Women and Sports – Page 4 – The Sport Journal

Female Athletes and Eating Disorders

Abstract

Sports should prevent athletes from having eating disorders not develop eating disorders. There is evidence that female athletes are at a risk of developing disordered eating. The purpose of this study was to find how prevalent eating disorders are in female athletes and examine factors that may have a relationship with eating disorders.

A questionnaire containing two instruments was distributed to volunteer female athletes at a Midwestern university. The EAT 26 was used to measure the prevalence of eating disorders. The ATHLETE questionnaire was used to inquire some factors that may have a relationship with eating disorders among athletes. Results showed 14.3% of the respondents scored a 20 and above on the EAT 26 and thus considered at risk of having an eating disorder. The ATHLETE questionnaire showed that there were some significant negative correlations between the EAT 26 score and participant’s feelings about their body, feelings about sports, feelings about performance, and feelings about eating. The negative correlations meant that the more the participants scored high on their feelings about their body, sports, performance, and eating, the less likely they scored low on the EAT 26, indicating they did not have a risk of an eating disorder.

This study implies that when athletes feel good about their body, sport, performance and their eating, the less likely they will have an eating disorder. This study makes an important contribution in understanding female athletes and eating disorders as well as factors that may have a relationship to eating disorders in female athletes.

(more…)

U.S. Sports Academy2017-08-03T10:50:58-05:00August 30th, 2012|Contemporary Sports Issues, Sports Studies and Sports Psychology, Women and Sports|Comments Off

Dietary Habits of African Canadian Women: A Sampled Survey

Sherldine Tomlinson, M.Sc.; Jordan R. Moon, PhD

### Abstract

The countless health benefits of adopting healthy eating habits have been well documented. It is troubling then that studies examining dietary behaviors among minority women find that compared with European American women, African American women practice poorer dietary habits. Given this reality, and the knowledge that poor nutrition is a contributing risk factor for chronic, cardiovascular and metabolic diseases, better understandings of minority women and their relationships with food are needed. This study aimed to contribute to this effort by surveying African Canadian women to explore both their eating habits and their perceptions of nutrition. Participants in this study were Canadian women of African ancestry who were 25 years old or older. Fifty of these women chose to participate and did so by completing a brief written survey and answering one open-ended question. Survey results revealed that the respondents rated their present eating habits as “excellent” (6%), “very good” (36%), “good” (40%), or “fair” (17%). Top dietary changes made by participants included reducing salt, fat and/or sugar intake, and/or increasing fruit and vegetable consumption. The open-ended question asked what supports could be put in place to encourage healthy eating and many of the respondents noted that nutritional classes/workshops for black women that could be offered through the community or the church would be beneficial. This study suggests increased efforts are required to further educate African Canadian women about healthy eating as poor nutrition is a significant risk factor for many of the diseases prevalent in black communities. It is imperative that any initiated nutritional education programmes be tailored to meet the cultural and linguistic background of the targeted group in question. Further research is warranted to expand our understandings of African Canadian women’s eating habits and how their food choices affect their overall health.

**Key Words:** minority women, nutrition, health status, diet-related illnesses

### Introduction

Many health professionals agree that the most significant and controllable risk factor affecting long-term health and well-being is diet. Indeed, the first steps commonly suggested for improving health and longevity are lifestyle changes like lowering salt intake, reducing total fat/saturated fat in our diets, increasing fibre intake and fruit and vegetable consumption, and integrating regular exercise into our daily routine. Without a doubt, there are countless benefits to adopting healthy eating habits. It is troubling then that studies in the United States examining dietary behaviors among minority women find that compared with European American women, African American women practice poorer dietary habits. In a number of recent studies for example, African American women were shown to consume less fruits and vegetables, and to eat more foods that were high in sodium and/or fat (1-3). The American Heart Association’s 2009 Heart Disease and Stroke Statistical Update (4) reported that on average, only three to five percent of adult African Americans consumed the recommended three or more daily servings of whole grains, only six to nine percent consumed four or more daily servings of fruit and only five to ten percent consumed five or more daily servings of vegetables.

Research also suggests that poor eating habits are a significant risk factor in the development of chronic illnesses (5) and are known to act as precursors for other risk factors, especially being overweight or obese (4). Not surprisingly then, poor nutrition among African American women is believed to contribute to the higher incidences of diabetes, hypertension and cardiovascular diseases they experience in comparison to White American women. Until minority women’s dietary habits are improved they will continue to be plagued by nutrition related illnesses.

Current literature provides limited explanation as to why African American women have poor dietary practices. What is known from the research is that health disparities, such as lack of access to proper preventative care, stressful lifestyles, lack of education about nutrition, inadequate housing, lower income and the lack of health insurance in the United States, are all believed to be factors in poor health outcomes among African Americans (6). The ongoing disparity in well-being between African Americans and their fellow citizens suggests further efforts are required to identify and implement appropriate strategies to improve this group’s nutritional and overall health status. This study aimed to contribute to this effort by surveying African Canadian women to explore both their eating habits and their perceptions of nutrition. The results of this study provide useful information for health care practitioners and educators seeking to improve health among minority populations.

### Methods

#### Participant Recruitment

The targeted participant group for this study were Canadian women of African ancestry who were 25 years of age or older. The recruitment process involved approaching African Canadian women in shopping malls, medical centers, universities/colleges and churches, providing them with a brief overview of the survey, and inviting them to participate. Those women who agreed to participate were given a consent form to read and sign. Recruitment was not stratified by socioeconomic status as many participants refused to fill out the survey or answer the open-ended question if their income, marital status or educational background was required. After one month of recruitment, 50 African Canadian women agreed to participate in the study.

#### Survey implementation

Each participant was given a written questionnaire to complete. On average, the questionnaire took participants approximately two minutes to finish. Participants were then asked an open-ended question and a digital recorder was employed to record their responses. This oral portion of the survey took approximately one and a half minutes to complete. For the purposes of confidentiality, all the respondents were assigned a file number.

#### Primary outcome measures

The primary outcome measures for the study were to provide some useful insights into African Canadian women’s dietary habits and their awareness of nutrition. It is hoped that these findings lead to open dialogues among health practitioners and educators on how best to promote healthier lifestyles among women of African descent in North America and beyond.

#### Procedures

The survey questionnaire used a likert scale to assess participant’s top dietary approaches to good nutrition; barriers to healthy eating; familiarity with Canada’s Food Guide and its recommendations; motivators in changing dietary habits; sources for nutrition information; nutrition concerns; importance of nutrition to improving Black women’s health and ratings of dietary habits. The open-ended question asked participants to indentify strategies they believed would be useful in promoting healthy eating habits among African Canadian women. With the exception of questions focusing on the link between nutrition and Black women’s health, the survey questions were adapted from the Canadian National Institute of Nutrition: Tracking Nutrition Trends series of surveys (7).

#### Statistical analysis

Analyses of the data were performed using the Statistical Package for the Social Sciences (SPSS) software version 13.0. Responses to the survey questions were coded, allowing the data to be converted into numbers. This descriptive data was then calculated and expressed as means, standard deviations, and percentage except where otherwise noted.

### Results

A total of 50 African Canadian women, ranging in age from 31 to 78 years, took part in the study. All 50 participants completed the survey questionnaire and answered the open-ended question. Based on analysis of survey results only 6% (n=3/50) of the respondents rated their present eating habits as “excellent”, whilst 36% (n=18/50) rated them as “very good”, 40% (n=20/50) as “good”, and 18% (n=9/50) as “fair.” (Table 1). Top dietary changes adopted by participants to improve their nutrition included reducing salt, fat and/or sugar intake, and/or increasing fruit and vegetable consumption.

When asked to identify barriers to adopting good eating habits the participants gave a variety of responses; 52% (n=26/50) of the women cited lack of time to prepare healthy meals, 26% (n=13/50) selected taste as an impediment and 22% (n=11/50) cited lack of desire as an obstacle. Affordability of healthy foods was not selected as a barrier to healthy eating, which may suggest that costs associated with buying healthy foods is not a concern for these women. Interestingly, only 38% (n=19/50) of the sampled women were aware of Canada’s Food Guide, whereas 62% (n=31/50) of the women were not familiar with the guide. Most women who knew of the guide also cited that they were familiar with some of its recommendations regarding daily nutritional needs. 52% (n=26/50) of the women also said that they considered themselves “somewhat knowledgeable” about nutrition, while 22% (n=11/50) reported they were “very knowledgeable”, 18% (n=9/50) “extremely knowledgeable” and 8% (n=4/50) “quite knowledgeable.”

On the topic of how important participants believed good nutrition was in maintaining or improving Black women’s health, 52% (n=26/50) of the respondents answered “extremely important,” 42% (n=21/50) said “very important” and 6% (n=3/50) recorded “somewhat important.” The top three nutritional concerns for participants were consuming too much fried foods (70%, n=35/50), consuming too much sodium (68%, n=34/50) and the presence of trans fat in foods (62%, n=31/50) (Figure 1). In terms of where they typically obtained nutritional information, 56% (n=28/50) of the women reported turning to standard nutrition leaflets/booklets, whereas 28% (n=14/50) consulted with their physician for dietary advice (Figure 2). Participants identified a number of key motivators to improving dietary habits, “having a health condition” (46%, n=23) and “to maintain health” (28% (n=14) were the top two motivators (Table 2).

#### Analysis of Open-ended Question

When asked what strategies could be employed to encourage African Canadian women to adopt healthy eating habits, a number of answers were given. Introducing nutritional workshops/classes through community-based (i.e. church) programs was a suggestion offered by many of the women. For example, one woman conveyed “if there were nutrition classes available in my church I would definitely go,” while another said “I think having some workshops to teach Black people more about good eating is a very good idea…I would go to the classes.” Still another woman echoed the idea of the church as an ideal place to deliver meaningful and effective health promotional messages within the Black community, explaining that “since a lot of black people do go to church, it would be a good thing to have nutrition classes there to learn more about nutrition.” One woman noted that she had heard of Black churches in the United States offering nutrition and exercise programs for their congregations and said “we need something like that in Canada…if we had our own nutrition or even fitness programs available in our community, a lot of us wouldn’t have all this sickness.”

