Higher prevalence of eating disorders among adolescent elite athletes than controls

The objective of this study is to examine the prevalence of eating disorders (ED) among female and male adolescent elite athletes and nonathletic controls.

This was a two-phase study, including a self-report questionnaire (part I) followed by clinical interviews (part II). The total population of first-year students at 16 Norwegian Elite Sport High Schools (n = 677) and two randomly selected high schools (controls, n = 421) were invited to participate. The questionnaire was completed by 611 (90%) athletes and 355 (84%) controls. The subjects reporting symptoms associated with ED were classified as "at risk" for ED. In part II, all "at-risk" athletes (n = 153), a random sample of not "at risk" (n = 153), and a random sample of 50% of the controls classified as "at risk" (n = 91) and not "at risk" (n = 88) were invited to the clinical interview to screen for ED (i.e., meeting the Diagnostic and Statistical Manual of Mental Disorders criteria for anorexia nervosa, bulimia nervosa, or ED not otherwise specified).

In part I, more controls than athletes were classified as "at risk" for ED (50.7% vs 25.0%, P < 0.001). In part II, the prevalence of ED among the total population of athletes and controls was estimated to be 7.0% versus 2.3%, with a difference of 4.7% (95% confidence interval, 3.4-6.0; P = 0.001), with the ED prevalence being higher for female than male athletes (14.0% vs 3.2%, P < 0.001) and female and male controls (5.1% vs 0%, P < 0.001). No difference in the prevalence of ED was detected between the females in weight-sensitive and less weight-sensitive sport groups (19.7% vs 11.9%, P = 0.136).

The prevalence of ED is higher in adolescent elite athletes than controls and higher in female than male athletes. Clinical interview is needed to determine accurate prevalence of ED.