THE RELATIONSHIP BETWEEN BODY IMAGE AND DISORDERED EATING
IN INDIVIDUAL AND TEAM FEMALE COLLEGIATE SPORTS

A THESIS
Submitted to the Faculty of the School of Graduate Studies
and Research
of
California University of Pennsylvania in partial
fulfillment of the requirements for the degree of
Master of Science

by
Lacie Johnson

Research Advisor, Dr. Shelly F. DiCesaro
California, Pennsylvania
2012

ii

iii

ACKNOWLEDGEMENTS
There are so many people in my life that mean so
much to me and I wouldn’t be here without them. First
of all my family, they are my rock and backbone. They
have helped me persevere through the past 20 some
years of my life always telling me to reach for the
stars. I love you Mom, Dad, Stephen, and Mollie!
Next, I would not have made it through the year
if it weren’t for the love of my life and fiancé Joe.
Even though we are four and half hours apart, he has
helped me tackle all of my troubles and been there
through all of my achievements. They say distance
makes the heart grow fonder, I believe our love has
grown stronger because of this years experience. I
cant wait to spend the rest of my life with him.
I would also like to thank Dr. Shelly DiCesaro,
my thesis advisor, for all of her thoughtfulness and
dedication, helping to make this project a successful
one. I also need to thank my committee members, Dr.
Carol Biddington and Dr. Laura Miller for their hard
work and support as well.

iv
I would like to especially thank all the student
athletes from California University of Pennsylvania,
Frostburg State University, Shippensburg University
Lock Haven University, and their willingness to
participate in my study.
To Jason Porterfield, and all the athletes and
coaches at Trinity High School, thank you so much for
the wonderful experience you have given me this year.
I have truly loved every moment being your athletic
trainer. Trinity will always hold a special place
inside my heart. Go Hillers!
I would like to thank and send out love to all of
my California graduate classmates. Thank you for all
the laughs and fun memories. I wish you the best of
luck with your future endeavors and hope that our
paths will cross again sometime.
Finally to Annie Turner, Micayla Bowman, Hannah
Ehlman, and Rachel Keil thank you for being some of
the best friends a person can have! You guys always
know how to put a smile on my face and I am so lucky
to have you all as friends.

v

TABLE OF CONTENTS
Page
SIGNATURE PAGE

. . . . . . . . . . . . . . . ii

AKNOWLEDGEMENTS . . . . . . . . . . . . . . . iii
TABLE OF CONTENTS
LIST OF TABLES

. . . . . . . . . . . . . . v

. . . . . . . . . . . . . . . viii

LIST OF FIGURES . . . . . . . . . . . . . . . xi
INTRODUCTION
METHODS

. . . . . . . . . . . . . . . . 1

. . . . . . . . . . . . . . . . . . 6

Research Design
Subjects

. . . . . . . . . . . . . . 6

. . . . . . . . . . . . . . . . . 6

Instruments . . . . . . . . . . . . . . . . 7
Procedures

. . . . . . . . . . . . . . . . 9

Hypothesis(or Hypotheses). . . . . . . . . . . 10
Data Analysis
RESULTS

. . . . . . . . . . . . . . . 11

. . . . . . . . . . . . . . . . . . 13

Demographic Data . . . . . . . . . . . . . . 13
Hypothesis Testing

. . . . . . . . . . . . . 16

Additional Findings . . . . . . . . . . . . . 19
DISCUSSION . . . . . . . . . . . . . . . . . 22
Discussion of Results . . . . . . . . . . . . 22
Conclusions . . . . . . . . . . . . . . . . 29
Recommendations

. . . . . . . . . . . . . . 30

vi
REFERENCES . . . . . . . . . . . . . . . . . 32
APPENDICES . . . . . . . . . . . . . . . . . 34
APPENDIX A: REVIEW OF LITERATURE

. . . . . . . . 35

Body Composition . . . . . . . . . . .
Calorie Expenditure and Nutritional Need

. . . 37

. . . . 38

Body Image . . . . . . . . . . . . . . . . 39
Factors that Affect Body Image. . . . . . . .

. 41

Disordered Eating . . . . . . . . . . . . . . 43
Anorexia Ner vosa

. . . . . . . . . . . . 43

Bulimia Nervosa . . . . . . . . . . . . . 44
Causes of Disordered Eating

. . . . . . . 46

Prevalence in Athletics . . . . . . . . . 49
Effects of Disordered Eating . . . . . . . 52
Summary . . . . . . . . . . . . . . . . . . 55
APPENDIX B: The Problem . . . . . . . . . . . . 57
Statement of the Problem . . . . . . . . . . . 58
Definition of Terms . . . . . . . . . . . . . 59
Basic Assumptions . . . . . . . . . . . . . . 61
Limitations of the Study . . . . . . . . . . . 62
Significance of the Study

. . . . . . . . . . 62

APPENDIX C: Additional Methods . . . . . . . . . 64
Survey Cover Letter (C1)

. . . . . . . . . . 65

Demographic Questions (C2) . . . . . . . . . 67
EAT-26 (C3). . . . . . . . . . . . . . . . 70

vii
BESAA (C4) . . . . . . . . . . . . . . . . 72
IRB: California University of Pennsylvania (C5) . . 74
REFRENCES

. . . . . . . . . . . . . . . . . 97

viii
LIST OF TABLES
Table

Page

1. Frequency table of sports participation

. . . . 14

2. Demographic information of subjects . . . . . . 15
3. Characteristics of Participants . . . . . . . . 15
4. BMI of subjects . . . . . . . . . . . . . . 15
5. Average scores on EAT-26 and BESAA