Many of the participants also noted that any educational offerings about nutrition should be made culturally relevant for the African community. For instance, one woman stated, “if they have nutrition classes available for Black people, it should be cultural and to our needs…we eat different from White Canadians and we have different needs,” and another explained “we need our own diet classes to teach us [Black people] how to cook our own foods more healthy……. black people don’t realize that foods from our country are very healthy….we think that we have to eat Canadian foods to eat good.”

### Discussion

Findings from the survey and an open-ended question indicate that African Canadian women hold a variety of opinions about nutrition, and similarly, practice a variety of eating behaviors. A number of the women had made efforts to modify their current diets by either reducing salt and/or sugar intake or by choosing to consume more fruits and vegetables. Time constraints, lack of taste, and lack of desire were all noted as major barriers that prevented some of the women from adopting healthier diets.

One assumption that can be drawn from the survey findings is that reliance on physician advice about diet may not be sufficient (on its own) to produce desired and sustainable behavioral changes in food habits among African Canadian women. Indeed, many of the women in the survey had not sought or been offered advice on proper nutrition from their physicians. In their research, Podl et al. (8) assert that physicians often do not spend the extra time necessary to help their patients make lifestyle changes that could be beneficial to their health. In particular, physicians often do not give thorough advice or provide specific information on proper eating habits either because they have doubts in their ability to deliver this type of information, and/or doubts about its efficacy in leading to lifestyle change (8). A lack of training in or education about, behavioral counselling on healthy dietary practices among healthcare professionals is a major contributing factor to the reluctance in offering lifestyle advice to patients. Unfortunately, medical schools in and outside the United States only briefly cover nutrition in their curriculum, leaving medical doctors insufficient knowledge to provide assistance to patients with dietary and nutritional needs.

In spite of these challenges, it is essential for healthcare practitioners to provide counselling to their patients on preventative health measures (i.e. nutritional counselling) as health tracking studies continue to show a significant rise in nutrition-related illnesses like cardiovascular disease and diabetes in Canada (9).

The survey outcomes also suggest that more attention should be given to educating African Canadian and other minority women about Canada’s Food Guide. Many of the women in the study were unfamiliar with the guide and did not know the daily recommendations for a healthy diet. It is important that dieticians, nutrition educators and health agencies become more proactive in their attempts to promote Canada’s Food Guide in minority communities. Public service announcements from health agencies via local ethnic community newspapers, for example, could help to increase public exposure to Canada’s Food Guide among African Canadians and other minority populations who are thus far unfamiliar with it. More broadly, efforts should be made among healthcare professionals to identify and implement targeted strategies for improving dietary behaviors, and well-being in general, among minority populations in Canada.

It is important to note that there were a number of limitations and challenges with the present study. During the recruitment phase it became clear that participants were not willing to take part in the study if it required revealing their household income, educational or employment background, or marital status. Without this data, it is difficult to determine whether the sample participants were a representative reflection of the wider African Canadian community and to unravel in what ways the outcomes may have been tied to social class. A second challenge was that it was difficult to persuade participants to complete the survey. Concerns about a lack of cultural sensitivity in research studies and distrust of healthcare professionals (especially worries about being misrepresented or used for the benefit of researchers or for-profit companies) were reasons expressed by many of the women who chose not to complete the survey. These sentiments are in line with American studies that have investigated barriers that impede African American participation in clinical research (10). However, this challenge was somewhat overcome since the lead researcher is a members of the African Canadian community, and was able to connect with many of the women and convince them to participate. Nonetheless, the relatively small size of the sample population (50 women) is a limitation. Recruitment of a larger sample of participants, and a greater effort to include social class indicators, would be useful in further studies on this topic.

Finally, the methodology employed in this study did not include focus groups or detailed interviews. Focus groups are a common and useful method for understanding the perspectives of women of African descent as they allow participants to verbalize and express their opinions on selected subjects. In research undertaken by El-Kebbi et al. (11), for example, a focus group structure was employed to identify barriers to dietary self-management among a group of African Americans with type 2 diabetes (11). The resulting data yielded a wide range of identified barriers including the cost of special foods, poor taste of low fat foods, lack of family support, difficulty using the exchange system and reading food labels, and problems changing habitual patterns of behavior. A focus group or in-depth interviews would have been preferable for this study as it would likely have allowed for better insights into the participant’s dietary practices and nutritional beliefs. Thus it is suggested that future research on this topic use focus groups or detailed interviews in order to gain a deeper understanding of African Canadian women and diet.

### Conclusion

Despite the limitations discussed above, the survey did produce significant findings. For one, while African Canadian women are aware that healthy nutrition practices promote good health, it is also clear that more informed awareness, specific information and education would be beneficial. For instance, African Canadian women would benefit from information about how to be aware of portion size, how to read food labels and how to incorporate the Canada’s Food Guide recommendations into their daily meal plans. As the women identified themselves, introducing more community-based nutritional education programmes would be a good starting point for this kind of learning.

The study also reveals that if African Canadian women are to respond positively to any such nutritional education programs, these programs must be tailored to meet the cultural and linguistic background of these women. Initiating community-based dietary education programmes that are specifically for African Canadian women, for example, ought to include educational materials and resources that reflect this population’s cultural background. For instance, since taste was identified as a potential barrier to healthy eating by many of the women in the survey, the programs would need to encourage a consideration of healthier cooking methods, while at the same time, still allowing for the use and enjoyment of traditional foods and ingredients (12). The programs may also need to take into account economic factors affecting this group such as lack of time resulting from under-employment and low wage employment leading to the need to hold two or more jobs; indeed quite a few of the women cited time constraints as a major barrier to adopting healthy dietary practices. This factor would need to be taken into account in the scheduling of the program as well.

It is also suggested that any nutritional education programs be delivered by trained peer educators or volunteers from the African Canadian community. Given a history of past slavery and present racism, many African Canadian women are understandably distrustful and/or uncomfortable with mainstream institutions and experts, particularly when talking of topics as intimate as food and health. In addition, having trainers of African descent helps to ensure the validity of cultural elements and values in the program material/content and allows the trainers to serve as role models. Additionally, it would be helpful for any initiating nutritional programs to teach more African Canadian women about their African ancestors and how they ate, since they ate much more differently than African Canadians do today. With this knowledge, African Canadian women would not have to feel like they were giving up their traditional food. All of these measures increase the probability that African Canadian women would participate in, and be motivated to learn from, any community-based nutritional educational program offerings.

The higher prevalence and increasing rates of diet-related disease among women of African descent suggest that the need for this population to modify their diets is critical. Canada’s health care infrastructure can afford to, and should, expand health promotion programs encouraging healthy lifestyles among Africans Canadians. Designing and implementing culturally sensitive, community-based nutritional education programs would be a positive step in helping women of African descent and other minority communities in Canada adopt healthy diets, while still enjoying their traditional foods. Furthermore, it should be noted that the findings of this study provide some important, initial insights about African Canadian women and their dietary perceptions and practices, and these insights can be extended to women of African descent in North America and beyond. Further research is warranted to better understand African Canadian women’s eating habits and how these relate to their health and well-being. Equally, because physical activity and exercise are associated with dietary behavior, investigating African Canadian women physical activity level is also encouraged.

### Applications In Sport

Poor lifestyle choices increase the risk of developing a number of disease and health complications. However, a combination of regular exercise and/or physical activity along with good eating habits will significantly decrease the risk and is a primary defence for prevention. Very little information is available on African Canadian women as it relates to dietary habits and their exercise behavior. Further research is needed in this area to find effective intervention strategies and to understand African Canadian women lifestyle practices.

### Acknowledgements

The author would like to thank the subjects for their time and co-operation.

There were no specific funding sources for this research survey.

The author has no conflicts of interest to disclose.

### Tables

#### Table 1
Rating healthy habits

Rate Healthy Habits	valid %	N=50
Excellent	6%	3
Very good	36%	18
Good	40%	20
Fair	18%	9
Total	100%	50

#### Table 2
Key motivators to change / improve diet

key motivators	valid %	N=50
having a health condition	46%	23
to maintain health	28%	14
to prevent other diseases	12%	6
weight loss	8%	4
look better	6%	3
Total	100%	50

### Figures

#### Figure 1
Top Nutrition Concerns
![Figure 1](//thesportjournal.org/files/volume-15/460/figure-1.png “Top Nutrition Concerns”)

#### Figure 2
Source of Nutrition Information
![Figure 1](//thesportjournal.org/files/volume-15/460/figure-1.png “Source of Nutrition Information”)

