Program Seeks to Intervene in Disordered Eating on Campus

Disordered eating is a growing problem on college campuses, particularly among female college athletes. Student athletes often adopt such rigid training diets that they become undernourished, fatigued, and sometimes injured. It is estimated that as many as a third of female athletes have disordered eating patterns.

At Boston University, nutritionists working with the athletic department developed and tested a multidisciplinary treatment model for Division 1 college athletes. Paula A. Quatromoni, DSc, RD, recently described the results of the model after two years (J Am Diet Assoc. 2008; 108: 689). The campus sports wellness program has three components: (1) creation of a sports wellness team; (2) development and provision of a team-based nutrition education program, and (3) referral of “at-risk” student athletes for individual counseling and other services. 

A sports wellness team

The sports wellness team includes sports medicine physicians, athletic trainers, strength and conditioning coaches, academic counselors, sports psychologists, sports dietitians, and related subspecialists. The sports wellness team provides screening, referral, assessment, diagnosis, treatment and educational programs for all members of the athletic community, including students, coaches and trainers. The program also uses the Female Athlete Screening Tool (FAST), a self-administered 33-item questionnaire, as a way to identify students at risk of eating pathology and to trigger intervention for them. 

Identifying student athletes at risk 

In 2004, the sports wellness team set out to identify at-risk athletes, particularly those with disordered eating behaviors, and to refer them to the sports dietitian for counseling. Nutrition referrals were also made for general sports nutrition guidance, healthful eating on campus, and healthful weight management. Some students referred themselves after attending a sports nutrition orientation lecture and others were referred by coaches or teammates. “Disordered eating” included clinically diagnosable eating disorders, based on DSM-IV criteria. 

During the first year, nutrition services were provided to 25 athletes across 10 varsity teams. Slightly more than half of the athletes seen were females and about one-third were participants in “lean sports,” such as track, cross-country running, and swimming. Nearly half of this subgroup had disordered eating behaviors—58% of these students were involved in lean sports.

By the second year, the number of individuals served had doubled and the number of consultations increased to 165 as more students learned about the program. Athletes from 19 of 22 school teams were now participating in nutritional interventions, and 82% were women. Over the two-year period, most participating athletes were female, and most women were members of swim (20%) track and cross country (18%), rowing (14%), and basketball (14%) teams. Results from the FAST questionnaires showed that more than half of women seen in the program were at risk for disordered eating, and those who scored in the highest risk group were either freshmen or sophomores.

Participation in lean sports was not a strong correlate of high FAST scores. Only 1 in 8 students in the highest risk category was participating in a lean sport, compared with 42% of those with subclinical scores and 32% of those with healthy scores. Male athletes seeking nutrition advice came mostly from sports programs such as ice hockey (58%), track and cross country running (16%), and rowing (11%) programs.

Although disordered eating was common among female athletes, a substantial portion of the femal athletes affected affected did not meet clinical diagnostic criteria for an eating disorder. Common contributing factors, such as body image dissatisfaction, weight preoccupation, and chronic dieting were often reported. Some women reported that purging to “get rid of” calories after binge drinking was considered socially acceptable. For some, this led to purging to get rid of food calories, and eventually to bulimia nervosa.

Sports teams can promote healthful lifestyles

According to the author, sports teams can be effective vehicles to promote, model, and support healthful lifestyles. In addition, the study results indicate that student-athletes value and seek out, and then willingly participate in, nutrition services programs that help guide them to healthful eating and weight control. Dr. Quatromoni believes the key to successful programs like the one offered at Boston College is close collaboration with athletic trainers and sports medicine colleagues, because these professionals see the young athletes daily and are often the first to recognize students at risk.