Context: Coaches, athletic trainers (ATs), strength and conditioning specialists (SCSs), and registered dietitians are common nutrition resources for athletes, but coaches, ATs, and SCSs might offer only limited nutrition information. Little research exists about sports nutrition knowledge and current available resources for nutrition information for athletes, coaches, ATs, and SCSs. Objective: To identify resources of nutrition information that athletes, coaches, ATs, and SCSs use; to examine nutrition knowledge among athletes, coaches, ATs, and SCSs; and to determine confidence levels in the correctness of nutrition knowledge questions within all groups. Design: Cross-sectional study. Setting: National Collegiate Athletic Association Division I, II, and III institutions across the United States. Patients and Other Participants: The 579 participants consisted of athletes (n = 185), coaches (n = 131), ATs (n = 192), and SCSs (n = 71). Main Outcome Measure(s): Participants answered questions about nutrition resources and domains regarding basic nutrition, supplements and performance, weight management, and hydration. Adequate sports nutrition knowledge was defined as an overall score of 75% in all domains (highest achievable score was 100%). Results: Participants averaged 68.5% in all domains. The ATs (77.8%) and SCSs (81.6%) had the highest average scores. Adequate knowledge was found in 35.9% of coaches, 71.4% of ATs, 83.1% of SCSs, and only 9% of athletes. The most used nutrition resources for coaches, ATs, and SCSs were registered dietitians. Conclusions: Overall, we demonstrated that ATs and SCSs have adequate sports nutrition knowledge, whereas most coaches and athletes have inadequate knowledge. Athletes have frequent contact with ATs and SCSs; therefore, proper nutrition education among these staff members is critical. We suggest that proper nutrition programming should be provided for athletes, coaches, ATs, and SCSs. However, a separate nutrition program should be integrated for ATs and SCSs. This integrative approach is beneficial for the continuity of care, as both categories of professionals might be developing and integrating preventive or rehabilitative programs for athletes.

Mental health research exists for student-athletes in the areas of depression, anxiety, and self-esteem prevalence. However, updated prevalence rates and assessment of risks across sports, academic status, and genders are needed. Filling the gaps in research assists in the creation of patient-centered mental health screening and interventions designed for student-athletes. Therefore, the purpose is to examine the prevalence of depression, anxiety, and self-esteem in collegiate student-athletes and differences between sex, academic status, and sport type, and identify associations for risks. Using a cross-sectional design, collegiate student-athletes were surveyed to assess for risks of depression, anxiety, and self-esteem. With the use of SPSS, Chi-square analyses and multinomial logistic regressions were used. Student-athletes (22.3%) were at risk for depression, anxiety (12.5%), and low self-esteem (8%). No significant differences were found for sex, academic status, and sport type for depression or self-esteem; however, significant differences occurred for state and trait anxiety by sex. A significant association for depression and anxiety risk was found with females at risk. Depression and anxiety are present within student-athletes, regardless of sport type. Females are at a higher risk; however, all student-athletes would benefit from the creation of validated, patient-centered mental health screenings and psychotherapeutic interventions.

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.

Context: With increased media coverage and competitive opportunities, cheerleaders may be facing an increase in eating disorder (ED) prevalence linked to clothing-related body image (BI). Objective: To examine ED risk prevalence, pathogenic weight control behaviors, and variation in clothing-specific BI across position and academic status among collegiate cheerleaders. Design: Cross-sectional study. Setting: National Collegiate Athletic Association Division I and II institutions. Patients or Other Participants: Female collegiate cheerleaders (n = 136, age = 20.4 ± 1.3 years, height = 160.2 ± 8.1 cm, weight = 57.2 ± 8.3 kg). Main Outcome Measure(s): Participants self-reported height, weight, and desired weight and completed the Eating Attitudes Test. Body image perceptions in 3 clothing types (daily clothing, midriff uniform, full uniform) were assessed using sex-based silhouettes (body mass index = 18.3 kg/m2 for silhouette 1, 23.1 kg/m2 for silhouette 4). Results: The ED risk for cheerleaders was estimated at 33.1%. However, when body mass index was controlled using backward stepwise logistic regression, flyers had greater odds (odds ratio = 4.4, 95% confidence interval = 1.5, 13.2, P = .008) of being at risk compared with bases, but no difference was noted between the base and back-spot positions (odds ratio = 1.9, 95% confidence interval = 0.5, 6.6, P = .333). A main effect of BI perceptions was seen (P < .001), with a significant interaction by clothing type (F2,133 = 22.5, P < .001, η2 = 0.14). Cheerleaders desired to be smaller than their perceived BIs for each clothing type, with the largest difference for midriff uniform (2.6 ± 0.8 versus 3.7 ± 0.9), followed by full uniform (2.7 ± 0.8 versus 3.5 ± 0.9) and daily clothing (2.8 ± 0.8 versus 3.5 ± 0.9). Conclusions: Cheerleaders, especially flyers, appear to be at risk for EDs, with greatest BI dissatisfaction when wearing their most revealing uniforms (ie, midriffs). Universities, colleges, and the national governing bodies of these squads need to focus on preventing eating disorders and BI dissatisfaction and promoting self-esteem.

