A longitudinal investigation of sports-related risk factors for disordered eating in aesthetic sports

Krentz EM, Warschburger P. Scand J Med Sci Sports 2011 [Epub ahead of print]

For years we have appreciated that athletes participating in elite aesthetic sports (e.g., rhythmical gymnastics, figure skating, dance) are at higher risk for disordered eating. Based on cross-sectional studies, the potential risk factors for disordered eating in sports have been merged into a model that is based on nonathletic populations and emphasizes societal pressures from the sports environment. Krentz & Warschburger hypothesized that these models need to consider the risk factors unique to the sports environment. Unfortunately, these risk factors have not been thoroughly evaluated in longitudinal studies. Therefore, the authors examined sports-related risk factors for disordered eating in a 1-year longitudinal study among 65 adolescent elite-level athletes (38 females and 27 males) from aesthetic sports (e.g., gymnastics, figure skating, ballet). The authors initially recruited 97 participants but could only collect follow-up data on 65 athletes; fortunately, they found no baseline differences between the athletes lost to follow-up and those who completed the study. Athletes completed, at baseline and 12-month follow-up, several surveys to screen for disordered eating, assessment of emotional distress from missing exercise sessions, sports-related body dissatisfaction, assumption that dieting enhances performance, and social pressure from the sports environment. Age, sex, and body mass index did not predict changes in disordered eating scores. A change in the desire to be leaner to improve sports performance was associated with changes in disordered eating. Furthermore, the desire to be leaner to improve sports performance at baseline was predictive of disordered eating and not vice versa.

This study provides support for previous cross-sectional studies that found that dieting behaviors are related to perceived performance benefits of being leaner more so than sports-related body dissatisfaction. The authors acknowledge that many more longitudinal studies will be needed to gain a better understanding of disordered eating among athletes; including longer studies, larger cohorts, and studies of other sports (e.g., team sports). Even with the need for further research we need to be aware that athletes in aesthetic sports are at greater risk for disordered eating if they believe that weight loss can enhance their performance. It is important for clinicians, coaches, and parents to keep this possible risk factor in mind when discussing performance enhancement with our elite aesthetic athletes; and until we know more we should probably be conservative with this issue for all our athletes. As sports medicine clinicians we should help educate our coaches and parents about being sensitive to disordered eating among males and females. Furthermore, we should have conversations with parents or coaches that suggest an athlete may benefit from losing weight. Eating disorders represent a challenging area when working with young athletes and we should strive to provide an environment that minimizes the risk for disordered eating and helps athletes that we suspect have an eating disorder. Pushing the issue to the back burner is not helping our patients. What are your experiences with athletes wanting to be leaner to improve performance?

Written by: Jeffrey B. Driban
Reviewed by: Stephen Thomas

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