Risk of Low Energy Availability, Disordered Eating, Eating Disorders, and Bone Stress Injuries in United States Female Track and Field Original Research
Main Article Content
Keywords
Runners, Nutrition, Injury
Abstract
Introduction: Female track and field athletes have increased risk of low energy availability (LEA), disordered eating (DE), and eating disorders (ED), which are associated with health and performance consequences. This study explored LEA, DE, and ED risk among United States female track and field athletes and assessed differences in proportions between risk and competition level and bone stress injury (BSI) risk.
Methods: Female track and field athletes (n = 392, aged 18-68 years) completed an online survey including the Low Energy Availability in Females Questionnaire (LEAF-Q), Eating Disorder Examination Questionnaire (EDE-Q), and Female Athlete Screening Tool (FAST), and self-reported BSIs. Chi-square tests of homogeneity assessed differences in proportions between competition level and BSI and LEA, DE, and ED risk.
Results: 49%, 48%, and 22% of participants had high risk for LEA, DE, and ED, respectively; and concurrent risk of LEA, DE, and ED was 27%. There was a significant difference in proportions between competition level and LEA risk (X2 (3, 387) = 11.93, p = 0.008, Φ= 0.176) and ED/DE risk (X2 (3, 387) = 11.65, p = 0.007, Φ= 0.213); and BSI and LEA risk (X2 (2, 392) = 8.58, p = 0.014, Φ= 0.148).
Conclusions: This study demonstrated a considerable portion of US female track and field athletes had high risk of LEA, DE, and ED.
References
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17. Palermo M, Rancourt D. An identity mis-match? The impact of self-reported competition level on the association between athletic identity and disordered eating behaviors. Eat Behav. 2019;35:101341. doi:10.1016/j.eatbeh.2019.101341
18. Chapa DAN, Johnson SN, Richson BN, et al. Eating‐disorder psychopathology in female athletes and non‐athletes: A meta‐analysis. International Journal of Eating Disorders. 2022;55(7):861-885. doi:10.1002/eat.23748
19. Torstveit MK, Sundgot-Borgen J. The Female Athlete Triad: Are Elite Athletes at Increased Risk? Med Sci Sports Exerc. 2005;37(2):184-193. doi:10.1249/01.MSS.0000152677.60545.3A
20. Martinsen M, Sundgot-Borgen J. Higher Prevalence of Eating Disorders among Adolescent Elite Athletes than Controls. Med Sci Sports Exerc. 2013;45(6):1188-1197. doi:10.1249/MSS.0b013e318281a939
21. Ravi S, Ihalainen JK, Taipale-Mikkonen RS, et al. Self-Reported Restrictive Eating, Eating Disorders, Menstrual Dysfunction, and Injuries in Athletes Competing at Different Levels and Sports. Nutrients. 2021;13(9):3275. doi:10.3390/nu13093275
22. Blair L, Aloia CR, Valliant MW, Knight KB, Garner JC, Nahar VK. Association between athletic participation and the risk of eating disorder and body dissatisfaction in college students. Int J Health Sci (Qassim). 2017;11(4):8-12.
