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Public health professionals from nine countries in Southern and Eastern Europe are equipped to use a stable isotope method to assess body composition following a four-year project to strengthen efforts to reduce childhood overweight and obesity, with IAEA support.

While the rates of undernutrition are small in most European countries, rates of childhood overweight and obesity are high and isotope techniques can help provide the information policymakers need to tackle it.

With a long-term vision to halt future potential epidemics of diabetes and heart disease which can result from overweight, public health professionals from Albania, Bosnia & Herzegovina, Greece, Hungary, Latvia, Montenegro, Moldova, North Macedonia, Portugal and Ukraine have been exploring the use of the deuterium dilution technique, which goes beyond the measure of weight and height by assessing the fat and fat free mass proportions of body weight. The technique is based on measuring total body water using deuterium, a stable isotope of hydrogen. Because fat does not include water, the total body water is indicative of the fat free mass. Fat mass can then be calculated by subtracting fat free mass from body weight. For more information, see this page.

With this technique now in their toolbox, public health institutions can generate better data on body composition to inform public health programmes at both the national and regional levels.

Detailed and accurate methods are needed to assess whether interventions are really effective, said Cornelia Loechl, Head of the Nutritional and Health-Related Environmental Studies Section at the IAEA. The deuterium dilution technique is the right technique to verify whether interventions to prevent or reduce overweight in children lead to the desired loss of fat.

In 2014, the World Health Organization (WHO) estimated that every third 11-year-old child in Europe and Central Asia was overweight or obese. The WHO-supported Childhood Obesity Surveillance Initiative (COSI) is gathering data on the weight and height of several hundred thousands of school children in more than 40 countries and the numbers give cause for great concern, Loechl said. The COSI data has led to increased awareness and action, and improvements are observed in the most affected countries in Southern Europe. At the same time, the overall magnitude of overweight has not improved much. A continuous preventative effort to improve dietary habits, limit sedentary behaviour and increase physical activity of school children is needed, according to WHO.

Even with COSI running regularly in the country and showing that childhood obesity is a growing public health problem, we do not yet have any programmes in place to combat this health risk in North Macedonia, said Igor Spiroski from the countrys Institute of Public Health. The deuterium dilution technique to measure body composition will support the assessment of the populations health and ultimately shape policy propositions.

The WHO Regional Office for Europe has welcomed the IAEA initiative. We are very keen on this collaboration, said Joo Breda, Head of the WHO European Office for the Prevention and Control of Noncommunicable Diseases. While WHO continues to use the body mass index (BMI) for surveillance purposes, we fully acknowledge that body composition can complement the population surveillance and offer the extra mile. Body composition provides the opportunity to measure progress in weight loss interventions.

The regional project, supported by the IAEA's Technical Cooperation Programme, involvedcapacity building in terms of training and laboratory equipment, and public health professionals from the region were able to network and exchange experiences with colleagues from other countries. Alban Ylli, a public health specialist from Albania, said: We have been able to build a network of professionals who will continue to work together for a long time after the end of the project. In addition to sharing data and knowledge between institutions, it may provide an excellent opportunity for future consortiums to compete in European Union research and development programmes.

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Isotope Tool to Help Fight Childhood Obesity Now in Use in Southern and Eastern Europe - International Atomic Energy Agency

WINNIPEG -- Maintaining a healthy body weight is one of the most important things to do to help keep your heart healthy University of Manitoba cardiology fellow Dr. Phyllis Sin says.

She told CTV News that lifestyle changes, like dieting, exercising, quitting smoking and reducing alcohol intake make the biggest impact on improving heart health.

"But we also know that these are also the most difficult to implement," she explained Friday, after hosting a session on two popular diets at The Wellness Institute.

The two diets she and a colleague covered were the ketogenic diet and intermittent fasting.

"It's not 100 per cent clear what it does long term to your heart health and same with intermittent fasting," she said.

Eating keto, she explained is when most of your calories come from fats, a little protein and very little carbohydrates.

Intermittent fasting is limiting hours in the day when you eat a common window is 11a.m. to 7p.m.

Sin added that there is evidence that these two diets do help people with weight loss, but when choosing one, its important to consult with your doctor or a dietitian to use the right approach for your lifestyle.

"If you use a more plant based approach for both of these diets, that can also lower your bad cholesterol and raise your good cholesterol, and perhaps let you come off your blood pressure medications cholesterol medications and help improve the way your body processes sugars," she said.

She did caution that for people living with diabetes, these two diets may not be ideal because a low carb diet and not eating for a long period of time could cause blood sugar levels to dip too low.

Winnipegger Melina Elliott has been doing the ketogenic diet for two and a half years.

"I went for my physical and my doctor said to me, 'you have a strong family history of type 2 diabetes , your body is holding out well now, but you need to make a change," she said via Skype from Ontario where she was for work.

Elliott is also sure she was on track to be at a higher risk for heart attack and stroke. Shes now lost 85 pounds and says people are amazed with her progress.

"They'll see me and they'll ask, what did you do? and I tell them I flipped my diet," she said.

Through her work at BodyMeasure, she is able to keep a very close eye on her health markers.

"I am at no risk now for type 2 diabetes or heart disease," she said.

Her motivation is her health and the choice to stick with it is an easy one.

Dr. Sin was a part of the free Matters of the Heart Event put on by the Wellness Institute. A team of resident physicians from the University of Manitoba Cardiac Sciences Program give presentations on current heart health issues.

The next event is a free webinar called, Womens Heart Health: What Makes Us Different will be held February 26 at noon featuring Cardiac Rehabilitation Nurse, Kendra Gierys.

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Ketogenic dieting, intermittent fasting and the impacts to your heart health - CTV News

London-based Second Nature, the tech-enabled digital health programme designed to combat obesity, has raised $10 million in a funding round led by Beringea.

Previously named OurPath, the health tech startup is the first lifestyle change programme to be commissioned by the UKs National Health Service (NHS) for diabetes management. Second Natures twelve-week program combines advice from health experts with tracking technology on a smartphone app, and peer-reviewed studies confirm the programmes habit changes have led to sustained weight loss.

Healthcare systems are struggling to cope with spiralling rates of obesity and associated illnesses, which are projected to cost the global economy $1.2 trillion annually by 2025. Second Natures pioneering approach to lifestyle change empowers people to address these conditions, develop sustainably healthier habits, and foster long-term physical and mental wellbeing in the process, commented Philip Edmondson-Jones, an investment manager at Beringea who will join the startups board.

Founded in 2015 by Chris Edson and Mike Gibbs, two former NHS advisors, the company now employs 80 people.

Our goal as Second Nature is to solve obesity. We need to rise above the confusing health misinformation to provide clarity about whats really important: changing habits. Our new brand and investment will help us realise that, said Gibbs.

The round included investments from Uniqa Ventures, the venture capital fund of European insurance group Uniqa, and the founders of mySugr, the digital diabetes management platform which was acquired by Roche. Existing investors Connect, Speedinvest, and Bethnal Green Ventures also participated.

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London-based health tech startup Second Nature raises $10 million to combat obesity and diabetes - Tech.eu

The Japanese drug maker Eisai on Thursday said it would withdraw the weight-loss drug Belviq from the U.S. market after the Food and Drug Administration expressed concerns about an increased occurrence of cancer reported in people who used the product.

The agency recommended that people using Belviq to lose weight should stop taking the medicine immediately, although the FDA is not recommending special cancer screening for people who have used the drug.

We are taking this action because we believe that the risks of lorcaserin outweigh its benefits based on our completed review of results from a randomized clinical trial assessing safety, the FDA statement said. Lorcaserin is the scientific name for Belviq.

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Belviq was developed by the San Diego biotech firm Arena Pharmaceuticals and secured U.S. approval in 2012. The drug was a commercial bust, however, because weight loss was only nominally more than placebo. Arena eventually sold Belviq to Eisai, which continued to market the drug in the U.S. Sales were just $41 million in the first nine months of 2019.

The FDA decided to ask for Belviq to be pulled from the market based on findings from a clinical trial that was started after approval, meant to assess the drugs long-term heart safety.

