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Cited by 35Eating Disorders and BehaviorsNutrition, Health and Food BehaviorLower Extremity Biomechanics and Pathologies

Symptoms of eating disorders and low energy availability in recreational active female runners

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Karlsson, Elin, Alricsson, Marie, Melin, Anna·2023·BMJ Open Sport & Exercise Medicine
DOI 10.1136/bmjsem-2023-001623PMC PMC10357753
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Abstract

Objectives: This retrospective, cross-sectional study aimed to investigate symptoms of eating disorders (EDs) and low energy availability (LEA) among recreational female runners. Methods: Females (18–39 years) (n=89) participating in running group sessions organised by running clubs and companies were recruited via social media and completed an anonymous online survey compromising the Eating Disorder Examination Questionnaire (EDE-Q) and Low Energy Availability in Females Questionnaire (LEAF-Q). An EDE-Q global score ≥2.3 and a LEAF-Q total score ≥8 (in combination with an injury score≥2 and/or menstruation dysfunction score≥4) were used to categorise subjects as having symptoms of EDs and LEA, respectively. Results: Among the subjects fulfilling the age criteria (n=85), 18% (n=15) had symptoms of EDs and 19% (n=16) had symptoms of LEA. Of those with symptoms of EDs, 13% (n=2) had concomitant symptoms of LEA. The higher the EDE-Q dietary restraint score, the higher the gastrointestinal problem score (r=0.23, p=0.04), otherwise no other associations were found between EDE-Q global or subscale scores and LEAF-Q scores. Conclusion: Our results indicate that symptoms of EDs and LEA are frequent among adult females at all athletic levels, including the recreational level. Hence, to prevent the negative health consequences of EDs and LEA, preventative initiatives are also needed in recreational running communities.

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  • Karlsson et al. found 41/85 (48%) female recreational runners experienced a sports injury in the previous year, but there was no statistically significant relationship between either LEA or eating disorders and overall injury rate.

    “In Karlsson et al.'s study of female recreational runners, they found that 41/85 (48%) athletes experienced a sports injury in the previous year, but there was no statistically significant relationship between either LEA or eating disorders and overall injury rate [51].”

    From Low Energy Availability and Relative Energy Deficiency in Sport: A Systematic Review and Meta-analysis (2025) · cites this paper as [51]

    The Results (Symptoms of LEA) report that 41 of 85 runners (48%) were absent or markedly limited by a sports injury in the previous year. The Discussion (Symptoms of EDs and LEA) says no association was found between sports injuries and symptoms of eating disorders, but it does not report the same finding for LEA and overall injury rate; it says injury responses could not conclusively be attributed to LEA. (LLM, conf=0.87)

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Research works printed but not linked: 31

