Prevalence of risk behaviors for eating disorders in athletes: A systematic review
Abstract
Introduction: The competitive sports environment requires a lot of discipline and requires ruled routines to achieve better results, which can generate demands and stress. It is believed that this environment may favor the development of eating disorders (ED’s). The aim of this study was to investigate the prevalence of risk behaviors for eating disorders (RBED’s) in athletes. Materials and Methods: Systematic review carried out in the PubMed, Lillacs and SciELO databases, for articles published in the last five years, in Portuguese and English. For search, the terms used were "Anorexia", “Athletes", "Bulimia", "Exercise", "Feeding and Eating Disorders" and "Sports". Results: A total of 2101 studies were found and, after applying the eligibility criteria, 30 studies were included. A total of 7820 people were included. In this review, 80% of the studies identified the presence of RBED’s. Regarding body image, dissatisfaction ranged from 3.8% to 87%. It was found that the most studied disorder was bulimia, followed by anorexia, binge eating disorder and orthorexia. The Eating Attitudes Test-26 was the most used questionnaire (40%). The most studied sports were running (25%), football (20.8%), ballet (16.7%) and bodybuilding (12.5%). The prevalence of RBED’s in women was 23.5%, and 18.7% in men. The average age of study participants (n=18) was 25.2 years. Conclusion: Athletes appear to be vulnerable to the development of EDs, which can affect any sport, gender and age. The EAT-26 was the most used instrument for the identification of RBED's. Research on this topic helps to clarify this problem, to prevent risks and treat them early.
References
-Anderson, L.M.; Reilly, E.E.; Gorrell, S.; Anderson, D.A. Running to win or to be thin? An evaluation of body dissatisfaction and eating disorder symptoms among adult runners. Body Image. Vol. 43. Num. 17. 2016. p. 43-47.
-Arcelus, J.; Witcomb, G.L.; Mitchell, A. Prevalence of Eating Disorders amongst Dancers: A Systemic Review and Meta‐Analysis. European Eating Disorders Review. Vol. 22. Num. 2. 2013. p. 92-101.
-Assal, S.; Fernandes, D.C. Imagem corporal e comportamentos de risco para transtornos alimentares em praticantes de exercícios e atletas: evidências científicas. Revista EVS - Revista de Ciências Ambientais e Saúde. Vol. 41. Num. 1. 2014. p. 31-41.
-Azevedo, A.P.; Santos, C.C.; Fonseca, D.C. Transtorno da compulsão alimentar periódica. Rev. psiquiatr. clín. Vol. 31. Num. 4. 2004. p.170-172.
-Baum, A. Eating disorders in the male athlete. Sports Medicine. Vol. 36, Num. 1. 2006. p. 1-6.
-Baldó, V.D.; Bonfanti, N. Eating disorders risk assessment on semi-professional male team sports players. Nutr Hosp. Vol. 36, Num. 5. 2019. p. 1171-1178.
-Bert, F.; Gualano, M.R.; Voglino, G.; Rossello, P.; PerretI, J. P.; Siliquini, R. Orthorexia Nervosa: A cross-sectional study among athletes competing in endurance sports in Northern Italy. PLoS ONE. Vol. 14. Num. 8. 2019. p. 1-12.
-Bighetti, F.A.; e colaboradores. Tradução e avaliação do Eating Attitudes Test em adolescentes do sexo feminino de Ribeirão Preto. São Paulo. J Bras Psiquiatr. Vol. 53, Num. 6. 2004. p. 339-46.
-Bonci, C.M.; Bonci, L.J.; Granger, L.R.; Johnson, C.L.; Malina, R.M.; Milne, L.W.; Ryan, R.R.; Vanderbunt, E.M. National athletic trainers’ association position statement: preventing, detecting, and managing disordered eating in athletes. Journal of Athletic Training. Vol. 43. Num.1. 2008. p. 80-108.
-Castro, C.B.; Magajewski, F.; Lin, J. Atitudes alimentares e autopercepção da imagem corporal em bailarinas do município de Tubarão-Santa Catarina. Arquivos Catarinenses de Medicina. Vol. 46. Num. 1. 2017. p. 33-42.