In that study, the FDA did not find an increased risk of heart-safety problems associated with Belviq. However, there was a numerical imbalance in the number of patients with cancer, with one additional cancer observed per 470 patients treated for one year.

Over the course of the trial, 462 patients, or 7.7%, treated with Belviq were diagnosed with 520 primary cancers compared to the placebo group, in which 423 patients (7.1%) were diagnosed with 470 cancers. The imbalance in cancer increased with longer duration on Belviq, according to the FDA.

Prior to Belviqs approval in 2012, Arena conducted an animal safety study, which linked Belviq to an increased occurrence of tumors in rats. While the FDA raised concerns about this cancer risk, the agency allowed the drug to reach the market anyway, even though Arena could not disprove the causal cancer connection.

Eight years later, the FDA has now reversed itself after finding more definitive evidence that links Belviq to a higher incidence of cancer in people.

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Weight-loss drug to be pulled from market over concerns of cancer risk - STAT

The Aston Martin Music hitmaker Rick Rosss weight loss journey began after suffering a series of seizures and now thanks to a good diet and plenty of exercise hes in really good health. In this article, we take a look at what caused Rick Rosss weight loss.

In a 2010 interview Rick Ross spoke about hurtful comments that had been thrown at him in the past. I was always the fat black dude with the cheap shoes on, Ive always had thick skin he told DR Jays. But he also said that he didnt care: he could take a joke and he could give a joke.

After suffering two seizures in less than 24 hours in 2011, Rick the Bawse Ross found himself sitting in the waiting room of a very expensive doctors office. I was the only black dude, and the rest were 55- to 80-year-old white males sitting in the room. He stated: It was all silence and we all was kind of just looking at each other, like, What the f*ck he here for?

Rick Ross noticed elderly Caucasian male after elderly Caucasian male were being called by the nurse. Finally, when it was his turn, the doctor broke it down for him.

He told me I didnt have high blood pressure but I was hypertensive, which is a phase under having high blood pressure. And thats when I said right then, Yo, whats my biggest enemy?

After the doctor checked his chart he said:Right now, for you, based on everything you wrote down: sodas. Soda wasnt the only thing on that chart, but it was the starting point that Ross remembers.

By 2014, the then 43-year-old rapper who once tipped the scale at 350 pounds, dropped down to right around 200 pounds. Rick Rosss weight loss journey began in 2011and he has been able to keep the pounds off years later.

Rick Ross spoke about his weight loss plan and routine in the 2014 issue of Mens Health magazine revealing that hes not only lighter in weight, he feels good about life. Im happy, Ross told the magazine. Im still losing weight, and now Im starting to build hard muscle in places.

If youre wondering how he pulled it off, Rick Ross chose a slower, long term plan for weight loss. Instead of jumping on a fad diet or taking a cleanse he chose to take another route.

By working out with friends, and creating a personal version of Cross Fit or the Ross Fit, helped the entertainer get four days of exercise in a week. He also worked with a personal chef, and doesnt deprive himself of guilty pleasures.

Rapper Rick Ross credits his body transformation with the art of balance.

Its all about the balance to me, Ross told ABC News. I wanted to balance myself but still enjoy the things I love so if I lost weight one year, the next year it wouldnt be right back on me.

Im almost at two-and-a-half years doing this RossFit [a CrossFit training program that Ross has jokingly coined RossFit], the entertainer said. And that comes from that balance of still being able to enjoy Wingstop with a couple of wings when I want to, but still four days out of the week, I still go put in 45 minutes at the gym. And that balance is what got me where Im at and Im happy and I feel good.

He went on to say: You know, I try to throw in healthy snacks in between the meals. That was really my trick, and slowing down the heavy meals as it got later in the day. So, during the day I get up early. 2 oclock, I feel I could do what I want, eat what I want. But as it gets 5 oclock, 6 oclock, Im really shutting down for the day. Maybe at 9 or 10, I will eat a salad versus 2 in the morning being in the studio eating steaks, prime rib and everything else. And thats what I had to change.

As you can see in 2016, Rick Ross was all about portion control. He was allowed to indulge in eateries like Wingstop and Checkers one or twice a week, and between the hours of noon and 5 p.m.

If I quit all the things I loved cold turkey, I knew it would only be so long before I went back to my old ways, he explained.

In 2018 Rick, Ross posted photos on Instagram of his dramatic weight loss.

Following his dramatic hospitalisation in March 2018, the rapper shared a photo of his noticeably smaller figure on Instagram. The entertainer who was reportedly on life-support, shed a huge amount of weight.

Rapper Rick Ross celebrated after losing 100 pounds (45.3 kilograms) in his health battle. In 2019 on the U.S. breakfast show Good Morning America, Ross said: (I was) just focusing on my eating, really just being more disciplined, working out three or four times a week.

Rick Ross explained that his last life-threatening seizure 18 months ago made him step on the gas with his new memoir, adding, This was nothing that was ever really on my bucket list but after waking up (in the hospital) My mother, my family, my best friends, we just reminisced on how far we came everything weve accomplished.

Sleeping for 3 hours a night, belting 24-oz steaks at 4 AM, and weighing 350 pounds was a bad concoction of activities for Rick Ross. In 2011, the rapper had TWO seizures within 24 hours that required his private jet to make emergency landings both times. This went on to force Rick Ross to reevaluate everything.

The kind of seizures Ross had occurs when normal brain activity is interrupted and involuntary muscle spasms are common, can be caused by alcohol. Drinking it can cause seizures in a variety of different ways; binge drinking, alcohol withdrawals and adverse reactions to drink ingredients can all put you at increased risk for a seizure.

After his doctor urged and encouraged Ross to change his diet and exercise, Ross saved his life, losing 75 lbs. Im happy, Ross told Mens Health in its September issue, on newsstands now. Im still losing weight, and now Im starting to build hard muscle in places.

The key to Ross weight loss was taking things slow, rather than trying quick fixes that wouldnt stick. If I quit all the things I loved cold turkey, I knew it would only be so long before I went back to my old ways, he says. Instead, Ross allowed himself to have the fast-food from Checkers and Wingstop that he always loved, but only between noon and 5 PM, and only two or three days a week.

For the bulk of his meals, Ross worked with a chef to come up with healthy recipes that he would want to eat. He also started working out with a group of friends for motivation, and came up with his version of CrossFit, which he calls RossFit.

Four days a week, Ross goes for a warm-up jog, and then sets up five exercise stations with moves like deadlifts and push-ups, working through them for 30 minutes. To aid with weight loss, Rick Ross also found that classic powerlifting lifts like the deadlift leads to changing your body fast.

The rapper shared that finding workouts and foods that he would enjoy was the key. My advice for anyone looking to lose weight is not to make it feel like a job, he say

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Rick Ross Weight Loss Journey and Transformation - Daily Hawker

For a short while there, the keto diet seemed to be taking the world by storm.Widely touted for promoting rapid weight loss, the high-fat, low-carb food plan gained enormous attentionfrom media, celebrities and health professionals alike.

While many devotees still swear by the keto diet, some dietitians and researchers have started questioningits long-term benefits, potentially jeopardising its popularity and credibility.

The ketogenic diet was originally developed about a century ago as a therapeutic treatment for people with epilepsy and has since been used to help treat otherconditions including depression, anxiety, Parkinson's disease and Alzheimer's.

Over the years, the Atkins andpaleo diets have also popularised similar low-carb eating plans.

The typical keto diet restrictscarbohydratesto just 5-10 per cent of daily energyintake, coupled with a much higher fat intake.

The low carb intake is intended to sendyour body into a metabolic state called ketosis, meaning your body becomes highly efficient in burning fat as its energy source, rather than glucose (sugar).

People are starting to realise the difficulties and danger associated with adhering to the diet long-term.

While this sounds fantastic in theory, the diet may be difficult to maintain in the long term and research suggests that, despite some indications it can lead to fat loss and lowerblood sugar and insulin levels, it may harm health over time.

Sydney accredited practising dietitian Bronwen Greenfield welcomesthe recent scrutiny ofthe keto diet, saying people need to be aware of the lack of evidence supporting its use.