. . . . . . 16

6. Pearson-Product Moment Correlation analysis between
body image scores and disordered eating score . . 17
7. MANOVA for type of sports on the EAT-26 and BESAA and
NCAA division II and division III on EAT-26 and BESAA
scores . . . . . . . . . . . . . . . . . . 19
8. MANOVA for type of sports on the BESAA; Appearance,
Weight, and Attribution . . . . . . . . . . . 20
9. Pearson-Product Moment correlation for BMI and EAT-26
. . . . . . . . . . . . . . . . . . . . 20
10. Pearson-Product Moment correlation for BMI and BESAA
. . . . . . . . . . . . . . . . . . . . 20

ix
LIST OF FIGURES
Figure

Page

1. Scatterplot of BESAA vs. EAT-26 scores . . . . 18

1

INTRODUCTION

In the sports arena today, the number of female
athletes is on the rise. Regardless of gender, there is
always the risk of injury or illness, but the risks
associated with women may be different than those for
men. The awareness of these injuries/illnesses, which are
more specific to women, needs to become more ubiquitous.
For most women, participation in sports provides
them with a positive experience. It can provide better
health, well being, and of course a higher level of
fitness. Unfortunately for some, this is not the case.
They get trapped in the pressures to succeed and have the
ideal body weight, which may result in restrictive eating
and weight reduction behaviors that negatively affect
performance, health, and well being.1
Body image refers to the internal perception of
one’s own physical or outer appearance.2 This can
typically be measured as the difference between an
individual’s current and ideal body shape.3 This can be
altered on many different occasions. Stresses can come
from internal pressures or external stimuli. For example,
it is seen that media influence and the desire to be

2
socially “thin” have the ability to cause a distorted
body image.3 This study conducted by Steadman et al,3 also
found that female athletes who participated in “lean”
sports such as track and field, swimming and diving, etc.
have a greater body image disturbance than those who did
not. Even though the track athletes that participated in
the survey had a lower body mass index than both that of
the martial arts athletes and non athletes, they still
saw themselves to have a significantly larger body size
than what they actually had.3
A study done by Peden et al4 showed that athletes
actually had a lower level of body dissatisfaction when
surveyed about external pressures. Even though the
external pressures of being an athlete were at a higher
level; the rest of the population actually saw a higher
amount of body dissatisfaction. This could be because
they have no outlet such as exercise, like athletes do,
so they turn all of their negative energy inward. It was
also observed that there was a positive correlation in
the athletic sample between competitiveness and body
dissatisfaction.4 This feeling of inadequacy can lead to
a multitude of disorders that are detrimental to a female
athlete’s health and performance.

3
Disordered eating is another issue that can be
common within the female athletic population. Female
athletes actually suffer from eating disorders more than
the general population.5 It was found in a study done by
Sundgot-Borgen and Torstveit5 that there was more
incidence of subclinical and clinical eating disorders in
the athletic population (14.3%) when compared to the
control, which was the general population (4.6%). It was
also found in this study that eating disorders are more
prevalent in females then males.5
Altered dietary intake can harm an athlete in one
way or another. Two common types of disordered eating are
anorexia nervosa and bulimia nervosa. Anorexia nervosa is
characterized by self-starvation while bulimia is a binge
and purge syndrome in which huge quantities of food are
consumed and then expelled though self-induced vomiting,
use of diuretics or laxative, excessive exercise, or a
combination of these methods.6 Both of these disorders
are seen in the female athletic population. Some factors
found to be possible causes of these negative actions
were found in a study by Arthur-Cameselle and
Quatromoni7. They included, negative mood states, low
self esteem, perfectionism/ drive for achievement, desire

4
for control, negative influences on self-esteem, hurtful
relationships, hurtful role models and sport performance.
A study completed by Hasse8 focused specifically on
the associations between social physique anxiety and
disordered eating in female athletes. Social physique
anxiety is a subsection of social anxiety that
specifically deals with a person’s evaluation of
themselves which can be directly related to body image.8
This relationship was looked at within team and
individual sports. The results showed that individual
sport athletes exhibited a higher level of social
physique anxiety and bulimic behavior than team sport
athletes. It was stated that involvement in these types
of sports could in fact contribute to altered diet and
bulimic symptoms.8
Body image and disordered eating have the capability
of having a harmful affect on female athletes. While both
can be totally separate from one another, there is the
possibility of them coinciding. This study aims to see if
there is any relationship as well as a link between body
image and disordered eating. It will also evaluate these
variables in a) team vs. individual sports and b)
Division II and Division III NCAA athletics for body
image and disordered eating. This was done by using a

5
2(team vs. individual) x 2(Division II vs. Division III)
factorial MANOVA for body image and disordered eating.

6
METHODS

The primary purpose of this study is to examine the
relationship between body image and disordered eating in
team and individual sports. This section will include the
following subsections:

research design, subjects,

instruments, procedures, hypotheses, and data analysis.

Research Design

This study is a descriptive design using online
surveys distributed though survey monkey to female
athletes in the Pennsylvania State Athletic Conference
and Capital Athletic Conference to gather data
investigating the dependent variables body image and
disordered eating. The independent variables in this
study are the type of athlete, either team or individual
as well as whether they compete at the NCAA division II
or III level.

Subjects

The subjects for this study (N=106) were female
collegiate athletes that participate in the PSAC and CAC.

7
There was a possibility of a total of 1326 surveys to be
distributed The following seven college/universities were
used in this study; California University of
Pennsylvania, Kutztown University, Bloomsburg University
, Shippensburg University, Lock Haven University,
Marymount University and Frostburg State University. The
subjects were found to compete in team sports consisting
of soccer, volleyball, basketball, lacrosse, softball,
and field hockey and the individual sports, cross
country, tennis, swimming/diving, track and field and
golf. Prior to viewing the survey, there was a cover
letter (appendix C1) each athlete read, which implied
consent with participation.