  1. [1]Smink FRE, van Hoeken D, Hoek HW. Epidemiology of eating disorders: incidence, prevalence and mortality rates. Curr Psychiatry Rep 2012; 14: 406– 14. 10.1007/s11920-012-0282-y 22644309 PMC3409365 · DOI · Paper page
  2. [2]Sundgot-Borgen J, Meyer NL, Lohman TG, et al. How to minimise the health risks to athletes who compete in weight-sensitive sports review and position statement on behalf of the ad hoc research working group on body composition, health and performance, under the auspices of the IOC medical Commission. Br J Sports Med 2013; 47: 1012– 22. 10.1136/bjsports-2013-092966 24115480 · DOI · Paper page
  3. [3]Burke LM, Lundy B, Fahrenholtz IL, et al. Pitfalls of conducting and interpreting estimates of energy availability in free-living athletes. Int J Sport Nutr Exerc Metab 2018; 28: 350– 63. 10.1123/ijsnem.2018-0142 30029584 · DOI · Paper page
  4. [4]Mountjoy M, Sundgot-Borgen JK, Burke LM, et al. IOC consensus statement on relative energy deficiency in sport (RED-S): 2018 update. Br J Sports Med 2018; 52: 687– 97. 10.1136/bjsports-2018-099193 29773536 · DOI · Paper page
  5. [5]Melin AK, Areta JL, Heikura IA, et al. Direct and indirect impact of low energy availability on sports performance. Scand J Med Sci Sports 9, 2023. 10.1111/sms.14327 36894187 · DOI
  6. [6]Melin A, Tornberg AB, 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: 540– 5. 10.1136/bjsports-2013-093240 24563388 · DOI · Paper page
  7. [7]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 2008; 18: 108– 18. 10.1111/j.1600-0838.2007.00657.x 17490455 · DOI
  8. [8]Fairburn CG. Cognitive behavior therapy and eating disorders. New York: Guilford Press, 2008.
  9. [9]Lichtenstein MB, Haastrup L, Johansen KK, et al. Validation of the eating disorder examination questionnaire in Danish eating disorder patients and athletes. J Clin Med 2021; 10: 3976. 10.3390/jcm10173976 34501422 PMC8432050 · DOI
  10. [10]Mond JM, Hay PJ, Rodgers B, et al. Validity of the eating disorder examination questionnaire (EDE-Q) in screening for eating disorders in community samples. Behav Res Ther 2004; 42: 551– 67. 10.1016/S0005-7967(03)00161-X 15033501 · DOI
  11. [11]Rogers MA, Drew MK, Appaneal R, et al. The utility of the low energy availability in females questionnaire to detect markers consistent with low energy availability-related conditions in a mixed-sport cohort. Int J Sport Nutr Exerc Metab 2021; 31: 427– 37. 10.1123/ijsnem.2020-0233 34284349 · DOI
  12. [12]Ackerman KE, Misra M. Amenorrhoea in adolescent female athletes. Lancet Child Adolesc Health 2018; 2: 677– 88. 10.1016/S2352-4642(18)30145-7 30119761 · DOI
  13. [14]Thein-Nissenbaum JM, Rauh MJ, Carr KE, et al. Menstrual irregularity and musculoskeletal injury in female high school athletes. J Athl Train 2012; 47: 74– 82. 10.4085/1062-6050-47.1.74 22488233 PMC3418118 · DOI
  14. [15]Rauh MJ, Nichols JF, Barrack MT. Relationships among injury and disordered eating, Menstrual dysfunction, and low bone mineral density in high school athletes: a prospective study. J Athl Train 2010; 45: 243– 52. 10.4085/1062-6050-45.3.243 20446837 PMC2865962 · DOI
  15. [18]Barrack MT, Van Loan MD, Rauh M, et al. Disordered eating, development of Menstrual irregularity, and reduced bone mass change after a 3-year follow-up in female adolescent endurance runners. Int J Sport Nutr Exerc Metab 2021; 31: 337– 44. 10.1123/ijsnem.2021-0011 34098530 · DOI
  16. [19]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: 869594. 10.3389/fspor.2022.869594 35592590 PMC9110838 · DOI
  17. [20]Melin A, Tornberg ÅB, Skouby S, et al. Energy availability and the female athlete Triad in elite endurance athletes. Scand J Med Sci Sports 2015; 25: 610– 22. 10.1111/sms.12261 24888644 · DOI
  18. [21]Sundgot-Borgen J, Torstveit MK. Prevalence of eating disorders in elite athletes is higher than in the general population. Clin J Sport Med 2004; 14: 25– 32. 10.1097/00042752-200401000-00005 14712163 · DOI
