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Background: The high frequency of eating disorders (EDs) in sports speaks of a need for early-stage preventive measures., Objectives: This study evaluated the acceptability of an age, sex, and sports adapted version of the "Body Project" and changes in mental health symptoms., Methods: This noncontrolled pilot study included a class of athletes from 18 sports (N = 73, 13-14 years) at a sport-specialized junior high school in six small-group workshops. We interviewed 34 athletes on program acceptability, and all athletes responded to questionnaires at pretest, posttest, and 6-month follow-up including the Body Appreciation Scale 2-Children, Social Attitudes towards Appearance Questionnaire-4 revised, Eating Disorder Examination Questionnaire Short form-12 modified, and questions about body appearance pressure (BAP)., Results: Athletes found the program acceptable and beneficial, but some missed physically oriented activities or did not identify with the focus, particularly boys. There were acceptable levels in mental health constructs before the workshops. There were temporary changes in the percentage of boys experiencing "BAP in society" by -14.8% points (95% CI: -.6 to .0, p = .04), % in total group experiencing "BAP at school" by +11% points (95% CI: .0-.2, p = .05), thinness idealization by girls (g = .6, p = .002) and total group (g = .4, p = .006), and muscularity idealization by boys (g = .3, p = .05) and total group (g = .23, p = .04)., Discussion: Athletes experienced benefits from the Young Athlete Body Project. Seeing stabilization in outcomes may mean a dampening of the otherwise expected worsening in body appreciation and ED symptoms over time., Public Significance: Adolescent athletes are at risk for developing EDs. Due to lack of prevention programs for this group, we adapted and evaluated a well-documented effective program, the Body Project, to fit male and female athletes <15 years. The athletes accepted the program and experienced participation benefits, with stronger acceptance among girls. Our promising findings encourage larger scaled randomized controlled trials to further evaluate a refined version this program among very young athletes., (© 2024 The Authors. International Journal of Eating Disorders published by Wiley Periodicals LLC.)

Overall athlete health is a stated priority by the International Olympic Committee (IOC), yet it can be difficult for athletes to safely balance nutritional needs, training load, recovery, social interactions, expectations and other demands. The effect of energy intake and, especially, low energy availability (LEA) on athlete mental health, is understudied. In this narrative review, we examine research that has included psychological factors and mental health variables when investigating the effect of LEA, dieting/restrictive eating and Relative Energy Deficiency in Sport (REDs), since the 2018 IOC consensus statement on REDs. Based on currently available data, early psychological indicators associated with problematic LEA are mood changes, fatigue and psychological conflict. More severe mental health outcomes associated with REDs are reduced well-being, elevated anxiety, depressive symptoms and eating disorders. We propose a psychological model that helps structure how possible risk factors (eg, body dissatisfaction, environmental demands or increased training load) and moderating (eg, gender, sport) and/or potential mediating (eg, social climate, self-esteem) factors are associated with LEA and ultimately REDs. The current scientific literature underscores the importance of including mental health factors when screening for REDs and for developing a clinical approach to address the psychological sequelae of REDs once diagnosed. An interdisciplinary perspective is recommended. Lastly, and importantly, the athlete perspective urges clinicians to not underestimate the drive for success and denial of health consequences that athletes demonstrate when pursuing their sport goals., Competing Interests: Competing interests: MM is a deputy editor of the BJSM and a member of the BJSM IPHP Editorial Board., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Disordered eating (DE) behaviors are relatively common among high-level dancers, especially in classical ballet. At the same time, interventions aimed at reducing DE behaviors in this population are scarce., Methods: An 8-week exploratory preventive intervention for DE behaviors was carried out in a high-level ballet school for 40 teenagers aged 12-15 years (77.5% female). Both risk factors (perfectionism) and potentially protective factors (self-esteem, self-compassion) for the development of DE behaviors were considered. The intervention was created specifically for this study and consisted of five cognitive behavior therapy (CBT) workshops and four nutrition workshops. Additional components included newsletters for pupils and educational sessions and social media interactions with staff and parents. The intervention comprised two phases (control and intervention periods), with students acting as their own controls. Standardized questionnaires were completed before and after both phases., Results: Questionnaire results did not indicate any changes in reported perfectionism, self-esteem, or self-compassion, nor were symptoms of DE affected during either the control or intervention periods., Conclusions: The intervention did not yield any discernible impact. However, it was affected by the onset of the COVID-19 pandemic, which limits our ability to draw conclusions about intervention effectiveness. Evaluations with pupils offer several considerations for future improvements.

