Background: To determine if following specific diets was associated with reporting behaviors that are consistent with disordered eating compared to non-diet-adherent athletes. We hypothesized that athletes adhering to specific diets were more likely to report disordered eating than those not following a diet.
Methods: One thousand female athletes (15-30 years) completed a comprehensive survey about athletic health and wellness. Athletes were asked to specify their diet and completed 3 eating disorder screening tools: the Brief Eating Disorder in Athletes Questionnaire, the Eating Disorder Screen for Primary Care, and self-reported current or past history of eating disorder or disordered eating. Descriptive statistics were calculated for all study measures and chi-squared tests assessed relationships between athletes' dietary practices and their responses to eating disorder screening tools. Statistical significance was defined as p < 0.05.
Results: Two hundred thirty-four of 1000 female athletes reported adherence to specific diets. 69 of the 234 diet-adhering athletes (29.5%) were excluded due to medically-indicated dietary practices or vague dietary descriptions. Of the 165 diet-adherent athletes, 113 (68.5%) screened positively to ≥1 of the 3 eating disorder screening tools. Specifically, athletes practicing a low-carbohydrate diet were more likely to report disordered eating vs. athletes without dietary restrictions (80% vs. 41.8%; p < 0.0001).
Conclusion: Specific diet adherence in female athletes may be associated with reporting behaviors that are consistent with disordered eating. Health practitioners should consider further questioning of athletes reporting specific diet adherence in order to enhance nutritional knowledge and help treat and prevent eating disorders or disordered eating.
Keywords: Disordered eating; Eating disorder; Female athlete; RED-S.
Female athletes may follow special diets for various reasons including sociocultural practices, environmental concerns, or health and weight-management benefits. These practices may put them at risk for developing eating disorders, which peak during adolescence, and are more common among athletes. Eating disorders or disordered eating in athletes may lead to inadequate fueling or low energy availability and its subsequent health and performance-related complications, also known as Relative Energy Deficiency in Sport (RED-S). It may be difficult to detect eating disorders among athletes due to the secretive nature behind these behaviors. In addition, objective information such as low weight or body mass index (BMI) may not be reliable due to their increased muscle mass. The results of this study revealed that female athletes who reported practicing special diets, especially those who follow a low-carbohydrate diet may be associated with developing eating disorders compared to female athletes who did not report any dietary restrictions. These findings should prompt healthcare providers to evaluate these individuals further in order to enhance their nutritional knowledge and help treat and prevent consequences linked to eating disorders or disordered eating.