  19. [22]Chapa DAN, Johnson SN, Richson BN, et al. Eating-disorder psychopathology in female athletes and non-athletes: A meta-analysis. Int J Eat Disord 2022; 55: 861– 85. 10.1002/eat.23748 35665528 PMC9303059 · DOI
  20. [23]Heikura IA, Uusitalo ALT, Stellingwerff T, et al. 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: 403– 11. 10.1123/ijsnem.2017-0313 29252050 · DOI · Paper page
  21. [24]Logue DM, Madigan SM, Heinen M, et al. Screening for risk of low energy availability in athletic and Recreationally active females in Ireland. Eur J Sport Sci 2019; 19: 112– 22. 10.1080/17461391.2018.1526973 30303470 · DOI · Paper page
  22. [26]De Souza MJ, Nattiv A, Joy E, et al. Female athlete Triad coalition consensus statement on treatment and return to play of the female athlete Triad: 1ST international conference held in San Francisco, California, may 2012 and 2ND international conference held in Indianapolis, Indiana, may 2013. Br J Sports Med 2014; 48: 289. 10.1136/bjsports-2013-093218 24463911 · DOI · Paper page
  23. [27]Black DR, Larkin LJS, Coster DC, et al. Physiologic screening test for eating disorders/disordered eating among female collegiate athletes. J Athl Train 2003; 38: 286– 97. 14737209 PMC314386
  24. [28]Rauh MJ, Barrack M, Nichols JF. Associations between the female athlete Triad and injury among high school runners. Int J Sports Phys Ther 2014; 9: 948– 58. 25540710 PMC4275199
  25. [29]Sundgot-Borgen J, Torstveit MK. Aspects of disordered eating continuum in elite high-intensity sports. Scand J Med Sci Sports 2010; 20 Suppl 2: 112– 21. 10.1111/j.1600-0838.2010.01190.x 20840569 · DOI
  26. [30]Barrack MT, Domino S, Gray VB, et al. Support for inadvertent Undereating in female adolescent athletes with clinical indicators of low energy availability. J Sci Med Sport 2023; 26: 285– 90. 10.1016/j.jsams.2023.04.003 37248163 · DOI
  27. [31]Black K, Slater J, Brown RC, et al. Low energy availability, plasma lipids, and hormonal profiles of recreational athletes. J Strength Cond Res 2018; 32: 2816– 24. 10.1519/JSC.0000000000002540 29624522 · DOI · Paper page
  28. [32]Loucks AB. The response of luteinizing hormone Pulsatility to 5 days of low energy availability disappears by 14 years of gynecological age. J Clin Endocrinol Metab 2006; 91: 3158– 64. 10.1210/jc.2006-0570 16720651 · DOI
  29. [33]Ihalainen JK, Kettunen O, McGawley K, et al. Body composition, energy availability, training, and Menstrual status in female runners. Int J Sports Physiol Perform 2021; 16: 1043– 8. 10.1123/ijspp.2020-0276 33690163 · DOI
  30. [34]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: 41. 10.1186/s40337-021-00396-7 33789771 PMC8011161 · DOI · Paper page
  31. [35]Gabbe BJ, Finch CF, Bennell KL, et al. How valid is a self reported 12 month sports injury history? Br J Sports Med 2003; 37: 545– 7. 10.1136/bjsm.37.6.545 14665599 PMC1724702 · DOI

Cited by

Sorted by citations

Authors
Karlsson, E., Alricsson, M., & Melin, A.
Affiliations
Linnaeus University (SE)
Corresponding author
Karlsson, Elin
ORCID
Venue
BMJ Open Sport & Exercise Medicine
Publisher
BMJ
Published
2023-07
Volume
9
Issue
3
Pages
e001623
ISSN
2055-7647 (ISSN-L)
DOI
10.1136/bmjsem-2023-001623
PMC
PMC10357753
OpenAlex
W4384652228
Cited by
35
References
3
Citations by year
2026: 6 · 2025: 8 · 2024: 21
FWCI
10.12
Type
journal article
Language
en
Open access
Licence
Locations
  • BMJ Open Sport & Exercise Medicine (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • KTH Publication Database DiVA (KTH Royal Institute of Technology) (submittedVersion, other-oa)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
  • Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
  • Physical Sciences › Engineering › Biomedical Engineering › Lower Extremity Biomechanics and Pathologies
Keywords
eating disorders, low energy availability, female runners, recreational running, running clubs, dietary restraint, gastrointestinal symptoms, menstrual disorders, running injuries, eating disorder prevention, Eating Disorder Examination Questionnaire, LEAF-Q

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