Accumulating evidence suggests that supervised and adapted physical activity provides cognitive benefits for individuals with eating disorders (EDs). The mechanisms underlying the benefits of physical activity are poorly understood. Addressing this knowledge gap may inform the appropriate integration of structured physical activity into eating disorders treatment and recovery. We draw attention to recent findings in the study of the impact of physical activity on the brain, and we describe the neurostructural and neurocognitive changes associated with physical activity observed in various clinical and nonclinical populations. Considering the identified impairment in brain volume- and/or neurocognitive function in various EDs, we propose that positive effects of physical activity may play a meaningful role in successful ED treatment. Accordingly, we outline research steps for closing the knowledge gap on how physical activity may aid in ED recovery, and emphasize the need to combine measures of cognitive and behavioral responses to physical activity, with technology capable of measuring changes in brain structure and/or function., (© 2021 The Authors. International Journal of Eating Disorders published by Wiley Periodicals LLC.)

Purpose : Eating disorders (ED) are complex and severe illnesses where evidence-based treatment is needed to recover. However, about half of the patients with ED do not respond to treatments currently available, which call for efforts to expand the portfolio of treatments. The aim of this study was to explore experiences from patients who dropped out of a new treatment for bulimia nervosa and binge ED, combining p hysical e xercise and d ietary t herapy (PED-t). Methods : We conducted open-ended face-to-face interviews. The interviews were transcribed verbatim and the data were analysed with a phenomenological hermeneutical approach. Results : Three themes emerged: "standing on the outside", "unmet expectations" and "participation not a waste of time". Feelings of standing on the outside were elicited by being different from other group members and having challenges with sharing thoughts. Unmet expectations were related to treatment content and intensity, as well as the development of unhealthy thoughts and behaviours. Finally, some positive experiences were voiced. Conclusion : A need to clarify pre-treatment expectations and refining criteria for treatment suitability is indicated. The findings have contributed to the chain of clinical evidence regarding the PED-t and may lead to treatment modifications improving the treatment and thereby reducing drop out.

Background: Body dissatisfaction and disordered eating raise the risk for eating disorders. In the prevention of eating disorders, many programmes have proved partly successful in using cognitive techniques to combat such risk factors. However, specific strategies to actively promote a positive body image are rarely used. The present paper outlines a protocol for a programme integrating the promotion of a positive body image and the prevention of disordered eating., Methods and Design: Using a cluster randomized controlled mixed methods design, 30 high schools and 2481 12th grade students were allocated to the Healthy Body Image programme or to a control condition. The intervention comprised three workshops, each of 90 min with the main themes body image, media literacy, and lifestyle. The intervention was interactive in nature, and were led by trained scientists. The outcome measures include standardized instruments administered pre-post intervention, and at 3 and 12 months follow-ups, respectively. Survey data cover feasibility and implementation issues. Qualitative interviews covers experiential data about students' benefits and satisfaction with the programme., Discussion: The present study is one of the first in the body image and disordered eating literature that integrates a health promotion and a disease prevention approach, as well as integrating standardized outcome measures and experiential findings. Along with mediator and moderator analyses it is expected that the Healthy Body Image programme may prove its efficacy. If so, plans are made with respect to further dissemination as well as communicating the findings to regional and national decision makers in the education and health care services., Trial Registration: The study was registered and released at ClinicalTrials.gov 21th August 2016 with the Clinical Trial.gov ID: PRSNCT02901457 . In addition, the study is approved by the Regional Committee for Medical and Health Research Ethics.