-Castro, V.H.A.P.; Catib, N.O.M. Corpo e beleza: como anda a saúde na busca pela perfeição estética. Revista Eletrônica de Educação e Ciência. Vol. 4. Num. 1. 2014. p. 37-42
-Carrigan, K.W.; Petrie, T. A.; Anderson, C. M. To Weigh or Not to Weigh? Relation to Disordered Eating Attitudes and Behaviors Among Female Collegiate Athletes. Journal of Sport & Exercise Psychology. Vol. 37. Num. 6. 2015. p. 659- 665.
-Chatterton, J.; Petrie, T.A.; Schuler, K.L.; Ruggero, C. Bulimic Symptomatology Among Male Collegiate Athletes: A Test of an Etiological Model. Journal of Sport & Exercise Psychology. Vol. 39. Num. 5. 2017. p. 313-326.
-Compte, E.J.; Murray, S.B.; Sepúlveda, A.R.; Schweiger, S.; Bressan, M.; Torrente, F. What position do you play? Eating disorder pathology among rugby players, and the understudied role of player position. Int J Eat Disord. Vol. 51. Num. 8. 2018. p.1015-1019.
-Cooper, P.J. The development and validation of the body shape questionnaire. Int J Eat Dis. Vol. 6. Num. 4. 1987. p. 485-94.
-Costa, G.M.S. Transtornos alimentares e percepção da imagem corporal em culturistas do Interior do Estado de São Paulo. Rev. Augustus. Vol. 22. Num. 43. 2017. p.172-181.
-Devrim, A.; Bilgic, P.; Hongu, N. Is There Any Relationship Between Body Image Perception, Eating Disorders, and Muscle Dysmorphic Disorders in Male Bodybuilders? American Journal of Men’s Health. Vol. 12. Num. 5. 2018. p. 1746-1758.
-Di Lodovico, L.; Dubertret, C.; Ameller, A. Vulnerability to exercise addiction, socio-demographic, behavioral and psychological characteristics of runners at risk for eating disorders. Comprehensive Psychiatry. Vol. 81. 2018. p. 48-52.
-Fairburn, C.G.; Beglin, S.J. Assessment of eating disorder: interview or self-report questionnaire? Int J Eat Dis. Vol. 16. Num. 4. 1994. p. 363-70.
-Fortes, L.S.; Paes, S.T.; Ribeiro, J.D.B.; Almeida, S.S.; Ferreira, M.E.C. Busca pela muscularidade, humor e transtornos alimentares em atletas do sexo masculino. Rev Bras Med Esporte. Vol. 23. Num. 1. 2017. p. 37-41.
-Fortes, L.S.; Almeida, S.S.; Ferreira, M.E.C. Psychometric analysis of disordered eating in sports (DES). Paidéia. Vol. 26. Num. 64. 2016. p. 171- 180.
-Fortes, L. S.; Lira, H.A.A.S.; Carvalho, P.H.B.; Ferreira, M.E.C.; Almeida, S.S. What is more strongly related to disordered eating in male surfers, body fat or muscularity? Motriz. Vol. 23. Num. 2. 2017. p. 1-5.
-Fortes, L.S.; Ferreira, M.E.C. Comparação da insatisfação corporal e do comportamento alimentar inadequado em atletas adolescentes de diferentes modalidades esportivas. Rev. bras. educ. fís. esporte. Vol. 25. Num. 4. 2011. p. 707-716.
-Freitas, S.; Gorenstein, C.; Appolinario, J.C. Assessment instruments for eating disorders. Rev Bras Psiquiatr. Vol. 24. Num. 3. 2002. p. 34-8.
-Gallagher, K.A.; Sonneville, K.R.; Hazzard, V.M.; Carson, T.L.; Needham, B.L. Evaluating gender bias in an eating disorder risk assessment questionnaire for athletes. Eat Disord. Vol. 29. Num. 1. 2019. p. 29-41.
-Garner, D.M.; Garfinkel, P.E. The eating attitudes test: an index of the symptoms of anorexia nervosa. Psychol Med. Vol. 9. Num. 2. 1979. p. 273-9.
