Examining compulsive exercise as a risk factor for eating disorder symptoms in first-year college students using a latent change score modeling approach.

OBJECTIVE: Research suggests that both compulsive exercise and eating disordered behaviors increase during college. Despite strong cross-sectional associations between compulsive exercise and eating disorders, it is unknown if compulsive exercise is a variable risk factor for eating disorders or simply a correlate. It was hypothesized that increases in compulsive exercise would significantly and prospectively predict increases in overall number of eating disorder symptoms over the study period. METHOD: A total of 265 first year college students who did not meet criteria for a full or subthreshold eating disorder diagnosis at Time 1 (age M = 18.15; SD = 0.42; 122 female [46%] at Time 1) completed reports of compulsive exercise and eating disorder symptoms via online questionnaires at four timepoints over the 9-month 2021-2022 academic year (76% retention rate). Hypotheses were tested using a bivariate latent change score model. RESULTS: Hypotheses were not supported. Change in compulsive exercise did not predict change in number of eating disorder symptoms. Change in number of eating disorder symptoms also did not predict change in compulsive exercise. CONCLUSIONS: Compulsive exercise did not emerge as a variable risk factor for the development of eating disorder symptoms among first year college students. The relationship between these behaviors should be investigated at different developmental timepoints, such as early adolescence, and potential third variables that may explain the observed co-occurrence should be explored. PUBLIC SIGNIFICANCE: This study investigated whether increases in compulsive exercise predicted increases in number of eating disorder symptoms among first year college students. Compulsive exercise did not significantly predict number of eating disorder symptoms. Additional research is warranted to clarify the relationship between compulsive exercise and eating disorder symptoms.

Anxiety, body dissatisfaction, and exercise identity: Differentiating between adaptive and compulsive exercise.

OBJECTIVE: Little is known about psychosocial variables that may be differentially associated with compulsive exercise versus adaptive exercise. The current study simultaneously examined associations of exercise identity, anxiety, and body dissatisfaction with both compulsive and adaptive exercise behaviors and investigated which construct may account for the most unique variance in compulsive and adaptive exercise. Hypotheses were that: 1) body dissatisfaction, anxiety, and exercise identity would be significantly associated with compulsive exercise and 2) exercise identity would be significantly associated with adaptive exercise. METHOD: A total of 446 individuals (50.2 % female) completed reports of compulsive exercise, adaptive exercise, body dissatisfaction, exercise identity, and anxiety via an online survey. Multiple linear regression and dominance analyses were used to test hypotheses. RESULTS: Exercise identity, body dissatisfaction, and anxiety were all significantly associated with compulsive exercise. Only exercise identity and anxiety were significantly associated with adaptive exercise. Dominance analyses suggested that exercise identity accounted for the largest proportion of variance in compulsive (Dominance R2 = 0.27) and adaptive exercise (Dominance R2 = 0.45). CONCLUSION: Exercise identity emerged as the strongest predictor of both compulsive and adaptive exercise. The simultaneous presence of exercise identity, body dissatisfaction, and anxiety may contribute to high risk for engagement in compulsive exercise. Incorporating exercise identity into established eating disorder preventions and treatments may contribute to the reduction of compulsive exercise behaviors.

Athlete-specific risk factors for the development of disordered eating behaviors in first-year college athletes.

OBJECTIVE: The current study tested whether proposed sport-related risk factors for disordered eating behaviors were associated with increases in disordered eating over first-year college athletes' first four months of collegiate sport participation. PARTICIPANTS: Participants included a sample of first-year college athletes (N = 59, 45% female) from a Division I National Collegiate Athletics Association (DI) university. METHOD: This follow-up study tested whether 1) wearing a uniform that emphasizes body concerns, 2) participating in a lean sport, and 3) perceived pressure for thinness from coaches and teammates would lead to increases in weight/shape concerns and disordered eating behaviors over the first four months of collegiate sport participation. RESULTS: Wearing a uniform that emphasizes body concerns and perceived coach pressure for thinness predicted increases in weight/shape concern. Both teammate and coach pressure for thinness predicted increases in restrained eating behaviors. CONCLUSION: Findings suggest that there are identifiable, athlete-specific risk factors for the development of disordered eating behaviors among first-year college athletes.