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"A lot of the evidence supporting the benefits of the diet is largely limited to therapeutic use for specific health conditions [such as epilepsy]," shesays.

"In other words, there is little evidence around to suggest that the diet is successful in otherwise healthy individuals."

Greenfield believes too many people overlookthe risks of the diet and concentrate on its potential to offer a "quick fix" to weight gain.

"The keto diet undeniably results in short-term weight loss," she says.

"This is because it's cutting out so many foods, which then results in a reduction in total caloric intake.

"The depletion of liver and muscle glycogen stores, and thus water, also results in a quick loss of weight."

But it's important to remember that these are only short-term results, Greenfield says: "The key to long-term fat loss is an eating pattern that is sustainable over time."

Last year, Google Trends recorded a 75 per cent decline in Australian searches for the term "keto", before increasing again in thenew year,suggesting people still regardketo as a short-term fix to ditch holiday weight.

One recent blow to the diet's popularity came after the US News & World Report, which publishes rankings across education and healthcare,evaluated 35 of the most popular diets around the world and listed keto as the worst for healthy eating out of all of the diets considered.

The list evaluated each diet's nutritional completeness, ease of maintaining, potential for long- and short-term weight loss, safety, and possible side effects.

Keto ranked poorly dueto the difficulty of maintaining the diet, and the fact it restricts essential food groups such as wholegrains, fruit and vegetables. The only category it received a strong result in was its ability to achieve fast weight loss.

Greenfield says these results highlight significant concerns around the healthfulness of the diet.

"I think any diet that omits a number of key food groups should be avoided, predominantly because it makes it difficult to stick to long-term," she says.

"Studies investigating the keto diet have begun to reveal the high drop-out rates, and people are starting to realise the difficulties and danger associated with adhering to the diet long-term."

The severely restrictive nature of the diet means the body is often not obtaining adequate nutrient-dense foods such as fruit, wholegrains and vegetables, Greenfield says.

"[These are] rich sources of a variety of antioxidants, phytochemicals, vitamins and minerals," she says.

Lack of fibre is also an issue,which can lead toconstipation, increase the risk of bowel cancer, and limit prebiotic fibre.

By starving the gut microbiome of essential nutrients such as carbs and fibre, the changes to gut health can harmdigestion, hormone balance,and even mental health.

Greenfield questions the high fat content of the keto diet, too.

Much of the total energy intake comes from fat, and while it's possible to modify the diet to place a focus on healthy fats such as extra virgin olive oil, nuts, seeds, oily fish and avocado, much of the emphasis is on foods high in saturated fats such as bacon, cream and butter,she says, saying this canincreasebad cholesterol levels.

While there is still much we have to learn about the keto diet,existing studies suggest itslong-term effects may harmthe body's metabolism, inflammation levels and fat stores.

One recent papersuggests while the keto diet may offer some short-term benefits, these couldbe outweighed by other risks in the longer term.The study, conducted on mice and published by researchers at Yale University in January inNature Metabolism,discovered that after a week keto's benefits begin to wane.

Essentially, the keto diet tricks the body into burning fat as fuel and reduces glucose levels, causing the body to behave as though it's in a starvation state. After a week, the study showed a reduction in blood sugar levels and inflammation, but any longer than a week saw the mice consuming more fat than they could burn, and starting to develop obesity and diabetes.This is owing to the body acting in survival mode, which means it is storing fat, while simultaneously using it as a fuel source.

Accredited practising dietitian Michelle Gale says the Yale study provides much-needed insight into the health effects of the keto diet and the potential risks it poses, however she recommends caution when applying these findings to humans.

"The physiological differences between mice and humans means we cannot guarantee the same effects or consequences," she says.

"We are unsure what these long-term health consequences might be, as there is simply not enough human-based evidence at the moment.A stronger evidence base of human clinical trials is needed to confirm these findings and determine the long-term safety of the ketogenic diet in healthy individuals."

Gale also says it's possible theketo diet may work for some people and not others.

"The success of a keto diet for weight loss comes down to compliance," she says.

"For the body to switch into ketosis and result in weight loss, total energy intake must be reduced and carbohydrate intake must be limited to only 20-50g per day, which equates to just two slices of bread, half a cup of rice or one large apple."

"There can also be unpleasant side effects that will reduce compliance, such as fatigue, headaches, bad breath, nausea and constipation. Following the ketogenic diet can have a negative impact on [people's] social life as well, as drastic lifestyle changes are often required."

Gale says there has been conflicting evidence to suggest that low carbohydrate diets are linked to increased mortality, but there is no consensus on the topic, and more research required to confirm these findings.

Like Greenfield, Gale says ketogenic diets tend to restrict important food groups as well as fibre, potentially leading to nutrient deficiencies and increasing the risk of bowel cancer.

To reduce the potential risks,it is important to ensure you're getting adequate nutrients. One way to do this is to try ketofor a very short period of time, such as the week outlined by theYale study, followed by the Mediterranean diet, which is rich in vegetables,fruits, herbs, nuts, beans and wholegrains.

"Mild" keto - a less restrictive version of the keto diet - also allows for a higher plant intake, increased gut diversity, and healthy weight loss without depriving the body of nutrients, offering a safer, lower-risk option.

Gale says while it is possible to follow the keto diet safely for a short period of time,she recommends speaking with a health professionalbefore starting.

"They can tailor a diet to your individual needs and monitor your progress closely to prevent nutrient deficiencies and unwanted side effects," she says.

In the same study by the US News & World Report, the Mediterranean diet was ranked the best overall diet, best plant-based diet, and the easiest diet to follow.

"I think the Mediterranean diet is an excellent example of a healthy, balanced diet that is relatively easy to follow," Greenfield says.

Research continues to grow in support of the Mediterranean diet's beneficial effects on obesity, cardiovascular health, metabolic syndrome and Type 2 diabetes.

It has stood the test of time, Greenfield says, placing emphasis on foods we should include more of - wholegrains, fruit, vegies, beans, legumes, nuts, olive oil, fish and seafood - rather than on what we should restrict or remove.

"This is really important from a healthy mindset and long-term sustainability perspective," she says.

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Is the keto diet everything it's cracked up to be? - Good Food

Meet Lola Clay, 'My 600-lb Life's Therapist to the Show's StarsAcceptWe allow third parties to collect information which we use for business purposes, for more info read CCPA section in the privacy policy page.AcceptBrowsers may block some cookies by default. Click accept to allow advertising partners to use cookies and serve more relevant ads. Visit our privacy policy page for more information.Source: TLCBy Pippa Raga

2 days ago

Each week, TLC's My 600-lb Life introduces us to patients of Dr. Nowzaradan, affectionately known as Dr. Now, as they battle their weight issues and work toward living healthier lives.

The patients who arrive at Dr. Now's clinic are extreme weight cases usually weighing upwards of 600 lbs, and before they can be considered for any type of weight-loss surgery, they must attempt to lose weight on their own.

Dr. Now prescribes a strict diet and exercise plan, then assesses whether the My 600-lb Life stars are suitable candidates for a gastric bypass surgery, and many of his patients don't make it to that step.

But as you can imagine, most patients find it difficult to stick to Dr. Now's diet after a lifetime over overeating, and oftentimes need to address deeper issues in order to maintain their physical progress in the long term.

Enter Lola Clay, My 600-lb Life's resident therapist who helps Dr. Now's patients address the emotional triggers that provoke them to overeat.

So, who is Lola and what qualifies her to work with Dr. Now's patients? Keep reading to find out!

As a licensed professional counsellor in the state of Texas, Lola uses a cognitive behavioral therapy approach to help patients change their deep-seated behavioral patterns. She's been a practicing counsellor for the past 16 years and specializes in dealing with addiction and weight-loss issues, along with impulse control disorders and life coaching.

Lola works with patients of all ages, starting with toddlers and going all the way up to seniors over the age of 65. For prospective clients looking to work with the therapist outside of the TLC show, sessions can cost anywhere between $250 and $485 per session.

She is also able to provide her services in Farsi, which she speaks fluently, and is able to bring in Spanish and Serbian translators at no additional cost.