-Garner, D.M.; Olmsted, M.P.; Polivy, J. Development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia. Int J Eat Dis. Vol.2. Num. 2. 1983. p.14-34.
-Gibson, C. Body image amongst elite rugby union players. J Strength Cond Res. Vol. 33. Num. 8. 2019. p. 2217-2222.
-Gomes, G.H.A.R.; Silva, N.M.D. Transtornos alimentares em praticantes de exercício físico: revisão sistemática. TCC. Centro Universitário Tiradentes. Curso de Graduação em Nutrição. 2020.
-Higgns, J.; Grren, S. Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0. The Cochrane Collaboration. 2011.
-Holm-Denoma, J.M.; Scaringi, V.; Gordon, K.H.; Van Orden, K.A.; Joiner, T.E.J. Eating disorder symptoms among undergraduate V arsity athletes, club athletes, independent exercisers, and non-exercisers. International Journal of Eating Disorders. Vol. 42. Num. 1. 2009. p. 47-53.
-Homan, K.J.; Crowley, S.L.; Sim, L. A. Motivation for sport participation and eating disorder risk among female collegiate athletes. Eating Disorders. Vol. 27. Num. 4. 2019. p. 369-383.
-Jáuregui, L. I.; Bolaños-Ríos, P.; Valero-Blanco, E.; Ortega-de-la-Torre, Á. Eating attitudes, body image and risk for eating disorders in a group of Spanish dancers. Nutr Hosp. Vol. 33. Num. 5. 2016. p.1213-1221.
-Kampouri, D. Prevalence of disordered eating in elite female athletes in team sports in Greece. European Journal of Sport Science. Vol. 19. Num. 9. 2019. p. 1267-1275.
-Krentz, E.M.; Warschburger, P. Sports-related correlates of disordered eating in aesthetic sports. Psychology of Sport and Exercise. Vol. 44, Num. 3. 2011. p. 315-21.
-Kristjánsdóttir, H; Sigurðardóttir, P; Jónsdóttir, S; Þorsteinsdóttir, G; Saavedra, J. Body Image Concern and Eating Disorder Symptoms Among Elite Icelandic Athletes. Int. J. Environ. Res. Public Health. Vol. 16. Num. 15. 2019. p. 2728.
-Leal, G.V.S.; Philippi, S.T.; Polacow, V.O.; Cordás, T.A.; Alvarenga, M.S. O que é comportamento de risco para transtornos alimentares em adolescentes?. Jornal Brasileiro de Psiquiatria. Vol. 62. Num. 1. 2013. p. 62-75.
-Lepage, M. L.; Crowther, J. H. The effects of exercise on body satisfaction and affect. Body Image. Vol. 7. Num. 1. 2010. p. 124-130.
-Levit, M.; Weinstein, A.; Weinstein, Y.; Tzur-Bitan, D.; Weinstein, A. A study on the relationship between exercise addiction, abnormal eating attitudes, anxiety and depression among athletes in Israel. Journal of Behavioral Addictions. Vol. 7. Num. 3. 2018. p. 800-805.
-Lira, H.A.; e colaboradores. O estado de humor e a insatisfação corporal possuem relação com os comportamentos de risco para transtornos alimentares em atletas de esportes coletivos do sexo masculino? R.bras. Ci. e Mov. Vol. 25. Num. 3. 2017. p. 82-89.
-Manarin, G. C.; Oliveira, D. C. X.; Christofaro, D. G. D.; Fernandes, R. A. Associação entre a Insatisfação Corporal e o Estado Nutricional em Jovens ginastas. Colloquium Vitae. Vol. 3. Num. 2. 2011. p. 9-14.
-Martins, M.C.T.; Alvarenga, M.S.; Vargas, S.V.A.; Sato, K.S.C.J.; Scagliusi, F.B. Ortorexia nervosa: reflexões sobre um novo conceito. Rev. Nutr. Vol. 24. Num. 2. 2011. p. 345-357.
-Milligan, B.; Pritchard, M. The relationship between gender, type of sport, body dissatisfaction, self-esteem and disordered eating behaviors in division I athletes. The Online Journal of Sport Psychology. Vol. 8. 2006. p. 32-46.