Intrinsic and extrinsic motivations as moderators of the association between exercise frequency and exercise behavior.

PURPOSE: Motivations underlying exercise may contribute to the extent to which exercise is maladaptive, independent of exercise frequency. Extrinsic and intrinsic exercise motivation may independently moderate associations between exercise frequency and 1) compulsive and 2) healthy exercise. It was expected that among individuals with high extrinsic motivation, greater exercise frequency would be associated with more compulsive exercise, whereas among individuals with high intrinsic motivation, greater exercise frequency would be associated with more healthy exercise. METHODS: A total of 446 university students (50.9% female; 67.0% White) completed measures of intrinsic and extrinsic exercise motivations, exercise frequency, compulsive exercise, and healthy exercise. Intrinsic and extrinsic motivations for exercise were entered as simultaneous independent moderators of the associations between exercise frequency and 1) compulsive exercise and 2) healthy exercise in multiple linear regressions. RESULTS: Moderation effects of exercise motivation were not supported for compulsive exercise. Only main effects of frequency (b = 0.04, p < 0.01) and extrinsic motivation (b = 0.27, p < 0.01) were observed. Intrinsic motivation moderated the association between frequency and healthy exercise (b = -0.02, p = 0.03). Among individuals with lower intrinsic motivation, greater frequency was related to more healthy exercise. This association was significantly weaker among individuals with high intrinsic motivation. CONCLUSION: Consistent with theory and extant work, extrinsic motivation was associated with compulsive exercise, while intrinsic motivation was associated with healthy exercise. Clinically, assessing the extent to which exercise is intrinsically or extrinsically motivated may help identify whether individuals may be more likely to engage in compulsive versus healthy exercise. Results support the importance of exploring the exercise motivations as predictors of compulsive and healthy exercise. LEVEL OF EVIDENCE: Level V, Descriptive Cross-Sectional Study.

Investigating engagement in maladaptive and adaptive exercise behaviors before and during COVID-19.

PURPOSE: Evidence suggests that the coronavirus (COVID-19) pandemic has resulted in increased mental health concerns (e.g., anxiety) and there is ample discussion of how the pandemic has resulted in increases in weight control strategies (e.g., maladaptive exercise behaviors). It remains unclear, however, if maladaptive exercise behaviors are on the rise among non-clinical samples. The objective of this study was to examine college students' engagement in exercise behaviors (both adaptive and maladaptive) before and during COVID-19. METHOD: This study compared reports of compulsive exercise, weight and shape exercise, and positive and healthy exercise in two separate samples recruited from a large southeastern university. Sample 1 was collected pre-COVID-19 (August 2019-February 2020) and Sample 2 was collected during COVID-19 (August 2020-April 2021). Case-control matched samples were generated for this study (N = 144; 52.1% male). Three separate analysis of covariance models tested the differences between (1) adaptive exercise; (2) compulsive exercise; and (3) weight and shape exercise in pre- and during COVID-19 samples, controlling for sex. RESULTS: Individuals in the during COVID-19 sample reported significantly more compulsive exercise (p < .001), weight and shape exercise (p < .001), and adaptive exercise (p < .001) compared to individuals in the pre-COVID-19 sample. Effects were of medium to large sizes. CONCLUSION: Consistent with reports from the research literature and popular press, the current study observed that both adaptive and maladaptive exercise were higher among college students during COVID-19 compared to pre-COVID-19. LEVEL OF EVIDENCE: Level V: Opinions of authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.

Invariance of the Eating Disorder Inventory-Drive for Thinness subscale across university and community samples.

