The Australian Institute of Sport (AIS) and National Eating Disorders Collaboration (NEDC) position statement on disordered eating in high performance sport

Abstract

Identification, evaluation and management of disordered eating (DE) is complex. DE exists along the spectrum from optimised nutrition through to clinical eating disorders (EDs). Individual athletes can move back and forth along the spectrum of eating behaviour at any point in time over their career and within different stages of a training cycle. Athletes are more likely to present with DE than a clinical ED. Overall, there is a higher prevalence of DE and EDs in athletes compared with non-athletes. Additionally, athletes participating in aesthetic, gravitational and weight-class sports are at higher risk of DE and EDs than those in sports without these characteristics. The evaluation and management of DE requires a cohesive team of professional practitioners consisting of, at minimum, a doctor, a sports dietitian and a psychologist, termed within this statement as the core multidisciplinary team. The Australian Institute of Sport and the National Eating Disorders Collaboration have collaborated to provide this position statement, containing guidelines for athletes, coaches, support staff, clinicians and sporting organisations. The guidelines support the prevention and early identification of DE, and promote timely intervention to optimise nutrition for performance in a safe, supported, purposeful and individualised manner. This position statement is a call to action to all involved in sport to be aware of poor self-image and poor body image among athletes. The practical recommendations should guide the clinical management of DE in high performance sport.

Iron Metabolism: Interactions with Energy and Carbohydrate Availability

“…With no innate mechanism available for the body to synthesize iron, humans are solely reliant on dietary iron sources to replace incidental daily [76] and exercise-induced [35] iron losses, including the replacement of iron used for adaptive purposes. Absolute restriction of energy intake, which is commonly involved in scenarios of LEA in weight restricted or weight sensitive sports [77], may contribute to reduced intake of micronutrients, exacerbated by disordered eating or other restrictions of dietary range. Furthermore, scenarios of LEA can also be accompanied by very high energy expenditures resulting from excessive training loads, which potentially increase exercise-induced iron losses via mechanisms such as hemolysis, sweating, gastrointestinal bleeding, inflammation and hepcidin elevations [35].…”

Indicators and correlates of low energy availability in male and female dancers

“…Previous studies have avoided the pitfalls of direct measurement of energy availability (EA) 7 by adopting a questionnaire approach to identify physiological indicators of LEA; but these studies have tended to focus on endurance sports. 8 For example, a validated questionnaire exists for the female athlete triad: the Low Energy Availability in Females Questionnaire: LEAF-Q. 9 LEA in female athletes measured using a self-reported questionnaire is strongly associated with many health and performance consequences of RED-S. 10 In male athletes, a self-reported questionnaire found evidence of exercise hypogonadal condition and other physiological indicators of RED-S. 11 A Sport-Specific Energy Availability Questionnaire combined with Interview (SEAQ-I) 12 for male cyclists was effective in indicating low bone mineral density (BMD) of the lumbar spine, characteristic of RED-S.…”

Are Coaches of Female Athletes Informed of Relative Energy Deficiency in Sport? A Scoping Review

“…Given the long-term adverse health effects of RED-S, individuals with the potential to influence EA must act as important potential moderators in the development of the condition (Wells et al, 2020). Coaches typically dictate the energy demands of training and are often in a prime position to observe changes in an athlete's health and performance (Kroshus, DeFreese, & Kerr, 2018).…”