Sport program reduced eating disordered behavior and body-shaping drug use in female high school athletes

A peer-led, sport team-centered program reduces eating disordered behavior and body-shaping drug use in female high school athletes, according to an article in the November issue of The Archives of Pediatrics & Adolescent Medicine.

According to the article, about half of male and female high school students participate in school sports. For young women, pressures to be thin may be compounded by influences of their sport, resulting in more disordered eating behaviors, drug use (tobacco, diet pills, diuretics, laxatives, amphetamines, and anabolic steroids). Athletic teams provide a natural setting for programs to educate about eating disorders and drug use, the article states. The ATHENA (Athletes Targeting Healthy Exercise and Nutrition Alternatives) program is a school-based, team-centered program that focuses on promoting healthy nutrition and effective exercise training as alternatives to harmful behavior in young women.

Diane L. Elliot, M.D., of Oregon Health & Science University, Portland, and colleagues evaluated the ATHENA program’s efficacy at 18 high schools among 928 female students (average age, 15.4 years). Schools were randomly assigned to implement the eight-week ATHENA program curriculum (45 minutes per week) incorporated into a team’s usual practice activities, or to engage in any of the usual programs for eating disorder prevention offered by the particular school (usual care). Athletes were surveyed on dieting, nutrition, and exercise habits before and after the study. Topics in the ATHENA program were gender specific, were led by the athletes participating, and included information on healthy sport nutrition, effective exercise training, drug use, media images of women and depression prevention.

The researchers found that athletes participating in the ATHENA program reported significantly less ongoing and new use of diet pills, and less use of amphetamines, anabolic steroids, and sport supplements. These athletes also reported more seatbelt use and less new sexual activity. The ATHENA athletes also had positive changes in healthy eating behaviors, and reductions in intent to use diet pills in the future, vomiting to lose weight and tobacco use.

“The ATHENA curriculum succeeded in most of its prevention and health promotion goals,” the authors write. “Following their sport season, intervention students reported less ongoing and new diet pill use and less new use of athletic-enhancing, body-shaping substances (amphetamines, anabolic steroids, and muscle-building supplements). Experimental participants understood more about the presented topics, had improved self-reported dietary habits, and indicated greater self-efficacy for exercise training,” write the researchers.


In an accompanying editorial, Jorge E. Gomez, M.D., of the University of Texas Health Science Center at San Antonio, writes of the ATHENA program: “The credibility of the intervention has been well established, however, with the scientific rigor of this study. Nevertheless, the ATHENA intervention faces stiff competition. While girls can be taught to see through advertising images of thin women, the siege from the media will continue to be relentless. In addition, there is a widely held belief among coaches that making an athlete thinner or leaner will make him or her a better athlete.”

“In defense of coaches, their jobs often depend on the success of their athletes, even at the high school level,” states Dr. Gomez. “The belief that a thinner athlete is a better athlete, combined with the coaches’ imperative to enhance all modifiable factors to ensure athletic success, often translates into pressure on young athletes to achieve a level of thinness as a performance criterion. However, the relationship between body composition and athletic performance is not straightforward.”

“There is little or no scientific evidence to support the idea that simply making a normal-weight athlete weigh less will, independent of other training adaptations, make him or her a better athlete. Efforts to make a normal-weight athlete leaner, or thinner, like restricting calories or excessive exercise, for the sake of improving athletic performance, are misguided,” Dr. Gomez writes.

“Undergraduate coaching curricula and continuing education should include more factual information to help dispel the myths relating performance and thinness to the benefit of young athletes,” Dr. Gomez concludes.

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