Behind the athletic body: a clinical interview study of identification of eating disorder symptoms and diagnoses in elite athletes

Eating disorders are more prevalent in athletes than in the general population and may have severe consequences for sports performance and health. Identifying symptoms can be difficult in athletes because restrictive eating and slim body images are often idealised in a sports setting. The Eating Dis...

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Bibliographic Details
Published in:BMJ Open Sport & Exercise Medicine 2022-06, Vol.8 (2), p.e001265-e001265
Main Authors: Lichtenstein, Mia Beck, Johansen, Karen Krogh, Runge, Eik, Hansen, Marina Bohn, Holmberg, Trine Theresa, Tarp, Kristine
Format: Article
Language:English
Subjects:
Age
Anorexia
Athletes
Badminton
Body image
COVID-19
Design
diagnosis
Eating behavior
Eating disorders
Exercise
Females
Handball
Interviews
Martial arts
Medical diagnosis
Orienteering
Qualitative Research
Questionnaires
Rowing
Self image
Skating
Track & field
Triathlon
validation
Validity
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Summary:Eating disorders are more prevalent in athletes than in the general population and may have severe consequences for sports performance and health. Identifying symptoms can be difficult in athletes because restrictive eating and slim body images are often idealised in a sports setting. The Eating Disorders Examination Questionnaire (EDE-Q) and the SCOFF (Sick, Control, One stone, Fat and Food) questionnaire (SCOFF) are widely used generic instruments to identify symptoms of eating disorders. This study aimed to investigate the instruments’ validity and explore eating disorder symptoms in a sample of athletes.A sample of 28 athletes (25 females) competing at a national level was interviewed based on the diagnostic criteria for eating disorders. We interviewed 18 athletes with a high score on EDE-Q and 10 with a low score. All interviews were transcribed and analysed from a general inductive approach. We identified 20 athletes with an eating disorder diagnosis, while 8 had no diagnosis. EDE-Q found 90% of the cases, while SCOFF found 94%. EDE-Q found no false-positive cases, while SCOFF found one.The qualitative results showed that most athletes reported eating concerns, restrictive eating, eating control (counting calories), weight concerns, body dissatisfaction (feeling fat and non-athletic), excessive exercise and health problems (eg, pain, fatigue).In conclusion, EDE-Q and SCOFF seem valid instruments to screen athletes’ samples but may fail to find 6%–10% cases with eating disorders. Despite athletic bodies and normal body mass index, many athletes report severe eating problems and dissatisfaction with weight and body appearance. Implementation of regular screening may identify these symptoms at an early stage.
ISSN:2055-7647
2055-7647
DOI:10.1136/bmjsem-2021-001265