Each participant’s identity

remained confidential throughout the survey and is not
included in the study.

Instruments

The instruments that were in this study included
Demographic Questions (Appendix C2), the Eating Attitude
Test (EAT-26) (Appendix C3), and The Body Esteem Scale
for Adolescents and Adults (BESAA) (Appendix C4). Each of
these were distributed via survey monkey.

8
The EAT-26 was used to evaluate eating attitudes of
the subjects at hand. The EAT-26 has posted reliability
coefficients ranging between .70 and .88.9 This test
consists of 26 questions that require an option of
“always”, “usually”, “often”, “sometimes”, “rarely”, or
“never”. There are also five additional questions that
ask about 1) eating binges, 2) self-induced vomiting, 3)
the use of weight control substances, and 4)the use of
exercise as a means of weight control and lastly 5) if
the subject has lost 20 pounds in the past 6 months.
There are a total of 26 items on the actual EAT-26
followed by a group of behavioral questions. “A score at
or above 20 on the EAT-26 indicates a high level of
concern about dieting, body weight or problematic eating
behaviors”.9 The higher the score the more of a chance
disordered eating could be involved.
The Body Esteem survey for adolescents and adults
was used to assess each subject’s body image, or what
they think of themselves. The BESAA tests in three
different areas, appearance, attribution and weight. The
internal consistency for the three were .92, .81, and .94
respectively.10 This scale consists of 23 questions in
which the choices to respond are, “Never”, “Seldom”,
“Sometimes”, “Often”, and “Always”. It includes questions

9
that evaluate general feelings about oneself, evaluations
attributed to others about one's body and appearance, and
weight satisfaction.10 The scores on this survey can range
from 0 to 92. The higher the score seen the more positive
body image the subject has.10 These two instruments will
allow for an evaluation of both body image and disordered
eating.
Demographic questions included gender, age, height,
current weight, highest and lowest adult weight, ideal
weight, year in school, college or university they attend
and the sport(s) they participate in.

Procedures

Prior to data collection, a cover letter asking for
the female athletes participation in this study was sent
to the 9 NCAA Division III Capital Athletic Conference
and the 16 NCAA Division II Pennsylvania State Athletic
Conference athletic directors. After receiving seven
confirmed letter back saying they would participate,
application was then made to the California University of
Pennsylvania institutional review board (Appendix C5) for
approval.

Once permission was granted to continue with

the study, a cover letter including a link to survey

10
monkey was sent to the athletic director’s for them to
forward to their female athletes. This link included a
demographic questionnaire, the EAT-26 and the Body Esteem
Scale for Adults and Adolescents. Consent was implied
upon reading the cover letter and completion of the
survey. This survey was strictly voluntary and
participation could stop at any time. Two weeks into the
survey, a reminder letter was sent to the athletic
directors to once again forward on the link to the
survey. After the surveys closed, all data was imported
into an excel spread sheet and then put into the SPSS
version 18.0 for the data analysis. All data was stored
under password on the computer in Hammer all and all
results are anonymous.

Hypotheses

The following hypotheses are based on previous
research and the researcher’s intuition after an
exhaustive review of the literature.
1.

There will be a negative correlation between
body image score as measured by the BSEAA, and
disordered eating as measured by the EAT-26.

11
2.

There will be a significant difference between
team and individual sports for a) Body Image
Scores as measured by the BSEAA and b)
disordered eating scores as measured by the
EAT-26

3.

There will be a significant difference between
NCAA Division II and division III for a) body
image score as measured by the BSEAA and b)
disordered eating scores as measured by the
EAT-26

Data Analysis

The level of significance was set to α=.05 to test
the acceptability of the stated hypothesis
The data was analyzed first using a Pearson Product
moment correlation to see if there was a correlation
between body image scores as measured by the BESAA and
disordered eating scores as measured by the EAT-26. A 2(
team vs. individual) x 2(Division II vs. Division III)
factorial MANOVA was done to compare body image and
disordered eating between a)team sport athletes and
individual sport athletes and b)division II and division
III athletes. All the data collected was imported into an

12
excel spreadsheet. The program SPSS version 18 was used
to do all the data analysis.

13

RESULTS

The purpose of this study was to examine the
relationship between body image and disordered eating in
the world of female collegiate athletics. These two
dependent variables were compared in team and individual
sports as well as NCAA division II and division III. The
following section contains the results that were
collected through this study presented in three different
subsections: Demographic Information, Hypothesis testing,
and Additional Findings.

Demographic Information

A total of seven schools gave permission for
participation for participation in this study. The
surveys had the possibility of reaching 1326 female
athletes. One hundred and thirty one surveys were
received; however 106 surveys were completed in entirety
and useable for data analysis. Responses were received
from 5 of the 7. This was a response rate of 10%.
Subjects completing the survey competed in the following

14
sports; soccer, volleyball, basketball, cross country,
track and field, lacrosse, softball, field hockey,
tennis, swimming/diving, and golf. Subjects were able to
choose more than one sport but were asked to indicate the
one that was their dominant sport. Table 1 displays the
frequency of each sport.
Table 1. Frequency table of Sports participation.
Sport
Soccer
Volleyball
Cross Country
Tennis
Swimming/Diving
Track and Field
Basketball
Lacrosse
Softball
Field Hockey
Golf

N
15
14
6
4
10
24
1
3
9
17
3

Percent
14%
13%
6%
4%
9%
23%
1%
3%
8%
16%
3%

Soccer, volleyball, basketball, lacrosse, softball and
field hockey were considered team sports while cross
country, tennis, swimming/diving, track and field, and
golf were classified at individual sports. There were 47
individual athletes and 59 team athletes that completed
the survey. Table 2 shows the frequency of NCAA division
II and NCAA division III athletes and classification of
athletes.