Lola helps her patients gain awareness around their problematic behaviors, which in the case of My 600-lb Life patients is often overeating. By identifying patients' patterns, she empowers them to make transformative changes.

Overeating is often a symptom of other emotional issues or traumas people have experienced earlier in life, so her job is to sort through patient's pasts to unearth these complexities.

Many of the patients on the show have suffered sexual traumas, or have chronic anxiety or depression, or are simply more prone to addictive behaviors. In dealing with their issues, the patients we see on the show often turn to food as a source of comfort during stressful times in their lives.

Using a combination of approaches, Lola is able to help Dr. Now's patients uncover and work through their past traumas that may be causing them to overeat. She helps her patients gain a larger and more inclusive perspective on their lives, in order to effect long-lasting changes in their lives, both mentally and physically.

New episodes of My 600-lb Life air Wednesdays at 8 p.m. on TLC.

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Meet Lola Clay, 'My 600-lb Life's Therapist to the Show's Stars - Distractify

At Wolfgang Pucks CUT, a high-ceilinged steak house known for its porterhouse, I found Resch, dewy-skinned and dressed in flowy chiffon, sipping water. The nutritionist was fresh from meeting with clients at her Beverly Hills practice, where shes seen its ranks swell to almost unmanageable proportions.

We were presented with the extensive menu, and our lesson began. Step one in intuitive eating, she told me, was to start a meal with a healthy hunger. Dont eat a late lunch if you want to be excited for dinner, but dont be so hungry you demolish the breadbasket. I was starving. Id gotten so nervous about wanting to appear to eat intuitively that I hadnt eaten in hours. Step two: Clear my mind and read the menu closely, attuned to which dishes would bring me pleasure and satisfaction. Should I focus on a variety of textures? Or colors? Or plants, then meat? Raw, then cooked? Resch smiled beatifically and suggested I focus on what sounded good. Step three: Believe that all foods are morally equivalent. None is better or worse than another.

In the long term, following a program whose only rule is no rules seems as low-stress as warm hydrotherapy. But sitting across from said programs guru while evaluating a menu is stressful. When my eye landed on a salad, I worried Resch would think I was a restrictive eater, and when my eye landed on french fries, that I was beginning a binge. In the end, my intuition inexplicably insisted on French loup de mer in a steakhouse. My intuition also found the French loup de mer overcooked, but found the cherry--tomato vinaigrette irreproachable. I liked the wine, too.

Elyse told me that as a lover of food, I was uniquely well positioned to be good at this. Satisfaction, she told me, is the driving force of intuitive eating. But isnt the pursuit of satisfaction the driving force of overeating? It was time to play hardball. I love french fries, I declared. What if all I wanted to eat was french fries? Resch explained what she calls emotion light. When I am satisfied with my french fries, she saysto which I must stay closely attunedI will feel and then observe a slight sense of mourning. It feels sad to say goodbye to my french fries. It is a small sadness, though, and I should let myself feel it. I must remind myself I can have french fries again whenever I want them. She pointed out that if I did eat french fries for a number of consecutive meals, guiltlessly, I would want something else. Its impossible to envision this scenario.

What about inflammation? Detoxification? Nutrition? The obesity epidemic? Standards of beauty? Resch knocked these down like so many Cadbury Creme Eggs. (1) Worrying over everything you eat causes an increase in the stress hormone cortisol, which is known to cause cancer growth. Thats worse than inflammation. (2) The very idea that we are toxicthe premise for detoxificationis toxic. If you are after wellness, you should feel good. You cant put health over the horizon line and expect to achieve it. (3) Infants and toddlers eat intuitively. This has been proven. Resch didnt bring it up, but Ive read a fascinating 1928 study by a pediatrician named Clara M. Davis who tested nutritional intuition with a cohort of toddlers. The toddlers were presented with 34 foods at each meal for a number of years. Nurses administering the study were under strict instruction to show no bias for any food over another. The children not only ate a varied diet, but all ended up remarkably healthy. (4) Diet culture has grown as our dietary crisis and rates of unhealthy weight have increased. Whatever we are doing isnt working! There is no better evidence than the millions of years before ours. In essence, Resch said, sipping her Domaine du Bagnol and dabbing butter on her baked potato, if there is no rule to break, no code against which to cheat, longing itself takes on a different flavor: Without restriction, what need is there to indulge?

Do you know why intuitive eating is having such a moment? Resch asked provocatively. Its Trump. After so many decades of being told to be thinnerwhich, she notes, coincided with women entering the workplacewomen have had enough. Trump pushed us over the edge. We wont stand for being told how to look or sound or be anymore. The overt misogyny of the current administration might, according to her theory, spur actual liberation from restrictive eating.

As we said good night, Resch left me with a gentle reminder: If you cant really eat for yourself, you are always in a state of friction. But you can begin practicing your intuition at any time, she said. Its really very simple. It sounded religious, I remarked. She replied, Its intuitive.

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All You Can Eat? Inside the Intuitive Eating Craze - Vogue

Authors: Ksenia Power, M.S., Sara Kovacs, Ph.D., Lois Butcher-Poffley, Ph.D., Jingwei Wu, Ph.D., and David Sarwer, Ph.D.

Corresponding Author:Ksenia Power, PhD Candidate1800 N. Broad Street, Pearson Hall, 242Philadelphia PA, 19122tug82764@temple.edu267-766-8938

Ksenia Power is a Doctoral Candidate and an Instructor of Record inthe Department of Kinesiology at Temple University, majoring in Psychology ofHuman Movement. She is also a VolunteerAssistant Womens Tennis Coach at Temple University.

ABSTRACT

Over the lastthree decades, a large body of research has examined the issue of eatingdisorders, both formal diagnoses and subclinical features, as well ascompensatory behaviors in National Collegiate Athletic Association (NCAA)athletes. In general, this literature suggests that large numbers ofstudent-athletes engage in disordered eating and compensatory behaviors;smaller percentages have symptoms that reach the threshold of formal diagnoses.Increased symptoms are associated with reduced athletic and academicperformance, both of which may impact psychosocial functioning later inadulthood. Unfortunately, a number of methodological shortcomings across thisbody of research (e.g., studies with insufficient sample sizes, inappropriatecomparison groups, and suboptimal or biased psychometric measures) limit theconfidence that can be placed in these findings, underscoring the need for anew generation of studies. This paper provides an overview of this literature,focusing on issues of gender differences, sport type, and age. It alsohighlights the relationship between disordered eating and compulsive exercise,a compensatory behavior that is highly prevalent among collegiateathletes. The health and athleticperformance consequences of eating disorders in conjunction with compulsiveexercise are also discussed. Inaddition, a focus on more recently recognized eating disorders, such as bingeeating disorder and the night eating syndrome is underscored. Future work in this area needs to include themost methodologically rigorous measures available in order to aid mostappropriately coaches and athletic trainers in promptlyidentifying at-risk athletes and to inform future prevention and treatmentefforts.

Key words: eating disorder, disordered eating, compulsive exercise

INTRODUCTION

Over the past decade, a number of studies have examined thesymptoms of disordered eating among National Collegiate Athletic Association(NCAA) athletes (9,12,13,24,30).Up to 84% of collegiate athletesreportedengaging in maladaptive eating and weight control behaviors, such as bingeeating, excessive exercise, strict dieting, fasting, self-induced vomiting, andthe use of weight loss supplements (12,13,24).Subclinical symptoms or those that reach diagnostic criteria maycontribute to poor physical and mental health, as well as suboptimal athleticand academic performance (29).

