Jump to ContentJump to Main Navigation
Show Summary Details
More options …

International Journal of Adolescent Medicine and Health

Editor-in-Chief: Merrick, Joav

Editorial Board: Birch, Diana ML / Blum, Robert W. / Greydanus, MD, Dr. HC (Athens), Donald E. / Hardoff, Daniel / Kerr, Mike / Levy, Howard B / Morad, Mohammed / Omar, Hatim A. / de Paul, Joaquin / Rydelius, Per-Anders / Shek, Daniel T.L. / Sher, Leo / Silber, Tomas J. / Towns, Susan / Urkin, Jacob / Verhofstadt-Deneve, Leni / Zeltzer, Lonnie / Tenenbaum, Ariel

CiteScore 2018: 0.79

SCImago Journal Rank (SJR) 2018: 0.350
Source Normalized Impact per Paper (SNIP) 2018: 0.476

See all formats and pricing
More options …
Ahead of print


Risk for eating disorders and body composition among adolescent female and male athletes and non-athlete controls

Suzana Pustivšek / Vedran Hadžić / Edvin Dervišević / Jamie Carruthers
Published Online: 2019-04-02 | DOI: https://doi.org/10.1515/ijamh-2017-0190



The objective of this research was to investigate the risk for eating disorders (EDs) and compare body composition in participants with and without risk in adolescent Slovenian athletes and aged matched controls.


A total of 583 randomly selected adolescents, aged from 15 to 17 years, completed a sick, control, one stone, fat, food (SCOFF) questionnaire for detecting risk for EDs. Weight and body composition were measured using a bioelectrical impedance machine. Based on the data body mass index (BMI), percentiles were calculated.


Overall, 37.7% of athletes and 39.8% of controls were classified as at risk for EDs. Girls showed a significantly higher frequency of risk than boys, 1:3.5. A higher percentage of underweight boys was found in control group compared to the athletes, but the difference was not significant in the subsample of girls. Differences in body composition show that the at-risk group had significantly higher values in BMI percentiles (p < 0.001) and percentages of fat mass (p < 0.001) and lower values in percentage of muscle mass (p < 0.01) and fat-free mass.


These finding demonstrate that the gap in risk for EDs between males and females is becoming smaller and stresses to consider specific parameters of body composition as being important when identifying at-risk groups for EDs.

Keywords: adolescents; athletes; body composition; eating disorders; non-athletes; SCOFF questionnaire


  • [1]

    Herpertz-Dahlmann B. Adolescent eating disorders. Child Adolesc Psychiatr Clin N Am. 2015;24(1):177–96.CrossrefPubMedGoogle Scholar

  • [2]

    Smink FR, Van Hoeken D, Oldehinkel AJ, Hoek HW. Prevalence and severity of DSM-5 eating disorders in a community cohort of adolescents. Int J Eat Disord. 2014;47(6):610–9.CrossrefGoogle Scholar

  • [3]

    Hudson JI, Hiripi E, Pope HG, Kessler RC. The prevalence and correlates of eating disorders in the national comorbidity survey replication. Biol Psychiatry. 2007;61:348–58.PubMedCrossrefGoogle Scholar

  • [4]

    Smink FR, Van Hoeken D, Hoek HW. Epidemiology of eating disorders: incidence, prevalence and mortality rates. Curr Psychiatry Rep. 2012;14:406–14.CrossrefPubMedGoogle Scholar

  • [5]

    Byrne S, McLean N. Eating disorders in athletes: a review of the literature. J Sci Med Sport. 2001;4(2):145–59.PubMedCrossrefGoogle Scholar

  • [6]

    Smolak L, Murnen SK, Ruble AE. Female athletes and eating problems: a meta-analysis. Int J Eat Disord. 2000;27(4):371–80.PubMedCrossrefGoogle Scholar

  • [7]

    Martinsen M, Sundgot-Borgen J. Higher prevalence of eating disorders among adolescent elite athletes than controls. Med Sci Sport Exerc. 2013;45(6):1188–97.CrossrefGoogle Scholar

  • [8]

    Sundgot-Borgen J, Torstveit MK. Prevalence of eating disorders in elite athletes is higher than in the general population. Clin J Sport Med. 2004;14(1):25–32.PubMedCrossrefGoogle Scholar

  • [9]

