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Katherine A. Beals and Melinda M. Manore

A growing body of evidence suggests that the prevalence of eating disorders and excessive concerns regarding body weight in certain subpopulations of female athletes are increasing. The pressure on female athletes to improve their performances and physiques, coupled with the general sociocultural demand placed on all women to be thin, often results in attempts to achieve unrealistic body size and body weight goals. For some female athletes the pressure to achieve and maintain a low body weight leads to potentially harmful patterns of restrictive eating or chronic dieting. This paper seeks to further delineate the characteristics of a recently identified subclinical eating disorder in female athletes: anorexia athletica. Research studies that support the existence of subclinical eating disorders will be reviewed. In addition, the possible physiological and psychological consequences of subclinical eating disorders will be explored.

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Katherine A. Beals and Melinda M. Manore

This study examined the prevalence of and relationship between the disorders of the female athlete triad in collegiate athletes participating in aesthetic, endurance, or team/anaerobic sports. Participants were 425 female collegiate athletes from 7 universities across the United States. Disordered eating, menstrual dysfunction, and musculoskeletal injuries were assessed by a health/medical, dieting and menstrual history questionnaire, the Eating Attitudes Test (EAT-26), and the Eating Disorder Inventory Body Dissatisfaction Subscale (EDI-BD). The percentage of athletes reporting a clinical diagnosis of anorexia and bulimia nervosa was 3.3% and 2.3%, respectively; mean (±SD) EAT and EDI-BD scores were 10.6 ± 9.6 and 9.8 ± 7.6, respectively. The percentage of athletes with scores indicating “at-risk” behavior for an eating disorder were 15.2% using the EAT-26 and 32.4% using the EDI-BD. A similar percentage of athletes in aesthetic, endurance, and team/anaerobic sports reported a clinical diagnosis of anorexia or bulimia. However, athletes in aesthetic sports scored higher on the EAT-26 (13.5 ± 10.9) than athletes in endurance (10.0 ± 9.3) or team/anaerobic sports (9.9 ± 9.0, p < .02); and more athletes in aesthetic versus endurance or team/anaerobic sports scored above the EAT-26 cut-off score of 20 (p < .01). Menstrual irregularity was reported by 31% of the athletes not using oral contraceptives, and there were no group differences in the prevalence of self-reported menstrual irregularity. Muscle and bone injuries sustained during the collegiate career were reported by 65.9% and 34.3% of athletes, respectively, and more athletes in aesthetic versus endurance and team/anaerobic sports reported muscle (p = .005) and/or bone injuries (p < .001). Athletes “at risk” for eating disorders more frequently reported menstrual irregularity (p = .004) and sustained more bone injuries (p = .003) during their collegiate career. These data indicate that while the prevalence of clinical eating disorders is low in female collegiate athletes, many are “at risk” for an eating disorder, which places them at increased risk for menstrual irregularity and bone injuries.

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Katherine A. Beals and Amanda K. Hill

The purpose of this study was to examine the prevalence of disordered eating (DE), menstrual dysfunction (MD), and low bone mineral density (BMD) among US collegiate athletes (n = 112) representing 7 different sports (diving, swimming, x-country, track, tennis, field hockey, and softball) and determine differences in prevalence existed between athletes participating in lean-build (LB) and non-lean build (NLB) sports. DE and MD were assessed by a health, weight, dieting, and menstrual history questionnaire. Spinal BMD was determined via dual energy x-ray absorptiometry. Twenty-eight athletes met the criteria for DE, twenty-nine for MD, and two athletes had low BMDs (using a Z score below −2.0). Ten athletes met the criteria for two disorders (one with disordered eating and low BMD and nine with disordered eating and menstrual dysfunction), while only one athlete met the criteria for all three disorders. Using a Z score below −1.0, two additional athletes met the criteria for all three disorders and three more athletes met the criteria for a combination of two disorders. With the exception of MD, which was significantly more prevalent among LB vs. NLB sports (P = 0.053), there were no differences between the groups in the prevalence of individual disorders or combinations of disorders. These data indicate that the combined prevalence of DE, MD, and low BMD among collegiate athletes is small; however, a significant number suffer from individual disorders of the Triad.