The substantial physical demands of being a student-athlete are believed to contribute to the development of eating pathology and compensatory behaviors (32). In season, student-athletes are restricted to 20 hours of weekly on-and-off the court/field physical workload, including the time spent in competition (1).However, the 20-hour rule if frequently violated, which results in excessive hours of physical activity and subsequent overtraining (39). For instance, Division I football, baseball, and basketball players reported the highest weekly in-season athletic commitments, averaging nearly 40 hours per week (39). In all other sports, the weekly times spent in training and competition averaged 32 hours (39). The combination of disordered eating and physical overtraining may further produce significant health impairments, such as low energy availability, muscle weakness, acquisition of overuse injuries, mineral bone deficiency, cardiac complications, impaired immune function, malnutrition, dehydration, fatigue, amenorrhea, and osteoporosis (5,15). Some of these conditions are sustained after the athlete has moved on from organized competition (29,44). Physical overtraining and inadequate nutrition can also negatively impact an athletes mood, contributing to poor academic and athletic performance (29,44,45).

Some collegiate athletes suffering from disordered eating are known to engage in compulsive exercise as a strategy to compensate for excessive caloric intake (33). Compulsive exercise, beyond sport-required training, places student-athletes at a high-risk for physical overtraining, overuse injuries, and subsequent diminished performance (12, 53). In addition, this compensatory behavior often occurs as a symptom of eating psychopathology (21, 33). Particularly worrisome is the finding that maladaptive eating with simultaneous engagement in compulsive exercise can often remain undetected in athletes and contribute to the progression of an eating disorder (36, 45). Like subclinical eating disorders, formal eating disorders can endure into adulthood and have a continued, negative impact on physical and psychosocial health (56). Unfortunately, most of these athletes experience eating disorder symptoms in isolation, as these behaviors often are missed by the coaching and athletic training staff (62,63). Thus, further studies are necessary for identifying eating disordered athletes (9,25,29).

Disordered Eating Symptoms and EatingDisorder Diagnoses

According to the Diagnostic and Statistical Manual (DSM-V) of theAmerican Psychiatric Association (2013), eating disorders are characterized bysevere alterations in an individuals eating habits that are linked tophysiological changes.Individuals with eating disorders becomepre-occupied with food, body weight, and physical appearance. Common eating disorders that occur incollegiate athletes are Anorexia Nervosa (AN) and Bulimia Nervosa (BN) (4,10,12,24, 42). For instance, in a mixed-sportsample of Division I collegiate athletes, 5.1% of all women scored in theclinical range for either Anorexia Nervosa or Bulimia Nervosa (49). Similarrates of clinical eating disorders were reported in a sample of 414 NCAADivision I athletes (6.3%), with Bulimia Nervosa being the most frequent one(4).

According to the American Psychiatric Association (2013), AnorexiaNervosa (AN)is characterized bypersistent restriction of caloric intake, resulting in significantly low bodyweight (below the minimal norm considering an individuals age, height, weight,and developmental trajectory). It alsomanifests through an intense fear of gaining weight and severe disturbances inones perceptions of his or her own body weight and shape (i.e., refusal torecognize the seriousness of ones low body weight). Bulimia Nervosa (BN) is characterized by thefollowing symptoms: (a) recurrent episodes of binge eating; (b) recurrentengagement in detrimental compensatory behaviors in order to prevent weightgain; (c) the binge eating and compensatory behaviors must occur at least oncea week for three consecutive months; and (d) an individuals body and shapebecome vital parts in his or her self-evaluation (3). Binge Eating Disorder(BED)includes the followingsymptoms: (a) recurrent engagement in episodes of binge eating; (b) occurrenceof binge eating episodes, on average, at least once a week for threeconsecutive months; (c) manifestation of distress related to binge eating; and(d) disassociation with the recurrent use of compensatory behaviors as inBulimia Nervosa or Anorexia Nervosa (3).Other Specified Feeding or Eating Disorder (OSFED) can be applied tocases, when a person engages in eating behaviors that cause clinicallysignificant distress or impaired functioning, but does not meet full criteria foran eating disorder (3). Lastly, NightEating Syndrome is characterized by recurring episodes of eating afterawakening from sleep or by immoderate food consumption following the eveningmeal (3).

The Prevalence ofEating Disorders in Athletes

Although disordered eating and exercise behaviors have beenhighlighted as significant issues among collegiate athletes, the percentage of athletes who meet fulldiagnostic criteria for clinical or subclinical eating disorders vary greatly,from 1.1% to 49.2% across studies (4,10,12,24,30,42). For instance, Greenleaf et al. (2009) foundthat, in a group of female collegiate athletes, 2% met the criteria for aneating disorder diagnosis and another 25.5% exhibited subclinical symptoms ofan eating disorder (e.g., binge eating, self-induced vomiting, and excessivedieting). Similarly, in Petrie et al.s(2008) study, 19.2% of collegiate athletes reported maladaptive eatingbehaviors. Sanford-Martens et al. (2005)detected slightly lower rates of subclinical eating problems (14.5%).

In Anderson and Petries (2012)study among female collegiate athletes, 26.8% of women reported disorderedeating behaviors. Approximately 40% of the athletes engaged in at least twohours of daily physical activity, suggesting that many may be using this highlevel of activity as a compensatory strategy in response to binge eating. Up to 28% of athletes reported dieting orfasting at least two times over the past year (4). Kato and colleagues (2011) reported thehighest rates of disordered eating in a sample of NCAA Division I and IIIathletes, ranging from 40.4% to 49.2%.In addition, 30.7% of all athletes reported body dissatisfaction, weightpreoccupation, and bulimic tendencies. Wide-ranging rates of clinical and subclinical eatingdisorders in collegiate athletes call for additional research on eatingdisorders and associated symptoms, including compulsive exercise (9,29). Although previous studies provided usefulprevalence data (4,12,24,30,42), new studies could potentially yield more accurateand consistent results of unhealthy eating and weight control behaviors incollegiate athletes.

Health Consequences of Eating Disorders

While each eatingdisorder has its distinct signs, symptoms, and health effects, the mostfrequent signs and symptoms of disordered eating and compensatory behaviorsinclude: sudden weight loss, gain, or fluctuation; hypothermia (i.e., adangerously low body temperature); and fatigue (29). Oral and dental problems caused by pathogenicweight control behaviors are dental erosion or caries, perimolysis (i.e., adental condition linked to frequent regurgitation), and recurrent sore throats(64). Dermatological issues, such ashair loss, brittle nails, skin discoloration, and poor skin healing; also arisein individuals suffering from an eating disorder (54). Disordered eating behaviors also severelyaffect an individuals endocrine system by resulting in irregular menstrualcycles or a complete absence of menstruation (i.e., amenorrhea), which couldpotentially lead to infertility (55).Furthermore, prolonged misuse of laxatives, diuretics, enemas, and dietpills, as well as self-induced vomiting lead to various gastrointestinalproblems, such as abdominal pain, early satiety and delayed gastric emptying,constipation, hematemesis (i.e., the vomiting of blood), and hemorrhoids (40). The resulting damages of disordered eating onthe cardiorespiratory system include, but are not limited to, chest pains,hypotension (i.e., low blood pressure), arrhythmia (i.e., irregular heartbeat), bradycardia (i.e., an extremely low heart rate), and shortness of breath(11).

Anotherconsequence of maladaptive eating and compensatory behaviors is the FemaleAthlete Triad, which is characterized by energy deficiency, menstrualirregularities, and low bone mass that occur as a consequence of malnutritionand disordered eating (40). Low bonemineral density can result in injuries, stress fractures, and potentialosteoporosis (55). This may be especially hazardous for competitive athleteswho are generally at higher risks for overuse injuries due to their continuousengagement in high amounts of intense physical training (61). For instance, disordered eating, amenorrhea,and low bone mineral density were associated with musculoskeletal injuries ininterscholastic female athletes (46). Finally, neuropsychiatric symptoms, includingmemory loss or lack of concentration, insomnia, increased anxiety, depression,seizures, obsessive-compulsive behavior, and suicidal ideation can be seen inpersons with eating disorders (50). Up to a third of athletes at-risk for an eating disordertend to engage in multiple pathogenic behaviors, as opposed to a singlebehavior such as restrictive eating (41).

