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The Female Athlete Body Project

By: Dr. Tiffany Stewart (Pennington Biomedical), Dr. Lisa Smith Kilpela (Trinity University), Dr. Carolyn Becker (Trinity University), and Nicole Wesley (Pennington Biomedical).

Female Athletes are a special population of college women, and special attention is required to inform them of the proper nutritional needs of their athletic bodies. In addition, many female athletes engage in restrictive eating, sometimes in hopes that losing weight will increase performance in their sport6.  Other times, they do not consume enough calories to fuel their active lifestyle; unintentionally, neglecting the fact that they require more calories from nutrient dense foods than non-athlete females their age.6  Furthermore, research suggests that disordered eating among female athletes is especially dangerous because it increases risk for relative energy deficiency in sport (REDS)7 and subsequent injury.

Formerly known as the Female Athlete Triad, symptoms of REDS include, but are not limited to, low energy availability/disordered eating, menstrual disorders, and decreased bone mineral density/osteoporosis. REDS is a major health risk among female athletes, who may believe that being extremely thin or maintaining extremely low body fat will enhance their performance. Consuming inadequate calories to adequately match activity level, however, can induce a negative energy balance. This negative energy balance elevates risk for cessation of regular menses, which in turn is associated with decreased bone mineral density; thus, placing the athlete at greater risk for injuries, such as stress fractures, in addition to putting the athlete at risk for developing long term health consequences such as osteoporosis and cardiovascular disease.8,9

Desirable Traits of an Athlete Traits of Individuals with Eating Disorders
Mental Toughness
Commitment to Training
Pursuit of Excellence
Coachability
Unselfishness
Performance Despite Pain
Asceticism
Excessive Exercise
Perfectionism
Over-compliance
Selflessness
Denial of Discomfort

Not only might these similar traits increase the risk of ED onset in female athletes, but also these traits, which are often perceived as desirable traits in an athlete, may complicate identification of an ED because these signs can be viewed as an athlete’s dedication to her sport. Especially in regards to mental toughness, an athlete can seemingly be very committed to her sport, but in actuality be severely harming her body.

Despite the literature highlighting the unique risk of disordered eating in female athletes, eating disorder prevention programs targeting female athletes have been extremely limited. Of the existing prevention programs for female athletes, data have been equivocal. Becker and colleagues5, however, compared an athlete-modified dissonance prevention (DBP) or healthy weight intervention (AM-HWI) in female collegiate athletes. In this study, 157 female athletes were randomly assigned to receive with the DBP or AM-HWI, and researchers assessed ED risk factors at pre/post-intervention, and again at 6-week and 1-year follow-up. Results indicated that both interventions reduced thin-ideal internalization, dietary restraint, bulimic pathology, shape and weight concern, and negative affect at 6-week follow-up. Results at 1-year follow-up indicated reduced bulimic pathology, shape concern, and negative affect. Of note, an additional and unpredicted outcome of this study on the campus was an observed increase in students spontaneously seeking medical consultation for REDS. Lastly, qualitative results suggested that AM-HWI was more preferred by athletes.

What is FAB?

Based on these initial results, Becker and colleagues modified the AM-HWI program to incorporate key activities in the DBP that athletes reported as important. Now termed the Female Athlete Body Project (FAB), Dr. Tiffany Stewart (Pennington Biomedical/Louisiana State University, Baton Rouge, LA) and Dr. Carolyn Becker (Trinity University, San Antonio, TX) launched an NIMH-funded multi-site, randomized controlled trial comparing FAB to a waitlist control.

The FAB program is an ED prevention program designed for female athletes that is run within a team. The program consists of three, 90-minute sessions. In a current large scale multi-site trial, groups are conducted by trained peer-facilitators, who are student athletes from the teams participating in the program. FAB utilizes an interactive format in a group setting, and consists of a series of verbal, written, and behavioral exercises requiring participants to embrace their athlete-specific healthy-ideal, which includes balancing physical, mental, and emotional health. For instance, participants receive and discuss information regarding strategies to increase the nutrient density of foods, ways to achieve adequate energy balance, how to identify signs of REDS, and ways to combat athlete fat talk. With a focus on maximizing health from a multidimensional perspective (e.g. physical, mental, emotional health), FAB includes an emphasis on athletic performance in the context of maintaining health.

Your Opportunity to Benefit

The Female Athlete Body Project (FAB) is currently recruiting campuses to participate in a new study of FAB. Your university could be one of 52 schools across the country selected to participate in the next large dissemination study (application to NIH June 2015) of the FAB program. By being a part of the FAB program study, you have an opportunity to offer a prevention program for the improvement of body image, and prevention of eating disorders to your athletes. If you are selected to participate, your school will be assigned to either an online or peer led version of the program. If interested, please contact the authors for more information.

For information regarding the Female Athlete Body Project, contact Dr. Stewart:

Tiffany M. Stewart, PhD
Associate Professor
Director | Behavior Technology Laboratory: Eating Disorders & Obesity
Founder | CSO, Body Evolution Technologies, Inc.
6400 Perkins Road | Baton Rouge, LA | 70808
T: (225) 763-2554
F: (225) 763-3009
EA: Nicole Wesley (Nicole.Wesley@pbrc.edu | 225-763-2721)
E: Tiffany.Stewart@pbrc.edu
W: http://labs.pbrc.edu/BTL/index.htm

References

  1. Stice E, Chase A, Stormer S, Appel A. A randomized trial of a dissonance-based eating disorder prevention program. The International Journal of Eating Disorders. 2001; 29(3): 247-262.
  2. Stice E, Shaw H. Eating disorder prevention programs: a meta-analytic review. Psychological Bulletin. 2004; 130(2): 206-227.
  3. Festinger L. A Theory of Cognitive Dissonance. Stanford, C.A.: Stanford University Press; 1957.
  4. Stice E, Marti CN, Spoor S, Presnell K, Shaw H. Dissonance and healthy weight eating disorder prevention programs: long-term effects from a randomized efficacy trial. Journal of Consulting and Clinical Psychology. 2008; 76(2): 329-340.
  5. Becker CB, McDaniel L, Bull S, Powell M, McIntyre K. Can we reduce eating disorder risk factors in female college athletes? A randomized exploratory investigation of two peer-led interventions. Body Image. 2012; 9(1): 31-42.
  6. Hinton PS, Kubas KL. Psychosocial correlates of disordered eating in female collegiate athletes: Validation of the ATHLETE questionnaire. Journal of American College Health. 2005; 54(3): 149-156.
  7. Mountjoy M, Sundgot-Borgen J, Burke L, et al. The IOC consensus statement: beyond the Female Athlete Triad – Relative Energy Deficiency in Sport (RED-S). Journal of Sports Medicine. 2014; 48: 491-497.
  8. O’Donnell E, De Souza MJ. The cardiovascular effects of chronic hypoestrogenism in amenorrhoeic athletes: A critical review. Sports Medicine. 2004; 34(9): 601-627.
  9. HealthLink Medical College of Wisconsin from The National Institute of Health. 2006
  10. Sherman RT, Thompson RA. Athletes and disordered eating: Four major issues for the professional psychologist. Professional Psychology: Research & Practice. 2010; 32(1): 27-33.