Eating Disorders in Female College Athletes - Research Paper Example

Eating Disorders in Female College Athletes The hypothesis of the current study, "Risk factors for disordered eating in female athletes" by Tanya R Berry andBruce L Howe, posits that engaging in sports may increase the risk for an eating disorder in female athletes and that this could lead to a clinical eating disorder. To test the hypothesis, this study examined the role of social pressure, self-esteem, body-image and competition anxiety as risk factors for an eating disorder in female university athletes. In addition, the study investigated the relationship of body fat index and body mass index to indicators of disordered eating patterns. Using canonical correlations, the study found significant relationships between restrained eating and all the risk factors, as well as a significant relationship between high body mass and restrained eating. No significant differences were found in risk for an eating disorder and the type of sport. The study concluded that psychological predisposing factors to eating disorders occur in female university athletes and that further investigation is needed to explore the extent of the relationship between the variables. The study also recommended the examination of the role of peers and coaches in the development of disordered eating. A critique of the study found several flaws in methodology and questioned the purpose of conducting a study that merely reiterated previously researched relationships documented in many other studies without adding significantly new data. Eating Disorders in Female College Athletes The causes of disordered eating in females, including anorexia and bulimia, are complex and involve social, psychological, and physiologic factors (Putukian, 1998 & 2001; Otis, 1997). Risk factors for disordered eating in all populations include social pressures to be beautiful and thin, poor self-esteem, family dysfunction, sexual abuse, dieting, and biological factors (Putukian, 2001; Otis, 1997). Research has found that, as a group, athletes display high levels of disordered eating and concern about weight and appearance (Beals & Manore, 2002; Harris, 2000). In athletes, the notion of athletic perfection and a belief in the inverse relationship between body size and performance may also encourage disordered eating (Sanborn, 2000). The current study, "Risk factors for disordered eating in female university athletes" by Tanya R Berry andBruce L Howe, investigated the role of social pressure, self-esteem, body-image and competition anxiety as risk factors for an eating disorder in female university athletes. Further, the study investigated the relationship of body fat index and body mass index to indicators of disordered eating patterns. This paper explores the literature involving female athletes and eating disorders and reviews and critiques the current study. Literature Review Eating disorders in the female population are of concern in this society. And though The American Psychological Association in the Diagnostic and Statistical Manual, fourth edition (DSM-IV) has outlined strict, clinical, diagnostic criteria for these eating disorders, certain identifiable groups appear more at risk than others for exhibiting eating and distorted body image that do not necessarily meet the DSMIV criteria for a clinical diagnosis (Beats & Manore, 1994). Athletics often emphasize appearance and competition and athletes have been targeted as one of the groups that exhibit high levels of disordered eating (e.g., Burckes-Miller & Black, 1988; O'Connor, Lewis, & Kirchner, 1995; Petrie, 1993; Rucinski, 1989; Sundgot-Borgen, 1994a). Rosen et al (1998) found that 32% of a female collegiate athlete sample practiced extreme weight-control behaviors, and 70% of those athletes perceived such practices as harmless. A 1999 National Collegiate Athletic Association study of eating disorders in athletes (562 women and 883 men) showed that 1.1% of the female athletes met the diagnostic criteria for bulimia, but none met the criteria for anorexia nervosa (Johnson, 1999). However, the authors concluded that 13% of the female athletes had "clinically significant" extreme weight control behaviors. These results are consistent with those of Sundgot-Borgen who found that 18% of elite female Norwegian athletes displayed behaviors consistent with eating disorders, compared with only 5% of a group of nonathlete controls (1990). Other researchers have reported similar incidences of disordered eating among female athletes (Sundgot-Borgen, 1993; Benson, 1990). Beats and Manore (1994) found that eating disorders may be more pervasive than expected and particularly in specific sports. For instance, studies of high-performance athletes across Canada found that female athletes participating in weight-matched sports (lightweight rowing and judo) and sports that place a competitive or aesthetic value on leanness (gymnastics, swimming, dance and diving) had significantly higher scores on an eating disorder inventory than athletes in nonweight-restricted sports (volleyball and heavyweight rowing) (Stoutjesdyk & Jevne, 1993; Otis, 1997). A Norwegian study confirmed these results and found that the sports with the greatest number of athletes using pathological weight control methods were those that were considered aesthetic, were weight dependent, or required endurance (Sundgot-Borgen, 1993). In contrast, research by Taub and Blinde (1992) found conflicting results. The researchers compared adolescent female athletes with nonathletes on behavioral and psychological traits associated with eating disorders as well as the use of extreme dieting techniques such as vomiting and diet aids. They found that athletes showed higher perfectionism and bulimia than nonathletes, but found no differences among various sport teams. That female athletes are as a group at greater risk for an eating disorder is not found consistently. One study at least found that athletes may be at a lower risk for eating disorders than the general population (Wilkins, Boland, & Albinson, 1991 ). In fact, compared to nonathletes, some researchers have found athletes to exhibit less eating disorder symptoms and healthier psychological functioning. Others have found no relationship between prevalence of eating disorder, level of