Consequences of Eating Disorders on Athletic Performance

Disordered eatingcan have an effect on athletic performance (18). In aesthetic (e.g.,gymnastics, swimming, diving), endurance (e.g., cross-country), andweight-classsports (e.g., wrestling, rowing), itis believed that leanness leads to enhanced performance (9). However, many athletesachieve low weight through disordered eating and compensatory behaviors, whichcan significantly decrease athletic performance (18,29). Specifically, long-term disordered eatingimpairs the main components of muscular fitness (i.e., aerobic fitness, musculoskeletalfitness, motor fitness, and flexibility), thus resulting in poor athleticperformance (18). In addition, thehealth consequences of restricted caloric intake, such as loss of fat, leanbody mass, electrolyte imbalances, and dehydration, can contribute todiminished performance (29). In a studyamong junior elite female swimmers, Van Heest and colleagues (2014) found thatfemale athletes who restricted caloric intake and increased energy expenditurein training frequently suffered from ovarian suppression (i.e., lack ofestrogen production). Female athleteswho trained in the presence of low energy availability and ovarian suppressionexhibited significant declines in their swim velocity (59).

A similar study of high school athletes found a negativerelationship between disordered eating and athletic performance (56). Among a large sample of high school athletes,35.4% were found to suffer from disordered eating, 18.8% reported menstrualirregularities, while 65.6% reported suffering a sports-related musculoskeletalinjury during the ongoing season. Athletesexhibiting disordered eating behaviors were twice as likely to sustain asports-related injury during a competitive season, as compared to the athletesreporting healthy eating behaviors.Moreover, the inability to train and compete due to an injury furtherresults in decreased athlete performance upon the athletes return to play (56).

In addition to physical consequences on sport performance,disordered eating may contribute to other psychosocial issues (18). In particular, obsessive concern about weightand body image, as well as continuous eating restriction have been associatedwith mood disorders, which may impact athletic but also academic performance(27). Furthermore, overvaluation ofshape, weight and eating control, anxiety, and depression that often coexist inathletes at-risk for an eating disorder, are capable of decreasing athletesmotivation to train and compete. Theresulting poor performance may further increase the pressure experienced byathletes to train more intensely and adhere to even more rigid dieting forweight loss (18). Disordered eatingbehaviors in competitive athletes may not only severely undermine an athleteshealth, but may also produce deterioration in sport performance (18).

Eating Disorders by Gender

A number of studies have foundhigher rates of maladaptive eating habits in female athletes compared to maleathletes (9,10,24,31). Forexample, in a sample of 800 NCAA Division I student-athletes, 19% of women and 12% of menreported unhealthy eating habits (10).Krebs et al. (2019) also found a higher rate of eating disorders in collegiate femaleathletes than males. Specifically, threetimes as many female distance runners screened positively for an eatingdisorder as compared to male (46% and 14%, respectively). In another study, 26% of student-athletesscored in the clinical range for an eating disorder, with five times morefemales (84%) than males (16%) reporting disordered eating behaviors (37).

The main explanation for this tendency isthat female athletes are more subjected to socio-cultural pressure to diet andbe thin, while male athletes tend to be more concerned with physical fitness andmasculinity (51). Thus, fewer male athletescontemplate dieting as compared to female athletes, which represents a riskfactor for the development of eating disordered in females (51). Nevertheless, disordered eating has beensignificantly increasing among male athletes (22,12,42,52). For instance, certain male athletes,specifically wrestlers, rowers, and long-distance runners, are more likely toengage in pathogenic weight control behaviors than female athletes in generaldue to an increased focus on physical appearance and weight (22,26).

Hinton and colleagues (2004)examined dietary intake and eating behaviors in 345 NCAA Division Istudent-athletes. They found that moremale athletes than female athletes exhibited having inadequate nutrient intake. Specifically, only 10% of male athletes, ascompared to 19% of female athletes, consumed the recommended minimum ofcarbohydrates per each kilogram of their body weight, while 19% of males and32% of females consumed the minimum recommended amount of protein. Moreover, male athletes were more likely toexceed the Dietary Guidelines for fat, saturated fat, sodium, and cholesterolintakes, as compared to female athletes (26).

In contrast to female athletes,who indicated restricting their nutrient intakes for weight gain prevention,male athletes reported using dietary supplements (other than vitamins) forweight reduction (26). Also,approximately 6% of male athletes indicated restricting their fluidintake. These findings can potentiallybe understood in the context of mens preoccupation with muscularity, resultingin a focus on diet, nutritional supplements, and excessive exercise (10). Hintonet al.s (2004) study findings suggest that male athletes, just as femaleathletes, undergo psychological problems of body dissatisfaction and low self-esteem,which leads to the onset of eating pathologies.In regards to sport-specific factors, male athletes are equallypressured to diet and exercise compulsively in order to maintain low bodyweight and produce successful athletic results (14).

In summary, asubstantial body of literature shows that rates of eating disorders anddisordered eating symptoms among collegiate athletes range widely, 0-19% inmale athletes and 6-45% in female athletes (9,29,31,34). While the occurrence of clinical eating disorders is more prevalent infemale athletes than male athletes, male athletes, in sports such as wrestling,rowing, and cross country, are at greater risk for pathological weight controlbehaviors (26,49,52). Such findings highlight inconsistencies in the eatingdisorder area and emphasize the need for additional research on the prevalenceof eating disorders among both male and female athletes.

EatingDisorders by Sport

A number of studieshave determined that the sport type in which an athlete participates can serveas a risk-factor for the development of disordered eating (4,22,48,52). In eating disorder research, sports have beencategorized according to the level of pressure an athlete faces to maintain alow body weight for aesthetic reasons and/or performance enhancement (14). Across several studies (4,22,29,42),thefollowing categories have been described: aesthetic or lean sports (e.g.,gymnastics, figure skating, swimming, diving, track and field), endurancesports (e.g., cross country, cycling), technical sports (e.g., tennis, golf,baseball, softball), ball game sports (e.g., soccer, volleyball, basketball,football), weight-class sports (e.g., wrestling, rowing), andanti-gravitational sports (e.g., skiing, pole vault jumping).

Higher rates ofeating disorders in aesthetic, endurance, and weight-class sports have been consistentlyreported (9,29,57). For example, Thiemann et al.(2015) found a greater frequency of maladaptive eating in aesthetic sports(17%) than in ball-game sports (3%). InSundgot-Borgen and Torstveits (2004) study on elite athletes, 42% of women inaesthetic sports had subclinical and clinical eating disorders (e.g.,gymnastics, figure skating, diving), 24% in endurance sports (e.g.,long-distance running, cycling, swimming), 17% in technical sports (e.g., golf,tennis), and 16% in ball game sports (e.g., soccer, volleyball,basketball). Among male athletes, 9% ofeating disorders were seen in men participating in endurance sports and 5% inball-game sports (52). There are three possible explanations ofhigher rates of eating disorders in aesthetic, endurance, and weight-classsports. First, in endurance sports, suchas cross-country, weight higher than an athletes optimum performance weight islinked to decreased performance (14).Second, in weight category sports, such as wrestling, athletes arepressured to meet a specific weight requirement just to qualify for acompetition (9). Third, in aestheticsports, such as gymnastics, athletes physical appearance is a part of anaesthetic evaluation, which pressures athletes to attain a certain bodycomposition (14).

While the prevalence ofdisordered eating in sports that emphasize leanness is high, the reported ratesof eating disorders vary by sport (48,53,57).For instance, in a sample of 414 NCAA Division I female athletescompeting in gymnastics and swimming/diving, 108 (26%) scored in thesubclinical range for an eating disorder (4).In addition, 26 athletes (6.1% of gymnasts and 6.7% of swimmers/divers)were classified as having an eating disorder.Out of 26 athletes in the eating disorder group, 20 athletes wereidentified as having subthreshold Bulimia Nervosa, 4 with Non-bingeing Bulimia,and 2 with Binge Eating Disorder (4).

