Examining Eating Attitudes and Behaviors in Collegiate Athletes, the Association Between Orthorexia Nervosa and Eating Disorders

Purpose: Orthorexia nervosa (Orthorexia) is an eating attitude and behavior associated with a fixation on healthy eating, while eating disorders (EDs) are clinically diagnosed psychiatric disorders associated with marked disturbances in eating that may cause impairment to psychosocial and physical health. The purpose of this study was to examine risk for Orthorexia and EDs in student-athletes across sex and sport type and determine the association between the two. Methods: Student-athletes (n = 1,090; age: 19.6 ± 1.4 years; females = 756; males = 334) completed a survey including demographics, the ORTO-15 test (values), the Eating Attitudes Test-26 (EAT-26; \u3e20 score), and additional questions about pathogenic behaviors to screen for EDs. Results: Using a ORTO-15, 67.9% were at risk for Orthorexia, a more restrictive threshold value of 17.7% prevalence across student-athletes with significant differences across sex [ \u3c40: \u3eχ2(1,1,090) = 4.914, p= 0.027; \u3c35: \u3eχ2(1,1,090) = 5.923, p = 0.015). Overall, ED risk (EAT-26 and/or pathogenic behavior use) resulted in a 20.9% prevalence, with significant differences across sex (χ2 = 11.360, p \u3c 0.001) and sport-type category (χ2 = 10.312, p = 0.035). Multiple logistic regressions indicated a significant association between EAT-26 subscales scores and Orthorexia, and between Orthorexia positivity, ORTO-15 scores, and risk for EDs. Conclusions: Risk for Orthorexia and ED is present in collegiate student-athletes. While healthy and balanced eating is important, obsessive healthy eating fixations may increase the risk for EDs in athletes. More education and awareness are warranted to minimize the risk for Orthorexia and EDs in student-athletes

Access to Care, Reporting Behaviors, and Quality of Athletic Training Service Interactions for Reserve Officers\u27 Training Corps cadets

Purpose: Reserve Officers’ Training Corps (ROTC) programs prepare student-civilians to become leaders through strenuous physical and leadership training. Unlike their student-athlete counterparts who have direct access to athletic training services, ROTC cadets may or may not have a healthcare provider available. The purpose of this study was to examine the access to care and reporting behaviors of ROTC cadets with a secondary aim exploring the quality of healthcare service interactions relative to patient-centered care. Methods: An online survey assessed access to care using a self-report tool on the type of medical providers available to the ROTC cadets (n=132, age=20±3 y) dispersed between the Army, Navy, Air Force, and Marines, and their illness/injury history and reporting behaviors. The participants who sought care for an injury/illness also completed the Consultation and Relational Empathy tool to measure the level of patient-centered care by the healthcare provider with follow-up analysis using the Consultation Care Measure tool for all athletic training service interactions. Data were analyzed using descriptive statistics. Results: ROTC cadets reported access to 2±1 healthcare providers including a designated civilian physician (26.5%), athletic trainer (23.5%), and ROTC peer first responder (14.4%). However, 50.8% of respondents stated they were unsure what healthcare providers were available. In total, 22.7% of cadets reported being injured and 26.5% reported being sick/ill while participating in ROTC activities. Of those who stated they had sustained an injury during ROTC, 59.9% seldomly or never reported their injury. The ROTC cadets who sought healthcare expressed they were satisfied with their injury (35.96±10.60) and illness (35.48±13.10) treatment from a patient-centered viewpoint. Conclusions: The ROTC cadets reported a general unfamiliarity with the healthcare providers available to them. Despite the reporting behaviors, the cadets reported being satisfied with the care they received

Examination of the Cumulative Risk Assessment and Nutritional Profiles among College Ballet Dancers

This study examined female collegiate ballet dancers\u27 ( = 28) Female Athlete Triad (Triad) risk via the Cumulative Risk Assessment (CRA) and nutritional profiles (macro- and micronutrients; = 26). The CRA identified Triad return to play criteria (RTP: Full Clearance, Provisional Clearance, or Restricted/Medical Disqualified) by assessing eating disorder risk, low energy availability, menstrual cycle dysfunction, and low bone mineral density. Seven-day dietary assessments identified any energy imbalances of macro- and micronutrients. Ballet dancers were identified as low, within normal, or high for each of the 19 nutrients assessed. Basic descriptive statistics assessed CRA risk classification and dietary macro- and micronutrient levels. Dancers averaged 3.5 ± 1.6 total score on the CRA. Based on these scores, the RTP outcomes revealed Full Clearance 7.1%, = 2; Provisional Clearance 82.1%, = 23; and Restricted/Medical Disqualification 10.7%, = 3. Dietary reports revealed that 96.2% ( = 25) of ballet dancers were low in carbohydrates, 92.3% ( = 24) low in protein, 19.2% ( = 5) low in fat percent, 19.2% ( = 5) exceeding saturated fats, 100% ( = 26) low in Vitamin D, and 96.2% ( = 25) low in calcium. Due to the variability in individual risks and nutrient requirements, a patient-centered approach is a critical part of early prevention, evaluation, intervention, and healthcare for the Triad and nutritional-based clinical evaluations

