Body dissatisfaction, disordered eating and exercise behaviours: associations with symptoms of REDs in male and female athletes

Abstract

ObjectivesDisordered eating and compulsive exercise behaviours are common among athletes and can increase the risk of relative energy deficiency in sport (REDs). Contrarily, the prevalence of muscle dysmorphia and its relationship with REDs are unknown. This cross-sectional study aimed to evaluate associations of all three with REDs symptoms.MethodsElite and subelite Icelandic athletes (n=83, 67.5% females) answered the Low Energy Availability in Females/Males Questionnaires (LEAF-Q/LEAM-Q), Eating Disorder Examination–Questionnaire Short (EDE-QS), Exercise Addiction Inventory (EAI) and Muscle Dysmorphic Disorder Inventory (MDDI). Body composition was assessed via dual-energy X-ray absorptiometry; resting metabolic rate via indirect calorimetry; and blood samples were drawn for analysis of nutrition and hormonal status. Females were compared based on LEAF-Q total score (≥8 (at risk) vs <8). Simple linear regression was applied to evaluate associations of (a) testosterone with other objective measures and LEAM-Q scores in males; and (b) LEAF-Q/LEAM-Q scores with EDE-QS, EAI and MDDI scores.ResultsIn total, 8.4% of participants scored above cut-off on EDE-QS, 19.3% on EAI and 13.3% on MDDI. Females with LEAF-Q total score ≥8 had higher median scores on EDE-QS, EAI and MDDI compared with those scoring <8. Testosterone was positively associated with iron and inversely with total iron-binding capacity but was not associated with scoring on any of the administered questionnaires.ConclusionDrive for muscularity and aesthetic physique may play a role in the complex presentation of REDs. Screening for muscle dysmorphia, in addition to disordered eating and compulsive exercise, could therefore facilitate early detection of REDs.

Patterns of energy availability and carbohydrate intake differentiate between adaptable and problematic low energy availability in female athletes

“…Although between-group differences were only observed for EDE-QS scores, there are indications that multifactorial body image concerns and disordered eating behaviours are among external modulators of energy availability. Moreover, as outlined previously ( 26 ), the drive for thinness and aesthetic physique are not mutually exclusive. Our results are also in agreement with studies reporting that the association of compulsive exercise with REDs is diminished by the absence of disordered or otherwise insufficient eating habits ( 73 ).…”

“…Previously, we have reported associations of self-reported disordered eating, compulsive exercise, and muscle dysmorphia with symptoms of REDs in male and female athletes ( 26 ). In accordance, here the LEA + LCHO group scored highest on the EDE-QS, with two out of nine exceeding the questionnaire cutoff.…”

“…This study used data from a larger cross-sectional research project on REDs in high-level Icelandic athletes aged ≥15 years. The eligibility criteria and recruitment of participants have been described in detail elsewhere ( 26 ). The athletes initially responded to an online questionnaire in 2021 (July–December) consisting of the Low Energy Availability in Females Questionnaire (LEAF-Q) ( 27 ) and additional background questions.…”

“…RMR ratio <0.90 is among suggested secondary markers of REDs ( 35 , 36 ). DXA and RMR measurement procedures have been described in detail elsewhere ( 26 ).…”

“…Fasted serum blood samples were collected and analysed as described earlier ( 26 ). Ferritin, iron, and total iron binding capacity (TIBC) were measured for the evaluation of iron status, and 25-hydroxyvitamin D (25-OH-Vitamin D) for vitamin D status.…”