The Association of a High Drive for Thinness With Energy Deficiency and Severe Menstrual Disturbances: Confirmation in a Large Population of Exercising Women

Abstract

A high drive-for-thinness (DT) score obtained from the Eating Disorder Inventory-2 is associated with surrogate markers of energy deficiency in exercising women. The purposes of this study were to confirm the association between DT and energy deficiency in a larger population of exercising women that was previously published and to compare the distribution of menstrual status in exercising women when categorized as high vs. normal DT. A high DT was defined as a score ≥7, corresponding to the 75th percentile for college-age women. Exercising women age 22.9 ± 4.3 yr with a BMI of 21.2 ± 2.2 kg/m2 were retrospectively grouped as high DT (n = 27) or normal DT (n = 90) to compare psychometric, energetic, and reproductive characteristics. Chi-square analyses were performed to compare the distribution of menstrual disturbances between groups. Measures of resting energy expenditure (REE) (4,949 ± 494 kJ/day vs. 5,406 ± 560 kJ/day, p < .001) and adjusted REE (123 ± 16 kJ/LBM vs. 130 ± 9 kJ/LBM, p = .027) were suppressed in exercising women with high DT vs. normal DT, respectively. Ratio of measured REE to predicted REE (pREE) in the high-DT group was 0.85 ± 0.10, meeting the authors' operational definition for an energy deficiency (REE:pREE <0.90). A greater prevalence of severe menstrual disturbances such as amenorrhea and oligomenorrhea was observed in the high-DT group (χ2 = 9.3, p = .003) than in the normal-DT group. The current study confirms the association between a high DT score and energy deficiency in exercising women and demonstrates a greater prevalence of severe menstrual disturbances in exercising women with high DT.

Low resting metabolic rate in exercise-associated amenorrhea is not due to a reduced proportion of highly active metabolic tissue compartments

“…The present study further expands upon previous reports of low RMR in women with EAMD, in whom RMR is 14-20% lower than predicted by the Harris-Benedict equation (10,15,21). However, the Harris-Benedict equation, which predicts RMR from height, weight, and age (24), does not account for differences in body tissue composition at all.…”

“…As a result of these energy-conserving adaptations, resting metabolic rate (RMR) is suppressed in chronically energy-deficient women, as observed in anorexia nervosa patients who exhibit RMRs that are 20-40% lower than expected (29,38,40). Likewise, lower than expected RMRs have also been reported in women with exercise-associated menstrual disturbances (EAMD) (10,15,21), a condition caused by insufficient dietary energy intake relative to the energy expenditure of exercise (13). Because women with EAMD frequently display disrupted profiles of leptin, triiodothyronine, insulin, and other peptides involved in energy homeostasis, their lower than expected RMRs are understood as evidence of energy conservation (10,12,42).…”

“…Previous investigators have addressed this issue by normalizing RMR for lean mass (10,15,21,32) or by comparing measured RMR with predicted RMR, which is derived from prediction equations that utilize anthropometric characteristics (10,15,21,29,38,40). However, these approaches may not be adequately sensitive to reflect the true magnitude of RMR suppression (42).…”

IOC consensus statement on relative energy deficiency in sport (RED-S): 2018 update

“…Additionally, due to stigma associated with eating disorders, athletes may be motivated to hide their illness. An elevated Eating Disorder Inventory—drive for thinness score168 has been reported to indicate energy deficiency in exercising women,173 and amenorrhoeic athletes seem more likely to have an elevated drive for thinness score compared with eumenorrhoeic athletes 173. In order to diagnose an eating disorder, additional in-depth personal interviews must be performed 117 121 122 166.…”

Susceptibility to Eating Disorders Among Collegiate Female Student–Athletes

“…Therefore, the prevalence of eating disorders among various groups remains unclear. However, investigators 7,10,14 have consistently shown that certain groups-college-aged people, females, and athletes-may be at higher risk for developing an eating disorder than the general population.…”