CONTEXT: Female athletes/performing artists can present with low energy availability (LEA) either through unintentional (e.g., inadvertent undereating) or intentional methods (e.g., eating disorder [ED]). While LEA and ED risk have been examined independently, little research has examined these simultaneously. Awareness of LEA with or without ED risk may provide clinicians with innovative prevention and intervention strategies. OBJECTIVE: To examine LEA with or without ED risk (e.g., eating attitudes, pathogenic behaviors) in female collegiate athletes/performing artists. DESIGN: Cross-sectional and descriptive. SETTING: Free-living in sport-specific settings. PARTICIPANTS: Collegiate female athletes/performing artist (n=121; age: 19.8±2.0 years; height: 168.9±7.7 cm; weight: 63.6±9.26 kg) in equestrian (n=28), volleyball (n=12), softball (n=17), beach volleyball (n=18), ballet (n=26) and soccer (n=20) participated in this study. MAIN OUTCOME MEASURES: Anthropometric measurements (height, weight, body composition), resting metabolic rate, energy intake, total daily energy expenditure, exercise energy expenditure, Eating Disorder Inventory-3 (EDI-3), and EDI-3 Symptom Checklist were assessed. Chi-square analysis examined differences between LEA and sport type, LEA and ED risk, ED risk and sport type, and pathogenic behaviors and sport type. RESULTS: Female athletes/performing artists (81%; n=98) displayed LEA and significant differences were found between LEA and sport type (χ²₅=43.8, P<.01). Female athletes/performing artists (76.0%; n=92) presented with ED risk with no significant difference between ED risk and sport. EDI-3 Symptom Checklist revealed 61.2% (n=74) engaged in pathogenic behaviors, with dieting the most common (51.2%; n=62). Athletes/performing artist displayed LEA with ED risk (76.0%; n=92). No significant differences were found between LEA with ED risk and sport. Softball was the highest with 82.4% (n=14) reporting LEA with ED risk followed by ballet (76%; n=19). CONCLUSION: Our results suggest a large proportion of collegiate female athletes/performing artists are at risk for LEA with ED risk, thus warranting education, identification, prevention, and intervention strategies relative to fueling for performance.

Injury risk is multifactorial including non-modifiable and modifiable factors such as nutrition and mental health. The purpose of this study was to estimate eating disorder risk and body image (BI) dissatisfaction among Reserve Officers Training Corps (ROTC) cadets. A total of 102 (male: n = 75, female: n = 27; age: 20 ± 2 years) ROTC cadets self-reported height, current and ideal weight, and completed the Eating Attitudes Test-26 (EAT-26) and self-perceived BI current and perceived sex-specific figural stimuli. The overall eating disorder risk for ROTC cadets was 32.4%. No significant differences were found when comparing sex, ethnicity, or military branch. Overall risk of pathogenic behaviors included 11.8% who reported binge eating; 8.8% who used laxatives, diuretics, or diet pills; 8.8% who exercised for >60 min to control their weight; and 8.8% who lost 9.1 kg or more within the last 6 months. We identified significant interactions (p ≤ 0.01) between sex of the solider, overall perceptions of male and female soldiers, and BI self-perceptions. The ROTC cadets in this study displayed eating disorder risk and BI dissatisfaction, which is concerning for tactical readiness, long-term behavioral health issues, and injury from pathogenic behaviors. Education and quality healthcare are necessary to mitigate the increased risk of eating and BI dissatisfaction within this population.

CONTEXT: Research exists on energy balance (EB) and eating disorder (ED) risk in physically active populations and occupations by settings, but EB and ED in athletic trainers (ATs) has not been investigated. OBJECTIVE: To assess ATs' energy needs, including macronutrient profile, and to examine ED risk and pathogenic behavior between sex (males, females), job status (part-time=PT-AT; full-time=FT-AT) and setting (college/university, high school, non-traditional). DESIGN: Cross-sectional and descriptive. SETTING: Free-living in job settings. PARTICIPANT: ATs (n=46; males PT-AT n=12, males FT-AT n=11; females PT-AT n=11, female FT-AT n=12) in Southeastern United States. MAIN OUTCOME MEASURES: Anthropometric measurements (age, height, weight, body composition), resting metabolic rate (RMR), energy intake (EI), total daily energy expenditure (TDEE), exercise energy expenditure (EEE), EB, macronutrients (carbohydrates, protein, fats), Eating Disorder Inventory-3, and the Eating Disorder Inventory-3 Symptom Checklist. RESULTS: Majority (84.8%, n=39) had ED risk, with 26.1% (n=12) engaging in at least 1 pathogenic behavior, 50% (n=23) in 2 pathogenic behaviors, and 10.8% (n=5) in more than 2 pathogenic behaviors. 82.6% of ATs (n=38) presented in negative EB (EI<TDEE). Significant differences were found for sex and job status for RMR (F(1,45)=16.48, P=.001), EI (F(1,45)=12.01, P=.001), TDEE (F(1,45)=40.36, P<.001) and EEE (F(1,38)=5.353, P=.026). No significant differences were found in EB, sex and job status (F(1.45)=1.751, P=.193); Chi-squared analysis revealed no significant differences between ATs' sex and EB [χ2(1,46)=0.0, P=1.00] and job status and EB χ2(1,46) = 2.42, P= 0.120]. No significant difference found between Daily Reference Intakes recommendations for all macronutrients and sex or job status. CONCLUSIONS: Athletic trainers experience negative EB, similar to other high-demand occupational professions. Regardless of sex or job status, ATs have a high ED risk and participate in unhealthy pathogenic behaviors. The physical and mental concerns associated with these findings indicates a need for interventions targeted toward ATs' health behaviors.

Context: No research has investigated thermoregulatory responses and exertional heat illness (EHI) risk factors in marching band (MB) artists performing physical activity in high environmental temperatures. Objective: Examine core temperature (Tc) and EHI risk factors in MB artists. Design: Descriptive epidemiology study. Setting: Three rehearsals and 2 football games for 2 NCAA Division I MBs. Participants: Nineteen volunteers completed the study (female = 13, males = 6; age = 20.5 ± 0.9 years; weight = 75.0 ± 19.1 kg; height = 165.1 ± 7.1 cm). Main Outcome Measures: We measured Tc pre-, post-, and every 15 minutes during activity and recorded wet-bulb globe temperature (WBGT) and relative humidity (RH) every 15 minutes. Other variables included activity time and intensity, ground surface, hydration characteristics (fluid volume, sweat rate, urine specific gravity, percent body mass loss [%BM]), and medical history (eg, previous EHI, medications). Statistical analysis included descriptives (mean ± standard deviation), comparative analyses determined differences within and between days, and linear regression identified variables that significantly explained Tc. Results: Mean rehearsal time = 102.8 ± 19.8 minutes and game time = 260.5 ± 47.7 minutes. Max game Tc (39.1 ± 1.1°C) was significantly higher than rehearsal (38.4 ± 0.7°C, P = .003). The highest max game Tc = 41.2°C. Participants consumed significantly more fluid than their sweat rates (P < .003), which minimized %BM loss, particularly during rehearsals (−0.4 ± 0.6%). Mean game %BM loss = −0.9 ± 2.0%; however, 63.6% of the time, participants reported hypohydrated to game day. Max Tc was significantly predicted by max WBGT, max RH, ground surface, using mental health medications, and hours of sleep (adjusted R2 = 0.542, P < .001). Conclusions: Marching band artists experience high Tc during activity and should have access to athletic trainers who can implement EHI prevention and management strategies.