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Jorunn Sundgot-Borgen

This study examined clinical and subclinical eating disorders (EDs) in young Norwegian modern rhythmic gymnasts. Subjects were 12 members of the national team, age 13-20 years, and individually matched nonathletic controls. All subjects participated in a structured clinical interview for EDs, medical examination, and dietary analysis. Two of the gymnasts met the DSM-III-R criteria for anorexia nervosa, and 2 met the criteria for anorexia athletica (a subclinical ED). AH the gymnasts were dieting in spite of the fact that they were all extremely lean. The avoidance of maturity, menstrual irregularities, energy deficit, high training volume, and high frequency of injuries were common features among the gymnasts. There is a need to learn more about risk factors and the etiology of EDs in different sports. Coaches, parents, and athletes need more information about principles of proper nutrition and methods to achieve ideal body composition for optimal health and athletic performance.

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Ron A. Thompson

While college women in general are at risk for anorexia nervosa and bulimia, these disorders may present more of a problem for the student-athlete due to her weight/body consciousness and the pressure associated with athletic competition at the college or university level. This paper discusses the physical and psychological characteristics of each disorder, their etiology, and how each affects the life and performance of the athlete. Recommendations are offered regarding the role of the sport management team (i.e., sport psychologist, team physician, coach, athletic trainer, exercise physiologist) in assisting the eating-disordered athlete.

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Jorunn Sundgot-Borgen

This study assessed the nutrient intake and eating behavior in Norwegian female elite athletes suffering from eating disorders (ED) who met the criteria for anorexia nervosa (AN), anorexia athletica (AA), or bulimia nervosa (BN). The subjects included 7 AN, 43 AA, 42 BN, and 30 controls. Three-day and 24-hr food records were used to assess energy and nutrient intake. Results revealed that a significant number of AN and AA athletes have diets too low in energy and nutrients, the mean intake for energy and CHO being lower than recommended for active females. A significant number did not reach the protein level recommended for athletes. In addition, there were low intakes of several micronutrients, most notably calcium, vitamin D, and iron. The energy and nutritional inadequacy, combined with the use of purging, are of major concern since the athletes in this study were relatively young. It is unknown whether the abnormal eating pattern is a consequence of ED or is typical of top level athletes.

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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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Sharon R. Guthrie, Cathy Ferguson and Dixie Grimmett

This research examined the nutritional practices and body images of 13 competitive women bodybuilders living in southern California and in the Midwest. Data collection included both structured interviews and survey methods. Findings indicate nutritional health and positive body image among this sample of women. None of the bodybuilders had anorexia nervosa or bulimia nervosa, as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R; American Psychiatric Association, 1987) criteria, were binge eaters or used pathogenic weight control measures. Instead, they reported significant improvement in their nutritional attitudes and behaviors after beginning bodybuilding training. These data suggest a relationship between participating in competitive bodybuilding and other behaviors related to nutrition and self-perception.

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Zella E. Moore, Raquel Ciampa, Jaime Wilsnack and Elizabeth Wright

Eating disorders are serious clinical issues that can have severe physical and psychological ramifications. Although prevalence rates of anorexia nervosa and bulimia nervosa are low in the general population, it has been reported that prevalence rates are higher among individuals involved in the athletic milieu. Unfortunately, based on the demands of the sport environment, these individuals may be significantly less likely to seek treatment for these disorders, thus may experience dangerous short- and long-term consequences. Yet, even when such athletes do seek help, they often receive psychological treatments that have not been demonstrated to be efficacious among methodologically sound research studies. This article clarifies the current state of eating disorder treatment efficacy so that practitioners working with eating disordered athletic clientele can adopt more ethical and effective treatment practices.

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Diane E. Taub and Rose Ann Benson

Since most research on eating disorders among athletes has focused on college-age samples, the present investigation examines the adolescent competitive swimmer. Three areas related to weight and eating habits were explored: general concerns about weight, use of weight control techniques, and tendencies toward anorexia nervosa and bulimia nervosa and associated behavioral/personal characteristics. Previous research has found females to be at greater risk than males, thus gender comparisons were undertaken. Questionnaires were completed by 85 adolescent competitive swimmers attending a nationally known summer swim camp at a large midwestern university. Consistent with the cultural norm of thinness for women, young female swimmers desired weight loss more than their male counterparts did. In terms of actual pathogenic weight control techniques or eating disorder tendencies, however, few significant gender differences were found. Neither male nor female adolescent swimmers were particularly susceptible to eating disorders or pathogenic weight control techniques.

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Renée M. Parker, Michael J. Lambert and Gary M. Burlingame

The present study was conducted to determine if female distance runners who report engaging in pathological food behaviors display the psychological characteristics of clinically diagnosed female eating-disordered patients. Comparisons were made among 29 eating-disturbed college runners, 31 normal college runners, 19 clinically diagnosed eating-disordered patients, and 34 nonathletic, non-eating-disordered college students. Measures included a 3-day diet journal, questionnaires collecting both personal information and information on eating behaviors and sports participation, the Eating Disorder Inventory (EDI), the Setting Conditions for Anorexia Nervosa Scale (SCANS), and the Minnesota Multiphasic Personality Inventory (MMPI). Without reaching eating-disordered clinical levels, the eating-disturbed runners appeared on psychological inventories as being more concerned with food and dieting than were the comparison runners and non-eating-disordered nonathletes. Only the eating-disordered group presented with significant levels of psychopathology. Implications for the athletic community are discussed.

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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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Wagner L. Prado, P. Babu Balagopal, Mara C. Lofrano-Prado, Lila M. Oyama, Thiago Ricardo S., João Paulo Botero and James O. Hill

Exercise is implicated in modifying subsequent energy intake (EI) through alterations in hunger and/or satiety hormones. Our aim was to examine the effects of aerobic exercise on hunger, satiety regulatory peptides, and EI in obese adolescents. Nine obese girls (age: 13–18 years old, BMI: 33.74 ± 4.04 kg/m2) participated in this randomized controlled crossover study. Each participant randomly underwent 2 experimental protocols: control (seated for 150 min) and exercise (exercised for 30 min on a treadmill performed at ventilatory threshold [VT] intensity and then remained seated for 120 min). Leptin, peptide YY3–36 (PYY3–36), and subjective hunger were measured at baseline as well as 30 min and 150 min, followed by 24-hr EI measurement. Exercise session resulted in an acute increase in PYY3–36 (p < .01) without changes in leptin and/or hunger scores. The control session increased hunger scores (p < .01) and decreased circulating leptin levels (p = .03). There was a strong effect size for carbohydrate intake (d = 2.14) and a modest effect size for protein intake (d = 0.61) after the exercise compared with the control session. Exercise performed at VT intensity in this study appears to provoke a state of transient anorexia in obese girls. These changes may be linked to an increase in circulating PYY3–36 and maintenance of leptin levels.