Self-esteem, body image, internalization, and disordered eating among female athletes

Sears LA, Tracy KR, McBrier NM. Athletic Training & Sports Health Care 2011; 4(1): 29-37.

Young female athletes are exposed to sociocultural pressures and sometimes other sports-specific pressures to maintain a low body weight to enhance performance. The majority of research involving disordered eating has involved female college athletes attending NCAA Division I schools. Despite the larger number of females in NCAA Division III schools, few studies have evaluated disordered eating in this population. Therefore, Sears et al evaluated whether self-esteem, body image, and internalization of cultural ideals predicts risky eating behaviors in female athletes attending NCAA Division III schools. The authors focused on female athletes (18 to 23 years of age) participating in individual sports (e.g., diving, golf, gymnastics, swimming) at 111 NCAA Division III schools in the United States Midwest.  Approximately, 6,685 athletes were estimated to be eligible. Athletes could complete the online survey anonymously. The survey included questions regarding demographics, nature and extent of athletic involvement, eating-related behaviors, exercise-related behaviors, and attitudes concerning body image and weight-related issues. The survey also included the Questionnaire for Eating Disorders Diagnoses (assesses risky eating behaviors), Rosenberg Self-Esteem Scale (assesses self-esteem), Multidimensional Body-Self Relations Questionnaire (assesses body image), and Sociocultural Attitude Towards Appearance Scale-3 (assesses sociocultural influences on body image by measuring internalization of cultural ideals). 423 athletes completed the surveys (~6.32% response rate; 94% Caucasian). Twenty-five (5.9%) athletes had a current or previously diagnosed eating disorder and were excluded from the analyses since the goal was to determine factors related to subclinical risky eating behavior. Among the remaining 398 athletes, 117 (29%) athletes had no eating disorder symptoms and 281 (71%) athletes had some eating disorder behaviors according to the Questionnaire for Eating Disorders Diagnoses. Body image was different between those with some eating disorder symptoms compared to those without symptoms. Furthermore, additional analyses suggested that body image may be a key variable in differentiating those with and without risky eating behaviors. Self-esteem and internalization were not associated with the presence of eating disorder symptoms.

This is an interesting study that suggests that over 25% of NCAA Division III female athletes may have some eating disorder behaviors and therefore may be at risk for developing eating disorders. The authors acknowledge that the response rate was low and it is important to note that it is unclear how the low response might impact the estimate of female athletes at risk for eat disorders. Regardless, the large number of potential at-risk athletes is enough to warrant more attention by clinicians and researchers. The study also found that female athletes with some eating disorder behaviors reported a negative body image. The authors recommend that adding questions regarding body image to preparticipation screening may help identify risky eating behaviors. An early detection of risky eating behaviors may help us prevent or reduce the long-term impact of the female athlete triad (disordered eating, amenorrhea, osteoporosis). It will be interesting to see future studies assess how well questions about body image can detect athletes with risky eating behaviors and how these outcomes compare across level of competition. Have you done screening or interventions to address body image concerns among the athletes?  Do you think this could be an issue among team sports as well as male athletes?

Written by: Jeffrey Driban
Reviewed by:  Stephen Thomas

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Sears, L., Tracy, K., & McBrier, N. (2012). Self-Esteem, Body Image, Internalization, and Disordered Eating Among Female Athletes Athletic Training & Sports Health Care, 4 (1), 29-37 DOI: 10.3928/19425864-20110331-02