    Torstveit MK, Rosenvinge JH, Sundgot-Borgen J. Prevalence of eating disorders and the predictive power of risk models in female elite athletes: a controlled study. Scand J Med Sci Sport. 2008;18(1):108–18.Google Scholar

  • [10]

    Martinsen M, Bratland-Sanda S, Eriksson AK, Sundgot-Borgen J. Dieting to win or to be thin? A study of dieting and disordered eating among adolescent elite athletes and non-athlete controls. Br J Sport Med. 2010;44(1):70–6.CrossrefGoogle Scholar

  • [11]

    Rosendahl J, Bormann B, Aschenbrenner K, Aschenbrenner F, Strauss B. Dieting and disordered eating in German high school athletes and non-athletes. Scand J Med Sci Sport. 2009;19(5):731–9.CrossrefGoogle Scholar

  • [12]

    Bratland-Sanda S, Sundgot-Borgen J. Eating disorders in athletes: overview of prevalence, risk factors and recommendations for prevention and treatment. Eur J Sport Sci. 2013;13(5):499–508.CrossrefPubMedGoogle Scholar

  • [13]

    Currie C, Roberts C, Morgan A, Smith R, Settertobulte W, Samdal O, et al. Health Policy for Children and Adolescents, No. 4. Denmark, 2004.Google Scholar

  • [14]

    Eik-Nes T, Romild U, Guzey I, Holmen T, Micali N, Bjørnelv S. Women’s weight and disordered eating in a large Norwegian community sample: the Nord-Trøndelag Health Study (HUNT). BMJ Open. 2015;5(10):e008125.Google Scholar

  • [15]

    Neumark-Sztainer D, Hannan A. Weight-related behaviors among adolescent girls and boys. Arch Pediatr Adolesc Med. 2000;154(6):569.PubMedCrossrefGoogle Scholar

  • [16]

    Lohman TG, Ring K, Schmitz KH, Treuth MS, Loftin M, Yang S, et al. Associations of body size and composition with physical activity in adolescent girls. Med Sci Sports Exerc. 2006;38(6):1175–81.CrossrefPubMedGoogle Scholar

  • [17]

    Stevens J, Suchindran C, Ring K, Baggett CD, Jobe JB, Story M, et al. Physical activity as a predictor of body composition in American Indian children. Obes Res. 2004;12(12):1974–80.CrossrefPubMedGoogle Scholar

  • [18]

    Ackland TR, Lohman TG, Sundgot-Borgen J, Maughan RJ, Meyer NL, Stewart AD, et al. Current status of body composition assessment in sport: review and position statement on behalf of the ad hoc research working group on body composition health and performance, under the auspices of the I.O.C. Medical Commission. Sports Med. 2012;42(3):227–49.CrossrefGoogle Scholar

  • [19]

    Sundgot-Borgen J, Garthe I. Elite athletes in aesthetic and Olympic weight-class sports and the challenge of body weight and body compositions. J Sports Sci. 2011;29(1):101–14.CrossrefGoogle Scholar

  • [20]

    Sundgot-Borgen J, Meyer NL, Lohman TG, Ackland TR, Maughan RJ, Stewart AD, et al. How to minimise the health risks to athletes who compete in weight-sensitive sports review and position statement on behalf of the Ad Hoc Research Working Group on Body Composition, Health and Performance, under the auspices of the IOC Medical Commission. Br J Sports Med. 2013;47(16):1012–22.CrossrefGoogle Scholar

  • [21]

    Babio N, Canals J, Pietrobelli A, Perez S, Arija V. A two-phase population study: relationships between overweight, body composition and risk of eating disorders. Nutr Hosp. 2009;24(4):485–91.PubMedGoogle Scholar

  • [22]

    Swenne I. Changes in body weight and body mass index (BMI) in teenage girls prior to the onset and diagnosis of an eating disorder. Acta Paediatr. 2001;90(6):677–81.CrossrefPubMedGoogle Scholar

  • [23]

    SURS. Osnovni podatki o rojenih, Slovenija, letno. Available at: http://pxweb.stat.si/pxweb/Dialog/varval.asp?ma=05J1002S&ti=&path=../Database/Dem_soc/05_prebivalstvo/30_Rodnost/05_05J10_rojeni_SL/&lang=2, 2014. Access date: 25th, September, 2003.