Context: Participation in appearance-based sports, particularly at the collegiate level, may place additional pressures on female athletes to be thin, which may increase the likelihood of their resorting to drastic weight control measures, such as disordered eating behaviors. Objectives: (1) To estimate the prevalence and sources of eating disorder risk classification by academic status (freshman, sophomore, junior, or senior) and riding discipline (English and Western), (2) to examine riding style and academic status variations in body mass index (BMI) and silhouette type, and (3) to examine these variations across eating disorder risk classification type (eg, body image disturbances). Design: Cross-sectional study. Setting: Seven universities throughout the United States. Patients or Other Participants: A total of 138 participants volunteered (mean age = 19.88 ± 1.29 years). They represented 2 equestrian disciplines: English riding (n = 91) and Western riding (n = 47). Main Outcome Measure(s): Participants self-reported menstrual cycle history, height, and weight. We screened for eating disorder risk behaviors with the Eating Attitudes Test and for body disturbance with sex-specific BMI silhouettes. Results: Based on the Eating Attitudes Test, estimated eating disorder prevalence was 42.0% in the total sample, 38.5% among English riders, and 48.9% among Western riders. No BMI or silhouette differences were found across academic status or discipline in disordered eating risk. Overall, participants perceived their body images as significantly larger than their actual physical sizes (self-reported BMI) and wanted to be significantly smaller in both normal clothing and competitive uniforms. Conclusions: Disordered eating risk prevalence among equestrian athletes was similar to that reported in other aesthetic sports and lower than that in nonaesthetic sports. Athletic trainers working with these athletes should be sensitive to these risks and refer athletes as needed to clinicians knowledgeable about disordered eating. Professionals working with this population should avoid making negative comments about physical size and appearance.

Purpose: Orthorexia nervosa (Orthorexia) is an eating attitude and behavior associated with a fixation on healthy eating, while eating disorders (EDs) are clinically diagnosed psychiatric disorders associated with marked disturbances in eating that may cause impairment to psychosocial and physical health. The purpose of this study was to examine risk for Orthorexia and EDs in student-athletes across sex and sport type and determine the association between the two.Methods: Student-athletes (n = 1,090; age: 19.6 ± 1.4 years; females = 756; males = 334) completed a survey including demographics, the ORTO-15 test (<40 and 20 score), and additional questions about pathogenic behaviors to screen for EDs.Results: Using a <40 threshold value for the ORTO-15, 67.9% were at risk for Orthorexia, a more restrictive threshold value of <35 determined 17.7% prevalence across student-athletes with significant differences across sex [ <40: χ(1,1,090)2 = 4.914, p = 0.027; <35: χ(1,1,090)2 = 5.923, p = 0.015). Overall, ED risk (EAT-26 and/or pathogenic behavior use) resulted in a 20.9% prevalence, with significant differences across sex (χ² = 11.360, p < 0.001) and sport-type category (χ² = 10.312, p = 0.035). Multiple logistic regressions indicated a significant association between EAT-26 subscales scores and Orthorexia, and between Orthorexia positivity, ORTO-15 scores, and risk for EDs.Conclusions: Risk for Orthorexia and ED is present in collegiate student-athletes. While healthy and balanced eating is important, obsessive healthy eating fixations may increase the risk for EDs in athletes. More education and awareness are warranted to minimize the risk for Orthorexia and EDs in student-athletes.