15
Table 2. Demographic Information of subjects
Division
Division II
Division III
Individual
Team

N

Percent
28
78
47
59

26%
74%
44%
56%

With only receiving surveys from one division III
school, the frequencies were asymmetrical with three
times the number of surveys received from division II
athletes as compared to division III. Finally within the
demographic questioning, there was a section that asked
for the subject’s height, current weight, highest weight,
lowest weight, and ideal weight. These characteristics
can be seen below in table 3.
Table 3. Characteristics
Characteristic
Height (M)
Current Weight(kg)
65.67±11.61
Highest Weight(kg)
69.00±13.09
Lowest Weight(kg)
55.43±10.32
Ideal Weight(kg)

of Participants
Range
1.49-1.85
45.36-108.86

Mean
1.68±.08

48.53-115.67
31.75-105.69
45.36-90.72

61.79±9.08

With this data it was possible to calculate body
mass index (BMI) using the following formula BMI= (weight
in pounds*703)/(height in inches).2 Table 4 shows the
values that were observed.
Table 4. BMI of subjects
Range
BMI
18.48-33.48
*BMI (Body Mass Index)

Mean
23.31±3.37

16

Hypothesis Testing

The level of significance used for testing each
hypothesis was set at an alpha level of .05. Table 5
displays scores that were obtained on the EAT-26 and
BESAA for both team and individual sport athletes.
Table 5. Average Scores on EAT-26 and BESAA.
EAT-26
BESAA

Sport Type

Mean

Individual
Team
All
Individual
Team
All

9.36
8.83
9.07
56.13
58.34
57.36

Std.
Deviation
10.182
7.728
8.859
22.048
15.969
18.843

N
47
59
106
47
59
106

Hypothesis 1: There will be a negative correlation
between body image score as measured by the BSEAA, and
disordered eating as measured by the EAT-26.
A Pearson Product moment correlation was obtained to
determine if there was a relationship between body image
as measured by the BSEAA and disordered eating as
measured by the EAT-26.
Conclusion: From this analysis we are able to
conclude that there is a moderately negative correlation
between body image scores as measured by the BESAA and
disordered eating as measured by EAT-26. The Pearson
Product Moment correlation found a value a value of -.528

17
with a significance of P <0.001. Table 6 provides the
statistics that were derived from the Pearson Product
Moment correlation.
Table 6. Pearson-Product Moment Correlation analysis
between body image scores and disordered eating score
Variable
n
R
P
EAT-26 Score
106
-.528
.000*
and BSEAA
Score
*P < .001
This leads us to believe that within the population
of collegiate female athletes, the higher the EAT-26
score examining disordered eating, a lower score on the
body esteem survey for adolescents and adults can be
expected meaning disordered eating and body image are
inversely related. Figure 1 shows the scores of the EAT26 and BESAA for each subject respectively, in a scatter
plot form. A line of best fit was found at y= 1.124x+67.549 with an r value of .528.

18

Figure 1. Scatterplot of BESAA Score vs. EAT-26 Scores
Hypothesis 2: There will be a significant difference
between team and individual sports for a) B=body image
scores as measured by the BSEAA and b) disordered eating
scores as measured by the EAT-26
Hypothesis 3: There will be a difference between
NCAA Division II and division III for a) body image score
as measured by the BSEAA and b) disordered eating scores
as measured by the EAT-26.
Conclusion: A 2 x 2 factorial MANOVA was calculated
examining the effect of type of sport, individual or team
and NCAA Division II v. III on the EAT-26 score and the
BESAA score. No significant effect was found for either
type of sport (Λ2,101=.990, P>.05) or the division II v.
division III (Λ2,101=.971, P>.05). Neither the EAT-26 score

19
nor the BESAA score were significantly influenced by the
independent variables type of sport or NCAA division.
Table 7 shows the results of the 2x2 factorial MANOVA.
Table 7. MANOVA for type of sports on the EAT-26 and
BESAA and NCAA division II and division III on EAT-26 and
BESAA scores
Source

Dependent
Variable

Team v. Individual
EAT-26
BESAA
Division II v.
Division III
EAT-26
BESAA

Type III
sum of
squares

Df

MS

F

P

65.787
281.766

1
1

65.787
281.766

.840
.785

.362
.378

226.021
514.723

1
1

226.021
514.723

2.885
1.443

.092
.234

*EAT-26 (Eating Attitudes test), BSEAA ( Body esteem
survey for adolescents and adults)

Additional Findings

The first additional finding of interest focused on
the three subsections of the body esteem survey for
adolescents and adults, weight, appearance and
attribution within team and individual sports to see if
there was a significant difference. The results of the
MANOVA are shown in table 8.