### References

1. Harris, E., & Bonner, Y. (2001). Food counts in the African American community: Chartbook 2001. Baltimore, MD: Morgan State University.
2. Shikany, J.M., & White, G.L. (Dec 2000). Dietary guidelines for chronic disease prevention. Southern Medical Journal. 93: 1138-1151.
3. Bowen, D.J., & ¬Beresford, S.A. (May 2002). Dietary intervention to prevent disease. Annual Review Public Health. 23: 255-286.
4. American Heart Association. (2009). Heart disease and stroke statistical update 2009. Dallas, Texas: American Heart Association. Available at www.americanheart.org/downloadable/heart/1240250946756LS-1982%20Heart%20and%20Stroke%20Update.042009.pdf
5. Hargreaves, M.K., & Schlundt, D.G., & Buchowski, M.S. (Aug 2002). Contextual factors influencing the eating behaviors of African American women: A focus group investigation. Ethnic Health. 7(3): 133-147.
6. Drayton-Brooks, S., & White, N. (Sep-Oct 2004). Health promoting behaviors among African American women with faith-based support. The Association of Black Nursing Faculty Journal (ABNFJ). 15(5): 84-90.
7. Tracking Nutrition Trends VII: The Canadian Council of Food and Nutrition. August 2008. http://www.ccfn.ca/membership/membersonly/content/Tracking%20Nutrition%20Trends/TNT_VII_FINAL_REPORT_full_report_Sept.pdf
8. Podl, T.R., & Goodwin, M.A., & Kikano, G.E., & Stange, K.C. (Oct 1999). Direct observation of exercise counseling in community family practice. American Journal of Preventive Medicine. 17(3): 207-210.
9. A Perfect Storm of Heart Disease Looming on our Horizon: The Heart and Stroke Foundation’s 2010 Annual Report on Canadians’ Health. Available at http://www.heartandstroke.com/site/c.ikIQLcMWJtE/b.5761931/k.8118/2010_R….
10. Corbie-Smith, G., & Thomas, S.B., & Williams, M.V., & Moody-Ayers, S. (Sept 1999). Attitudes and beliefs of African Americans toward participation in medical research. Journal of General Internal Medicine. 14(9): 537-546.
11. El-Kebbi, I.M., & Bacha, G.A., & Ziemer, D.C., Musey, V.C., & Gallina, D.L., & Dunbar, V., & Phillips, L.S. (Sept-Oct 1996). Diabetes in urban African Americans. V. Use of discussion groups to identify barriers to dietary therapy among low-income individuals with non-insulin-dependent diabetes mellitus. Diabetes Education. 22(5): 488-492.
12. Mondelus C.V. (2003). Assessing the perceptions of Black American women within Virginia’s faith community regarding health and nutrition practices and their concerns [masters’ thesis]. Virginia: Virginia Polytechnic Institute and State University.

### Corresponding Author

Sherldine Tomlinson, M.Sc
2-440 Silverstone Drive
Toronto, Ont. M9V 3K8
<srtomlinson@students.ussa.edu>
1+ (416) 749-7723

Sherldine Tomlinson is the proprietor and a clinical exercise physiologist at the Centre of Chronic Disease & Health Inc. She is also a graduate student at the United States Sports Academy.

U.S. Sports Academy2016-10-12T15:02:32-05:00April 9th, 2012|Contemporary Sports Issues, Sports Exercise Science, Sports Studies and Sports Psychology, Women and Sports|Comments Off

The Lifestyle and Sport Activity of Secretaries

Jera Zajec, Mateja Videmšek, Maja Meško, Jože Štihec (assist. Jera Zajec, Ph.D., University of Ljubljana, Faculty of Education prof. Mateja Videmšek, Ph.D., University of Ljubljana, Faculty of Sport assist. Maja Meško, Ph.D., University of Primorska, Faculty of Management asoc. prof. Jože Štihec, Ph.D., University of Ljubljana, Faculty of Sport)

### Abstract

#### Purpose
The aim of the study was to analyse the sports activity and lifestyle of secretaries in Slovenia.

#### Methods
A questionnaire with 37 variables was completed by 104 secretaries from different places within Slovenia. We calculated the frequencies and contingency tables, whereas the statistical characteristics were determined on the basis of a 5% risk level.

#### Results
We established that 26% of the secretaries were obese; most of the time secretaries are sitting down, working with their fingers, and are in forced positions. 56% of the secretaries occasionally take medicines; most of their pain occurs in the neck region, of the back, the shoulder region and in the loins; other common problems include insomnia, emotional exhaustion, and headache. The majority of secretaries engage in sporting activities on the weekend and 2 – 3 times weekly; most of them practiced sport in an unorganized way, with their family or by themselves. A good 20% engaged in an organized sport in a sport club or society, where fitness can also be classified. A good 20% practiced sport in an unorganized way, with their friends. It was established that those secretaries who engaged in an unorganized sport activity were accompanied by their friends or family. Those practicing an organized sport were mainly alone.

#### Conslusion
Secretaries who are frequently active often have a lower Body Mass Index (BMI), take painkillers less often or never, and believe that sport has a great impact on their health.

#### Applications in Sports
Sports clubs and associations should prepare appropriate activities for secretaries which will fullfil their interest, health, and wellbeing.

**Key words:** working conditions, wellbeing, health.

### Introduction

Modern professions are completely different from those undertaken in the past. Cutting-edge technology, robotics, and computer science have disburdened the human labour force and thus caused an increase in the demand and supply of office workers (secretaries, administrators, clerks etc.) whose sedentary jobs are characterized by long hours in forced postures. It is clear to see that the working conditions have drastically changed. Besides that, the leisure time and leisure activity preferences have also changed. According to the results of the latest studies, sport and recreation activities are being promoted and are increasingly gaining ground (13). The effects were first seen with highly educated people as they are aware of the potential negative consequences of a sedentary lifestyle, which is why they include a suitable sport activity in their everyday life (7, 9, 10). The fact that Slovenia is among the top European Union (EU) member states in terms of the physical activity of the population is more than encouraging. However, the latest studies show that 37.91% of adult residents of Slovenia are physically inactive (11). Due to the pressure to achieve higher productivity at work, the desire to be promoted and the aspirations for a higher income there is simply not enough time to engage in sport (8). People of different professions find themselves constantly pressed for time.

The work of secretaries is highly specific. Secretaries spend most of their working time in forced postures, sitting in unventilated offices, looking at a computer monitor most of the time, memorising huge amounts of information, and this all burdens them psychically and physically. Due to the many positive impacts of sport on physical, emotional and mental well-being (the condition of being contented, healthy, or successful) and given the nature of their work, it is highly recommended that secretaries engage in a sport activity (12). Long hours of sitting in front of a computer in a bent posture are detrimental to the human body. An appropriate sport activity can alleviate or even eliminate problems caused by a sedentary job (6). What is meant by appropriate sport activity is a recreational physical activity which positively affects both health and well-being (mood, sleep and self-confidence) (1).

This study aimed to establish the correlation between the sport activity of secretaries and some selected healthy lifestyle factors. For this purpose, a sample of secretaries was surveyed to establish the correlation between secretaries’ sport activity and the characteristics of their living environment as well as between the state of their nutrition and the type of their sport activity. We also established the frequency of health problems which precondition secretaries’ active engagement in sport activities.

### Methods

#### Sample of subjects

The sample included 104 randomly selected secretaries from different parts of Slovenia. The sample was selected at the congress of secretaries. The subjects were aged 23 to 61 years, while their average age was 41. Their jobs included personal assistant, business secretary and administrator.

#### Sample of variables

The study was based on a survey questionnaire consisting of 37 questions which enquired about social, environmental and work factors, the frequency and type of sport activity, nutrition, health condition, and psychical well-being (14). The data acquisition process was carried out in compliance with the Personal Data Protection Act. Subject gave informed consent for this study. The study was approved from the Etics Commission.

#### Data-processing methods

The data were processed using the SPSS-15.0 statistical program at the Computer Data Processing Department at the Faculty of Sport in Ljubljana. The basic statistical parameters and contingency tables were calculated. The subprograms FREQUENCIES and CROSSTABS were used for the calculation. The probability of a correlation between the variables was tested by a contingency coefficient. The statistical significance of the differences was accepted at a two-way 5% alpha error level.

### Results

#### Body characteristics

Body weight and height were self-reported. BMI was calculated from those data. Average BMI for secretaries was 23.7, indicating that the secretaries participating in the study had a normal body weight.

#### Working conditions

The secretaries’ working conditions varied (Table 1): sitting, standing – straight, standing – bending, lots of walking, working with fingers, working with hands, frequent forced posture (head and neck, turn of the torso, deep bending posture). Most secretaries spend almost all day sitting on a chair, working with their fingers and are in a forced postures. 10% of them stated these three combinations and 10% the combination of sitting and working with fingers

#### Taking work home

Secretaries often take work home with them. Sometimes they have to finish assignments at home, at other times they bring home their stress, problems, and burdens. Nearly 70% of the secretaries confirmed they sometimes feel the pressures of their work when at home (Figure 1).

#### Secretaries’ current health condition and their taking of painkillers

Most secretaries (57.7%) assessed their health condition as good. As many as 56% of them occasionally take medicines. It is statistically characteristic that those secretaries who take medicines more frequently less frequently engage in a sport activity. We established that nearly 40% of the surveyed secretaries never take any painkillers. Occasional use was reported by 56% and frequent use by 5%.

#### Secretaries’ injuries in the past three months and health problems

91.3% of the secretaries reported no injuries had been sustained in the past three months. The most frequent pains occurred in the neck, shoulder girdle, and the lumbar part of the spine. Also frequently reported were insomnia, emotional exhaustion, and headache. Other pains occur less frequently.

#### Secretaries’ absences from work

We established that 75.5% of the secretaries had not been absent on sick leave in the past six months. In the same period, 17.6% of the secretaries were on sick leave for less than 14 days. The reasons for their sick leave mainly included respiratory diseases (53.3%), care for other family members (16.7%), and injury at work or outside work (6.7%).

#### Secretaries’ assessment of the impact of sport on their health

It was established that the secretaries were aware of the importance of sport activity for their health, as nearly one-half (45.6%) of them assessed the positive impacts of sport on their health as strong, whereas the rest (53.4%) assessed them as very strong.

#### Frequency of engaging in sport

Most of the secretaries engaged in sport on weekends and 2-3 times a week. Only 4.9% of them stated they never engaged in sport (Figure 2). The time most of the secretaries dedicate to sport ranges from 35 minutes to 2 hours.

#### Types of sport activities

It was established that the secretaries engaged in several different sports at a time. The most practiced sports include cycling, fast walking, mountaineering, and swimming; skiing is also popular. One-quarter of the secretaries practice racquet sports. These sports constitute a type of physical activity which one may adapt to one’s momentary well-being and general physical fitness and, what is more, they enable the venting of psychical tensions typical of a secretary’s work. Degenerative changes in the body are not an obstacle to practicing racquet sports.