-Mitchell, L.; Murray, S.B; Hoon, M.; Hackett, D.; Prvan, T.; O'Connor, H. Correlates of muscle dysmorphia symptomatology in natural bodybuilders: Distinguishing factors in the pursuit of hyper-muscularity. Body Image. Vol. 22. 2017. p. 1-5.
-Nishimura, L.M.M. Fatores associados ao risco para transtornos alimentares em corredores de média e longa distância. Dissertação Mestrado. Faculdade de Ciências Farmacêuticas da USP. 2016.
-Neto, J.J.; Pastre, C.M.; Monteiro, H.L. Alterações posturais em atletas brasileiros do sexo masculino que participaram de provas de potência muscular em competições internacionais. Rev Bras Med Esporte. Vol. 10. Num. 3. 2004. p. 195-198.
-Neves, C.M. Body dissatisfaction in women’s artistic gymnastics: A longitudinal study of psychosocial indicators. Journal of Sports Sciences. Vol. 35. Num. 17. 2017. p. 1745-1751
-Neves, C.M.; Meireles, J.F.F.; Carvalho, P.H.B.; Ferreira, M.E.C. Insatisfação corporal e comportamento alimentar em atletas de esportes estéticos: uma revisão. Pensar a Prática. Vol. 18. Num. 4. 2015. p. 922-936.
-Perini, T.A.; Vieira, R.S.; Vigário, P.S.; Oliveira, G.L.; Ornellas, J.S.; Oliveira, F.P. Transtorno do comportamento alimentar em atletas de elite de nado sincronizado. Rev Bras Med Esporte. Vol. 15. 2009. Num. 1. p. 54-57.
-Petisco, R.C.; Sánchez, S.L.C.; Fernández, G.R.; Sánchez, S.J.; García, M.J.M. Disordered Eating Attitudes, Anxiety, Self-Esteem and Perfectionism in Young Athletes and Non-Athletes. International journal of environmental research and public health. Vol. 17. Num. 18. 2020. p. 6754.
-Piacentino, D.; Kotzalidis, G.D.; Longo, L.; Pavan, A.; Stivali, L.; Stivali, G.; Ferracuti, S.; Brugnoli, R.; Frati, P.; Fineschi, V.; Girardi, P.; Sani, G. Body Image and Eating Disorders are Common among Professional and Amateur Athletes Using Performance and Image Enhancing Drugs: A Cross-Sectional Study. J Psychoactive Drugs. Vol. 49. Num. 5. 2017. p. 373-384.
-Pinto, A.J.; Dolan, E.; Baldissera, G.; Gonçalves, L.S.; Jardim, F.G.A.; Mazzolani, B.C.; Smaira, F.I.; Sato, P.M.; Scagliusi, F.B.; Gualano, B. "Despite being an athlete, I am also a humanbeing": Male elite gymnasts’ reflections on food and body image. Eur J Sport Sci. Vol. 20. Num. 7. 2017. p. 964-972
-Plateau, C. R.; Arcelus, J.; Meyer, C. Detecting Eating Psychopathology in Female Athletes by Asking About Exercise: Use of the Compulsive Exercise Test. Eur. Eat. Disorders Rev. Vol. 25. Num. 6. 2017. p. 618-624.
-Plessow, F.; Singhal, V.; Toth, A.T.; Micali, N.; Eddy, K.T.; Misra, M. Estrogen administration improves the trajectory of eating disorder pathology in oligo- amenorrheic athletes: A randomized controlled trial. Psychoneuroendocrinology. Vol. 102. 2019. p. 273-280.
-Pope, Z.; Gao, Y.; Bolter, N.; Pritchard, M. Validity and reliability of eating disorder assessments used with athletes: A review. Journal of Sport and Health Science. Vol. 4. Num. 3. 2015. p. 211-221.
-Rodríguez, M.A.; Salar, V.N.; Carretero, M.C.; Gimeno, C.E.; Collado, E.R. Eating disorders and diet management in contact sports; eat-26 questionnaire does not seem appropriate to evaluate eating disorders in sports. Nutr Sport. Vol. 32. Num. 4. 2015. p. 1708-14.