23. Pustivšek S, Hadžić V, Dervišević E, Carruthers J. Risk for eating disorders and body composition among adolescent female and male athletes and non-athlete controls. Int J Adolesc Med Health. 2019;32(4). doi:10.1515/ijamh-2017-0190
24. Flatt RE, Thornton LM, Fitzsimmons‐Craft EE, et al. Comparing eating disorder characteristics and treatment in self‐identified competitive athletes and non‐athletes from the National Eating Disorders Association online screening tool. International Journal of Eating Disorders. 2021;54(3):365-375. doi:10.1002/eat.23415
25. Borowiec J, Banio-Krajnik A, Malchrowicz-Mośko E, Kantanista A. Eating disorder risk in adolescent and adult female athletes: the role of body satisfaction, sport type, BMI, level of competition, and training background. BMC Sports Sci Med Rehabil. 2023;15:1-11. doi:https://doi.org/10.1186/s13102-023-00683-7
26. Hausenblas HA, McNally KD. Eating Disorder Prevalence and Symptoms for Track and Field Athletes and Nonathletes. J Appl Sport Psychol. 2004;16(3):274-286. doi:10.1080/10413200490485630
27. Lichtenstein MB, Hertz SPT, Johansen KK, et al. Are Sub-elite Athletes at Higher Risk of Eating Disorders, Exercise Addiction, Depression, and Low Energy Availability Compared With Elite Athletes? Clinical Journal of Sport Medicine. Published online July 16, 2024. doi:10.1097/JSM.0000000000001257
28. Melin A, Tornberg ÅB, Skouby S, et al. The LEAF questionnaire: a screening tool for the identification of female athletes at risk for the female athlete triad. Br J Sports Med. 2014;48(7):540-545. doi:10.1136/bjsports-2013-093240
29. Fairburn C, Beglin S. Eating Disorder Examination Questionnaire (EDE-Q 6.0). Cognitive behavior therapy and eating disorders. Published online 2008:309-313.
30. Mond JM, Hay PJ, Rodgers B, Owen C, Beumont PJV. Validity of the Eating Disorder Examination Questionnaire (EDE-Q) in screening for eating disorders in community samples. Behaviour Research and Therapy. 2004;42(5):551-567. doi:10.1016/S0005-7967(03)00161-X
31. McNulty KY, Adams CH, Anderson JM, Affenito SG. Development and validation of a screening tool to identify eating disorders in female athletes. J Am Diet Assoc. 2001;101(8):886-892.
32. Affenito SG, Yeager KA, Rosman JL, Ludemann MA, Adams CH, Welch GW. Development and Validation of a Screening Tool to Identify Eating Disorders in the Female Athlete. J Am Diet Assoc. 1998;98(9):A78. doi:10.1016/S0002-8223(98)00588-4
33. Fahrenholtz IL, Melin AK, Wasserfurth P, et al. Risk of Low Energy Availability, Disordered Eating, Exercise Addiction, and Food Intolerances in Female Endurance Athletes. Front Sports Act Living. 2022;4. doi:10.3389/fspor.2022.869594
34. Sharps FRJ, Wilson LJ, Graham CAM, Curtis C. Prevalence of disordered eating, eating disorders and risk of low energy availability in professional, competitive and recreational female athletes based in the United Kingdom. Eur J Sport Sci. 2022;22(9):1445-1451. doi:10.1080/17461391.2021.1943712
35. Dervish RA, Wilson LJ, Curtis C. Investigating the prevalence of low energy availability, disordered eating and eating disorders in competitive and recreational female endurance runners. Eur J Sport Sci. 2023;23(5):869-876. doi:10.1080/17461391.2022.2079423
36. Sygo J, Coates AM, Sesbreno E, Mountjoy ML, Burr JF. Prevalence of Indicators of Low Energy Availability in Elite Female Sprinters. Int J Sport Nutr Exerc Metab. 2018;28(5):490-496. doi:10.1123/ijsnem.2017-0397
37. Stenqvist TB, Melin AK, Garthe I, et al. Prevalence of Surrogate Markers of Relative Energy Deficiency in Male Norwegian Olympic-Level Athletes. Int J Sport Nutr Exerc Metab. 2021;31(6):497-506. doi:10.1123/ijsnem.2020-0368
38. Monserrat Hernández M, Arjona Garrido Á, Checa Olmos JC, Salguero García D. Relationship between Negative Running Addiction and Eating Disorder Patterns in Runners. Nutrients. 2021;13(12):4344. doi:10.3390/nu13124344
39. Folscher LL, Grant CC, Fletcher L, Janse van Rensberg DC. Ultra-Marathon Athletes at Risk for the Female Athlete Triad. Sports Med Open. 2015;1(1):29. doi:10.1186/s40798-015-0027-7
40. Karlsson E, Alricsson M, Melin A. Symptoms of eating disorders and low energy availability in recreational active female runners. BMJ Open Sport Exerc Med. 2023;9(3):e001623. doi:10.1136/bmjsem-2023-001623
41. Sophia B, Kelly P, Ogan D, Larson A. Self Reported History of Eating Disorders, Training, Weight Control Methods, and Body Satisfaction in Elite Female Runners Competing at the 2020 U.S. Olympic Marathon Trials. Int J Exerc Sci. 2022;15(2):721-732.
