Eating disorders (EDs) and disordered-eating behaviors (DEBs), pose a high risk of morbidity and mortality, threatening physical health, emotional health, and overall quality of life. Unfortunately, among athletes, prevalence rates continue to increase. This document summarizes the challenges of establishing and navigating the multidisciplinary care needed to effectively treat EDs and DEBs among athletes. The benefits of timely and frequent communication within the multidisciplinary treatment team (MDTT) are emphasized and discussed. Authors advise who should be selected as members of the MDTT and suggest that all personnel, including athletic coaches, athletic trainers, physical therapists, and certified fitness professionals be ED-informed and ED-sensitive. Vital components of care are noted including use of a variety of evidence-based psychotherapeutic modalities, interventions which target emotional regulation, and prioritize values based compassionate care. Authors caution that performance decrements and medical/physiological changes are not always easily observable in individuals with EDs and DEBs and therefore, attuned, consistent, and ongoing monitoring is needed. Consensus regarding previously established parameters for return to play and careful titration of physical activity throughout the ED recovery process are suggested as important for preserving health, preventing re-injury, or relapse and facilitating successful return to sport participation.
Jenny H. Conviser, Amanda Schlitzer Tierney, and Riley Nickols
Andrea S. Hartmann, Florian Steenbergen, Silja Vocks, Dirk Büsch, and Manuel Waldorf
Fitness training to attain the lean body ideal is becoming increasingly popular among women. However, it remains unclear how the drive for leanness (DL), as compared to the drives for thinness (DT) and muscularity (DM), relates to body image pathology and substance use in female weight-trainers. Participants (N = 168) completed a survey assessing DL, DT, DM, eating and body dysmorphic disorder pathology, and substance use. DT and DM were related to eating disorder and body dysmorphic disorder symptoms (all r ≥ .29; all ps < .01), while DL only to the former (r = .19, p < .05). Supplement use was associated with DL and DM (r = .17 and .55; both p < .01) and pharmaceutical use with DT and DM (r ≥ .21; both p < .01). Female weight-trainers should not be neglected in body image disorder prevention, with a particular focus on DT and DM.
Dana K. Voelker and Justine J. Reel
The purpose of this qualitative investigation was to examine male competitive figure skaters’ experiences of weight pressure in sport. Specifically, male skaters’ perceptions of the ideal skating body, sources of weight pressure in elite figure skating, and the perceived role of their sport in shaping body image, athletic performance, eating, and exercise behaviors were explored. Through a social constructivist lens, an inductive thematic analysis was used to examine the contextual influences of the skating environment. Thirteen male figure skaters ages 16–24 (M = 18.53, SD = 3.33) with an average 10.38 years of skating experience (SD = 4.05) were interviewed. Skaters identified the parameters for the ideal body in skating along with specific weight pressures, body image concerns, and weight management strategies. Similar to female skaters, male skaters perceived that body image affected psychological factors that influence sport performance. Sport psychologists and consultants should be attentive to the skating environment and how specific performance and appearance demands may influence an athlete’s mindset.
Taylor K. Wise
Disordered eating (DE) plays a significant role in the overall health and athletic performance of collegiate athletes. The present study sought to determine how many NCAA Division I Football Bowl Subdivision Institutions have a policy that specifically addresses the prevention and management of DE for their participating athletes and to examine the content of the existing policies. The study searched for policies in the 128 FBS institutions through an online web-search and by contacting athletic department personnel. A total of 33 currently existing policies on athletes with eating disorders (EDs) were found, 13 of which were found online. A documentary analysis was then conducted to determine the type of information that policies include. Sixteen major themes were found throughout the analysis, including themes that related to prevention, risk factors, identification, treatment, referral, and return-to-play guidelines.