  • [24]

    Charan J, Biswas T. How to calculate sample size for different study designs in medical research? Indian J Psychol Med. 2013;35(2):121–6.CrossrefPubMedGoogle Scholar

  • [25]

    Botella J, Sepúlveda AR, Huang H, Gambara H. A meta-analysis of the diagnostic accuracy of the SCOFF. Span J Psychol. 2013;16:E92.PubMedGoogle Scholar

  • [26]

    Morgan JF, Reid F, Lacey JH. The SCOFF questionnaire: assessment of a new screening tool for eating disorders. BMJ. 1999;319(7223):1467–8.CrossrefPubMedGoogle Scholar

  • [27]

    Hill LS, Reid F, Morgan JF, Lacey JH. SCOFF, the development of an eating disorder screening questionnaire. Int J Eat Disord. 2010;43(4):344–51.PubMedGoogle Scholar

  • [28]

    Pustivšek S, Hadžić V, Derviševic E. Risk factors for eating disorders among male adolescent athletes. Zdr Varst. 2015;54(1):58–65.PubMedGoogle Scholar

  • [29]

    Rueda Jaimes GE, Díaz Martínez LA, Ortiz Barajas DP, Pinzón Plata C, Rodríguez Martínez J, Cadena Afanador LP. Validation of the SCOFF questionnaire for screening the eating behaviour disorders of adolescents in school. Aten Primaria. 2005;35(2):89–94.PubMedGoogle Scholar

  • [30]

    Siervo M, Boschi V, Papa A, Bellini O, Falconi C. Application of the SCOFF, eating attitude test 26 (EAT 26) and eating inventory (TFEQ) questionnaires in young women seeking diet-therapy. Eat Weight Disord. 2005;10(2):76–82.CrossrefPubMedGoogle Scholar

  • [31]

    Wan Wahida WMZ, Lai PSM, Abdul Hadi H. Validity and reliability of the english version of the sick, control, one stone, fat, food (SCOFF) in Malaysia. Clinical Clinical Nutrition ESPEN. 2017;18:55–8.PubMedCrossrefGoogle Scholar

  • [32]

    Biospace Co. In Body User's Manual. Seoul: Biospace Co.; 2008, p. 5–64, pp. 65.Google Scholar

  • [33]

    Ballesteros-Pomar MD, Calleja-Fernandez A, Diez-Rodriguez R, Vidal-Casariego A, Blanco-Suarez MD, Cano-Rodriguez I. Comparison of different body composition mesurements in severely obese patients in the clinical setting. Nutr Hosp. 2012;27(5):1626–30.Google Scholar

  • [34]

    Lim JS, Hwang JS, Lee JA, Kim DH, Park KD, Jeong JS, et al. Cross-calibration of multi-frequency bioelectrical impedance analysis with eight-point tactile electrodes and dual-energy X-ray absorptiometry for assessment of body composition in healthy children aged 6–18 years. Pediatr Int. 2009;51(2):263–8.CrossrefPubMedGoogle Scholar

  • [35]

    Cole Tim J, Flegal Katherine M, Nicholls Dasha, Jackson Alan A. Body mass index cut offs to define thinness in children and adolescents: international survey. BMJ. 2007;335(7612):194.CrossrefPubMedGoogle Scholar

  • [36]

    de Onis Mercedes. Development of a WHO growth reference for school-aged children and adolescents. Bulletin Bulletin of the World Health Organization. 2007;85(09):660–7.CrossrefPubMedGoogle Scholar

  • [37]

    WHO. Physical status: The use and interpretation of anthropometry. Geneva: WHO, 1995.Google Scholar

  • [38]

    Fragkos KC, Frangos CC. Assessing eating disorder risk: the pivotal role of achievement anxiety, depression and female gender in non-clinical samples. Nutrient. 2013;5(3):811–28.CrossrefGoogle Scholar

  • [39]

    Sanchez-Armass O, Drumond-Andrade FC, Wiley AR, Raffaelli M, Aradillas-Garcia C, UP AMIGOS 2008 Study Group. Evaluation of the psychometric performance of the SCOFF questionnaire in a Mexican young adult sample. Salud Publica Mex. 2012;54(4):375–82.CrossrefGoogle Scholar

  • [40]

    Schaal K, Tafflet M, Nassif H, Thibault V, Pichard C, Alcotte M, et al. Psychological balance in high level athletes: gender-based differences and sport-specific patterns. PLoS One. 2011;6(5):e19007.PubMedGoogle Scholar