42. Bennell KL, Malcolm SA, Thomas SA, et al. Risk Factors for Stress Fractures in Track and Field Athletes. Am J Sports Med. 1996;24(6):810-818. doi:10.1177/036354659602400617
43. Wasserfurth P, Palmowski J, Hahn A, Krüger K. Reasons for and Consequences of Low Energy Availability in Female and Male Athletes: Social Environment, Adaptations, and Prevention. Sports Med Open. 2020;44(6):1-14. doi:10.1186/s40798-020-00275-6
44. Wells EK, Chin AD, Tacke JA, Bunn JA. Risk of Disordered Eating Among Division I Female College Athletes. Int J Exerc Sci. 2015;8(3):256-264.
45. Wilwand M, Pritchett K, Miles M, Pritchett R, Larson A. The Prevalence of Stress Fractures and the Associated LEAF-Q Responses, Self-Reported Exercise Volume and Dietary Behaviors in Female Recreational Runners. Int J Exerc Sci. 2024;17(2):1092-1104.
46. Werner A, Thiel A, Schneider S, Mayer J, Giel KE, Zipfel S. Weight-control behaviour and weight-concerns in young elite athletes – a systematic review. J Eat Disord. 2013;1(1):18. doi:10.1186/2050-2974-1-18
47. Fochesato R, Guidotti S, Pruneti C. Risk of developing eating disorders through the misperception of the body image and the adoption of bad eating habits in a sample of young volleyball athletes. Archives of Food and Nutritional Science. 2021;5(1):007-017. doi:10.29328/journal.afns.1001027
2. Wells KR, Jeacocke NA, Appaneal R, et al. The Australian Institute of Sport (AIS) and National Eating Disorders Collaboration (NEDC) position statement on disordered eating in high performance sport. Br J Sports Med. 2020;54(21):1247-1258. doi:10.1136/bjsports-2019-101813
3. Mountjoy M, Ackerman KE, Bailey DM, et al. 2023 International Olympic Committee’s (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs). Br J Sports Med. 2023;57(17):1073-1097. doi:10.1136/bjsports-2023-106994
4. Torstveit MK, Rosenvinge JH, Sundgot-Borgen J. Prevalence of eating disorders and the predictive power of risk models in female elite athletes: a controlled study. Scand J Med Sci Sports. 2007;18(1):108-118. doi:10.1111/j.1600-0838.2007.00657.x
5. Ghazzawi HA, Nimer LS, Haddad AJ, et al. A systematic review, meta-analysis, and meta-regression of the prevalence of self-reported disordered eating and associated factors among athletes worldwide. J Eat Disord. 2024;12(1):24. doi:10.1186/s40337-024-00982-5
6. Ghazzawi HA, Nimer LS, Sweidan DH, et al. The global prevalence of screen-based disordered eating and associated risk factors among high school students: systematic review, meta-analysis, and meta-regression. J Eat Disord. 2023;11:1-23. doi:https://doi.org/10.1186/s40337-023-00849-1
7. Melin AK, Heikura IA, Tenforde A, Mountjoy M. Energy Availability in Athletics: Health, Performance, and Physique. Int J Sport Nutr Exerc Metab. 2019;29(2):152-164. doi:10.1123/ijsnem.2018-0201
8. Stellingwerff T, Mountjoy M, McCluskey WT, Ackerman KE, Verhagen E, Heikura IA. Review of the scientific rationale, development and validation of the International Olympic Committee Relative Energy Deficiency in Sport Clinical Assessment Tool: V.2 (IOC REDs CAT2)—by a subgroup of the IOC consensus on REDs. Br J Sports Med. 2023;57(17):1109-1118. doi:10.1136/bjsports-2023-106914