Background and Aims: To enable clinicians to identify the clinical picture and treatment progress and to adjust eating plans according to personal energy needs, it is important to know the patient's correct resting metabolic rate (RMR). Indirect calorimetry (IC) is the preferred method for assessment of RMR, but long duration of measurement increases the load on the patients, and reduces the effectiveness in clinical and scientific settings. Further; not all patients reach a valid RMR according to the suggested best practice protocol, with 5 min of steady state (SS) where respiratory gas volume exchange varies less than 10%. The aim of this study was to evaluate the possibility for an abbreviated RMR protocol and SS criterion., Methods: Forty two women diagnosed with bulimia nervosa or binge eating disorder (eating disorder group, ED), originally recruited for an outpatient treatment study, and 26 age and gender matched healthy controls (HC) were studied during a single, prolonged IC measurement. Participants rested for 10 min in supine position wearing a two-way breathing facemask, before a continuous measurement period of 20 min. Results from a standard 5 min SS criterion was compared to an abbreviated 3 min SS criterion. Both SS-criteria were evaluated through three different SS protocols (<10% variation in respiratory gas exchange), being: 1) measurement during the first 3 or 5 min, 2) measurement after discarding the first 5 min, and 3) the lowest identified RMR during the 20 min of measurement., Results: About 50% of the participants reached an early SS in both the defined SS minute criteria. Participants reaching a valid SS throughout the 20 min of measurement increased from ∼90% to 100% with an abbreviated 3 min SS. With a 5 min SS criterion, the median (range) RMR for the 3 protocols were 1639.9 (1239.2), 1508.8 (1457.6) and 1500.6 (1328.8) respectively for the ED group, and 1702.2 (1239.4), 1608.4 (1076.4) and 1594.8 (1029.2) respectively for the HC group, (p > 0.05 for all between-group analysis). With a 3 min SS criterion, the median (range) RMR were 1533.6 (1298.2), 1461.2 (1406.1), and 1395.8 (1447.3) respectively for the ED group and 1681.7 (1332.4), 1613.7 (1266.0) and 1523.1 (1050.3), respectively for the HC group, (p > 0.05 for all between-group analysis). Lowest measured RMR was different compared to the other two SS protocols in both the ED- and the HC group, and for both the 5 min- and the 3 min SS criteria, respectively (p < 0.04). Furthermore, a SS of 3 min resulted in lower RMR compared to 5 min SS (p < 0.00) and an increased number of participants classified as hypo-metabolic (RMRmeasured/RMRcalculated < 0.9)., Conclusions: An abbreviated measurement protocol to identify the lowest RMR using IC was not successful. Abbreviating the SS criteria from 5 to 3 min, resulted in a lower RMR, hence encouraging further examination of the validity of shorter SS criterion than practiced today. Registered in Clinical Trials by id-number NCT02079935, and approved by the Norwegian Regional Committee for Medical and Health Research Ethics with id-number 2013/1871. The trial in which control persons were recruited, is approved by the Norwegian Regional Committees for Medical and Health Research Ethics with the id-number 2016/1718, and prospectively registered in Clinical Trials with the id-number NCT03007459., (Copyright © 2017 The Author. Published by Elsevier Ltd.. All rights reserved.)

Objective: To examine group fitness instructors' knowledge and attitudes toward identification and management of disordered eating (DE)., Method: Group fitness instructors representing the three largest fitness center companies in Norway (n = 837, response rate: 57%) completed a questionnaire through Questback (www.questback.com). The questionnaire contained items regarding gender, age, educational background, exercise behavior, and knowledge of recognition and response to DE., Results: Eighty-nine percent of the respondents reported knowledge about symptoms of DE, 29% was classified with adequate DE knowledge skills. Forty-nine percent of the instructors reported current concern about DE among one or more members, 47% reported knowledge about how to recognize and respond to DE, and 37% reported knowledge about their fitness center's guidelines for approaching DE concerns. The level of formal education in sports and exercise, and a history of self-reported eating disorder, but not fitness instructor experience, were explanatory factors for knowledge about DE symptoms. Both exercise specific educational level and instructor experience were explanatory variables for knowledge about recognition of and response to DE concerns., Discussion: Implications of the findings include a need for increased confidence among group fitness instructors regarding how to approach DE concerns, increased awareness of excessive/compulsive exercise as a symptom of DE, and enhanced dissemination of existing guidelines for managing DE concerns among members and/or staff., (© 2014 Wiley Periodicals, Inc.)