#### Method of practicing sport

Most of the secretaries practice sport in an unorganized way, with their family or by themselves. A good 20% of them engage in an organized sport in a sport club or society and the same percentage practice sport with their friends in an unorganized way. Racquet sports are undoubtedly among those activities which require only a small financial input and can be practiced nearly everywhere due to the availability of sport facilities and grounds and the fact that they can be modified to suit individual needs. It was established that those secretaries who engaged in a sport in an unorganized way were accompanied by their friends or family. Those who practiced an organized sport were mainly doing it by themselves.

#### Sport inactivity and motives for sport activity and against it

The reasons for sport inactivity lie primarily in the lack of time, fatigue, and lack of motivation, as well as inadequate organization. The motives for sport activity relate to different reasons: practice sport means to relax, maintain and improve one’s health, maintain and improve one’s physical fitness, and have a good feeling from doing something for oneself.

#### Impact of sport activity on well-being

Most of the secretaries who practice sport are more self-confident and efficient in their work. A good mood and relaxation are typical indicators of well-being and the secretaries reported being full of vitality and energy. They also enjoy better sleep after a sport activity. They reported that their tenacity, strength, flexibility, and adroitness have improved. Most of them claimed they were able to better withstand psychological pressures. All but one agreed they were not tired more than usual after engaging in a sport activity. The same was true for pain in the legs. Only three of them thought that pain in their legs was due to sport activity.

#### Employers’ role in the secretaries’ sport activity

Most of the secretaries believed that sport and recreation belonged to the private sphere of each individual. 20% of them thought that their employer should support their sport activity at least morally. The same percentage of secretaries said their employer sponsored sports events and employees’ sport clubs. Only three secretaries wished for sport activities to be included in the work process (exercises in the workplace, recreational facilities in the company). The employers did not award their employees for sport achievements (Figure 3).

The selected variables (14) were cross-checked using contingency tables in the CROSSTABS subprogram of the SPSS statistical package and the results showed a statistically significant correlation between the BMI and frequency of engaging in sport (k = 0.644, p = 0.001). A more frequent engagement in sport conditioned a lower BMI. The differences between taking medication and a frequent engagement in sport were also statistically significant (k = 0.444, p = 0.034). The more physically active secretaries only rarely took painkillers or never. The assessed health condition and frequency of engaging in sport were also statistically significantly correlated (k = 0.490, p = 0.004). A more frequent engagement in sport preconditioned a good health condition. The secretaries’ opinion on the impact of sport on their health and the frequency of engaging in sport were also statistically significantly correlated (k = 0.593, p = 0.002). The physically active secretaries believed that sport had a strong impact on their health.

### Discussion

The World Health Organization (WHO) defines obesity as excessive fat accumulation that presents a risk to health (1977). Women generally have more body fat than men. Men and women whose fat exceeds 25% and 30%, respectively, are obese. The results of our study showed that 26% of the secretaries were obese. In an extensive study involving the adult population of Slovenia, Zaletel Kragelj and Fras (15) established that as many as 40.1% of the individuals surveyed were obese and 38.5% had a normal weight. This leads us to conclude that the surveyed secretaries had a lower BMI than the Slovenian average. With reference to the above, in the future it would be reasonable to establish the ratio between the muscle mass and fat mass.

Good working conditions are certainly an essential element of the better performance of an employee, which is why good employers always strive for a better working environment for their employees (12). It was established in our research that the secretaries mainly work in the following working conditions: sitting, standing – straight or bending, and lots of walking. The study results showed that the secretaries most frequently sit, work with fingers and in forced postures. Due to such working conditions they should do specific gymnastic exercises several times a day to compensate for their long maintained sedentary positions.

Another important finding of our study was the frequency of taking medication. It these research was established that as many as 56% of the secretaries occasionally take medicines. Other researchers have found similar findings (14). In their research was namely established that the majority of people (even 70%) suffer from various intestinal difficulties for several years as a result of taking painkillers such as ibuprofen. They reported taking painkillers all too often.

Our findings about the secretaries’ injuries in the previous three months are encouraging because as many as 91.3% of the secretaries had sustained no injuries in the said period. We established that 75.5% of the secretaries had not been absent on sick leave in the past six months. In the same period, 17.6% of the secretaries were on sick leave for less than 14 days. The reasons for their sick leave mainly include respiratory diseases (53.3%), looking after other family members (16.7%) and injury at work or outside work (6.7%). The predominant diseases in terms of the percentage of absences on sick leave were diseases of the skeleton and bone system and connective tissues, followed by injuries and infections outside work, with injuries and infections at work occupying third place. In women, frequent reasons for an absence include pregnancy and diseases in the prenatal and postnatal periods (2). This is also comparable with the findings of our research.

As regards the secretaries’ current health conditions, it can be concluded that they correspond with the Slovenian average; however, the latter is considerably higher than that in the EU. A comparison with a relevant EU study reveals that Slovenians are more burdened by health problems caused by work. Nearly every second employee reports pain in the back (45.9%), one-quarter (25.7%) complain about frequent headaches and four employees out of ten (38.2%) suffer from muscle pain. The EU averages are considerably lower (3, 5).

The analysis of the secretaries’ opinions about the importance of sport, frequency, type and method of engaging in sport yielded the results presented in the continuation. We assess the secretaries’ opinion about the importance of sport activity as good. An opinion as such is not enough, but the findings show that the secretaries corroborate their views with concrete activities. Namely, 55.7% of them practice a sport between 35 minutes and two hours mainly two to three times a week. In view of the Slovenian average established by Doupona Topič and Sila (4), namely that the Slovenian active population engages in sport 3.25 hours a week on average, we realised that the secretaries can be classified among the physically active population of Slovenia. In terms of the chosen type of sport activity, with the most popular being cycling, fast walking, mountaineering and swimming, this can be compared to the Slovenian average, for women, where high percentages also represented morning gymnastics, equestrian sports and martial arts (4). Most of the secretaries practiced sport in an unorganized way, with their family or by themselves. A good 20% engaged in an organized sport in a sport club or society, where fitness can also be classified. A good 20% practiced sport in an unorganized way, with their friends. It was established that those secretaries who engaged in an unorganized sport activity were accompanied by their friends or family. Those practicing an organized sport were mainly alone. The results of the Slovenian average show that unorganized sport activities are still predominant in Slovenia as 40.2% of people practice sport in this way. Less than 25% of the population practice organized sports (4). We believe that an employee’s opinion about sport and their method of engaging in sport (unorganized) is also influenced by their employer. Most secretaries (59.3%) answered the question about their employer’s support of their sport activity by saying that the employer considered sport activity as a private sphere of life. 25.3% of employers support sport activity at least morally.

### Conclusion

It has been established that sport activity plays an increasingly important role in the everyday life of the secretaries. Due to specificity of their work which exerts psychical and physical pressure on them secretaries are engaging in sport more frequently. This positively affects their well-being, health, general fitness, and lifestyle. In our sample, the frequency of practicing a sport and the time of practice were comparable to and higher than the Slovenian average for adults of the same age. The type of sport activity was also comparable. In our opinion, more attention should be paid to the organization of sport activities as the majority of secretaries engage in an unorganized physical activity. It was also established that the secretaries hoped for some organized types of sport that would be provided by their employers. The latter insufficiently support their secretaries’ sport activity. Most of them believe that sport is a private sphere of life, not part of work. They support sport activity only morally as they mainly fail to award sport achievements, sponsor sport events or include sport activities in the work process.

### Applications In Sport

The secretaries are aware of their work, presumptions, and life. They proved this with their low rate of absences on sick leave. They should be offered more possibilities for engaging in organized sport activities and be supported by their employers financially, not only morally. Consequently, they will reduce their excessive use of painkillers and alleviate the pain in their neck, lumbar part of the spine and shoulder girdle, which are consequences of the frequent forced postures they must adopt. At the same time, they will also improve their psychical, physical, and social life.

### Acknowledgments

Authors agree that this research has non-financial conflicts or interest. This includes all monetary reimbursement, salary, stocks, or shares in any company.