9. Torstveit MK, Ackerman KE, Constantini N, et al. Primary, secondary and tertiary prevention of Relative Energy Deficiency in Sport (REDs): a narrative review by a subgroup of the IOC consensus on REDs. Br J Sports Med. 2023;57(17):1119-1126. doi:10.1136/bjsports-2023-106932
10. Warden SJ, Davis IS, Fredericson M. Management and Prevention of Bone Stress Injuries in Long-Distance Runners. Journal of Orthopaedic & Sports Physical Therapy. 2014;44(10):749-765. doi:10.2519/jospt.2014.5334
11. Gehman S, Ackerman KE, Caksa S, et al. Restrictive Eating and Prior Low-Energy Fractures Are Associated With History of Multiple Bone Stress Injuries. Int J Sport Nutr Exerc Metab. 2022;32(5):325-333. doi:10.1123/ijsnem.2021-0323
12. Rizzone KH, Ackerman KE, Roos KG, Dompier TP, Kerr ZY. The Epidemiology of Stress Fractures in Collegiate Student-Athletes, 2004–2005 Through 2013–2014 Academic Years. J Athl Train. 2017;52(10):966-975. doi:10.4085/1062-6050-52.8.01
13. Heikura IA, Uusitalo ALT, Stellingwerff T, Bergland D, Mero AA, Burke LM. Low energy availability is difficult to assess but outcomes have large impact on bone injury rates in elite distance athletes. Int J Sport Nutr Exerc Metab. 2018;28(4):403-411. doi:10.1123/ijsnem.2017-0313
14. Ackerman KE, Rogers MA, Heikura IA, et al. Methodology for studying Relative Energy Deficiency in Sport (REDs): a narrative review by a subgroup of the International Olympic Committee (IOC) consensus on REDs. Br J Sports Med. 2023;57(17):1136-1147. doi:https://doi.org/10.1136/bjsports-2023-107359
15. Burke L, Lundy B, Fahrenholtz IL, Melin A. Pitfalls of Conducting and Interpreting Estimates of Energy Availability in Free-Living Athletes. Int J Sport Nutr Exerc Metab. 2018;28 4:350-363. doi:10.1123/ijsnem.2018-0142
16. Sim A, Burns SF. Review: questionnaires as measures for low energy availability (LEA) and relative energy deficiency in sport (RED-S) in athletes. J Eat Disord. 2021;9(1). doi:10.1186/s40337-021-00396-7
17. Palermo M, Rancourt D. An identity mis-match? The impact of self-reported competition level on the association between athletic identity and disordered eating behaviors. Eat Behav. 2019;35:101341. doi:10.1016/j.eatbeh.2019.101341
18. Chapa DAN, Johnson SN, Richson BN, et al. Eating‐disorder psychopathology in female athletes and non‐athletes: A meta‐analysis. International Journal of Eating Disorders. 2022;55(7):861-885. doi:10.1002/eat.23748
19. Torstveit MK, Sundgot-Borgen J. The Female Athlete Triad: Are Elite Athletes at Increased Risk? Med Sci Sports Exerc. 2005;37(2):184-193. doi:10.1249/01.MSS.0000152677.60545.3A
20. Martinsen M, Sundgot-Borgen J. Higher Prevalence of Eating Disorders among Adolescent Elite Athletes than Controls. Med Sci Sports Exerc. 2013;45(6):1188-1197. doi:10.1249/MSS.0b013e318281a939
21. Ravi S, Ihalainen JK, Taipale-Mikkonen RS, et al. Self-Reported Restrictive Eating, Eating Disorders, Menstrual Dysfunction, and Injuries in Athletes Competing at Different Levels and Sports. Nutrients. 2021;13(9):3275. doi:10.3390/nu13093275
22. Blair L, Aloia CR, Valliant MW, Knight KB, Garner JC, Nahar VK. Association between athletic participation and the risk of eating disorder and body dissatisfaction in college students. Int J Health Sci (Qassim). 2017;11(4):8-12.