20
Table 8. MANOVA for type of sports on the BESAA;
Appearance, Weight, and Attribution
Team vs
Individual

Appearance
Weight
Attribution

Type III
sum of
squares
11.656

.996
35.340

df

Mean square

F

Significance

1
1
1

11.656
.996
35.340

.155
.015
2.779

.695
.904
.099

When evaluated at a p<.05 significance level, there
are no significant differences between team and
individual sports for the three subsections of the Body
esteem survey for adolescents and adults.
Another additional finding that was evaluated was
looking at the Pearson product moment correlation between
BMI, which was calculated using the height and current
weight of each subject from the demographic section, and
the EAT-26 and BESAA separately. Table 9 shows the
results of the Pearson product moment correlation between
BMI and the EAT-26 and Table 10 shows that of BMI and the
BSEAA.
Table 9. Pearson-Product Moment correlation for BMI and
EAT-26
Variable
n
R
P
BMI and EAT-26
106
.006
.951
*P < .05
Table 10. Pearson-Product Moment correlation for BMI and
BESAA
Variable
n
R
P
BMI and BESAA
106
-.241*
.013
*P < .05

21

Conclusion: There is no significant correlation
between BMI and scores obtained from the EAT-26 at an
alpha level of P<.05. However there was a significant
weak negative correlation between BMI and scores from the
BESAA. This means that as higher body mass indexes are
seen, we could expect to see lower scores on the BESAA.

22
DISCUSSION
Discussion of Results
This study focused on the relationship between body
image and disordered eating in team and individual female
collegiate athletes. The researcher examined whether
there is a relationship between body image scores as
measured by the Body Esteem Survey for Adolescents and
Adults and disordered eating as measured by the EAT-26
were related, as well as if there were any differences
seen between the scores in the type of sport they
competed in.
Hypothesis 1 stated that there will be a negative
correlation between body image score as measured by the
BSEAA, and disordered eating as measured by the EAT-26.
The researcher proposed that these two variables are
related and do have an inverse influence on one another.
There has also been past research conducted with
consistencies that support this statement and that the
two variables are in fact related.8,12
Findings showed that there was a significant
moderate negative correlation found when comparing these
two variables, whereas 52.8% of the time a body image
score can be predicted from a disordered eating score and

23
vice versa. Previous research found that female athletes
who were unhappy with their weight experienced greater
social physique anxiety as well as more signs of
disordered eating.2 Social physique anxiety is a subtype
of social anxiety that involves one’s personal evaluation
involving ones physique.2 This study by Hasse2 found that
athletes in fact do experience higher weight perceptions
which was found to be associated with high perfectionism,
SPA and greater disordered eating. These concerns were
found to lead to situations that are often managed using
unhealthy behaviors such as disordered eating or
excessive exercise.12 Weight perception is one of the
three aspects of the body esteem scale for adolescents
and adults and could have an effect on the total score
seen.
Hypothesis 2 stated that there will be a difference
between body image scores as measured by the BESAA and
disordered eating scores as measured by the EAT-26 for
team and individual athletes. The researcher proposed
that individual sports would see lower body image scores
and higher disordered eating scores as compared to those
female athletes competing in team sports. This was
concluded from past research and their findings.8,11-14

24
No significant difference was found for individual
athletes when compared to team sport athletes when
comparing body image scores and disordered eating scores.
Past research results revealed significantly higher
social physique anxiety for individual sport athletes
were significantly higher than team sport athletes.2,8,11
Hasse8 found that social physique anxiety was more
strongly correlated with disordered eating correlates
(dieting and bulimia subscales) for individual sport
conditions as compared to team sport conditions. Review
of these findings would leave you to believe that
individual sport athletes would have lower body image
scores and higher disordered eating scores when compared
to team sport athletes. Reinking and Alexander11 showed
that 25% of lean sport athletes had more disordered
eating symptoms and were at greater risk of developing an
eating disordered compared to 2.9% in non-lean sports.
“Lean sports” are those sports that place a competitive
value on leanness, including sports such as running,
diving, swimming gymnastics, and dance.11 While athletes
in these sports are competing for a team score, the
events are predominantly individual. This would lead us
to believe that higher distorted body image and higher
instances of disordered eating would be seen in

25
individual sport athletes when compared to team sport
athletes. Although no significant differences were found
in this study between team and individual athletes for
body image scores and disordered eating scores, the
researcher believes that this area should continue to be
evaluated due to prior findings. Studies have shown
conflicting results. Our data is limited due to the
number of participants in this study.
Hypothesis 3 stated that there would be a
significant difference between body image scores as
measured by the BESAA and disordered eating scores as
measured by the EAT-26 for NCAA division II and division
III. The researcher proposed that it could be possible
that lower body image scores and higher disordered eating
scores may be seen at the division II level because of
the pressures of maintaining a scholarship. Some athletes
at this level are scholarship dependent and have to
perform to maintain their scholarship.
Our findings showed that there was no significant
difference between body image score and disordered eating
scores in division II and division III. Despite the lack
of significance in the data, scholarship dependency could
be crucial for screening those with a poor body image or

26
those that could be susceptible to dealing with
disordered eating.
In addition to these findings, analyses were
conducted looking at the scores of the BESAA in its three
subsections; appearance, weight, and attribution. The
researcher proposed that there would be differences in
these scores when categorized into team and individual
sport athletes. There were no significant differences
between the three scores for team and individual sports.
In past research, specifically track athletes, martial
artists and non-athletes, there were no significant
differences in the groups when asked about the body they
want to possess.3 It was also shown that track athletes
had a higher body dissatisfaction score than the martial
artists and non athletes.3 Although there was no
significant difference found in this study, the
researcher believes that further research should be done
to see if type of sport, team or individual, affects body
image and the three subsections of the body esteem survey
for adolescents and adults; appearance, weight, and
attribution.
Another additional finding examined the correlation
between BMI and both the EAT-26 and BESAA separately. It
was discovered that no significant correlation was found

27
between BMI and EAT-26 scores; conversely a significant
weak negative correlation was found between body mass
index and BESAA scores. From this it can be concluded
that it is possible that with a higher BMI a lower body
image score could be observed. Body mass index is a
calculation using strictly height and weight and does not
incorporate body composition. A higher BMI could cause a
female to have a lower body image, not realizing that the
reason their BMI is higher is because it does not account
for muscle mass. Just because they have a higher BMI does
not mean that they are overweight or obese. In order to
have a better idea of body composition, the researcher
would recommend them getting a body composition analysis.
This could help them to realize that they are in fact not
overweight.
When examining the mean current weight of the
subjects, 144.77±25.59 compared to the mean ideal weight
of the subjects, 136.23±20.01 the researcher found it
interesting that there was an eight and a half pound
difference in the two meaning that the majority of the
subjects are not happy with their weight. Also found in
the demographic section was the BMI. This was able to be
determined using the height in inches and weight in lbs.

