Disordered eating in female physique athletes

Jacqueline Whitehead

doi:10.25907/00337

Despite a significant increase in participation rates of physique sports in recent years, little is known about the modern day female physique athlete. The extreme physique traits of successful female physique athletes suggest this population may be particularly at risk of developing negative body image perceptions and disordered eating (DE) practices, the implications of which include reduced metabolic rate, impaired menstrual function and bone health, reduced immunological response, impaired protein metabolism and compromised cardiovascular and psychological health. The aim of this research was to determine if female physique athletes were at risk of DE and explore possible associated risk factors. It was hypothesized that there would be a high prevalence of athletes at risk of DE. Adult (≥18yrs) female physique athletes (n=348) were recruited from Australian and International bodybuilding federations, as well as through personal trainers and bodybuilding coaches using snowballing techniques. Athletes competing in either bikini, fitness, figure, and/or bodybuilding divisions of drug tested physique sport federations were eligible. Athletes without competition experience were excluded. Eligible participants completed an online survey based on validated questionnaires, including the Drive for Thinness, Body Dissatisfaction, and Bulimia subscales of the Eating Disordered Inventory (EDI), Pathogenic Weight Control Measures (PWCM), and the Cognitive Restraint subscale of the Three-Factor Eating Questionnaire (TFEQ-CDR). Additional demographic information was collected, including self-reported stature and body mass, competitive physique sport experience, level of success, when they last competed and when they intend to compete again in physique competition, amount of weight lost leading up to competition, current physique training goals, and sources of nutritional information. Disordered eating was categorized as clinical disordered eating (EDI-DT ≥15, EDI-BD ≥14, EDI-B ≥5) or subclinical disordered eating (EDI-DT ≥7, EDI-BD ≥9). A TFEQ-CDR score ≥9 indicated subclinical disordered eating, however approximately half of participants (48.9%) scored above the cut off-value for TFEQ-CDR, inferring dietary restraint is likely to be integral to the sport. Therefore the prevalence rate of DE was calculated factoring only the subclinical and clinical cut-offs for the EDI subscales. In the current study a weight loss of ≥10kg in the past 6 months and exercising for ≥60 minutes per day to lose or control weight were considered to be likely necessary to achieve the extreme physique traits of athletes competing in this sport. Consequently, only binge eating, self-induced vomiting, and laxative use were considered as the most concerning PWCM. Approximately half of the participants were identified with DE (46.6%), with 27.3% having clinical DE and 19.3% having subclinical DE. Furthermore, approximately half (48.9%) of participants engaged in at least one of the most concerning PWCM (binge eating, laxative use, and self-induced vomiting) within the past three months, with a smaller proportion (5.2%) of athletes engaging in all three PWCM. Weak but significant correlations were found between some EDI subscales and reason for sport participation, BMI and body composition goals. Drive for thinness and body dissatisfaction were positively associated with PWCM use. The most frequently reported source of dietary information was from coaches (87.1%), with a trend for higher prevalence of binge eating behavior in these participants. To our knowledge this is the only study that has investigated a large sample of female physique athletes across multiple divisions. The incidence of females competing in physique competitions are increasing and the sport may not only attract individuals with low self-esteem and body image, but also those who have an underlying predisposition to developing an eating disorder. Indeed, a high proportion of female physique athletes were identified with disordered eating, with a minority of athletes engaging in harmful PWCM. Given this, education programs targeting federations, coaches and physique athletes should focus on the identification, prevention and management of DE, and encourage the support of multidisciplinary teams (i.e. sports physicians, registered dietitians, psychologists, qualified strength and conditioning coaches) in the management of physique athletes. The use of the Relative Energy Deficiency in Sport (RED-S) Clinical Assessment Tool can help identify athletes with RED-S for targeted treatment.

Disordered eating in female physique athletes

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