### References

1. Backović Juričan, A., Kranjc Kušlan M., & Mlakar Novak, D. (2002). Slovenia on the move project – move to health. International conference: Promoting health through physical activity and nutrition. Radenci: 68-70.
2. Bolniški staž. [Sickness absence of the job]. Retrieved August 5, 2010, from Institute of Public Health of the Republic of Slovenia, Web site: <http://www.ivz.si/Mp.aspx?ni=78&pi=6&_6_id=52&_6_PageIndex=0&_6_groupId=2&_6_newsCategory=IVZ+kategorija&_6_action=ShowNewsFull&pl=78-6.0>
3. Dobre delovne razmere v Sloveniji ogrožata visoka stopnja delovne intenzivnosti in zdravstvene težave, ki jih povzroča delo. [Good working conditions in Slovenia threatens a high degree of labor intensity and health problems caused by work]. Retrieved May 17, 2009, from Eurofound, Web site: <http://www.eurofound.europa.eu/press/releases/2007/070917_sl.htm>.
4. Doupona Topič, M., & Sila, B. (2007). Oblike in načini športne aktivnosti v povezavi s socialno stratifikacijo [Types and methods of sport activity in relation to social stratification]. Šport, 3: 12-16.
5. Gibson, S., Lambert, J., & Neate, D. (2004). Associations between weight status, physical activity, and consumption of biscuits, cakes and confectionery among young people in Britain. Nutrition Bulletin, 4: 301.
6. Görner, K., Boraczyński, T., & Štihec, J. (2009). Physical activity, body mass, body composition and the level of aerobic capacity among young, adult women and men. Sport scientific and practical aspects, 2: 5-12.ž
7. Meško, M., Videmšek, M., Štihec, J., Meško Štok, Z., & Karpljuk, D. (2010). Razlike med spoloma pri nekaterih simptomih stresa ter intenzivnost doživljanja stresnih simptomov. [Gender differences in some symptoms of stress and intensity of experiencing stress symptoms] Management, 2: 149-161.
8. Mlinar, S., Štihec, J., Karpljuk, D., & Videmšek, M. (2009). Sports activity and state of health at the casino employees. Zdravstveno varstvo, 3: 122-130.
9. Mlinar, S., Videmšek, M., Štihec, J., & Karpljuk, D. (2009). Physical activity and lifestyles of Hit casino employees. Raziskave in razprave, 3: 63-88.
10. Morabia, A., & Costanza, M.C. (2004). Does walking 15 minutes per day keep the obesity epidemic away? American Journal of Public Health, 3: 437-440.
11. Sila, B. (2007). Leto 2006 in 16. študija o športnorekreativni dejavnosti Slovencev [Year 2006 and the 16th study on sport-recreational activity of Slovenians]. Šport, 3: 3-11.
12. Videmšek, M., Karpljuk, D., Meško, M., & Štihec, J. (2009). Športna dejavnost in življenjski slog oseb nekaterih poklicev v Sloveniji. [Sports activities and lifestyle of some employers in Slovenia]. Ljubljana: Faculty of sport, Institute for kineziology.
13. Videmšek, M., Štihec, J., Karpljuk, D. & Starman, A. (2008). Sport activity and eating habits of people who were attending special obesity treatment program. Collegium antropologicum, 3: 813-819.
14. Zajec, J. (2006). Povezanost športne dejavnosti tajnic z izbranimi dejavniki zdravega načina življenja. (Unpublished bachelor’s thesis). Ljubljana: Faculty of sport.
15. Zaletel-Kragelj, L., & Fras, Z. (2005). Stanje gibanja za zdravje pri odraslih prebivalcih v Sloveniji [The status of the exercise for health of adult population of Slovenia]. In: Expert conference ‘Exercise for Adults’ Health – status, problems, supportive environments. Ljubljana: Institute of Public Health of the Republic of Slovenia, 23-26.

### Tables

#### Table 1
Secretaries’ working conditions

Working conditions	Frequency	Percentage
Sitting	101	97.1
Standing – straight	11	10.6
Standing – bending	4	3.8
Lots of walking	28	26.9
Working with fingers	54	51.9
Working with hands	35	33.7
Frequent forced posture (head and neck, turn of the torso, deep bending posture)	40	38.5

#### Table 2
Types of sport activities

Sport	Frequency	Percentage
Cycling	53	57
Fast walking	47	50.5
Swimming	32	34.4
Mountaineering	32	34.4
Skiing	28	30.1
Racquet sports	25	26.9
Dancing	22	23.7
Rollerblading	18	19.4
Aerobics	17	18.3
Morning gymnastics	13	14
Yoga	8	8.6
Volleyball	7	7.5
Pilates	4	4.3

### Figures

#### Figure 1
Percentage of feeling the pressures of work at home

![Figure 1](/files/volume-15/452/figure-1.jpg)

#### Figure 2
Percentage of engaging in sport

![Figure 2](/files/volume-15/452/figure-2.jpg)

### Corresponding Author

assist. Jera Zajec, Ph.D.
University of Ljubljana
Faculty of Education
Kardeljeva ploščad 16, 1000 Ljubljana, Slovenia, Europa
<jera.zajec@pef.uni-lj.si>
gsm: 0038640757335

Jera Zajec, Ph.D. is the assistant professor in Faculty of Education in Ljubljana. She is a member of sport cathedra. Her bibliography contains article all over the word. Her interests in researching are wilde and contains development in motopedagogic for preschool children to adults.

U.S. Sports Academy2013-11-22T22:54:24-06:00January 5th, 2012|Contemporary Sports Issues, Sports Exercise Science, Sports Studies and Sports Psychology, Women and Sports|Comments Off

Black Women “DO” Workout!

Sherldine Tomlinson

### Abstract

Many studies cite that women of African descent have lower physical activity levels and/or are more sedentary, than White counterparts. The lack of exercise among Black women results in them experiencing compromised life quality and reduced life expectancy. To combat the striking rates of cardiovascular-related diseases and to increase habitual exercise, health promotion interventions have been initiated designed for Black populations. Female participants in Project Joy, a church-based cardiovascular education programme, reported weight loss and lower blood pressure. This paper reviews a similar initiative; Black Women “DO” Workout! (BWDW), which makes innovative use of social media to encourage physical activity (PA) among Black women.

**Key Words:** women of African descent; exercise; social media

### Introduction

Numerous studies indicate that women of African descent have lower physical activity levels, and/or are more sedentary, than their White counterparts. A 2006 national health survey on physical activity levels in Canada found that when compared to Caucasian Canadian females, both African Canadian and South Asian Canadian women less moderately active (Bryan, Tremblay, Pérez, Ardern & Katzmarzyk, 2004). In a similar American study looking at Black, White, Hispanic and Asian women, the data revealed that only 8.4% of African American women completed the recommended level of regular physical activity (Eyler, Matson-Koffman, Young, Wilcox, Wilbur, Thompson, Sanderson & Evenson, 2003). Unfortunately, this lack of exercise participation among Black women contributes to a significantly increased health risk of cardiovascular-related complications such as hypertension, type 2 diabetes and obesity (Flegal, Carroll, Ogden & Curtin, 2010). A lack of active activities also results in Black women experiencing compromised life quality and reduced life expectancy.

In an effort to combat these striking rates of cardiovascular-related diseases and complications among women of African descent, and to increase their habitual exercise involvement, a number of health promotion interventions have been initiated across North America. These include offerings of free exercise sessions especially designed for Black populations. Evaluative studies of these types of exercise programmes suggest they produce appreciably positive outcomes. The female participants in Project Joy, for instance, an African American church-based cardiovascular education programme, reported weight loss and improvement in blood pressure after participating in the included exercise sessions (Jakicic, Lang & Wing, 2010). This paper reviews a similar programme, Black Women “DO” Workout! (BWDW), which makes innovative use of social media to encourage exercise among women of African descent.

The BWDW initiative was created and founded by Crystal Adell, a fitness enthusiast and personal trainer. Adell uses Facebook as a tool to encourage regular exercise participation among African American women. She describes BWDW as a grassroots movement for championing weight loss and healthy living, a crusade she says is much needed to address the sobering statistics that show 49% of African American women are obese, while approximately 66% are overweight (US Dept of Health and Human Services 2000). Adell notes that using Facebook, which allows her to facilitate communication between Black women, is her “personal attempt to work with a collective who are more than willing to share their fitness goals, services and lifestyle changes towards healthier living”(personal communication, 2010). Information included on the site covers topics from exercising, body image, healthy eating habits and eating disorders to the importance of fitness and nutrition during pregnancy. Adell suggests that the success of BWDW is based on “information sharing and by showing praise, encouragement, inspiration and support in the way of sisterhood and by championing individuals for their fitness goals, which ultimately keep others motivated in to want to do the same”(C. Adell, personal communication, 2010).

There is little doubt that BWDW is a success. Thus far the site boasts more than 85,000 members, mainly women of African descent, many of whom regularly visit and post to the site. While African American women make up the largest block of BWDW users, the site also attracts international members from Canada, England, African and the Caribbean. Launching an online social media page as a means to promote exercise adherence and encourage healthy lifestyles among Black women is clearly a new, unique and successful approach. In addition to being innovative, the strategy is also in accordance with the American Healthy People 2010 mandate to (1) increase quality and years of healthy life and (2) eliminate health disparities that are associated with race, ethnicity and social economic status (US Dept of Health and Human Services 2000). One of Healthy 2010 physical activity and fitness objectives is to increase physical activity levels among Africa Americans as disparities in exercise and/or physical activity levels continue to exist with this group and other populations including Hispanics, the elders and people with disabilities (US Dept of Health and Human Services 2000). Indeed, the Black Women “Do” Workout social media campaign offers the opportunity for women of African descent to make regular exercise and a healthy lifestyle a part of their daily routine.

The BWDW web page is attractive, functional, and perhaps most importantly, interactive. Members are encouraged to participate through such means as submitting healthy recipes to the ‘Chef de Cuisine’ e-cookbook and posting images to the photo album which showcases before and after pictures. There are also announcements about the monthly BWDW ‘meet-ups’ held in locations across the United States for women who want to connect in person, as well as a service that informs members about personal trainers available in their area of the country. And the site has become a space of promotion for several members who now compete in fitness and body building competitions after experiencing significant body transformations via exercise and through healthy eating. In addition, a range of BWDW merchandise are available for sale on the site.

Health policy makers and promoters across North America have acknowledged the need for a better understanding of Black women’s exercise behaviour as a basis for improving their traditionally low physical activity rates. The BWDW programme offers an opportunity for those in the health field to learn from, and about, Black women and provides a potential avenue for the dissemination of health information. Adell herself notes these opportunities, commenting that she would like to see collaboration between BWDW and “organisations like the American Heart Association, Go Red For Women, the African American churches and corporate organisations” (C. Adell, personal communication, 2010). She believes these kinds of partnerships “will allow for an enhancement of services to local African American areas and communities that statistically have a high demand for wellness, health and fitness related support” (C. Adell, personal communication, 2010).

The BWDW programme presents a best practises model for building supportive and effective health networks within communities of African descent. The site has proven to be a powerful tool for increasing exercise rates and thus helping to address the troubling prevalence of cardiovascular-related and other diseases that continue to plague women of African descent. It is hoped the BWDW programme will inspire ongoing dialogue about finding other effective means of supporting Black women to become active, whether via other social media software, or in more traditional in-person venues.