28
The mean BMI found for subjects was 23.31. This is within
the normal range of BMI scores.
Lastly eating disorders can have effects from the
time of the eating disorder to later in life. A study
done by Rubenstein et al15 found that attempts at weight
loss at a younger age, made it more likely for them to
have worse eating habits as an adult. These problematic
habits may then be passed down to their children. It is
important for children to establish proper eating habits
at an early age for a multitude of reasons including
propoer growth, academic performance and general well
being into adulthood. Disordered eating may also be a
cause of low bone density.16 This can lead to a condition
called osteoporosis which is often an early onset when
coupled with disordered eating. This in turn may increase
the chance of stress fractures at an earlier age.16
Finally, amenorrhea is another side effect associated
with disordered eating. Amenorrhea and menstrual
irregularities associated with disordered eating can lead
to infertility and make it challenging if not impossible
to have children.17 This is due to changes in ovulation
with amenorrhea therefore changes in production of an egg
to be fertilized. All of the aforementioned health issues

29
may be side effects from disordered eating that can
affect adolescents into adulthood.
From the results of this study, it can be
hypothesized that there is a relationship between body
image and disordered eating in female collegiate
athletes. Coaches and athletic trainers should strive to
continue to educate themselves about the issues that may
be affecting their female athletes.

Conclusions

Based on the results found in this study, there was
a significant moderate negative correlation between body
image scores and eating attitudes scores. As athletic
trainers we need to be more aware of negative body image.
This could include recognizing poor self esteem, or body
dissatisfaction. Findings lead us to believe that in
these cases, athletes could be predisposed to disordered
eating. The results support previous research that shows
that poor body image and body dissatisfaction can be
related to disordered eating patterns.
It should also be noted that since there was no
difference found between team and individual sports for
the scores on the EAT-26 and BESAA, the type of sport the

30
athlete participates in is not a valid predictor of body
image issues and disordered eating habits. Thus, athletic
trainers, coaches, parents, and teammates must not be
biased towards specific sport athletes but instead treat
everyone equally, as if they could may be predisposed to
these issues.
The demands of a female collegiate athlete coupled
with the drive for perfection has lead to poor body image
and behaviors associated with disordered eating for some
athletes. These athletes may continue to practice these
unhealthy behaviors without being treated and
unrecognizing that they have a serious problem. These
issues may not only have an impact on their sport life,
but life after college athletics as well, such as
adulthood and parenting.

Recommendations

The results from this study were derived from only
five different schools with athletes participating in 11
different sports in a condensed demographic area.
Future research in this area should use all schools
from different demographic regions as well as divisions.
This would give you a better idea of female collegiate

31
athletes as a population. Additionally, more effective
distribution would be beneficial. Having the survey sent
directly to the female athletes may help to increase the
response rate.
Further research should include the effect of the
level of sport on body image and disordered eating,
ranging from high school level athletes to elite level
athletes. Furthermore, research could look at difference
between male and female athletes in these two different
areas of concern.
Lastly, focusing on just those who received a score
of 20 or more on the EAT-26, which is indicative of an
eating disorder may elicit different findings.
I think that it is important that as athletic
trainers we inform our athletes about poor body image and
disordered eating and the harm it can cause and also
provide them resources so if they need help, they can get
it.

32
REFERENCES
1.

Beals K. Subclinical eating disorders in female
athletes. J Physical Education Recreation Dance.
2000;71:23-29.

2.

Hasse, AM.; Weight perception in female athletes:
Association with disordered eating correlates and
behavior; Eating behaviors: 2010;12:64-67.

3.

Steadman L, Swami V, Tovee MJ, A comparison of body
size ideals, body dissatisfaction, and media
influence between female track athletes, martial
artists, and non-athletes. Psychology Sport
Exercise; 10(2009);609-614.

4.

Peden J, Stiles B, Vandehey M, Diekhoff G. The
effects of external pressures and competitiveness on
characteristics of eating disorders and body
dissatisfaction. Sport Social Issues. November
2008;32(4):415-429.

5.

Sundgot-Borgen J, Torstveit M. Prevalence of eating
disorders in elite athletes in higher then in
general population. Clinical Sports Medicine.
January 2004;14.

6.

Thompson J, Heinberg L, Altabe M, Tantleff-Dunn S.
Exacting Beauty: Theory, assessment, and treatment
of body image disturbance. American Psychological
Association. 1999.

7.

Arthur-Cameselle JN, Quatromoni PA. Factors related
to the onset of eating disorders reported by female
collegiate athletes. Sport Psycologist. 2010;25: 17.

8.

Hasse A. Physique anxiety and disordered eating
correlates in female athletes: Differences in team
and individual sports. Clinical Sport Psychology.
September 2009;3(3):218-231.

9.

Burnett K, Doninger G, Enders C. Validity evidence
for eating attitudes test scores in a sample of

33
female college athletes. Measurement Physical
Education Exercise Science.2005;9:35-49.
10.

Mendelson B, Mendelson M, White D. Body Esteem Scale
for adolescents and adults. Personality Assessment.
2001;76:90-106.