Purpose: It has been suggested that programs regarding early identification and prevention of eating disorders (ED) among athletes are unlikely to succeed without their coaches' endorsement and participation. Therefore, we developed a 1-yr intervention aiming to prevent the development of ED among adolescent elite athletes by targeting athletes and their coaches. The separate part of the intervention targeting the coaches was designed to provide knowledge and strategies regarding healthy nutrition, eating behavior, and ED (symptoms, identification, management, and prevention). In this trial, we examined the effect of the educational program on the coaches' knowledge and management index in three content areas (nutrition, weight regulation, and ED). We also examined their subjective evaluation of their ED knowledge., Methods: All Norwegian Elite Sport High Schools were included (intervention group (n = 9) and control group (n = 7)). Seventy-six coaches employed at and coaching first year student athletes at the different schools were followed for three school years (2008-2011). At pretest and posttest (9 months after intervention), they completed a questionnaire regarding nutrition, weight regulation, and ED., Results: Intervention coaches had higher knowledge index scores than control coaches for weight regulation (6.2 ± 1.7 vs. 4.8 ± 1.3, P < 0.001), ED (including recognition and management) (19.3 ± 4.4 vs. 16.5 ± 5.0, P = 0.004), and total knowledge (weight regulation, ED, and nutrition) (35.0 ± 7.2 vs. 31.6 ± 8.0, P = 0.021) at posttest. Moreover, the coaches likelihood of describing knowledge of ED as "somewhat good" or better was seven times higher for intervention than control coaches at posttest (OR = 7.1, 95% CI, 2.2-23.2, P = 0.001)., Conclusion: Intervention coaches had higher index scores on total knowledge, weight regulation, and ED (including recognition and management) than control coaches. The intervention also was successful in producing effects on the coaches' subjective evaluation of their ED knowledge.

Disordered eating behavior (DE) and eating disorders (EDs) are of great concern because of their associations with physical and mental health risks and, in the case of athletes, impaired performance. The syndrome originally known as the Female Athlete Triad, which focused on the interaction of energy availability, reproductive function, and bone health in female athletes, has recently been expanded to recognize that Relative Energy Deficiency in Sport (RED-S) has a broader range of negative effects on body systems with functional impairments in both male and female athletes. Athletes in leanness-demanding sports have an increased risk for RED-S and for developing EDs/DE. Special risk factors in aquatic sports related to weight and body composition management include the wearing of skimpy and tight-fitting bathing suits, and in the case of diving and synchronized swimming, the involvement of subjective judgments of performance. The reported prevalence of DE and EDs in athletic populations, including athletes from aquatic sports, ranges from 18 to 45% in female athletes and from 0 to 28% in male athletes. To prevent EDs, aquatic athletes should practice healthy eating behavior at all periods of development pathway, and coaches and members of the athletes' health care team should be able to recognize early symptoms indicating risk for energy deficiency, DE, and EDs. Coaches and leaders must accept that DE/EDs can be a problem in aquatic disciplines and that openness regarding this challenge is important.

Purpose: The objective of this study is to design and validate a brief questionnaire able to discriminate between female elite athletes with and without an eating disorder (ED)., Methods: In phase I, 221 (89.5%) adolescent athletes participated in a screening including the Eating Disorder Inventory-2 (EDI-2) and questions related to ED. All athletes reporting symptoms associated with ED (n = 96, 94.1%) and a random sample without symptoms (n = 88, 86.3%) attended the ED Examination Interview. On the basis of the screening, we extracted items with good predictive abilities for an ED diagnosis to the Brief ED in Athletes Questionnaire (BEDA-Q) versions 1 and 2. Version 1 consisted of seven items from the EDI-Body dissatisfaction, EDI-Drive for thinness, and questions regarding dieting. In version 2, two items from the EDI-Perfectionism subscale were added. In phase II, external predictive validity of version 1 was tested involving 54 age-matched elite athletes from an external data set. In phase III, predictive ability of posttest assessments was determined among athletes with no ED at pretest (n = 53, 100%). Logistic regression analyses were performed to identify predictors of ED., Results: Version 2 showed higher discriminative accuracy than version 1 in distinguishing athletes with and without an ED with a receiver operating characteristics area of 0.86 (95% confidence interval (CI), 0.78-0.93) compared with 0.83 (95% CI, 0.74-0.92). In phase II, the accuracy of version 1 was 0.77 (95% CI, 0.63-0.91). In predicting new cases, version 2 showed higher diagnostic accuracy than version 1 with a receiver operating characteristic area of 0.73 (98% CI, 0.52-0.93) compared with 0.70 (95% CI, 0.48-0.92)., Conclusion: The BEDA-Q containing nine items reveals good ability to distinguish between female elite athletes with and without an ED. The BEDA-Q's predictive ability should be tested in larger samples.