In contrast to Anderson andPetries (2012) findings, Carter and Rudd (2005) detected lower rates ofdisordered eating considering the sport type.In a mixed-gender sample of 800 NCAA Division I athletes, Carter andRudd (2005) found 9.2% of non-lean sport athletes and 17.5% of lean-sportathletes exhibiting subclinical features for an eating disorder. Additionally, 6.1% of athletes in lean sportssuffered from chronic dieting, as compared to 2.5% of athletes in non-leansports. Such high rates of disorderedeating in gymnasts and swimmers/divers support the notion that athletescompeting in lean and aesthetic sports are pressured to possess ideal bodyweight for reaching optimal performance.Thus, lean- and aesthetic-sport athletes are exposed to higher risks fordeveloping an eating disorder than athletes competing in sports that do notoverly emphasize body weight and physical appearance (4,10). Furthermore, Glazer (2008) found that athletesparticipating in lean sports averaged significantly higher on the EatingAttitudes Test (EAT) and the Social Physique Anxiety Scale (SPAS), suggestinggreater disordered eating and physique anxiety, as compared to athletesparticipating in non-physique-salient sports.Glazers (2008) findings support the notion of increased prevalence ofeating disorders in sports that emphasize leanness (e.g., gymnastics, longdistance running). Participation in nonphysique-salient sports (e.g., basketball, softball, soccer) may be aprotective factor for the development of disordered eating (22).

Although some studies have linkedthe sport team classification to disordered eating levels (4,10,48), otherstudies found no support for this relationship (24,42,49). For example, despite the high frequency ofpathogenic eating in a sample of collegiate athletes (19.2%), no associationwas found between sport team classification and eating disorder status inPetrie et al.s (2008) study. Similarly,Greenleaf et al. (2009) found no differences in the frequency of maladaptiveeating behaviors across sport type. These results corroborated previousfindings from Sanford-Martens and colleagues (2005) study, which also found nodifferences in eating disorder symptoms across sport types. These findings suggest that sport type maynot be an influential factor in the development of maladaptive eating habits incompetitive athletes (49).

To conclude, somestudies suggested that lean-sport athletes (such as gymnasts, runners,swimmers, cyclists, and wrestlers) are more prone to developing an eatingdisorder than non-lean sport athletes, who do not overly emphasize body weightand physical appearance as part of their sport (4,10). However, other studies failed to establishthe relationship between athletes sport classification and their propensityfor unhealthy eating behaviors (24, 42).This observation calls for the need to broaden researchers perspectiveson identification of at-risk athletes (9).Future studies may provide a clearer pattern between the sport type anddisordered eating in collegiate athletes.

Eating Disorders and Age

While a great number of studieson the prevalence of eating disorders among athletes have reported their agesas a demographic variable (22,34,36,47,52), only a few studies assessed thedirect link between disordered eating and college athletes age (23,24,42). For instance, in Petrie et al.s (2008)study, disordered eating group status (symptomatic vs. asymptomatic) was notrelated to age, indicating that symptomatic athletes may be found among alldifferent ages (42). Similarly,Greenleaf et al. (2009) found no differences in athletes eating disorderstatus (i.e., symptomatic vs. eating disordered) based on their age. These findings suggest that the age variablemay not be an influential factor on collegiate athletes disordered eatingsymptomology (24). Similarly, in asample of 290 elite athletes between 14 and 30 years of age, Gomes et al.(2011) assessed the relationship between unhealthy eating behaviors andage. No association was found betweenathletes age and each subscale of the Eating Disorder ExaminationQuestionnaire (EDE-Q, 20). Thus, thefindings indicate that athletes across different ages may be equally at-riskfor developing maladaptive eating habits (23, 42).

Pettersen et al. (2016) furtherexamined the prevalence of disordered eating in 225 Norwegian athletes in theage groups of 17, 18, and 19+ years old.In total, 18.7% of the athletes exhibited symptoms of disorderedeating. Age was not a significantpredictor of athletes maladaptive eating patterns. As Pettersen et al. (2016) explain, the peakrisk for the development of an eating disorder occurs between childhood andearly adolescence. However, the majorityof the sample athletes were in their later adolescence and early adulthood,which may explain why age was unrelated to disordered eating symptoms.Specifically, adult athletes have acquired higher levels of confidence andself-esteem than athletes in their early adolescence, which could serve as aprotective mechanism against the development of eating pathologies (43).

In summary, some studies suggestthat the prevalence of maladaptive eating behaviors (e.g., fasting,self-induced vomiting, using laxatives and diuretics, binging followed byexercise, etc.) is higher in the college-aged athletes, as compared tocompetitive adolescent athletes (29, 30, 43).Nevertheless, a substantial body of literature indicates thatcompetitive adolescent athletes experience severe eating disorder symptoms asdo collegiate athletes (9, 29, 43). Additionally, the studies focusingspecifically on the impact of age, failed to establish a significantassociation between age and athletes eating disorder status (24, 42 ,43). Thus, additional studies are necessary toestablish a clearer association between athletes age and pathogeniceating.

CONCLUSIONS

Collegiate student-athletesrepresent a unique population of young adults who, because of the demands ontheir time associated with their sport, may be at particular risk fordisordered eating and compulsive exercise (32). Specifically,many collegiate athletes appear to use excessive exercise as a compensatorybehavior to control their body weight (4, 12, 36, 42, 48). Compulsive exercise, in combination with thesport-required training, place student-athletes at a high-risk for overuseinjuries, and physical exhaustion, which can further impede athleticperformance (12, 53). Therefore, thereis a need to further examine disordered eating and compulsive exercise patternsamong collegiate student-athletes in order to draw athletic staffs, coaches,and athletes attention to the deleterious health effects of these disorderedbehaviors.

APPLICATIONS IN SPORT

The roles of athletic trainers, administration, and coachesare paramount in recognizing detrimental eating and exercise patterns inathletes and providing them with the necessary professional assistance (14). First, expanding athletes knowledge aboutproper nutrition habits, maladaptive eating behaviors and their healthconsequences, and learning how to address the issue of disordered eating, arepivotal steps in primary prevention (40).There is a need to inform athletes that dietary restriction and purgingbehaviors for attainment of the desired body weight may lead to decreasedathletic performance and adverse health consequences. Structured educational programs have shown toreduce the impact of risk factors of disordered eating (6, 17, 19). For instance, Becker et al. (2012) observed asignificant reduction in bulimic symptoms just after 1 year following apeer-led educational intervention for athletes.In addition, the researchers found an increase in the number of athletesseeking medical assistance due to the concern that they may suffer from theFemale Athlete Triad symptoms (6).Through educational programs, athletes, parents, and coaches can alsolearn that menstrual dysfunction occurs as a result of low energy availabilitydue to deliberate dietary restriction, rather than a positive adaptation tohigh-intensity sport participation (17).

Changing perspectives on competitive sport participationfor athletes and coaches could be another strategy for eating disorderprevention. Specifically, the way inwhich athletes evaluate their maladaptive eating and exercise habits can fostermaintenance of an eating disorder (44,58).For instance, Thompson and Sherman (2010) found that athletes tend tounderreport their eating disorder symptoms due to the misconception thatdietary restriction and excessive exercise will result in enhanced sportperformance. Athletes and coaches oftenreinforce maladaptive behaviors (i.e., dietary restriction, excessive exercise)because they believe that certain aspects of sport participation, such asmental toughness and continuous engagement in intense training, are pivotal inreaching optimal performance (44). As aresult, athletes may perceive compulsive exercise as a demonstration of highcommitment to their sport, rather than a symptom of an eating disorder (16,28). In addition, athletes and coaches falselybelieve that weight loss achieved through food restriction and excessiveexercise will imminently lead to increased performance (16). Thus, due to perfectionistic andresult-oriented views of athletic participation, eating disorder symptoms areoften overlooked and underreported (28).Consequently, an emphasis of educational programs should be placed onprompt recognition of maladaptive eating and exercise habits to prevent thedevelopment of a clinical eating disorder.

Furthermore, despite the availability of various eatingdisorder prevention strategies, Vaughanet al. (2004) found that only 1 in 4 (27%) of athletic trainers feel confidentin identifying an athlete with an eating disorder. In addition, only 38% of athletic trainersfeel confident in asking an athlete about disordered eating behavior (60). Although educational programs and counselingservices have been created for collegiate student-athletes, proactive steps onbehalf of the university athletic staff are necessary for early identificationand prevention of eating disorders (8,35).Prompt detection of unhealthy eating behaviors through screeningprotocols has been associated with more effective treatment outcomes (8,57).