sport competition, and time spent exercising. Ashley et al found no difference in eating behaviors between 145 Division I collegiate athletes and a control group of 14 nonathlete subjects enrolled in an advanced program of study (1996). They also found no difference in eating behaviors between lean- and non-lean-sport athletes and athletes in different age groups. Karlson et al examined eating behaviors in female lightweight rowers, distance runners, and a control group (including some varsity athletes) and found no difference in the number of probable eating disorder cases among the 3 groups (Karlson et al, 2001). Several variables have been identified as possibly contributing to patterns of disordered eating in athletes. These include self esteem, body image, and social pressure. Self-Esteem Among the important psychological factors that have been associated with eating disorders is self-esteem. Not surprisingly, low self-esteem is commonly correlated with eating disorders (Lindeman, 1994). Further, low self esteem negatively affects dieting and bingeing behavior in adolescent girls (Neumark-Sztainer et al., 1996). The actual role of self-esteem in the development of eating disorders is not well understood. Davis and Cowles (1989) found that strenuous exercise may increase the possibility of eating disorders developing among female athletes in sports with an emphasis on a lean body, but the actual cause is unclear: do more emotionally vulnerable athletes gravitate to these sports or does the activity itself engender lower emotional wellbeing Thompson and Sherman (1993) propose three possible roles that affect eating disorders: the sport can attract already at risk individuals; participation results in the disorder; or the sport can precipitate an eating disorder in those who are predisposed to its development. Perhaps those female athletes with low self esteem starting or already involved in competitive sports are at risk for the development of an eating disorder particularly when the added pressures of the sports arena are factored. Body-Image Disturbances All individuals with eating disorders exhibit body-image disturbances (Molinari, 1995; Cooper et al.,1987). How this plays out in athletes is complex. On the one hand, athletes demonstrate higher self esteem and body satisfaction than nonathletes (Wilkins et al., 1991). At the same time, athletes as a group feel greater pressure to achieve the societal ideal of a thin, trim build (Beats & Manore, 1994) and among athletes, Williamson et al. (1995) found that concern with body size was a strong and primary predictor of eating disorder symptoms. Thus, while athletes have higher body image scores than nonathletes, the extent to which an athlete's body deviates from the "ideal" for a particular sport, the greater the risk that the athlete will develop an eating disorder (Brownell, Rodin and Wilmore (1992). Body image can also be a significant mediating variable for competition anxiety, social factors and low self appraisal, leading to eating disorder symptoms (Williamson et al., 1995). As such, the competitive nature of sports may impact anxiety and low self-esteem, leading to the development of eating disorders (Brownell et al 1992). A study by Furst and Tenebaum (1984) found athletes with higher anxiety to have higher body dissatisfaction. Social Pressures In athletics, both athletes and coaches often believe a certain weight and body shape is necessary for optimal athletic performance (Davis, 1992; Petrie, 1996) and that excess weight inhibits speed, endurance, and agility and increases fatigue. Conversely, leanness is assumed to enhance performance (Davis, 1992). In addition, some sports emphasize the athlete's aesthetic appeal during performance as in gymnastics and diving, for example. Sundgot-Borgen (1994b) found that a significant number of athletes dieting to improve their performance had been told by their coaches to lose weight. As coaches play a key role in an athlete's life, the athlete may feel compelled to lose weight to meet the coach's expectations. To support this, Rosen and Hough (1988) found that 75% of female gymnasts who were told they were overweight by their coaches began using unhealthy weight control methods. And Sundgot-Borgen (1994b) found eating disorders more prevalent in athletes who, having been told by their coaches to lose weight, started on an unsupervised dieting program. Other researchers found eating disorders significantly correlated with coach and peer influence (Williamson et al., 1995; Rosen & Hough, 1988; Neumark-Sztanier et al., 1996). Yet, although some researchers have identified social pressure as a possible variable contributing to the problem the role of social pressure from coaches or peers has not been clearly identified (Sundgot-Borgen,1994b; Rosen & Hough,1988; Williamson, Netemeyer, Jackman, Anderson, Funsch, & Rabalais, 1995). Further, the pressure on an athlete to meet weight restrictions or to conform to a certain body type may come from a number of different sources: general societal pressure; peer, trainer or coach pressure; judging criteria used in certain sports (Beals & Manore, 1994). Thus social pressure as a possible contributing factor to disordered eating in athletes warrants further investigation. Clearly, the literature presents discordant findings that pose many unanswered questions about an athlete's susceptibility to developing dieting problems and disordered eating, particularly about the role that social influences can have in unhealthy eating practices. Method Subjects Subjects were 46 female University varsity athletes competing in the 1996 -'97 athletic season who volunteered to participate in this study. The subjects' ages ranged from 17 to 24 years, with an average age of 19.85 and an average of 7.33 years of involvement in their sport. The average body fat percentage was 25.68, while the average BMI was 22.35. The represented sports included field hockey (n = 8), swimming (n = 8), soccer (n = 10), rowing (n = 8) and basketball (n=12). The average age of the athletes was 19.85 years. Procedures All subjects were weighed and measured at a University fitness-testing center to determine subject's body mass index (BMI). During the same testing session, skin fold measurements were taken at the bicep, tricep, suprailiac and subscapular