Purpose: To examine the effect of a 1-yr school-based intervention program to prevent the development of new cases of eating disorders (ED) and symptoms associated with ED among adolescent female and male elite athletes., Methods: All 16 Norwegian Elite Sport High Schools were included (intervention group [n = 9] and control group [n = 7]). In total, 465 (93.8%) first-year student athletes were followed during high school (2008-2011, three school years). The athletes completed the Eating Disorder Inventory 2 and questions related to ED before (pretest), immediately after (posttest 1), and 9 months after the intervention (posttest 2). Clinical interviews (Eating Disorder Examination) were conducted after the pretest (all with symptoms [n = 115, 97%] and a random sample without symptoms [n = 116, 97%]), and at posttest 2, all athletes were interviewed (n = 463, 99.6%)., Results: Among females, there were no new cases of ED in the intervention schools, while 13% at the control schools had developed and fulfilled the DSM-IV criteria for ED not otherwise specified (n = 7) or bulimia nervosa (n = 1), P = 0.001. The risk of reporting symptoms was lower in the intervention than in the control schools at posttest 1 (odds ratio [OR] = 0.45, 95% confidence interval [CI] = 0.23-0.89). This effect was attenuated by posttest 2 (OR = 0.57, 95% CI = 0.29-1.09). The intervention showed a relative risk reduction for current dieting (OR = 0.10, 95% CI = 0.02-0.54) and three or more weight loss attempts (OR = 0.47, 95% CI = 0.25-0.90). Among males, there was one new case of ED at posttest 2 (control school) and no difference in the risk of reporting symptoms between groups at posttest 1 or 2., Conclusion: A 1-yr intervention program can prevent new cases of ED and symptoms associated with ED in adolescent female elite athletes.

A focus on low body weight and body fat content, combined with regulations in some weight-sensitive sports, are considered risk factors for extreme dieting, eating disorders (EDs) and related health consequences among athletes. At present there are, from a health perspective, no generally accepted optimum values for body weight or percentage of fat mass in different sports and there is no 'gold standard' method for body composition assessment in athletes. On the basis of health considerations as well as performance, medical support teams should know how to approach elite athletes who seek to achieve an unrealistic body composition and how to prevent restrictive eating practices from developing into an ED. In addition, these teams must know when to raise the alarm and how to advice athletes who are affected by extreme dieting or clinical EDs. However, there is no consensus on when athletes struggling with extreme dieting or EDs should be referred for specialist medical treatment or removed from competition. Based on the present review, we conclude that there is a need for (1) sport-specific and gender-specific preventive programmes, (2) criteria for raising alarm and 'does not start' (DNS) for athletes with EDs and (3) modifications to the regulations in some sports. Further, the key areas for research identified include the development of standard methods for body composition assessment in elite athletes; screening measures for EDs among athletes; development and testing of prevention programmes; investigating the short and long-term effects of extreme dieting; and EDs on health and performance.

The prevalence of disordered eating and eating disorders vary from 0-19% in male athletes and 6-45% in female athletes. The objective of this paper is to present an overview of eating disorders in adolescent and adult athletes including: (1) prevalence data; (2) suggested sport- and gender-specific risk factors and (3) importance of early detection, management and prevention of eating disorders. Additionally, this paper presents suggestions for future research which includes: (1) the need for knowledge regarding possible gender-specific risk factors and sport- and gender-specific prevention programmes for eating disorders in sports; (2) suggestions for long-term follow-up for female and male athletes with eating disorders and (3) exploration of a possible male athlete triad.

Purpose: The aim of this study was to examine symptoms of eating disorders (ED), drive for muscularity and physical activity in a Norwegian adolescent population., Methods: A total of 722 adolescents aged 12-18 years (response rate: 83%) filled out a questionnaire containing the Drive for Muscularity Scale, Eating Disorders Inventory subscales Drive for Thinness (EDI-DT), Body Dissatisfaction (EDI-BD) and Bulimia (EDI-B), and questions about amount of and motives for physical activity., Results: Eating Disorders Inventory subscale scores were higher, and Drive for Muscularity Scale Score (DMS) scores were lower among girls compared with boys. EDI and DMS were correlated with motives for, but not amount of, physical activity. EDI and DMS were associated in boys, not girls., Discussion: The associations between EDI and DMS among boys call for a wider approach when examining ED among boys., (Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.)