  • [41]

    Hoek HW, van Hoeken D. Review of the prevalence and incidence of eating disorders. Int J Eat Disord. 2003;34:383–96.PubMedCrossrefGoogle Scholar

  • [42]

    Preti A, de Girolamo G, Vilagut G, Alonso J, de Graaf R, Bruffaerts R, et al. The epidemiology of eating disorders in six European countries: Results of the ESEMeD-WMH project. J Psychiatr Res. 2009;43:1125–32.PubMedCrossrefGoogle Scholar

  • [43]

    Swanson SA, Crow SJ, Le Grange D, Swendsen J, Merikangas KR. Prevalence and correlates of eating disorders in adolescents. Results from the national comorbidity survey replication adolescent supplement. Arch Gen Psychiatry. 2011;68:714–23.CrossrefPubMedGoogle Scholar

  • [44]

    Anderson CB, Bulik CM. Gender differences in compensatory behaviors, weight and shape salience, and drive for thinness. Eat Behav. 2004;5(1):1–11.PubMedCrossrefGoogle Scholar

  • [45]

    Lewinsohn PM, Seeley JR, Moerk KC, Striegel-Moore RH. Gender differences in eating disorder symptoms in young adults. Int J Eat Disord. 2002;32(4):426–40.PubMedCrossrefGoogle Scholar

  • [46]

    Striegel-Moore RH, Rosselli F, Perrin N, DeBar L, Wilson GT, May A, et al. Gender difference in the prevalence of eating disorder symptoms. Int J Eat Disord. 2009;42(5):471–4.CrossrefPubMedGoogle Scholar

  • [47]

    Fulkerson JA, Keel PK, Leon GR, Dorr T. Eating-disordered behaviors and personality characteristics of high school athletes and nonathletes. Int J Eat Disord. 1999;26(1):73–9.CrossrefPubMedGoogle Scholar

  • [48]

    Byrne S, McLean N. Elite athletes: effects of the pressure to be thin. J Sci Med Sport. 2002;5(2):80–94.CrossrefPubMedGoogle Scholar

  • [49]

    Sundgot-Borgen J. Risk and trigger factors for the development of eating disorders in female elite athletes. Med Sci Sport Exerc. 1994;26(4):414–9.Google Scholar

  • [50]

    De Bruin KAP, Woertman L, Bakker FC, Oudejans RRD. Weight-Related Sport Motives and Girls’ Body Image, Weight Control Behaviors, and Self-Esteem. Sex Roles. 2008;60(9-10):628–41.Google Scholar

  • [51]

    Martínez-Lagunas V, Niessen M, Hartmann U. Women’s football: Player characteristics and demands of the game. J Sport Heal Sci. 2014;3(4):258–72.CrossrefGoogle Scholar

  • [52]

    Varnes JR, Stellefson ML, Janelle CM, Dorman SM, Dodd V, Miller MD. A systematic review of studies comparing body image concerns among female college athletes and non-athletes, 1997-2012. Body Image. 2013;10:421–32.CrossrefPubMedGoogle Scholar

  • [53]

    Vander Wal JS, Thelen MH. Eating and body image concerns among obese and average-weight children. Addict Behav. 2000;25:775–8.CrossrefPubMedGoogle Scholar

  • [54]

    Barker M, Robinson S, Wilman C, Barker DJ. Behaviour, body composition and diet in adolescent girls. Appetite. 2000;35(2):161–70.PubMedCrossrefGoogle Scholar

  • [55]

    Da Costa NF, Schtscherbyna A, Soares EA, Ribeiro BG. Disordered eating among adolescent female swimmers: dietary, biochemical, and body composition factors. Nutrition. 2013;29(1):172–7.PubMedCrossrefGoogle Scholar

  • [56]

    Tanner JM. Growth and Maturation during Adolescence. Nutr Rev. 1981;39(2):43–55.PubMedGoogle Scholar

About the article

Received: 2017-10-27

Accepted: 2018-01-28

Published Online: 2019-04-02

Citation Information: International Journal of Adolescent Medicine and Health, 20170190, ISSN (Online) 2191-0278, DOI: https://doi.org/10.1515/ijamh-2017-0190.

Export Citation

©2019 Walter de Gruyter GmbH, Berlin/Boston.Get Permission

Comments (0)

Please log in or register to comment.
Log in