### References

1. Adell, C. (November 2010). Telephone interview with author.
2. Bryan, S.N., Tremblay, M.S., Pérez ,C.E,, Ardern, C.I., Katzmarzyk, P.T. (2006, Jul/Aug). Physical Activity and Ethnicity: Evidence from the Canadian Community Health Survey. Can J Public Health. 2006 Jul-Aug; 97(4):271-6.
3. Eyler, A.A., Matson-Koffman, D., Young, D.R., Wilcox, S., Wilbur, J., Thompson, J.L., Sanderson, B., Evenson, K.R. Quantitative study of correlates of physical activity in women from diverse racial/ethnic groups: The Women’s Cardiovascular Health Network Project–summary and conclusions Am J Prev Med. 2003 Oct;25(3 Suppl 1):93-103.
4. Flegal, K.M., Carroll, M.D., Ogden, C.L., Curtin, L.R. Prevalence and Trends in Obesity Among US Adults, 1999–2008. JAMA. 2010 Jan 20; 303(3):235-41.
5. Jakicic, J.M., Lang, W., Wing, R.R. Do African-American and Caucasian overweight women differ in oxygen consumption during fixed periods of exercise? Int J Obes Relat Metab Disord. 2001 Jul; 25(7):949-53.
6. US Dept of Health and Human Services. Healthy People 2010: Understanding and Improving Health. 2000 Washington, DC: Government Printing Office.

### Corresponding Author

Sherldine Tomlinson, MSc.
2-440 Silverstone Drive,
Toronto, Ontario,
M9V 3K8,
<srtomlinson@students.ussa.edu>
416 749-7723

U.S. Sports Academy2013-11-22T22:58:08-06:00January 3rd, 2012|Contemporary Sports Issues, Sports Exercise Science, Sports Studies and Sports Psychology, Women and Sports|Comments Off

Body Image Disturbances in NCAA Division I and III Female Athletes

Kato, K., Jevas, S., and Culpepper, D.

### Abstract

The purpose of this study was to examine and compare eating characteristics and body image disturbances in female NCAA Division I and III athletes in the mainstream sports of basketball, softball, track/cross country, volleyball, soccer, tennis, swimming/diving, and ice hockey. Female collegiate athletes (N = 118) from Division I and III universities completed the EAT-26 and MBSRQ. Personal demographics and anthropometric data including height, weight, BMI and Body Fat estimates were also assessed. The study found that 49.2% (Division I) and 40.4% (Division III) of female athletes were in the subclinical eating disorder range. Results assessing body satisfaction, reported that 24.2% of Division I female athletes and 30.7 % of Division III female athletes were either very dissatisfied or mostly dissatisfied with their overall appearance. Results also showed that Division I female athletes were less satisfied with their appearance evaluation (body areas satisfaction, and lower torso). Division III female athletes reported higher levels of bulimic behaviors and weight preoccupation. The results indicate that athletes in refereed female sports are at risk for eating disorders, and that body image risk factors vary between NCAA competition divisions. This research provides sport professionals with a better understanding of risk factors influencing the prevalence of eating disorders between female athletes’ divisional competition levels.

**Key words:** body dissatisfaction, eating disorders, NCAA division, collegiate female athletes, eating disorder risk factors

### Introduction

Eating disorders are among the four leading causes of disease that may lead to disability or death (2). Eating disorders have the highest mortality rate of any mental health illness (41). Approximately nine million Americans suffer from an eating disorder with a lifetime prevalence rate of 0.9% – 4.5% and approximately 10% of college women suffer from a clinical or near clinical eating disorder (19,22).

Body image refers to the self-perception and attitudes an individual holds with respect to his or her body and physical appearance. Body image is a complex synthesis of psychophysical elements that are perpetual, emotional, cognitive, and kinesthetic. Cash and Fleming (10) defined body image as “one’s perceptions and attitudes in relation to one’s own physical characteristics” (p. 455). Body dissatisfaction focuses on body build and is often operationalized as the difference between ideal and current self selected figures (7).

Body dissatisfaction is a significant source of distress for many females. Gender is reported to be a convincing risk factor for disordered eating since females are 10 times more likely to develop an eating disorder compared to males (14). Research shows that the size of the “ideal” woman is far smaller than the size of the average woman (25). “The overwhelming evidence of female gender as a risk factor for the development of an eating disorder highlights the importance of determining the factors that put women at risk, particularly the sociocultural context in which these disorders develop” (31, p. 766).

Risk factors that accompany eating disorders are multi-factorial in nature. Research has revealed that sociocultural, developmental, personality, athletic, trauma, familial, and biological factors are critical identifiable areas that house potential eating disorder risk factors (31). Within these specific areas, body image dissatisfaction and low self-esteem are two situational aspects typically associated with individuals who are at risk for developing an eating disorder. In an early study on body dissatisfaction (5), 23% of the women expressed dissatisfaction with various parts of their body. The particular areas problematic for women were the abdomen, hips, thighs, and overall weight. When the study was replicated in the mid-1980s (11), the percentage of females dissatisfied with their body increased to 38%, with the same general body areas being defined by the participants. These same general body areas were also identified in a more recent study (16) in 56% of women.

Considerable scientific attention has been directed toward the potential role that sport involvement play in an athletes’ development of attitudes and behaviors about disordered eating. Female athletes experience a higher rate of eating disorders than non-athletes (4,24,43). Female athletes have an eating disorder prevalence of 15% to 62% compared to 0.5% to 3% in late adolescent and young adult female non-athletes (21). Researchers (33) assessed disordered eating in female collegiate athletes (N = 204) from three NCAA universities. The responses to the Questionnaire for Eating Disorder Diagnoses (Q-EDD) found 72.5% (n = 148) of the female athletes were asymptomatic, 25.5% (n = 52) symptomatic, and 2.0% (n = 4) eating disorder (29). Compared to recent research (8,39), this research study found a higher percentage of female athletes who were symptomatic. Athlete’s prevalence rate is an important factor, but understanding variables associated with increasing or decreasing risk factors for disordered eating is significant etiological information that should be evaluated (32).

Athletic factors promoting eating disorder development were first identified through research that began in the 1980s, which found particular sports induced higher rates of disordered eating behaviors (1,17). Even though physical activity may develop self-esteem and encourage physical and emotional well-being, there is verification that female athletes are at greater risk for developing disordered eating than their peers who are non-athletes (6). Female athletes encounter the same sociocultural pressures that of non – athletes, however the increased demand of sport – related pressures may independently or dependently increase their risk of eating disordered attitudes and behaviors (40). Coaches, sponsors, and families may all play a role in influencing an athlete’s weight and shape. Negative comments from those that surround and evaluate the athlete may trigger the onset of abnormal eating behaviors leading to an eating disorder (12,28).

The type of sport may also play a role in predisposing an individual to eating disorders based on struggles with body performance satisfaction. Specific sports where performance is judged on body leanness, shape and movement such as ballet, gymnastics, figure skating, diving, and cheerleading have a higher incidence of eating disorders (1,42,47). Shape judged sports such as gymnastics, diving, cheerleading, and dance place more importance on the individual’s body appearance, which may lead to body shape discontent among competitors (47). Researchers also report that 15% to 65% of women in “thin build” sports such as gymnastics or ballet have pathogenic eating patterns known to influence or manipulate the history and development of the eating disorder (27,44). Participation in competitive “thin build” sports in conjunction with personality traits associated with disordered eating could put these individuals at an even greater risk for developing an eating disorder (15, 44). The personality trait of many perfectionist increase disordered eating behaviors for female athletes (20). Researchers (26) compared athletes and non-athletes and reported perfectionism was the only factor that significantly distinguished the groups. In addition, Wilmore (46) reported that athletes high in perfectionism had an increased drive for thinness than athletes low in perfectionism. Refereed sports such as basketball place a stronger emphasis on training and do not rely as much on body appearance; therefore athletes participating in these sports may be less likely to be associated with disordered eating patterns (47).

Most research to date focuses on Division I female athlete’s prevalence rates, while female athletes regardless of NCAA division, experience similar sport specific pressures associated with body image disturbances. Limited research has compared prevalence between NCAA divisions, eating attitudes, and body image disturbances in female athletes. Research has reported that the prevalence of disordered eating, unhealthy dieting, and distorted body image in the athletic population ranges from 12% to 57% (30). Elite female athletes who suffer from eating disorders put themselves at greater risk for serious illnesses and/or death (38). Research has shown that more than one-third of female Division I NCAA athletes report attitudes and symptoms placing them at risk for an eating disorder (2). The National Collegiate Athletic Association study that surveyed student athletes from 11 Division I schools (N = 1,445) reported 1.1% of the female athletes met DSM-IV criteria for bulimia nervosa while 9.2% of female athletes had clinically significant symptoms of bulimia nervosa. This study also reported 0% female athletes met the DSM-IV criteria for anorexia nervosa while 2.85% of the female athletes had clinically significant symptoms of anorexia nervosa (24). Researchers believed the results suggest that Division I female athletes are at significant risk for the progression of eating disorder thoughts and behaviors. The study also stressed the need for future research to examine non-elite Division I, II and III schools since eating disorder risk factors may be higher among lower tier schools. Comparing divisional levels of competition in NCAA athletics could be an important aspect to understanding risk factors involved in the developmental process of an eating disorder.

The purpose of this study was to examine and compare eating characteristics and body image disturbances in female NCAA Division I and III athletes in mainstream sports of basketball, softball, track/cross country, volleyball, soccer, tennis, swimming/diving, and ice hockey. This study also examined female body part dissatisfaction and eating attitudes utilizing the Multidimensional Body Self-Relations Questionnaire (MBSRQ) and Eating Attitudes Test (EAT-26). These findings may assist coaches, strength and conditioning coaches, and athletic trainers in understanding disordered eating and body image disturbances across various female sports in different competition divisions.