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Katherine A. Beals and Melinda M. Manore

The purpose of this study was to delineate and further define the behavioral, psychological, and physical characteristics of female athletes with subclinical eating disorders. Subjects consisted of 24 athletes with subclinical eating disorders (SCED) and 24 control athletes. Group classification was determined by scores on the Eating Disorder Inventory (EDI), the Body Shape Questionnaire (BSQ), and a symptom checklist for eating disorders (EDI-SC). Characteristics representative of the female athletes with subclinical eating disorders were derived from an extensive health and dieting history questionnaire and an in-depth interview (the Eating Disorder Examination). Energy intake and expenditure (kcal/d) were estimated using 7-day weighed food records and activity logs. The characteristics most common in the female athletes with subclinical eating disorders included: (a) preoccupation with food, energy intake, and body weight; (b) distorted body image and body weight dissatisfaction; (c) undue influence of body weight on self-evaluation; (d) intense fear of gaining weight even though at or slightly below (-5%) normal weight; (e) attempts to lose weight using one or more pathogenic weight control methods; (g) food intake governed by strict dietary rules, accompanied by extreme feelings of guilt and self-hatred upon breaking a rule; (h) absence of medical disorder to explain energy restriction, weight loss, or maintenance of low body weight; and (i) menstrual dysfunction. Awareness of these characteristics may aid in more timely identification and treatment of female athletes with disordered eating patterns and, perhaps, prevent the development of more serious, clinical eating disorders.

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Katie N. Brown, Heidi J. Wengreen, Katherine A. Beals and Edward M. Heath

This quasi-experimental study aimed to assess risk for the female athlete triad (Triad) and pilot a peer-led Triad educational intervention. Twenty-nine female high school track and field athletes (N = 29) at one high school in the western United States consented to participate. Participants were weighed and measured, and completed pre- and postsurveys that included Triad risk factor questions and 10 questions assessing Triad knowledge. 54% of athletes reported current menstrual irregularity; 7% reported a history of stress fractures. Significant increases in Triad knowledge were observed pre- to postintervention (4.7 ± 2.6 to 7.7 ± 1.78 out of 10; p < .0001). Triad education was generally accepted and enjoyed by participants; however, 86% preferred that a coach or other adult provide education instead of a peer.

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Kim Beals, Katherine A. Perlsweig, John E. Haubenstriker, Mita Lovalekar, Chris P. Beck, Darcie L. Yount, Matthew E. Darnell, Katelyn Allison and Bradley C. Nindl

Special operation forces participating in mountain warfare/cold weather (MWCW) training have higher energy demands, but adequate fueling is difficult to achieve. The purpose of the study was to determine energy expenditure relative to energy intake and examine fueling patterns during 3 days of MWCW training in Naval Special Warfare Sea, Air, Land (SEAL) Qualification Training (SQT) students. Ten SQT students (age: 23.3 ± 1.8 years, height: 182.3 ± 6.4 cm, and weight: 83.6 ± 4.5 kg) were fitted for heart rate and accelerometer monitors during MWCW training. Total daily energy expenditure was determined using a combination of direct observation and heart rate-VO2 regression. Total daily energy intake was collected using the Automated Self-Administered 24 (ASA24) assessment tool. Total daily energy expenditure for river crossing, alpine skills, and mountain patrol were 3,913 ± 293, 4,207 ± 400, and 5,457 ± 828 kcals, respectively. Reported total daily energy intakes were 2,854 ± 657 (river crossing) and 2,289 ± 680 kcals (mountain patrol), producing 1,044 ± 784 and 3,112 ± 1,420 kcal deficits, respectively. SQT students consumed 258 ± 95 g (3.1 ± 1.3 g·kg−1·day−1) of carbohydrates, 130 ± 55 g (1.6 ± 0.7 g·kg−1·day−1) of protein, and 113 ± 39 g (1.4 ± 0.5 g·kg−1·day−1) of fat. MWCW training evolutions elicited high total daily energy expenditure and inadequate energy intake, especially before and during active training sessions, which may lead to decreased work output, early onset fatigue, and increased risk of injury. Increasing total daily energy intake by providing fuel/fluids, primarily carbohydrates, during the planned breaks and “downtime” of each training evolution and focusing on provision of the balance of calories/macronutrients needed for a more complete and expedited recovery over dinner and evening snacks will help bridge the energy gap.