‐Q).ResultsA history of eating disorders was reported by 35% FA and 12% FR. There were no between‐group differences at T1, besides less mean (99% CI) fat mass (FM) of 3.1 kg (−0.4, 6.5) in FA (P = .02). At T2, FA had lower BW of 6.7 kg (−12.0, −1.3), fat mass of −9.0 kg (−12.5, −5.5), and resting heart rate of −8.0 beats per minute (−14.5, −1.5) compared to FR (P ≤ .006). FA reduced resting metabolic rate by −191 kcal (−11, −371) and increased symptoms of gastrointestinal dysfunction (GD) by 1.4 points (0.3, 2.5) and prevalence of amenorrhea from 8% to 24%, (P < .003). At T3, there was a between‐group difference in fat mass, and a high number of FA with amenorrhea and GD.ConclusionManifestation of symptoms of RED‐s, some with persistence one‐month post‐competition, raises concern for the health of FA and those complying with the fit body ideal.

Low energy availability (LEA) can have negative performance consequences, but the relationships between LEA and performance are poorly understood especially in field conditions. In addition, little is known about the contribution of macronutrients to long-term performance. Therefore, the aim of this study was to evaluate if energy availability (EA) and macronutrient intake in a field-based situation were associated with laboratory-measured performance, anthropometric characteristics, blood markers, training volume, and/or questionnaire-assessed risk of LEA in young female cross-country (XC) skiers. In addition, the study aimed to clarify which factors explained performance. During a one-year observational study, 23 highly trained female XC skiers and biathletes (age 17.1 ± 1.0 years) completed 3-day food and training logs on four occasions (September-October, February-March, April-May, July-August). Mean (±SD) EA and macronutrient intake from these 12 days were calculated to describe yearly overall practices. Laboratory measurements (body composition with bioimpedance, blood hormone concentrations, maximal oxygen uptake (VO2max), oxygen uptake (VO2) at 4 mmol·L-1 lactate threshold (OBLA), double poling (DP) performance (time to exhaustion), counter movement jump (height) and the Low Energy Availability in Females Questionnaire (LEAF-Q)) were completed at the beginning (August 2020, M1) and end of the study (August 2021, M2). Annual training volume between measurements was recorded using an online training diary. The 12-day mean EA (37.4 ± 9.1 kcal·kg FFM-1·d-1) and carbohydrate (CHO) intake (4.8 ± 0.8 g·kg-1·d-1) were suboptimal while intake of protein (1.8 ± 0.3 g·kg-1·d-1) and fat (31 ± 4 E%) were within recommended ranges. Lower EA and CHO intake were associated with a higher LEAF-Q score (r = 0.44, p = 0.042; r = 0.47, p = 0.026). Higher CHO and protein intake were associated with higher VO2max (r = 0.61, p = 0.005; r = 0.54, p = 0.014), VO2 at OBLA (r = 0.63, p = 0.003; r = 0.62, p = 0.003), and DP performance at M2 (r = 0.42, p = 0.051; r = 0.44, p = 0.039). Body fat percentage (F%) was negatively associated with CHO and protein intake (r = -0.50, p = 0.017; r = -0.66, p = 0.001). Better DP performance at M2 was explained by higher training volume (R2 = 0.24, p = 0.033) and higher relative VO2max and VO2 at OBLA at M2 by lower F% (R2 = 0.44, p = 0.004; R2 = 0.47, p = 0.003). Increase from M1 to M2 in DP performance was explained by a decrease in F% (R2 = 0.25, p = 0.029). F%, and training volume were the most important factors explaining performance in young female XC skiers. Notably, lower F% was associated with higher macronutrient intake, suggesting that restricting nutritional intake may not be a good strategy to modify body composition in young female athletes. In addition, lower overall CHO intake and EA increased risk of LEA determined by LEAF-Q. These findings highlight the importance of adequate nutritional intake to support performance and overall health.

ObjectiveThe primary objective was to compare bone mineral density (BMD) in Norwegian female elite long-distance runners with a control group of inactive females. Secondary objectives were to identify cases of...