The Eating Disorder Inventory-Drive for Thinness (EDI-DT) subscale is commonly used in research and as an eating disorder screening measure, but extant evidence is scant regarding its psychometric properties. University and community samples often are treated as interchangeable in terms of research conclusions. Given established demographic differences between these two populations, the present study tested measurement invariance of the EDI-DT across these two sample types. Two large samples of university students (n = 537; 50% female, 67% White; n = 584; 52% female, 67% White) and community participants (n = 535; 57% female, 81% White; n = 533; 63% female, 82% White) completed the EDI-DT online. Multiple group confirmatory factor analyses tested configural, metric, scalar, and strict invariance by sample type. The EDI-DT subscale was not invariant across university and community samples. Post-hoc-regularized multiple nonlinear factor analyses suggested potential item bias associated with sample type, age, and body mass index on six of the seven items. Item bias, however, appeared to be associated with minimal clinical impact. Collectively, results suggest that the EDI-DT may be functionally invariant and appropriate for use with broad populations. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Examining the impact of weight bias on the association between exercise identity and maladaptive exercise behaviors.

OBJECTIVE: Though exercise behaviors are typically viewed as health-promoting, certain forms of exercise (i.e., excessive exercise, unhealthy muscle-building behaviors) are considered maladaptive and are associated with negative physical and psychological outcomes. Psychosocial factors may put people at greater risk for engaging in maladaptive exercise. Based on deviance regulation theory, weight bias was examined as a potential moderator of the association between exercise identity and both excessive exercise and muscle-building behaviors. DESIGN: The current study is a secondary analysis of a larger data set investigating associations between athletic identity, exercise behaviors, and disordered eating behaviors. Hypotheses were examined using moderation testing in multiple linear regression. MAIN OUTCOME MEASURES: Participants (N = 225, 50.2% female) completed the Eating Pathology Symptoms Inventory as a measure of maladaptive exercise. RESULTS: Controlling for sex, age, athlete status, and body mass index, weight bias moderated the association between exercise identity and both excessive exercise and muscle-building behaviors. Among individuals with high exercise identity, higher weight bias was associated with increased maladaptive exercise behaviors. CONCLUSION: Individuals with higher exercise identity and higher weight bias may be at greatest risk of engaging in maladaptive exercise. Preventive interventions for maladaptive exercise behaviors may consider targeting exercise identity and weight bias.

Understanding athletic and exercise identity in relation to disordered eating behaviors.

PURPOSE: This study investigated the associations between athletic and exercise identities and a range of disordered eating and exercise behaviors. METHOD: Study 1 (N = 441; 53.5% female) included online questionnaires of athletic identity and disordered eating behaviors, anthropometrics, and demographic information. Study 2 (N = 225; 50.2% female) added measures of: exercise identity, exercise behaviors, and a broader measure of disordered eating behaviors. Multiple linear regressions were used to test hypotheses. Dominance analysis was used in Study 2 to determine the unique variance accounted for by each predictor. RESULTS: Controlling for body mass index (BMI), age, and sex, athletic identity was not significantly associated with disordered eating in Study 1 (ps > 0.039) but was significantly associated with lower cognitive restraint in Study 2 (p = 0.012). In Study 2, stronger exercise identity was significantly associated with more cognitive restraint (p < 0.001), more body dissatisfaction (p = 0.016), more compulsive exercise (p < 0.001), and more positive and healthy exercise (p < 0.001), after controlling for BMI, age, sex, and athletic identity. Dominance analyses suggested that exercise identity was more strongly associated with these outcomes than athletic identity. CONCLUSION: Exercise identity, but not athletic identity, may be an important risk factor for disordered eating and exercise behaviors in broad populations. LEVEL OF EVIDENCE: Level IV, results from uncontrolled trial.

Food and alcohol disturbance by athlete status: the roles of drive for thinness, drive for muscularity, and sex.