sites. Percent body fat was calculated using the Durnin and Womersly method (Baumgartner & Johnson, 1982). Immediately following the physical measurements, subjects completed a series of questionnaires on self esteem, body image, competition anxiety, social influence and eating disorder symptoms. Self esteem was measured using Rosenberg's Self Esteem Scale. Competition anxiety was tested using Marten's Sport Competition Anxiety Test (Martens, 1977). Body image was assessed using the Body Shape Questionnaire developed by Cooper, Taylor, Cooper and Fairburn (1987) to assess concerns about body shape in young western women. The demographic questionnaire included questions on the subject's experience and goals in her sport. The questions regarding social and peer influence on dieting behavior, were adapted by the researcher from Neumark-Sztainer et al., ( 1995), a non-athletic study of eating disorders. Eating disorder symptoms were tested using the Dutch Eating Behavior Questionnaire (DEBQ), a 33 item questionnaire scored on a five point Likert scale with three subscales of eating behavior: restrained eating, emotional eating and external eating. High scores on the restrained eating scale have shown high correlations with subjects who were watching their weight as well as with anorexic and bulimic patients. Discussion The results of the study found a strong relationship with between self esteem and eating disorder symptoms, supporting much of the previous literature (Lindeman, 1994; Neumark-Sztainer et al., 1996; Davis & Cowles, 1989) and that self esteem was highly correlated with competition anxiety. The authors caution, though, that other factors unrelated to the sport experience could be major influences on an athlete's mental state such as trauma. Results also showed emotional eating to be significantly predicted by body image and the strong correlation of low body image with eating disorder symptoms supports much of the other research in this area. The results of this study also showed body image and social pressure from coaches and peers to be significant predictors of restrained eating, supporting previous research supporting the available research showing that coaches may play a significant role. As previously noted in the literature review, many problems exist in researching eating disorders which is why the results seem to vary to a great degree. As a result, the researchers decided to also determine if there was a relationship between low body mass index or low body fat and eating disorder symptoms. The results showed a small but significant correlation between high body mass index and low body image, supporting the speculation that the greater an athlete's body shape deviates from what is considered "ideal" for her sport, the greater the risk of the development of an eating disorder (Wilson & Eldredge, 1992). The researchers proposed that coaches may play a role in this area. For instance, one study found that coaches tended to make subjective evaluations of their athletes' weight based on appearance more than objective indicators (Griffin & Harris, 1996) and that coaches tended to rate females as needing to lose weight and males needing to gain weight. There were no significant differences in eating disorder symptomologies and sport team membership. Critique This study had several flaws. To start, self selection of subjects is a problem in the area of research of eating disorders (Shaw & Garfinkel, 1990; Sundgot-Borgen, 1993; Wilmore, 1991). This study used volunteers only. Athletes who had an eating disorder or issues around their eating habits may have chosen not to participate while those individuals who did volunteer may have been less concerned. Interviews with subjects however revealed that many of the subjects participated because they wanted to find out about their body fat percentage, which in itself may have been indicated disturbance with body image. The numbers in this study were low - 46 participants across 5 sports. In addition, the relationship to eating disorders and type of sport was unclear. While lightweight rowing is associated greater risk for eating disorder versus heavyweight rowing the study did not distinguish which kind of rowing they investigated. Out of the five sports studied, the only one in which female athletes were more at risk for pathogenic eating was swimming and in this category there were only eight subjects. Thus the finding that kind of sport did not prove significant for an eating disorder is hardly robust. Further, the subjective nature of the testing procedure through the use of questionnaires is problematic. Sundgot-Borgen ( 1993) found that athletes tend to under-report eating disorders because of the potential negative consequences such as not being allowed to compete. Shaw and Garfinkel ( 1990) also state that perceived loss of control is difficult to assess reliably and that the precise reporting of binge eating may be difficult: what one person might consider a binge may be a normal meal to another. In my view, though, the greatest problem was the nature of the study itself. Numerous studies have already documented a potential relationship between self-esteem, body image and competition anxiety and eating disorders in female athletes. This study does not appear to have added anything new to the literature. Research dollars and time would have been better served to investigate something more specific that would shed greater light on understanding the delicate relationship between female athletes and eating disorders. For instance, they could have conducted an experimental study on having coaches and peers support the athletes for their present weight rather than encourage the athletes to lose weight. In conclusion, the purpose of this study was to attempt to identify risk factors for developing eating disorders in athletes. All of the risk factors examined -- self esteem, competition anxiety, social pressure and body image -- were significantly correlated with indicators of unhealthy diet practices. In addition, indicators of unhealthy dieting practices were found across all sporting groups tested. The study concluded that any athlete could be considered at risk for an eating disorder when some or all of the factors outlined above are present. 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