Bodybuilding has increasingly become popular between males since male body shape has become a subject of interest in the last decades. Bodybuilders have desired to gain more muscle and paid attention to their body shape. Based on this purpose, they have string rules that include restrictive eating and excessive exercise program. Recent research has demonstrated that desiring more muscular body shape exhibits eating behavior problems and body dissatisfaction issues in bodybuilders. Limited research exists on the relationship between body dissatisfaction and eating disorders in male bodybuilders. The aim of this study was to determine the relationship between body image disturbance and eating disorders in 120 male bodybuilders. The Eating Attitude Test (EAT-40) was used to determine eating disorders, the Muscle Dysmorphia Disorder Inventory was used to determine bigorexia symptoms, and Bodybuilder Image Grid-Original (BIG O) and Scaled (BIG S) forms were used to detect the factors associated with body dissatisfaction. There was a positive relationship between Eating Attitude Test and Muscle Dysmorphia Disorder Inventory total scores. Eating Attitude Test was positively correlated with both fat and muscle dissatisfaction. Our results indicated that eating disorder psychopathology is positively related to body dissatisfaction and body dysmorphic disorders in male bodybuilders.

Marching band (MB) members rehearse for pre-game and half-time performances outdoors for several hours a day starting at the end of July or beginning of August. There is lack of research on energy needs (e.g., energy availability) and proper hydration in MB during these hot months. PURPOSE: To examine energy availability and hydration status among MB members. A secondary purpose was to examine differences between sex. METHODS: We utilized data from a larger cross-sectional study. MB artists (n=37, Males: n=12, age: 19.8±1.4 years, height: 177.1±7.8 cm, weight: 74.6±23.8 kg; Females: n=25, age: 20.0±1.1 years, weight: 68.4±16.4 kg; height: 163.3±4.6 cm) from an NCAA Division I institution completed a survey (eg, basic demographics, band background, etc.) and were measured for height, weight, body composition, and resting metabolic rate (RMR). For 7-days, participants completed an online dietary log to measure energy intake (EI), wore a Polar m200 watch to estimate exercise energy expenditure (EEE) during rehearsals and gameday performances, and provided a morning urine sample to measure urine specific gravity (Usg). Low energy availability (LEA) was defined as <30 kcal/kg FFM/day and hypohydration was Usg >1.025. Basic descriptive statistics examined all energy needs and Usg. Chi square were used to identify proportions of members “at risk” for LEA and hypohydration and compared the differences across sex. RESULTS: Significant differences were found for EI for males and females respectively (2090.2±676.7 kcal, 1531.0± 460.8 kcals, P=.002)). No significant differences were found for EEE and EA for males and females (335.5±66.0 kcal, 333.8± 66.9 kcals and 23.6±11.0 kcal/kg FFM, 22.9± 10.1 kcal/kg FFM). Overall, 73.7% (n=28) were at risk for LEA. No significant differences were found for Usg and sex (Males: 1.022±.006, Females: 1.022±.005), however 36.8% (n=14) reported chronically hypohydrated (> 4/7 days >1.025). Of those with LEA (n=28), 31.6% (n=12) also reported to be chronically hypohydrated. CONCLUSION: The majority of MB members had LEA and over a third were also chronically hypohydrated. Due to performances in hot and humid environments, as well as the physical demands associated with MB, healthcare professionals should provide resources and education on hydration and proper fueling for MB artists.

The present study aimed to clarify existing research that has inconsistently shown that weight suppression (differences between individuals’ highest and current body weights) is associated with worse eating disorder (ED) behaviors and negative body image among women with lifetime EDs, by examining whether an understudied client-supported protective factor for ED pathology – self-acceptance – moderates these associations. Currently symptomatic women with lifetime EDs (N = 108) completed measures assessing self-acceptance and ED symptoms via an online survey. Moderated regressions examined whether self-acceptance moderated associations between weight suppression and both body image (weight/shape preoccupation, overvaluation, dissatisfaction) and ED behavior (dietary restraint, compensatory behaviors, binge eating) outcomes. Results indicated that weight suppression was associated with more severe negative body image and dietary restraint, but not compensatory behaviors or binge eating. In contrast, self-acceptance consistently emerged as a protective factor relative to all negative body image and ED behavior indices. This protective effect did not offset apparent risk factor associations between weight suppression, and negative body image and ED behavior outcomes. These results support further assessment of self-acceptance as an understudied protective factor for women’s ED symptoms and as a mechanism of change in EDs intervention research. Women’s weight suppression should be assessed during ED prevention initiatives.