OBJECTIVE: This study investigated the association between self-identified athlete status and Food and Alcohol Disturbance (FAD) behaviors, and whether this association was moderated by drives for thinness or muscularity, and sex. PARTICIPANTS: 575 individuals (77.6% female, 40.0% identifying as athletes) recruited from a large southeastern university. METHODS: Participants completed online measures of athletic identity, drives for muscularity and thinness, FAD behaviors, and demographic variables. RESULTS: Compared to non-athletes, male athletes with higher drive for muscularity endorsed more alcohol effects behaviors; female athletes endorsed the inverse relationship. Higher drive for thinness was associated with more diet and exercise behaviors among all participants, and extreme weight control behaviors among athletes. CONCLUSIONS: Athlete status moderated the associations between drives for thinness/muscularity and FAD Alcohol Effects and Extreme Weight Control Behaviors. Regardless of athlete status, college students with higher drive for thinness are at risk for engaging in more FAD Diet & Exercise behaviors.

Momentary changes in heart rate variability can detect risk for emotional eating episodes.

Emotion dysregulation is a known risk factor for a variety of maladaptive eating behaviors, including emotional eating (Crockett, Myhre, & Rokke, 2015; Lavender et al., 2015). New passive sensing technologies offer the prospect of detecting emotion dysregulation in real-time through measurement of heart rate variability (HRV), a transdiagnostic bio-signal of emotion regulation, which may in turn signal risk of engaging in a maladaptive eating behavior. In the current study, our primary aim was to test the hypothesis that momentary changes in HRV can be used to detect risk of experiencing an emotional eating episode in an ecologically valid setting using a wrist worn sensor with acceptable classification accuracy. Participants were 21 adults with clinically significant emotional eating behaviors. Participants wore the Empatica E4 wrist-sensor and tracked all emotional eating episodes using ecological momentary assessment for four weeks. Time and frequency domain features of HRV were extracted in the 30-min period preceding emotional eating episodes and control cases (defined as the 30 min prior to an EMA survey that did not contain an emotional eating episode). Support vector machine (SVM) learning models were implemented using time domain and frequency domain features. SVM models using frequency domain features achieved the highest classification accuracy (77.99%), sensitivity (78.75%), and specificity (75.00%), consistent with standards deemed acceptable for the prediction of event-level health behavior. SVM models using time domain features still performed above chance, though were less accurate at classifying episodes (accuracy 63.48%, sensitivity 62.68%, and specificity 70.00%) and did not meet acceptable classification accuracy. Wearable sensors that assess HRV show promise as a tool for capturing risk of engaging in emotional eating episodes.

An identity mis-match? The impact of self-reported competition level on the association between athletic identity and disordered eating behaviors.

OBJECTIVE: Self-reported level of sport competition was examined as a potential moderator of the association between athletic identity and disordered eating behaviors among college students. METHOD: Participants were a subset of individuals from a larger study who self-identified as athletes (N = 194; 39.7% female). Questionnaires were completed online and included measures of athletic identity and disordered eating behaviors, as well as items assessing level of sport competition, frequency of physical activity per week both in and out of sport, anthropometrics, and demographic information. Moderation was tested in a multiple linear regression. RESULTS: Controlling for physical activity levels, gender, and BMI, self-reported level of competition moderated the association between athletic identity and disordered eating behaviors (b = -0.01, p = .038; 95% CI = -0.026, -0.0008). Among individuals competing at lower levels of sport competition, higher athletic identity was associated with more disordered eating behaviors (b = -0.05, p = .013; CI = -0.193, -0.024). DISCUSSION: A mismatch between athletic identity and sport competition level was associated disordered eating behaviors. Individuals engaging in sport at a "non-competitive" level may be an under-identified and under-served population. A mis-match between athletic identity and sport competition level may be a risk factor for disordered eating. DATA AVAILABILITY STATEMENT: The data that support the findings of this study are available from the corresponding author upon reasonable request.