Sheryl Miller and Mary Fry
The purpose of this study was to examine the relationship of students’ perceptions of the motivational climate in their university exercise class to their body esteem (BE) and social physique anxiety (SPA). Students in physical activity classes at a Midwestern university completed a survey measuring their perceptions of the caring, task- and ego-involving features of the exercise class climate, BE (i.e., weight and appearance), and SPA. Canonical correlation analysis revealed one significant function for males and females. Loadings revealed males’ perceptions of a highly caring and task-involving climate with low emphasis on ego-involving climate features were associated with higher weight and appearance BE and lower SPA. Females were similar except the ego-involving climate did not significantly contribute to the model. Continued research may examine the link between motivational climate and BE, but mounting evidence suggests creating positive exercise environments is associated with participants’ adaptive responses, including BE and SPA.
Dana K. Voelker and Justine J. Reel
The number of studies examining eating disorders and body image in sport has increased, although several major challenges associated with conducting this research must be addressed to continue growth. In this paper, we describe these challenges based on our professional experiences and the academic literature. Mistrust of researchers and the area of study, communication gaps, and factors that affect data quality are among the strong barriers discussed. However, we suggest that these challenges may be addressed by building stronger partnerships between researchers and practitioners and offer critical steps for developing meaningful professional relationships that will help move the field forward.
Laura K. Fewell, Riley Nickols, Amanda Schlitzer Tierney, and Cheri A. Levinson
Understanding the unique needs of athletes who undergo eating disorder (ED) treatment is sorely needed. This study explores changes of strength and power in athlete (n = 21) and non-athlete (n = 36) patients from intake to discharge. Maximal oxygen consumption, vertical jump, push-ups, hand grip strength, and body mass index (in anorexia nervosa; AN) were measured among treatment center patients. The number of push-ups and hand grip strength were significantly improved upon discharge in the full sample (ps < .005) and in AN only (ps < .001). Body mass index was also significantly higher in AN (p < .001). Maximal oxygen consumption and vertical jump did not significantly improve between admission and discharge in either group (ps > .40). This study is the first to investigate measures of strength in athletes engaged in intensive eating disorder treatment and indicates the need to address the psychological mindset around physical activity using exercise education as part of a comprehensive program. Recommendations for incorporating exercise into an intensive ED treatment center are also provided.
Renee Engeln, Margaret Shavlik, and Colleen Daly
Two-hundred and three college women participated in a 16-minute strength and conditioning group fitness class. Participants were randomly assigned to a class that featured either appearance-focused motivational comments by the instructor (e.g., “Blast that cellulite!”) or function-focused comments (e.g., “Think of how strong you are getting!”). Body satisfaction from pre-test to post-test increased overall, but those in the function-focused (as opposed to appearance-focused) condition experienced a significantly greater increase in body satisfaction. A similar pattern was observed for positive affect. Additionally, those in the function-focused condition described the class in more positive terms and reported experiencing less body surveillance during the class. These findings are consistent with research suggesting that exercise can improve mood and body satisfaction, but also suggest that a more function-focused class can lead to even greater improvements. The motivational comments fitness instructors use may have a notable impact on women’s mood, body satisfaction, and body surveillance.
Jessyca N. Arthur-Cameselle and Molly Curcio
The purpose of this qualitative study was to identify turning points in eating disorder recovery in collegiate female athletes compared to non-athletes. The sample included 12 varsity athletes and 17 non-athlete college students who previously met criteria for Anorexia Nervosa (AN; n = 17); Bulimia Nervosa (BN; n = 3); Binge Eating Disorder (n = 1); or both AN and BN (n = 8). Participants completed individual interviews and responses were analyzed inductively. There was some commonality in the athletes’ and non-athletes’ experiences. For example, the most frequent turning point for both groups was Insight/Self Realization. Regarding the next three most frequent turning points, athletes reported Sport Performance, Confrontation, and Support/Concern from Others, whereas non-athletes reported Professional Treatment, Hitting a Low, and Support/Concern from Others. This study contributes to the sparse literature on competitive athletes’ recovery. Results indicated that athletes’ turning points differed from non-athletes; therefore, findings are discussed concerning athlete-specific treatment recommendations and suggestions for coaches.