### Methods

#### Participants

Participants (N = 118) included Division I (n = 41) and Division III (n = 87) female athletes from National Collegiate Athletic Association (NCAA) member institutes of the following sports: basketball, softball, track/cross country, volleyball, soccer, tennis, swimming/diving, and ice hockey. The convenient sample participants were voluntary, anonymous, and in accordance with university and federal guidelines for human subjects.

#### Instruments

Each athlete completed questionnaires assessing participant demographics and athletic involvement (sport, division). Eating behavior patterns were assessed utilizing the Eating Attitudes Test (EAT-26) and attitudes concerning body image were assessed with the Multidimensional Body-Self Relations Questionnaire (MBSRQ). Anthropometric measurements (height and weight) and body fat measurements were taken on each athlete. (Omron Fat Loss Monitor, Model HBF-306C). The Fat Loss Monitor (Omron Fat Loss Monitor, Model HBF-306C) displays the estimated value of body fat percentage by bioelectrical impedance method and indicates the Body Mass Index (BMI). The bioelectrical impedance, skinfold, and hydrostatic weighing methods have all been shown to be reliable measures of body composition (r = .957 – .987) (23).

##### Eating Attitudes Test (EAT-26)

Eating Attitudes Test (EAT-26) was used to differentiate participants with anorexia nervosa, bulimia nervosa, binge-eating, and those without disordered eating characteristics. It is a 26-item measurement consisting of three subscales: 1) dieting, 2) bulimia and food perception, and 3) oral control. Scoring for this instrument was a Likert scale of six possible answers (always, usually, often, sometimes, rarely, never). Scores ranged from zero to three for each question and a total score greater than 20 indicates excessive body image concern that may identify an eating disorder (Garner et al., 1982; Williamson et al., 1987). EAT-26 has been proven to be a reliable measurement (r = .88) (17). The total score of the EAT-26 and the Drive for Thinness scale of the Eating Disorder Inventory (EDI) have reports of a 90% agreement (37).

##### Multidimensional Body-Self Relations Questionnaire

The Multidimensional Body-Self Relations Questionnaire: The Multidimensional Body-Self Relations Questionnaire (MBSRQ) is a 69 item self-report inventory for the assessment of self-attitudinal aspects of the body image construct. The MBSRQ measures satisfaction and orientation with body appearance, fitness, and health. In addition to seven subscales (Appearance Evaluation and Orientation, Fitness Evaluation and Orientation, Health Evaluation and Orientation, and Illness Orientation), the MBSRQ has three special multi-item subscales: (1) The Body Areas Satisfaction Scale (BASS) approaches body image evaluation as dissatisfaction-satisfaction with body areas and attributes; 2) The Overweight Preoccupation Scale assesses fat anxiety, weight vigilance, dieting, and eating restraint; and 3) The Self-Classified Weight Scale assesses self-appraisals of weight from “very underweight” to “very overweight.” Internal consistency for MBSRQ subscales range from .74 – .91. This questionnaire has been studied and used extensively in the college population. Internal consistency for the subscales of the MBSRQ ranged from .67 to .85 for males and .71 to .86 for females (9).

### Results

#### Descriptive statistics

Participants in the study included 118 female athletes from NCAA Division I (34.7%) and Division III (73.7%) universities. Participants reported their ethnicity as 80.5% White (n =95), 16.1% Black (n =19), .02% Hispanic (n =2), .01% Asian (n =1), and .01% as other (n = 1). The female athletes had a mean age of 19.81 years + 1.29 and a mean body fat percentage of 21.17% + 5.07 (Table 1). There was no significant difference between the divisions in regards to body fat percentage F (1,117) = .727, p = .395.

#### Test for Significance

A multiple analysis of variance (MANOVA) was conducted to determine the effect of NCAA Divisional Status (I or III) on eating characteristics and body image (Table 2). Significant differences were found between Division I and III, Wilks’s Lambda = .664, F(17, 114), p<.0001.

##### Disordered Eating Behaviors

Base frequency scores indicated that 49.2% of Division I female athletes and 40.4% of Division III female athletes scored a 20 or higher on the EAT-26. A follow – up ANOVA reported no significant differences between 20 or higher EAT-26 scores and NCAA Division, F (1, 117) = 1.732, p = .190. A significant difference was found between divisions on the bulimia subscale of the EAT-26, F (1, 117) = 9.107, p = 003. No significant differences were found between division for the EAT-26 dieting subscale, F (1, 117) = .125, p = .724 and oral control subscale F (1, 117) = 2.123, p = .148.

##### Body Disturbance

The results of the MANOVA indicated a significant difference between divisions on the MBSRQ, F(17,114 ) = 3.391, p = .000. The results of the MBSRQ, which assessed body satisfaction, found that 24.2 % of Division I female athletes and 30.7 % of Division III female athletes were either very dissatisfied or mostly dissatisfied with their overall appearance. In addition, a difference was found between Division I and III athletes for appearance evaluation, F (1, 3) = 10.525, p = .001, body areas satisfaction F (1, 3) = 8.36, p = .004, lower torso F (1, 3) = 5.975, p = .016, and overweight preoccupation F (1, 3) = 17.895, p = .000. Division I female athletes were less satisfied with their appearance evaluation, body areas satisfaction, and lower torso than Division III female athletes. Division III female athletes were more weight preoccupied than Division I female athletes.

### Discussion

The main purpose of this study was to examine and compare the eating attitudes and body image satisfaction in female NCAA Division I and III athletes in mainstream sports of basketball, softball, track/cross country, volleyball, soccer, tennis, swimming/diving, and ice hockey. Limited research is available comparing eating disturbances between NCAA divisions so the information acquired may help explain the prevalence of body image disturbances and eating disorder among college female athletes at different levels of competition.

The results of this study indicated that 49.2% (Division I) and 40.4% (Division III) of the female athletes scored 20 or higher on the EAT-26, putting them in a subclinical eating disorder range (18). Comparative research studies using the EAT-26 reported percent subclinical populations of females athletes to be 15.2%, N = 425 (3); 5.8%, N = 190 (13); and 10.2%, N = 59 (36). The current research study did not find a significant difference between subclinical population scores and division, however both Division I and Division III female athletes had a considerably higher subclinical eating disorder female athletic population compared to these previous studies. This finding may be an important implication because the desire to be thin does not always result in clinically diagnosed signs and symptoms of anorexia or bulimia. If left undetected, subclinical eating disorders may result in dysfunctional social interaction, decreased physical performance reduced physical health, and an increase in the propensity for athletic injury.

Between divisions, a significant difference was found on the bulimia subscale of the EAT-26. Division III female athletes struggled more with bulimic behaviors compared to the Division I female athletes. This finding agrees with previous research suggesting that disturbed eating behavior may be higher among lower tiered athletes (35). Bulimic behaviors may be viewed as more destructive to athletic performance so the elite competitive athletes (Division I) may be deterred from participating in such behaviors. Bulimic behaviors may also require a greater level of secrecy, so elite competitive female athletes competing may avoid such behaviors due to increased time commitment, travel requirements, and contact they experience with their coaches and athletic trainers.

It has been reported that female athletes participating in judged sports such as gymnastics, cheerleading, and dance are more prone to eating disorders compared to those who participate in referred sports such as basketball, swimming, and softball (26,34,47). The assessment of body satisfaction through the MBSRQ found that 24.2 % of Division I female athletes and 30.7 % of Division III female athletes were either very dissatisfied or mostly dissatisfied with their overall appearance. We believe that our findings warrant further investigation into the relationship of female athlete’s body dissatisfaction and those participating in referred sports.

A significant difference was also reported on the MBSRQ subscales between Division I and III athletes for appearance evaluation, F (1, 3) = 10.525, p = .001, body areas satisfaction F (1, 3) = 8.36, p = .004, lower torso F (1, 3) = 5.975, p = .016, and overweight preoccupation F (1, 3) = 17.895, p = .000. Division I female athletes were less satisfied with their appearance evaluation, body areas satisfaction, and lower torso than Division III female athletes. Division III female athletes were more weight preoccupied than Division I female athletes. A performance-related drive for thinness through appearance evaluation, body areas satisfaction and lower torso may have a greater impact on female athletes that compete in higher level divisions such as Division I. Being weight preoccupied may not be as closely associated with physical performance measures as compared to general body dissatisfaction.

Even though this was a well-designed study and used a diverse sample of female athletes, it is not without limitations. The participant sample was limited in racial/ethnic minorities, therefore future research should examine female athletic samples with greater racial/ethnic diversity. This research also compared Division I female athletes to Division III female athletes. Increasing the number of institutes and divisions would greatly benefit the findings of this study. Lastly, although a diverse group of female athletic teams was represented in this study, equal number of female athletes from each team was not available due to the sports each institution offered, scholarships, and general participation. For example, ice hockey could only be evaluated at the Division III level. It is possible that the results would have varied if there were equal participant representation. Future research should examine a greater number of institutions at varied divisions to increase participant representations among each sport.

### Conclusion

Our results indicate that refereed female sports are at risk for eating disorders and body image risk factors vary between NCAA competition divisions of female sports. Body dissatisfaction factors that may lead to serious eating disorders will continue to impact the female athletic audience due to added pressures innate to sport performance. Female athletes, regardless of sport, show evidence of risk for developing an eating disorder. Understanding what motivates the developmental process to accelerate in sport may vary depending on level of competition. The educational and scholarly implications of this research project include contributing to the body of literature in the area of body image and eating attitudes of female athletes and providing professionals with a better understanding of the risk factors that influence the prevalence of eating disorders at varied levels of competition.