11.

Reinking M, Alexander L. Prevalence of disordered
eating behaviors in undergraduate female collegiate
athletes and non-athletes. Athletic Training.
2005;40:47-51.

12.

Martin Ginis KA, Leary MR. Self-presentational
processes in heath damaging behavior. Applied Sport
Psychology. 2004;16:59-74

13.

Catikkas F, Koyuncu M, Meliha C, Derdar T A.; Body
image satisfaction and dissatisfaction, social
physique anxiety, self-esteem, and body fat ratio in
female exercisers and non exercisers; Social
Behavior Personality;2010;38(4):561-570.

14.

Greenleaf C, Petrie T, Carter J, Reel J. Female
Collegiate Athletes: Prevalence of eating disorders
and disordered eating behaviors. American College
Health. March 2009;57(5):489-496.

15.

Rubinstein TB, McGinn AP, Wildman RP, Wylie-Rosett
J. Disordered eating in adulthood is associated with
reported weight loss attempts in childhood.
International Eating Disorder. 2010;43(7): 663-666.

16.

Manore MM, Kam K, Loucks AB. The female athlete
triad: components, nutrition issues, and health
consequences. Sport Sciences. 2007;25(1):61-71.

17.

Maxwell M, Thornton L, Bulik C, et al. Life beyond
the eating disorder: education, relationships, and
reproduction. International Eating Disorders. April
2011;44(3):225-232.

34

APPENDICES

35

APPENDIX A
Review of Literature

36
REVIEW OF LITERATURE

Women compete at very high levels and overcome just
as many obstacles as men as collegiate athletes, but in
some ways it can be very different. Body image, by
definition, is an opinion of one’s physical appearance
based on both the way one sees him/herself as well as
opinions of others.1 Research has shown that body image
can have an effect on disordered eating including both
anorexia nervosa and bulimia nervosa.2-4 These disorders
could lead to body dissatisfaction and/or disordered
eating because they feel the pressure to change.
In the following review of literature, body image
and eating disorder will be discussed in the following
sections: (1) Body Composition,(2)Calorie Expenditure and
Nutritional Needs,(3)Body Image, and (4)Disordered
Eating. Within disordered eating there are four
subsections; anorexia nervosa, bulimia nervosa, factors
that affect disordered eating, and prevalence. At the end
of the literature review there will be a summary.

37
Body Composition

A test of body composition is a measure that
determines the amounts of body fat versus lean muscle
mass a person has. It is one of the many factors that
influence performance capabilities in athletes with
published normal ranges suggested for female and male
athletes. Though optimal body fat percentages differ
between athletes, sports, and positions, in 2000,
estimated essential body fat for a male was approximately
5% while for a female it was 8 to 12 %.5 According to the
American academy of sports medicine, numbers below this
may be detrimental to an athlete’s health.5 Low body fat
percentage is often associated with disordered eating,
hormonal disturbances, low bone density, sports injuries,
and other health-related problems.5 In a 2006 study by
Gibson et al,5 body fat levels were evaluated among many
different male and female sports. It was seen that in
male Nordic skiers, distance runners, and multi event
track and field athletes that body fat percentages were
low.5 This is concerning because these levels can be
detrimental to their physical health. Body fat percentage
levels were very fluctuating within women’s sports as
well. Those who participated in tennis, softball, rowing,

38
jumping and multi event track and field sports showed
higher body fat percentages than normal while those in
basketball, skiing, soccer, individual track and field
events, swimming and diving, and volleyball showed lower
then average.5 For athletes, body composition is a very
important factor influencing performance capabilities and
health status. It is important to monitor these values
and note any unhealthy changes in any of the athletes.

Calorie Expenditure and Nutritional Needs

Athletes are not necessarily considered “average”
people when it comes to calorie expenditure. With the
rigor of competition and training, they burn up a
significant amount more. Total energy expenditure and
requirements are unique for each athlete and may be
dependent on basal metabolic rate, thermic effect of food
and activity, and in some cases growth.6 It is both
important for activity as well as recovery that necessary
measures are taken to ensure the health and well being of
the athletes. A study conducted by Clark et al6 was done
to report baseline dietary data, body composition and
performance indices of division 1 soccer players during
their rigorous two a day preseason and then in post-

39
competitive season. To measure baseline dietary data,
three day food logs were kept by each of the subjects. It
was observed that there was a greater intake of
carbohydrates, protein and total caloric intake in the
pre season phase compared to post season. Though their
ingestions of carbohydrates increased during pre season,
it was still not sufficient to provide for glycogen
repletion, even though they were taking in an adequate
amount of calories.6 Broad et al7 stated that there are
some dietary programs that restore and can even super
compensate muscle glycogen levels, which can enhance
play, especially during tournaments. It is important that
carbohydrates and protein are taken before and after
training sessions to optimize recovery. Any athlete
should be warned about taking in too little of an energy
source because it can have a negative effect on
metabolic, hormonal, and even immune system function.7
This could lead to more damaging effects on the body if
not noticed and taken care of.

Body Image

Body image can be a trying issue in all athletes but
is clearly more prevalent in female athletes.8 Body image

40
is classified as how someone feels about themselves based
on their opinion and their interpretation of how others
see them.9 There are a number of issues that can be wrong
with a person’s body according to oneself. Negative body
image can lead to multiple issues that could in turn lead
to unhealthy behaviors.