The purpose of this study was to examine changes in aerobic fitness, muscular strength, bone mineral density (BMD) and body composition during inpatient treatment of underweight and normal weight patients with longstanding eating disorders (ED). Twenty-nine underweight (BMI < 18.5, n = 7) and normal weight (BMI ≥ 18.5, n = 22) inpatients (mean (SD) age: 31.0 (9.0) years, ED duration: 14.9 (8.8) years, duration of treatment: 16.6 (5.5) weeks) completed this prospective naturalistic study. The treatment consisted of nutritional counseling, and 2 × 60 min weekly moderate intensive physical activity in addition to psychotherapy and milieu therapy. Underweight patients aimed to increase body weight with 0.5 kg/week until the weight gain goal was reached. Aerobic fitness, muscular strength, BMD and body composition were measured at admission and discharge. Results showed an increase in mean muscular strength, total body mass, fat mass, and body fat percentage, but not aerobic capacity, among both underweight and normal weight patients. Lumbar spine BMD increased among the underweight patients, no changes were observed in BMD among the normal weight patients. Three out of seven underweight patients were still underweight at discharge, and only three out of nine patients with excessive body fat (i.e., >33%) managed to reduce body fat to normal values during treatment. These results calls for a more individualized treatment approach to achieve a more optimal body composition among both underweight and normal to overweight patients with longstanding ED.

Objective: To examine associations among exercise dependence score, amount of physical activity and eating disorder (ED) symptoms in patients with longstanding ED and non-clinical controls., Methods: Adult female inpatients (n = 59) and 53 age-matched controls participated in this cross sectional study. Assessments included the eating disorders examination, eating disorders inventory, exercise dependence scale, reasons for exercise inventory, and MTI Actigraph accelerometer., Results: Positive associations were found among vigorous, not moderate, physical activity, exercise dependence score and ED symptoms in patients. In the controls, ED symptoms were negatively associated with vigorous physical activity and not correlated with exercise dependence score. Exercise for negative affect regulation, not weight/appearance, and amount of vigorous physical activity were explanatory variables for exercise dependence score in both groups., Conclusions: The positive associations among exercise dependence score, vigorous physical activity and ED symptoms need proper attention in the treatment of longstanding ED., (Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.)

Objective: To describe changes in physical activity (PA) and exercise dependence score during treatment of eating disorders (ED), and to explore correlations among changes in PA, exercise motivation, exercise dependence score and ED psychopathology in excessive and non-excessive exercisers., Method: Thirty-eight adult females receiving inpatient treatment for anorexia nervosa, bulimia nervosa or ED not otherwise specified participated in this prospective study. Assessments included accelerometer assessed PA, Exercise Dependence Scale, Reasons for Exercise Inventory, ED Examination, and ED Inventory., Results: Amount of PA was significantly reduced in non-excessive exercisers during treatment, in excessive exercisers there was a trend towards reduced amount of PA from admission to discharge. In excessive exercisers, reduced ED psychopathology was correlated with reduction in exercise dependence score and perceived importance of exercise to regulate negative affects, but not with importance of exercise for weight/appearance. These associations were not found in non-excessive exercisers., Discussion: Excessive exercise is an important issue in longstanding ED, and the excessive exercising patients need help to develop alternative strategies to regulate negative affects.

Objective: To examine self reported versus objectively assessed moderate-to-vigorous physical activity (MVPA), and different reasons for exercise, in patients with longstanding eating disorders (ED) when compared with controls., Method: Inpatient females (n = 59, mean 30.1 years) and nonclinical age matched controls (n = 53, mean 31.3 years) accepted participation in this cross sectional study. Instruments included accelerometer ActiGraph, physical activity diary, Reasons for Exercise Inventory, and Eating Disorders Examination interview., Results: Self reported and objectively assessed MVPA were higher across all ED diagnoses when compared with controls. The patients' self reported MVPA was lower than the objectively assessed MVPA; no difference was found in controls. Regulation of negative affects, not weight/appearance, was a more important, whereas fitness/health was a less important reason for exercise in patients than controls., Discussion: The underreporting of MVPA in some patients with ED may warrant clinical attention.

Purpose: To examine the prevalence of the female athlete triad (the Triad) in Norwegian elite athletes and controls., Methods: This study was conducted in three phases: (part I) screening by means of a detailed questionnaire, (part II) measurement of bone mineral density (BMD), and (part III) clinical interview. In part I, all female elite athletes representing the national teams at junior or senior level, aged 13-39 yr (N = 938) and an age group-matched randomly selected population-based control group (N = 900) were invited to participate. The questionnaire was completed by 88% of the athletes and 70% of the controls. Based on data from part I, a stratified random sample of athletes (N = 300) and controls (N = 300) was selected and invited to participate in parts II and III of the study. 186 athletes (62%) and 145 controls (48%) participated in all parts of the study., Results: Eight athletes (4.3%) and five controls (3.4%) met all the criteria for the Triad (disordered eating/eating disorder, menstrual dysfunction, and low BMD). Six of the athletes who met all the Triad criteria competed in leanness sports, and two in nonleanness sports. When evaluating the presence of two of the components of the Triad, prevalence ranged from 5.4 to 26.9% in the athletes and from 12.4 to 15.2% in the controls., Conclusion: Our results support the assumption that a significant proportion of female athletes suffer from the components of the Triad. In addition, we found that the Triad is also present in normal active females. Therefore, prevention of one or more of the Triad components should be geared towards all physically active girls and young women.