Examination of the Cumulative Risk Assessment and Nutritional Profiles among College Ballet Dancers

This study examined female collegiate ballet dancers’ (n = 28) Female Athlete Triad (Triad) risk via the Cumulative Risk Assessment (CRA) and nutritional profiles (macro- and micronutrients; n = 26). The CRA identified Triad return to play criteria (RTP: Full Clearance, Provisional Clearance, or Restricted/Medical Disqualified) by assessing eating disorder risk, low energy availability, menstrual cycle dysfunction, and low bone mineral density. Seven-day dietary assessments identified any energy imbalances of macro- and micronutrients. Ballet dancers were identified as low, within normal, or high for each of the 19 nutrients assessed. Basic descriptive statistics assessed CRA risk classification and dietary macro- and micronutrient levels. Dancers averaged 3.5 ± 1.6 total score on the CRA. Based on these scores, the RTP outcomes revealed Full Clearance 7.1%, n = 2; Provisional Clearance 82.1%, n = 23; and Restricted/Medical Disqualification 10.7%, n = 3. Dietary reports revealed that 96.2% (n = 25) of ballet dancers were low in carbohydrates, 92.3% (n = 24) low in protein, 19.2% (n = 5) low in fat percent, 19.2% (n = 5) exceeding saturated fats, 100% (n = 26) low in Vitamin D, and 96.2% (n = 25) low in calcium. Due to the variability in individual risks and nutrient requirements, a patient-centered approach is a critical part of early prevention, evaluation, intervention, and healthcare for the Triad and nutritional-based clinical evaluations

Energy Availability With or Without Eating Disorder Risk in Collegiate Female Athletes and Performing Artists

Context Female athletes and performing artists can present with low energy availability (LEA) from either unintentional (eg, inadvertent undereating) or intentional (eg, eating disorder [ED]) methods. Whereas LEA and ED risk have been examined independently, few researchers have examined them simultaneously. Awareness of LEA with or without ED risk may provide clinicians with innovative prevention and intervention strategies. Objective To examine LEA with or without ED risk (eg, eating attitudes, pathogenic behaviors) in female collegiate athletes and performing artists and compare sport type and LEA with the overall ED risk. Design Cross-sectional study. Setting Free living in sport-specific settings. Patients or Other Participants A total of 121 collegiate female athletes and performing artists (age = 19.8 ± 2.0 years, height = 168.9 ± 7.7 cm, mass = 63.6 ± 9.3 kg) participating in equestrian (n = 28), soccer (n = 20), beach volleyball (n = 18), softball (n = 17), volleyball (n = 12), and ballet (n = 26). Main Outcome Measure(s) Anthropometric measurements (height, mass, body composition), resting metabolic rate, energy intake, total daily energy expenditure, exercise energy expenditure, Eating Disorder Inventory-3 (EDI-3), and EDI-3 Symptom Checklist were assessed. Chi-square analysis was used to examine differences between LEA and sport type, LEA and ED risk, ED risk and sport type, and pathogenic behaviors and sport type. Results Most (81%, n = 98) female athletes and performing artists displayed LEA and differences between LEA and sport type (χ2/5 = 43.8, P \u3c .001). The majority (76.0%, n = 92) presented with an ED risk, but the ED risk did not differ by sport type (P = .94). The EDI-3 Symptom Checklist revealed that 61.2% (n = 74) engaged in pathogenic behaviors, with dieting being the most common (51.2%, n = 62). Most (76.0%, n = 92) displayed LEA with an ED risk. No differences were found in LEA by ED risk and sport type. Softball players reported the most LEA with an ED risk (82.4%, n = 14), followed by ballet dancers (76%, n = 19). Conclusions Our results suggested that a large proportion of collegiate female athletes and performing artists were at risk for LEA with an ED risk, thus warranting education, identification, prevention, and intervention strategies relative to fueling for performance