23. Pustivšek S, Hadžić V, Dervišević E, Carruthers J. Risk for eating disorders and body composition among adolescent female and male athletes and non-athlete controls. Int J Adolesc Med Health. 2019;32(4). doi:10.1515/ijamh-2017-0190
24. Flatt RE, Thornton LM, Fitzsimmons‐Craft EE, et al. Comparing eating disorder characteristics and treatment in self‐identified competitive athletes and non‐athletes from the National Eating Disorders Association online screening tool. International Journal of Eating Disorders. 2021;54(3):365-375. doi:10.1002/eat.23415
25. Borowiec J, Banio-Krajnik A, Malchrowicz-Mośko E, Kantanista A. Eating disorder risk in adolescent and adult female athletes: the role of body satisfaction, sport type, BMI, level of competition, and training background. BMC Sports Sci Med Rehabil. 2023;15:1-11. doi:https://doi.org/10.1186/s13102-023-00683-7
26. Hausenblas HA, McNally KD. Eating Disorder Prevalence and Symptoms for Track and Field Athletes and Nonathletes. J Appl Sport Psychol. 2004;16(3):274-286. doi:10.1080/10413200490485630
27. Lichtenstein MB, Hertz SPT, Johansen KK, et al. Are Sub-elite Athletes at Higher Risk of Eating Disorders, Exercise Addiction, Depression, and Low Energy Availability Compared With Elite Athletes? Clinical Journal of Sport Medicine. Published online July 16, 2024. doi:10.1097/JSM.0000000000001257
28. Melin A, Tornberg ÅB, Skouby S, et al. The LEAF questionnaire: a screening tool for the identification of female athletes at risk for the female athlete triad. Br J Sports Med. 2014;48(7):540-545. doi:10.1136/bjsports-2013-093240
29. Fairburn C, Beglin S. Eating Disorder Examination Questionnaire (EDE-Q 6.0). Cognitive behavior therapy and eating disorders. Published online 2008:309-313.
30. Mond JM, Hay PJ, Rodgers B, Owen C, Beumont PJV. Validity of the Eating Disorder Examination Questionnaire (EDE-Q) in screening for eating disorders in community samples. Behaviour Research and Therapy. 2004;42(5):551-567. doi:10.1016/S0005-7967(03)00161-X
31. McNulty KY, Adams CH, Anderson JM, Affenito SG. Development and validation of a screening tool to identify eating disorders in female athletes. J Am Diet Assoc. 2001;101(8):886-892.
