The spectrum of disordered eating in female elite atyhletes and non athletic controls-prevalence related to performance

Introduction

There is a continuum model of disordered eating (DE) ranging from abnormal eating behaviours to clinical eating disorders (EDs) such as anorexia nervosa and bulimia nervosa [1]. It has been questioned whether EDs are less prevalent among the very best athletes compared to athletes at lower performance level [2]. Therefore, the aims of this study were to 1) determine the prevalence of athletes classified as "at risk" for DE/ED and 2) determine the prevalence of subclinical and clinical EDs related to performance level.

Methods

This is a two-phase study including part I: questionnaire study, and part II: clinical interview. All female elite athletes representing the national teams at junior or senior level, aged 13-39 years (n=938) and a random sample of non athletic controls (n=900, 13-39 years) were invited to participate. The questionnaire was satisfactorily completed by 88% of the athletes and 70% of the controls. Based on data from part I, a random sample of athletes (n=71) and controls (n=71) classified as at risk for DE/ED (EDI-DT≥15, or EDI-BD≥14, or use of pathogenic weight control methods or self reported EDs) participated in part II. For part of the analysis, the athletes were divided into performance level.

Results

A higher percentage of controls (52%) than athletes (33%) was classified as at risk for DE/ED (p<0.001). Of the at-risk subjects participating in the clinical interview, 37 athletes (52%) and 26 controls (37%) were diagnosed with a subclinical or clinical ED (p=0.09). A higher percentage of the medallists in Olympic Games, world championship and/or world cup (32%) was diagnosed with EDs compared with those ranked from 4.-10. place (6%) (P<0.05). A total of 12% of those ranked from 11. place and lower and finally 50% of those who only had participated in other international and national competitions, were diagnosed with EDs.

Discussion/Conclusions

More controls than athletes were classified as at risk for DE/EDs. In contrast to earlier suggestions [2], results from this study show that the prevalence of EDs was higher among the very best athletes compared with the second best athletes. In spite of the fact that most of these athletes seem to perform at top level, we do not know the long term consequences on health and performance. Therefore, the ongoing preventive work has to be continued.

References

[1]. Shisslak CM. et al.(1995). Int J Eat Disord.18: 209-219.
[2]. Sundgot-Borgen J. (1993). Int J Sport Nutr. 3: 29-40.
Supported by The Norwegian Olympic Committee and Confederation of Sport, and The Norwegian Foundation for Health and Rehabilitation