### Applications in Sport

These findings may assist coaches, strength and conditioning coaches, and athletic trainers in understanding disordered eating and body image disturbances across various female sports in different competition divisions. Professionals that work with female athletes understand the sensitive nature of optimizing performance without compromising overall health. Recognizing and identifying prevention indicators for body image disturbances that lead to disordered eating will assist professionals when dealing with at risk female athletes in varied levels of competition of referred sports. This information will also greatly benefit programs aimed at ceasing the progression of disordered eating

### References

1. Abraham, S. (1996). Characteristics of eating disorders among young ballet dancers. Psychopathology, 29, 223-229.
2. Academy of Eating Disorders. (2008) Statistics and study findings: Burden and prevalence of eating disorders. Retrieved from <http://www.aedweb.org> on January 31, 2008.
3. Beals, K.A., & Manore, M.M. (2002). Disorders of female athlete triad among collegiate athletes. International Journal of Sports Nutrition and Exercise. 12(3), 281 – 293.
4. Berry, T.R., & Howe, B.L. (2000). Risk factors for disordered eating in female university athletes. J. Sport Behavior, 23(3), 207–218.
5. Berscheid, E., Walster, E., & Bohrnstedt, G. (1973) The happy American body: a survey report. Psychology Today, 7(6), 119.
6. Brownell, K.D., Rodin, J., & Wilmore, J.H. (1992). Eating, Body Weight and Performance in Athletes: Disorders of Modern Society. Lea and Febiger, Philadelphia, PA.
7. Candy, C.M., & Fee, V.E. (1998). Underlying dimensions and psychometric properties of the eating behaviors and body image test for preadolescent girls. Journal of Clinical Child Psychology, 27(1), 117-127.
8. Carter, J.E., and Rudd, N.A. (2005). Disordered eating assessment for college student athletes. Women in Sport and Physical Activity Journal, 14, 62–75.
9. Cash, T.F. (2000). The multidimensional body-self relations questionnaire users’ manual. Available from the author at www.body-images.com or through email (TCash@odu.edu).
10. Cash, T.F., & Fleming, E.C. (2002). The impact of body-image experiences: Development of the Body Image Quality of Life Inventory. International Journal of Eating Disorders, 31, 455-460.
11. Cash, T.F., Winstead, B.A., & Janda, L.H. (1985). Your body, yourself: A reader survey. Psychology Today, 20(4), 30-44.
12. Cobb, K.L., Bachrach, L.K., Greendale, G., Marcus, R., Neer, R., Nieves, J. et al. (2003). Disordered eating, menstrual irregularity, and bone mineral density in female runners. Medical Science, Sport, and Exercise, 35, 711-719.
13. Dunn, D., Turner, L.W., & Denny, G. (2007). Nutrition knowledge and attitudes of college athletes. The Sport Journal. 10(4), Retrieved July 5th, 2010, from <http://www.thesportjournal.org/article/nutrition-knowledge-and-attitudes-college-athletes>
14. Fairburn, C.G., & Beglin, S. J. (1990). Studies of the epidemiology of bulimia nervosa. American Journal of Psychiatry, 55, 425-432.
15. Fulkerson, J.A., Keel, P.K., Leon, G.R., & Dorr, T. (1999). Eating disordered behaviors and personality characteristics of high school athletes and nonathletes. International Journal of Eating Disorders, 26, 73-79.
16. Garner, D.M. (1997). The 1997 body image survey results. Psychology Today, 30(1), 30-57.
17. Garner, D.M. & Garfinkel, P.E. (1979). The eating attitudes test: An index of the symptoms of anorexia nervosa. Psychological Medicine, 9, 273-279.
18. Garner, D.M., Olmsted, M.P., Bohr, Y., & Garfinkel, P.E. (1982). The eating attitudes test: Psychometric features and clinical correlations. Psychological Medicine, 12, 871-878.
19. Gurze Books. (2010). Eating disorder statistics. Retrieved July 14th, 2010, from http://www.bulimia.com/client/client_pages/eatingdisorderstats.cfm
20. Hausenblas, H. & Carron, A. (1999). Eating disorder indices and athletes: An integration. Journal of Sport and & Exercise Psychology, 21, 230-258.
21. Hinton, P.S. & Kubas, K.L. (2005). Psychosocial correlates of disordered eating in female collegiate athletes: validation of the ATHLETE questionnaire. Journal of American College Health, 54, 149 – 156.
22. Hudson, J.I., Hiripi, E., Pope, H.G., & Kessler, R.C. (2007). The prevalence and correlates of eating disorders in the national comorbidity survey replication. Biological Psychiatry, 348-358.
23. Jackson, A.S., Pollock, M.L., Graves, J.E., & Mahr, M.T. (1988). Reliability and validity of bioelectrical impedance in determining body composition. Journal of Applied Physiology, 64, 529-534.
24. Johnson, C., Powers, P.S., & Dick, R. (1999). Athletes and eating disorders: The national collegiate athletic association survey. International Journal of Eating Disorders, 26, 79 – 88.
25. Katzmarzyk, P.T., & Davis, C. (2001). Thinness and body shape of Playboy centerfolds from 1978 to 1998. International Journal of Obesity and Related Metabolic Disorders, 25, 590-592.
26. Krane, V., Stiles-Shipley, J.A. Waldron, J., & Michalenok, J. (2001). Relationship among body satisfaction, social physique anxiety, and eating behaviors in female athletes and exercisers. Journal of Sport Behavior. 24(3), 247-265.
27. Macleod, A.D. (1998). Sport psychiatry. Australia New Zealand Journal Psychiatry. 32, 860-866.
28. McLean, J.A., Barr, S.I., & Prior, J. C. (2001). Dietary restraint, exercise and bone health in young women: Are they related? Medical & Science in Sport & Exercise, 33, 1292-1296.
29. Mintz, L.B., O’Halloran, M.S., Mulholland, A.M., & Schneider, P.A. (1997). Questionnaire for eating disorder diagnoses: Reliability and validity of operationalizing DSM-IV criteria into a self-report format. Journal of Counseling Psychology, 44, 1997.
30. Montenegro, S.O. (2006). Disordered eating in athletes. Athletic Therapy Today, 11, 60- 62.
31. Mussell, M.P., Binford, R.B., & Fulkerson, J.A. (2000). Eating disorders: Summary of risk factors, prevention programming, an prevention research. The Counseling Psychologist, 28, 764-796.
32. Petrie, T.A., & Greenleaf, C. (2007). Eating disorders in sport: From theory to research to intervention (pp. 352–378). In G. Tenenbaum & R. Eklund (Eds.), Handbook of Sport Psychology 3rd ed. Wiley & Sons, Inc, Hoboken, NJ.
33. Petrie, T.A., Greenleaf, C., Reel, J., & Carter, J. (2009). Personality and sychological factors as predictors of disordered eating among female collegiate athletes. Eating Disorders: The Journal of Treatment and Prevention, 17, 302 – 321.
34. Powers, P.S. (2000). Athletes and eating disorders. Healthy Weight Journal, 14(4), 59-62.
35. Powers, P.S., & Johnson, C. (1996). Small victories: Prevention of eating disorders among athletes. Eating Disorders: The Journal of Treatment and Prevention. 4, 364-367.
36. Raymond-Barker, P., Petroczi, A., & Quested, E. (2007). Assessment of nutritional knowledge in female athletes susceptible to female athlete triad syndrome. Journal of Occupational Medicine and Toxicology. 2, Retrieved January 27th, 2010, from <http://www.occup-med.com/content/2/1/10>
37. Raciti, M.C. & Norcross, J.C. (1987). The EAT and EDI: Screening, interrelationships and psychometrics. International Journal of Eating Disorders, 6, 579-586.
38. Ryan, J. (1995). Little girls in pretty boxes: The making and breaking of elite gymnasts and figure skaters. New York: Doubleday.
39. Sanford-Martens, T.C., Davidson, M.M., Yakushko, O.F., Martens, M.P., Hinton, P., & Beck, N.C. (2005). Clinical and subclinical eating disorders: An examination of collegiate athletes. Journal of Applied Sport Psychology, 17, 79–86.
40. Smith, A. & Petrie, T. (2008). Reducing the risk of disordered eating among female athletes: A test of alternative interventions. Journal of Applied Sport Psychology, 20, 392 – 407.
41. Sullivan, P.F. (1995)/ Mortality in Anorexia Nervosa. American Journal of Psychiatry, 152(7), 1073 – 1074.
42. Sundgot-Borgen, J. (1994). Risk and trigger factors for the development of eating disorders in female elite athletes. Medical & Science in Sports & Exercise, 14, 59-63.
43. Sundgot-Borgen, J., & Torstveit, M.K. (2004). Prevalence of eating disorders in elite athletes is higher than in the general population. Clinical Journal of Sport Medicine, 14(1), 25–32.
44. Warren, M.P. & Shantha, S. (2000). The female athlete. Baillière’s Clinical Endocrinology and Metabolism, 14, 37-53.
45. Williamson, D., Goreczny, A., & Duchman, E. (1987). Behavioral and psychophysiological assessment of bulimia. Annals of Behavioral Medicine, 9, 8-11.
46. Wilmore, J.H. (1996). Eating disorders in the young athlete. In O. Bar-Or (Ed.), The child and adolescent athlete (pp. 287-303). Oxford, England: Blackwell.
47. Zucker, N.L., Womble, L.G., Williamson, D.A., & Perrin, L.A. (1999). Protective factors for eating disorders in female college athletes. Eating Disorders, 7(3), 207-219.

### Corresponding Author

Kim Kato, Ed.D.
PO Box 13015, SFA Station
Nacogdoches, TX 75962-3015
<kkato@sfasu.edu>
936-468-1610

Dr. Kim Kato is an Assistant Professor in Health Science in the Department of Kinesiology and Health Science at Stephen F. Austin State University in Nacogdoches, Texas.

### Authors

**Kim Kato**, EdD, NSCA-CPT
Stephen F. Austin State University

**Stephanie Jevas**, PhD, ATC, LAT
Stephen F. Austin State University

**Dean Culpepper**, PhD, CC-AASP
Lubbock Christian University