32. Affenito SG, Yeager KA, Rosman JL, Ludemann MA, Adams CH, Welch GW. Development and Validation of a Screening Tool to Identify Eating Disorders in the Female Athlete. J Am Diet Assoc. 1998;98(9):A78. doi:10.1016/S0002-8223(98)00588-4
33. Fahrenholtz IL, Melin AK, Wasserfurth P, et al. Risk of Low Energy Availability, Disordered Eating, Exercise Addiction, and Food Intolerances in Female Endurance Athletes. Front Sports Act Living. 2022;4. doi:10.3389/fspor.2022.869594
34. Sharps FRJ, Wilson LJ, Graham CAM, Curtis C. Prevalence of disordered eating, eating disorders and risk of low energy availability in professional, competitive and recreational female athletes based in the United Kingdom. Eur J Sport Sci. 2022;22(9):1445-1451. doi:10.1080/17461391.2021.1943712
35. Dervish RA, Wilson LJ, Curtis C. Investigating the prevalence of low energy availability, disordered eating and eating disorders in competitive and recreational female endurance runners. Eur J Sport Sci. 2023;23(5):869-876. doi:10.1080/17461391.2022.2079423
36. Sygo J, Coates AM, Sesbreno E, Mountjoy ML, Burr JF. Prevalence of Indicators of Low Energy Availability in Elite Female Sprinters. Int J Sport Nutr Exerc Metab. 2018;28(5):490-496. doi:10.1123/ijsnem.2017-0397
37. Stenqvist TB, Melin AK, Garthe I, et al. Prevalence of Surrogate Markers of Relative Energy Deficiency in Male Norwegian Olympic-Level Athletes. Int J Sport Nutr Exerc Metab. 2021;31(6):497-506. doi:10.1123/ijsnem.2020-0368
38. Monserrat Hernández M, Arjona Garrido Á, Checa Olmos JC, Salguero García D. Relationship between Negative Running Addiction and Eating Disorder Patterns in Runners. Nutrients. 2021;13(12):4344. doi:10.3390/nu13124344
39. Folscher LL, Grant CC, Fletcher L, Janse van Rensberg DC. Ultra-Marathon Athletes at Risk for the Female Athlete Triad. Sports Med Open. 2015;1(1):29. doi:10.1186/s40798-015-0027-7
40. Karlsson E, Alricsson M, Melin A. Symptoms of eating disorders and low energy availability in recreational active female runners. BMJ Open Sport Exerc Med. 2023;9(3):e001623. doi:10.1136/bmjsem-2023-001623
41. Sophia B, Kelly P, Ogan D, Larson A. Self Reported History of Eating Disorders, Training, Weight Control Methods, and Body Satisfaction in Elite Female Runners Competing at the 2020 U.S. Olympic Marathon Trials. Int J Exerc Sci. 2022;15(2):721-732.
42. Bennell KL, Malcolm SA, Thomas SA, et al. Risk Factors for Stress Fractures in Track and Field Athletes. Am J Sports Med. 1996;24(6):810-818. doi:10.1177/036354659602400617
43. Wasserfurth P, Palmowski J, Hahn A, Krüger K. Reasons for and Consequences of Low Energy Availability in Female and Male Athletes: Social Environment, Adaptations, and Prevention. Sports Med Open. 2020;44(6):1-14. doi:10.1186/s40798-020-00275-6
44. Wells EK, Chin AD, Tacke JA, Bunn JA. Risk of Disordered Eating Among Division I Female College Athletes. Int J Exerc Sci. 2015;8(3):256-264.
45. Wilwand M, Pritchett K, Miles M, Pritchett R, Larson A. The Prevalence of Stress Fractures and the Associated LEAF-Q Responses, Self-Reported Exercise Volume and Dietary Behaviors in Female Recreational Runners. Int J Exerc Sci. 2024;17(2):1092-1104.
46. Werner A, Thiel A, Schneider S, Mayer J, Giel KE, Zipfel S. Weight-control behaviour and weight-concerns in young elite athletes – a systematic review. J Eat Disord. 2013;1(1):18. doi:10.1186/2050-2974-1-18
47. Fochesato R, Guidotti S, Pruneti C. Risk of developing eating disorders through the misperception of the body image and the adoption of bad eating habits in a sample of young volleyball athletes. Archives of Food and Nutritional Science. 2021;5(1):007-017. doi:10.29328/journal.afns.1001027
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Feb 28, 2025
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Risk of Low Energy Availability, Disordered Eating, Eating Disorders, and Bone Stress Injuries in United States Female Track and Field: Original Research. (2025). Journal of Exercise and Nutrition, 8(1). https://doi.org/10.53520/jen2025.103192
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Risk of Low Energy Availability, Disordered Eating, Eating Disorders, and Bone Stress Injuries in United States Female Track and Field: Original Research. (2025). Journal of Exercise and Nutrition, 8(1). https://doi.org/10.53520/jen2025.103192