Purpose: The aim of this study was to examine the percentage of elite athletes and controls at risk of the female athlete triad., Methods: A detailed questionnaire, which included questions regarding training and/or physical activity patterns, menstrual history, oral contraceptive use, weight history, eating patterns, dietary history, and the Body Dissatisfaction (BD) and Drive for Thinness (DT) subscales of the Eating Disorder Inventory (EDI), was prepared. The questionnaire was administered to the total population of female elite athletes in Norway representing the national teams at the junior or senior level, 13-39 yr of age (N = 938) and non-athlete controls in the same age group (N = 900). After exclusion, a total of 669 athletes (88%) and 607 controls (70%) completed the questionnaire satisfactorily., Results: A higher percentage of controls (69.2%) than athletes (60.4%) was classified as being at risk of the Triad (P < 0.01). A higher percentage of controls than athletes reported use of pathogenic weight-control methods and had high BD subscale scores (P < 0.001). However, more athletes reported menstrual dysfunction and stress fractures compared with controls (P < 0.05). A higher percentage of both athletes competing in leanness sports (70.1%) and the non-athlete control group (69.2%) was classified as being at risk of the Triad compared with athletes competing in non-leanness sports (55.3%) (P < 0.001). Furthermore, a higher percentage of athletes competing in aesthetic sports (66.4%) than ball game sports (52.6%) was classified as being at risk of the Triad (P < 0.001)., Conclusions: More athletes competing in leanness sports and more non-athlete controls were classified as being at risk of the Triad compared with athletes competing in non-leanness sports.

Over the past 20 years, a number of studies have been published that generally suggest a higher frequency of eating disorders among athletes than among non-athletes. Participation in competitive sport has also been considered an important factor related to the development of eating disorders. Taken together, most studies have suggested that eating disorders are particularly prevalent in sports that emphasise leanness or low body weight. However, some studies suggest a similar or lower prevalence of eating disorders compared with controls or athletes at a lower competitive level. Athletes constitute a unique population and the impact of factors such as training, eating pattern, extreme diets, restriction of food intake and psychopathological profile among them must be evaluated differently from that among non-athletes. A concerted effort by coaches, athletic trainers, parents, athletes and healthcare personnel is optimal in order to recognise, prevent and treat eating disorders in athletes.

Objective: The objectives of the study were to examine the prevalence of anorexia nervosa (AN), bulimia nervosa (BN), anorexia athletica (AA), and eating disorders not otherwise specified (ED-NOS) in both male and female Norwegian elite athletes and a representative sample from the general Norwegian population., Design: A 2-step study including self-reported questionnaire and clinical interview., Setting/participants: The entire population of Norwegian male and female elite athletes (n=1620) and controls (n=1696) was evaluated for the presence of eating disorders (EDs)., Main Outcome Measurement: Based on the results of the questionnaire, all athletes and controls classified as at risk for EDs, and a representative sample of athletes and controls classified as healthy participated in the clinical part of the study to determine the number of subjects meeting the Diagnostic and Statistical Manual of Mental Disorders-IV criteria for EDs., Results: More athletes (13.5%) than controls (4.6%; P<0.001) had subclinical or clinical EDs. The prevalence of EDs among male athletes was greater in antigravitation sports (22%) than in ball game (5%) and endurance sports (9%; P<0.05). The prevalence of EDs among female athletes competing in aesthetic sports (42%) was higher than that observed in endurance (24%), technical (17%), and ball game sports (16%)., Conclusions: The prevalence of EDs is higher in athletes than in controls, higher in female athletes than in male athletes, and more common among those competing in leanness-dependent and weight-dependent sports than in other sports. A collaborative effort among coaches, athletic trainers, parents, physicians, and athletes is optimal for recognizing, preventing, and treating EDs in athletes.