For instance, the Preparticipation Physical Examination(PPE) monograph, created by the American Medical Society for Sports Medicine(AMSSM) and the American College of Sports Medicine (ACSM), can serve as aneffective screening tool for identification of disordered eating behaviors inathletes (7). This instrument assesseswhether athletes suffer from body weight pre-occupation, restrict their caloricintake, use nutritional supplements for weight loss, and undergo pressure tolose weight by outside sources (7). TheFemale Athlete Triad Coalition developed an 11-question screening tool thatcould be successfully employed as a part of the Pre-participation PhysicalExamination (17). This measure evaluatesa female athletes pre-occupation with body weight, dietary restriction,menstrual dysfunction, bone injuries, and low bone mineral density. Consequently, simultaneous use of thesescreening tools could play a key role in identifying at-risk athletes andproviding immediate treatment prior to competitive season. Byutilizing screening protocols, coaches and athletic trainers can ensure thatstudent-athletes have rewarding collegiate experiences. In addition, this method can protect athletesagainst the development of eating disorders that otherwise mayendure into adulthood, impacting their physical and psychosocial health long-term(18,27).

Directions forFuture Research

Further studies investigating the patterns of disorderedeating in conjunction with compulsive exercise in collegiate athletes arenecessary for several reasons. First, itis pivotal to provide athletes, coaches, athletic trainers, and athleticadministrators with accurate information about the severity of maladaptiveeating and exercise in collegiate athletes.Second, various socio-cultural and sport-specific pressures have beenidentified as potential risk factors for the onset of eating disorders inathletes, which allows researchers to examine the links between these riskfactors and the development of disordered eating behaviors (14,18,51). While numerous studies have investigatedthese issues in great depth, wide gaps still exist in the literature due toinconsistent prevalence rates of eating disorders based on athletes gender,age, and sport type (9,29). In addition, certain studies yieldedcontradictory results and failed to establish the relationships among athletes sport classification, age, and theirpropensity for unhealthy eating behaviors (23,24,42).

To date, there is a scarcity of literature focusing on more recently recognized eating disorders, such as Binge Eating Disorder and the Night Eating Syndrome (4,12). Studies investigating the prevalence of clinical eating disorders in collegiate athletes reported rare instances of BED and the NES, ranging from 0 to 0.5% (4,10,12,24,42). The low rates of BEDs can be explained by the difficulty to disassociate the recurrent use of compensatory behaviors, which are distinct symptoms of AN and BN only (3). In the majority of clinical cases, athletes disordered eating occurs in conjunction with pathogenic weight control behaviors (12), which results in higher rates of AN and BN, and significantly lower rates of BED diagnoses.

In addition, agreat number of studies in eating disorder research used the Questionnaire forEating Disorder Diagnoses (Q-EDD; 38) due to its high psychometric properties(4,10,12,24,42,49). Based on the DSM-IV(2) diagnostic criteria for eating disorders, the Q-EDD mainly assesses thesymptoms of AN, BN, and BED, thus omitting questions related to the symptoms ofthe NES, an eating disorder that was later added the DSM-V (3). Consequently,questions exploring the NED symptoms, such as the frequency of recurringepisodes of eating after awakening from sleep and the episodes of immoderatefood consumption following the evening meal, should be added to the more recenteating disorder measures.

Considering limitations of the previously discussed studies of eating disorders in athletes, the following methodological recommendations could help future researchers to gain a better understanding of the nature and distribution of eating disorders. First, samples should include a large number of NCAA athletes to provide more reliable and valid results, and to ensure generalizability of the study findings. Second, athlete samples representative of each sport should be selected for accurate and valid comparisons by sport type. One way to achieve this goal is to categorize sports by their types (e.g., lean vs. non-lean, weight-class vs. non-weight-class) and recruit approximately an equal number of athletes for each sport category.

In regards to gender comparison, sufficient samples of bothfemale and male athletes competing at the collegiate level need to be recruitedto more accurately address the issue of gender differences in eatingdisorders. Although male athletesgenerally have a lower prevalence of eating disorders than female athletes, anincreasingly large body of literature indicates that disordered eating amongmale athletes is on the rise (12,22,42,52).Moreover, male athletes in certainsports are more likely to engage in compensatory behaviors than female athletes(26). This conclusion could not be drawnif the study focused solely on one gender.Thus, excluding one gender from theinvestigation may result in biased reporting of the disordered eating problemand inaccurate conclusions about its prevalence rates across both genders.

Lastly, the conditions under which athletes reporttheir eating behaviors must be assessed prior to data collection. Athletes tend to underreport theirmaladaptive eating and compulsive exercise habits due to the fear that theireating disorder may be discovered by their coaches and potentially affect theirathletic careers (52). Consequently,athletes must be provided with confidentiality and a pressure-free environmentin which they can answer instrument questions candidly. In addition, researchers need to chooseappropriate measures that have been previously validated in athlete samples tosuccessfully discriminate between eating disordered and healthy athletes.

ACKNOWLEDGMENTS

None

REFERENCES

Read more here:
Disordered Eating and Compulsive Exercise in Collegiate Athletes: Applications for Sport and Research - United States Sports Academy Sports Journal

The ketogenic diet, or keto for short, is one of the most controversial: lauded for its weight-loss benefits and effectiveness at treating epilepsy, but also critiqued by nutritionists as restrictive and extreme.

Now, a new study warns of another cause for concern: it may have an unexpected side effect of weakening athletes' bones during intense training, according to a new study published January in Frontiers in Endocrinology.

Researchers from the Australian Institute of Sport and Australian Catholic University looked at 30 elite race walkers (25 male and five female) over a period of three and a half weeks of intense athletic training.

About half of the group was assigned to a low-carb, high-fat ketogenic diet, getting 75%-80% of their daily calories from fat. The other half stuck to a high-carb diet. Both groups consumed the same amount of calories relative to their body weight, and both groups ate a moderate amount of protein.

By the end of the experiment, the athletes on the keto diet showed greater signs of bone breakdown than they had at the start of the study. Athletes on the high-carb diet, however, showed no significant difference from beginning of the study, according to the test results.

After reintroducing carbs into their diet, the keto athletes saw some improvement in their bone health, but they weren't back to full strength, the researchers found.

These results suggest that the ketogenic diet somehow sped up the breakdown of athletes' bones during intense exercise, and inhibited recovery, although it's not exactly clear how.

"We believe that the keto diet may affect bone metabolism due to the downstream effects of low-carbohydrate availability on certain hormones, along with other factors,"Louise Burke, lead author of the study and head of sports nutrition at the Australian Institute of Sport in Canberra, told the New York Times.

Burke's research followed on from previous studies on mice and children that found the keto diet could have more pronounced negative effects on bone health when combined with exercise. But another study, also published in the journal Frontiers, found no impact on bone health for diabetic patients who were on the keto diet for two years.

It's also not clear from this study how keto might affect bone health over a longer time period, and whether athletes might be able to adapt to the diet and mitigate some of the side effects. The keto diet is known to take some time for the body adjust to, and during that period (sometimes called the "keto flu"), people new to keto may experience symptoms like fatigue and dehydration.

"Keto" refers to any of number of different diets (some prefer the term "lifestyle") that restrict carbohydrates and increase intake of fats. This prompts the body to enter a state called "ketosis" in which it burns fat for energy instead of glucose, the body's preferred fuel store generated from carbohydrates.

Nutritionists and some medical professionals have previously raised concerns about the long-term health affects of the keto diet. Proponents of high-fat, low-carb eating, however, argue that there's evidence to show it can be beneficial for weight loss and diabetes managements, and that concerns about the health risks of eating fat have been overstated.

One of the central critiques of the keto diet is that there's little evidence of the long-term health effects, although that may soon change as more and more researchers are awarded funding to study keto.

Read more:

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A knee injury could change the structure of your brain, making it harder to recover

The keto diet is the worst diet for healthy eating, according to new rankings

Read more:
The keto diet may wear down athletes' bones and increase the risk of injury - Insider - INSIDER

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