Nearly a fifth of amateur and professional players were at risk.
Many amateur and professional football players are at increased risk for developing an eating disorder, according to the results of a recent study (Nutrients. 2024. 16:945). An important key to this risk lies in dissatisfaction with physical appearance and a desire to lose weight to improve performance. This can lead to restricting food intake and using ergogenic aides or laxatives. Ergogenic aides can range from pharmacologic products to compression garments, all used to lose weight and improve performance. Certain sports that focus on thinness or low body mass index, such as figure skating and gymnastics, carry increased risk.
Amateur and professional football players
Wicktoria Stáskiewicz-Barkteka, DPH, and Marek Kardas, PhD, of the Medical University of Silesia, Katowice, Poland, recently surveyed 90 male football players aged 18 years or older from football clubs participating in the 4th and 5th leagues in the Upper Silesia Metropolitan area. The authors’ goals were to assess the risk of eating disorders among these athletes and to examine the professional and amateur athletes’ own perception of their bodies.
Several questionnaires were used in the online study. The first included the respondent’s age, height, body mass index (BMI, kg/m2), any history of chronic diseases, including mental health problems such as depression, eating disorders, and neurosis, current medications, education, team field position, sports seniority, number of training sessions per week, sources of nutritional knowledge, exclusions of certain foods, and information on social media use. The participants also filled in two questionnaires, the Eating Attitudes Test-26 (EAT-26) and the Body Esteem Scale (BES).
Body image was measured with a Polish adaptation of the BES (Health Psychol. Rep. 2013. 1:71). The BES allows an individual to assess his attitude toward his body and contains 35 items in three subscales, which are somewhat different for men and women. The subscales for men include physical attractiveness, upper body strength, and physical condition. Subscales for women include physical attractiveness, weight concerns, and physical condition.
One unique section of the BES is the physical attractiveness subscale for men, based on an assessment of the features that mainly determine the description of a man as handsome. It includes both facial features and body parts such as hips and feet. The body strength subscale combines assessments of various parts of the body (such as the arms or chest), as well as their function and fitness ( Health Psychol Rep. 2013. 1:72). Study participants were also asked about daily use of the internet, particularly the amount of time the athletes spent on social media.
Findings
Nearly 86% of the study participants responded. Based on the calculated BMIs of the players, nearly a fourth (n=22) of the professional participants, were overweight; 76% (n=68) were in the normal weight range, and no player was underweight or obese. Among amateur football players, 25% (n=15) were overweight and 76% (n=44) had normal weight.
Statistically significant differences were found between nutritional status interpreted through the BMI values, according to World Health Organization recommendations, and the total score on the EAT-26 test. Overweight athletes were more likely to have an increased risk of developing an eating disorder. Using the EAT-26 score, it was estimated that 8.9% of respondents (amateurs and professionals) were at risk for an eating disorder, and were candidates for referral to a specialist. No significant differences were found between sports level and total EAT-26 scores.
Overweight athletes were more likely to have an increased risk of eating disorders. According to the results on the behavioral questions from the EAT-26 test, it was estimated that fairly equal percentages of amateur football players (10.2%) and professional players (9.7%) were at risk of developing an eating disorder. There was no significant effect of sports level on EAT-26 test scores.
Based on the overall results and interpretation of the EAT-26, it was found that 17% of respondents (both amateurs and professionals) met at least one of three criteria that may indicate the likely existence or susceptibility to an eating disorder and the need to see a specialist for further testing and diagnosis. There was no significant effect of sports level, amateur or professional, on the overall EAT-26 score. No statistically significant difference was found in the physical attractiveness and upper body strength subscales.
The authors note that BMI findings can be limited or even misleading, especially for athletes. For example, the BMI score does not account for differences in body proportions, nor does it distinguish between muscle mass and body fat. In the case of most football players, who often have increased muscle mass associated with high levels of physical activity, a high BMI may be the result of high muscle mass rather than overweight or obesity (Front. Nutri. 2022.9:981894).
In a study of 121 male and female “lean” versus “non-lean” athletes ( Eat Weight Disord. 2020. 25:745), there was a significant effect by type of sport on personal attitudes and eating behavior. Men who played “non-lean” sports scored higher on the attitudinal part of the EAT-26, while men who played “lean” sports scored higher on the behavioral part of the questionnaire. The study results showed that athletes, regardless of gender or sport type, may have eating disorder symptoms, and gender differences may be smaller in athlete populations than in non-athletic populations.
How the athletes learned about sports nutrition
The study participants reported that the main sources of their knowledge about sports nutrition were the internet (40 participants), a nutritionist (18), coaches (11), other players (10), and friends (9). Daily time spent using social media was statistically different between professional and amateur athletes. Athletes who reported using social media more than three hours a day were characterized by lower body ratings on all three subscales. Twitter users had higher self-esteem on the physical fitness subscale compared to Instagram users. Twitter users were also shown to have higher self-esteem on the physical fitness subscale, while Instagram users had lower self-esteem.
Study limitations and implications
The authors noted that the study included only football players in a single region, which may make it impossible to generalize the results to other populations. In addition, the study focused only on men, which limited the ability to analyze potential differences by gender. The use of self-assessment tools may also introduce some distortion in the results, due to the subjective perceptions of respondents. Additionally, the brief survey period may have limited the analysis of long-term trends and changes. In future studies, Drs. Stáskiewicz-Barkteka and Kardas suggest it may be more worthwhile to include body composition analysis instead of BMI, which will allow for the assessment of the proportion of muscle mass and body fat and the relationship of the values to test results.
This study showed that about 17% of amateur and professional football players were at risk of developing an eating disorder. This risk did not significantly differ between the two groups, but professional athletes rated their bodies higher in all aspects analyzed–physical attractiveness, upper body strength, and physical fitness. Analysis of BMI showed that overweight athletes were more likely to have an increased risk of eating disorders. In contrast, normal-weight athletes had higher self-assessments of physical attractiveness and body strength. The results underscored the importance of coaches, sports nutritionists, and clinicians monitoring and referring amateur and professional football players for evaluation when they suspect an athlete is at risk of developing an eating disorder.
