RESUMO
BACKGROUND: The purpose of this meta-analysis was to provide a pooled prevalence estimate of self-reported disordered eating (SRDE) in athletes based on the available literature, and to identify risk factors for their occurrence. METHODS: Across ten academic databases, an electronic search was conducted from inception to 7th January 2024. The proportion of athletes scoring at or above predetermined cutoffs on validated self-reporting screening measures was used to identify disordered eating (DE). Subgroup analysis per country, per culture, and per research measure were also conducted. Age, body mass index (BMI), and sex were considered as associated/correlated factors. RESULTS: The mean prevalence of SRDE among 70,957 athletes in 177 studies (132 publications) was 19.23% (17.04%; 21.62%), I2 = 97.4%, τ2 = 0.8990, Cochran's Q p value = 0. Australia had the highest percentage of SRDE athletes with a mean of 57.1% (36.0%-75.8%), while Iceland had the lowest, with a mean of 4.9% (1.2%-17.7%). The SRDE prevalence in Eastern countries was higher than in Western countries with 29.1% versus 18.5%. Anaerobic sports had almost double the prevalence of SRDE 37.9% (27.0%-50.2%) compared to aerobic sports 19.6% (15.2%-25%). Gymnastics sports had the highest SRDE prevalence rate, with 41.5% (30.4%-53.6%) while outdoor sports showed the lowest at 15.4% (11.6%-20.2%). Among various tools used to assess SRDE, the three-factor eating questionnaire yielded the highest SRDE rate 73.0% (60.1%-82.8%). Meta-regression analyses showed that female sex, older age, and higher BMI (all p < 0.01) are associated with higher prevalence rates of SRDE. CONCLUSION: The outcome of this review suggests that factors specific to the sport affect eating behaviors throughout an athlete's life. As a result, one in five athletes run the risk of developing an eating disorder. Culture-specific and sport-specific diagnostic tools need to be developed and increased attention paid to nutritional deficiencies in athletes.
Disordered eating (DE) refers to eating behaviors that limit food choices, reduce or exaggerate food intake, cause physical discomfort, create a sense of loss of control, or lead to negative emotions like shame or guilt. The DE label does not signify the presence of a diagnosed mental health disorder, but, rather, describes self-reported, regular eating patterns that psychiatrists consider to fall into the at-risk category for an eating disorder. In this review, we performed a search of academic databases to find all relevant studies that measured the frequency of self-reported DE in athletes. We analyzed 177 studies involving over 70,000 athletes in total. In this study, DE was defined as a score above cut-off on validated screening tests for problematic eating behaviors. Our goal was to estimate the prevalence of DE in athletes globally and to determine the factors that increase risk. We found that approximately 1 in 5 athletes (19%) endorsed DE behaviors such as, among others, restrictive dieting, bingeing, and purging. These behaviors were seen most commonly in indoor sports like gymnastics and less commonly in the context of outdoor sports. Rates were highest in female athletes, older athletes, athletes with high body mass index (BMI) scores, and those from Eastern countries and cultures. Australia had the highest rates (over 50%), while rates were lowest in Iceland. We suggest the development of screening tests specifically tailored and applicable to athletes. In addition, we recommend raising public awareness of the health effects of nutrition in sports.
RESUMO
OBJECTIVE: Estimate the prevalence, and associated risk factors, of high school students who are considered at risk for an eating disorder based on screening measures. METHODS: An electronic search of nine databases was completed from their inception until 1st September 2022. A random-effects meta-analysis was conducted, and confounder (moderator) analyses and meta-regressions examined whether the overall prevalence estimate for of screen-based disordered eating (SBDE) was moderated by student age, BMI, or gender, as well as culture and type of SBDE assessment. RESULTS: The mean estimate of the prevalence of SBDE among high school students (K = 42 (66 datapoints), N = 56282] in the sample of 25 countries was 13% ([95% CI] = 10.0-16.8%, I2 = 99.0%, Cochran's Q p = 0.001). This effect was not moderated by features of the samples such as gender, BMI, or age. Among cultures, non-Western countries had a higher prevalence of SBDE prevalence than Western countries, but the difference was not significant. There was considerable variability in the prevalence estimates as a function of the assessment measure, but no meaningful pattern emerged. CONCLUSION: The estimated figure of 1 in 8 high school students with SBDE-unmoderated by gender and BMI-stands out as a problem in need of attention from public health officials, psychologists, psychiatrists, pediatricians, parents, and educators. There is a great need for innovative, integrated policy and program development all along the spectrum of health promotion and universal, selective, and indicated prevention. Further research is also needed to validate and refine this estimate by (a) conducting basic research on the accuracy of eating disorder screening measurements in samples ages 14 through 17; (b) examining representative samples in more countries in general and Latin American countries in particular; (c) clarifying the relationships between SBDE and age throughout the different phases of late childhood, adolescence, and emerging adulthood; and (d) investigating whether there are meaningful forms of disordered eating and whether these are associated with variables such as gender, ethnicity, and BMI.
We searched nine databases to identify studies of high school students that yielded an estimate of disordered eating based on screening measures such as the Eating Attitudes Test. Forty-two 42 studies (N = 56282 students) from 25 countries met the selection criteria. A random effects meta-analysis indicated that across those countries the best estimate of the prevalence of screen-based disordered eating is 13%. This estimate was not significantly moderated by BMI, gender, age, and whether the country was Western or non-Western. There was considerable variability in the prevalence estimates as a function of the assessment measure, but no meaningful pattern emerged. The estimated figure of 1 in 8 high school students with disordered eating is a problem deserving of attention from public health officials, psychologists, psychiatrists, pediatricians, parents, educators, and leaders committed to prevention and early identification of eating disorders and referral for treatment. Further research in many more countries is also needed to validate this estimate and to explore its relationship with development throughout adolescence and with variables that can help us to refine prevention and effective early identification and treatment of eating disorders.