-Sattler, F. A.; Eickmeyer; S.; Eisenkolb, J. Body image disturbance in children and adolescents with anorexia nervosa and bulimia nervosa: a systematic review. Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity. Vol. 25. Num. 4. 2019. p. 857-865.
-Scott, C. L.; Plateau, C. R.; Haycraft, E. Teammate influences, psychological well- being, and athletes’ eating and exercise psychopathology: A moderated mediation analysis. Int J Eat Disord. Vol. 53. Num. 4. 2020. p. 564-573.
-Silva, J. S.; Baratto, I. Análise da percepção, satisfação corporal e conhecimento nutricional entre mulheres praticantes de atividade física. Revista Brasileira de Nutrição Esportiva. São Paulo. Vol. 8. Num. 46. 2014. p. 6.
-Silvestre, V.H.; Motta, L.M. Transtornos alimentares em fisiculturistas submetidos a dietas restritivas. Revista Augustus. Vol. 19. Num. 38. 2015.
-Simas, J.P.N.; Macara, A.; Melo, S.I.L. Eating disorders and associated factors in professional classical ballet dancers in Brazil. O Mundo da Saúde. Vol. 43. Num. 2. 2019. p. 472-493.
-Shamseer, L.; Moher, D.; Clarke, M.; Ghersi, D.; Liberati, A.; Petticrew, M.; Shekelle, P.; Stewart, L.A. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst. Rev. Vol. 4. Num. 1. 2015. p. 1-9.
-Shriver, L.H.; Wollenberg, G.; Gates, G.E. Prevalence of Disordered Eating and Its Association with Emotion Regulation in Female College Athletes. International Journal of Sport Nutrition and Exercise Metabolism. Vol. 26. Num. 3. 2016. p. 240-248
-Smith, M.C.; Thelen, M.H. Development and validation of a test for bulimia nervosa. J Consult Clin Psychol. Vol. 52. Num. 2. 1984. p. 863-72.
-Staal, S.; Sjödin, A.; Fahrenholtz, I.; Bonnesen, K.; Melin, A.K. Low RMRratio as a Surrogate Marker for Energy Deficiency, the Choice of Predictive Equation Vital for Correctly Identifying Male and Female Ballet Dancers at Risk. International Journal of Sport Nutrition and Exercise Metabolism. Vol. 28. Num. 4. 2018. p.412- 418. 2018.
-Stoyel, H.; Shanmuganathan, F.V.; Meyer, C.; Serpell, L. Psychological risk indicators of disordered eating in athletes. PLoS ONE. Vol. 15. Num. 5. 2020. p. 1-20.
-Turton, R.; Meyer, C.; Goodwin, H. Athletic identity, compulsive exercise and eating psychopathology in long-distance runners. Eat Behav. Vol. 26. 2017. p. 29-132.
-Weinberg, R.; Gould, D. Fundamentos da Psicologia do Esporte e Exercício. 6ª edição. Porto Alegre. Artmed. 2017.
-Whitehead, J.; Slater, G.; Wright, H.; Martin, L.; O'Connor, H.; Mitchell, L. Disordered eating behaviors in female physique athletes. European Journal of Sport Science. Vol. 20. Num. 9. 2020. p. 1206-1214.
Copyright (c) 2024 Rafaela Mendoça Fontella, Ana Letícia Vargas Barcelos, Karina Sanches Machado d'Almeida
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors who publish in this journal agree to the following terms:
- Authors retain the copyright and grant the journal the right of first publication, with work simultaneously licensed under the Creative Commons Attribution License BY-NC which allows the sharing of the work with acknowledgment of the authorship of the work and initial publication in this journal.
- Authors are authorized to enter into additional contracts separately for non-exclusive distribution of the version of the work published in this journal (eg, publishing in institutional repository or book chapter), with acknowledgment of authorship and initial publication in this journal.
- Authors are allowed and encouraged to post and distribute their work online (eg, in institutional repositories or on their personal page) at any point before or during the editorial process, as this can bring about productive change as well as increase impact and impact. citation of published work (See The Effect of Free Access).