There have been studies that

have been done to attempt to find the source of body
image distortions and what factors play into account. One
study by Catikkas et al10 focused on the relationship
between social physique anxiety, body image
dissatisfaction, self-esteem and body fat ratio in female
exercisers and non exercisers.10 There was a strong
relationship found between these three variables, meaning
that they do in fact affect one another. They have looked
at interventions for those female athletes with distorted
body image, with a desired response to decrease the
pressures assumed in their respected playing fields. The
study also worked on their attitudes on their appearance
and self efficacy. After intervention, according to postquestionnaires the only difference seen was they recorded
less pressure to be thin than the control group.10

41
Factors That Affect Body Image

There are many factors that can affect body image
including internal stimuli or the external environment.
Athletes are capable of being dissatisfied with their
bodies, a behavior exhibited with image distortion and
the way athletes see themselves. With societal pressure
to be thin and the use of extremely thin models and
actresses, society has a tendency to equate thin with
beauty. Steadman et al.11 did a study focusing on media
influence on body dissatisfaction. It was used to exam
body size ideals, body dissatisfaction, and media
influence dependant on the subjects demographic
information of being either a female recreational athlete
or non athlete.11 After looking at the results, there was
no statistical difference found between athletes and non
athletes when comparing ideal body size. It was seen that
track athletes reported the highest incidence of body
dissatisfaction as well as media influence. This finding
leads us to believe that track athletes worry about their
image and have the potential to be victims of social
standards. For the total sample, the body mass index of a
participant and the influence of the media were key
factors in determining body dissatisfaction rather than

42
sport type. The results do support that those women
participating in lean promoting sports experience higher
body dissatisfaction then those who do not.11
A study by Hasse12 examined associations that exist
between weight perception and disordered eating
correlates (perfectionism and social physique anxiety
(SPA)) and eating behaviors in female athletes. Social
physique anxiety is a subsection of social anxiety that
is a direct evaluation of oneself.12 This evaluation has a
direct link with body image. This study used the EAT-26,
9-item Social Physique Anxiety Scale, self reported
height and weight, and weight perception were obtained
from each of the subjects.12 It was found that athletes
who believed they were overweight reported negative
perfectionism, higher social physique anxiety and
disordered eating more than those who had normal weight
perceptions.12 This leads to the conclusion that a
negative evaluation of weight has an affect on evaluation
of oneself as a whole.
These are not the only sources of negative body
image, they can come from a variety of different places
as it has been seen. Negative body image has the
possibility of leading to behaviors that may be
detrimental to ones health and performance.

43
Disordered Eating

Disordered eating is a prevalent issue among female
athletes that may present itself in many different
ways.13-21 Two of the more common behaviors are anorexia
nervosa (AN) and bulimia nervosa, patterns of restrained
eating as well as binge eating. With disordered eating,
hunger and fullness are usually ignored. In some cases it
is hard to recognize signs of disordered eating because
they are so discrete. Common signs and symptoms of
disordered eating according to the National Eating
Disorder Information Center could include repeated
concerns about being fat, low self-esteem, extreme loss
or fluctuation in weight, avoidance of eating in public,
engaging in excessive exercise, etc.13 Any of these
behaviors should send an alert that someone may be
experiencing an eating disorder.

Anorexia Nervosa
Anorexia nervosa is characterized by the failure of
a person to keep their minimum weight within 15% of
normal body weight.14 There are many signs and symptoms
associated with this condition including food
restriction, concern about their weight and a fear of

44
gaining weight. Excessive exercising may also be used as
well as laxative as a means of losing weight. This
condition causes an obsession with ones weight to a
dangerous extent.14
Salbach et al15 conducted a study to compare as well
as look at the prevalence of, the signs and symptoms of
disordered eating within rhythmic gymnasts, high school
students and clinically diagnosed anorexia nervosa
patients. They were looking for irregular eating habits,
body image distortion, the presence of frequent
exercising and amenorrhea. The height, weight and BMI of
these subjects were taken into account as well. Even
though rhythmic gymnasts had a lower BMI than high school
students, they did not show any obvious signs of eating
disorders when compared to the anorexia nervosa patients.
Both high school students and rhythmic gymnasts showed
signs of being amenorrheic.15 This proves that signs and
symptoms of anorexia nervosa can be seen in multiple
populations, from everyday students to rigorous athletes,
and should be monitored and noted accordingly.

Bulimia Nervosa
Bulimia nervosa is another of the common eating

disorders that has been studied widely. Bulimia nervosa

45
is a sickness in which a person feels like they lose
control. It can consist of binging on food and/or having
regular episodes of overeating and feeling a loss of
control.16 There are several methods that can be used to
prevent weight gain. The most common include self-induced
vomiting or laxative abuse. Similar to anorexia nervosa
there are specific symptoms that are indicative of
bulimia nervosa.

Some of these could include, eating

binges that occur several times a day for many months,
purging to prevent weight gain in the form of vomiting,
excessive exercise, or laxatives, going to the bathroom
right after meals, etc.16 This is also an eating disorder
that requires medical and/or psychological attention and
has the possibility to affect female athletes.
In a study by Brannan et al,17 24% of the time it was
found that body dissatisfaction and bulimic symptoms were
related when looking at female collegiate athletes. The
strength of this relationship saw an increase when
concerns over making mistakes, being motivated to
exercise to improve appearance and attractiveness, or to
socialize and improve mood were used as moderators of
body dissatisfaction and bulimic symptoms. Self esteem
had a buffering effect on the relationship between body
dissatisfaction and bulimic symptoms; it was able to

46
weaken the relationship between the two variables if the
athlete had a positive self esteem.17 It was also shown in
an earlier study by the same authors, that 42% of the
cases reported, the psychosocial variable was the leading
cause of the bulimic symptoms.18 Higher levels of body
dissatisfaction, more dietary restraint, and stronger
feelings of guilt were associated with bulimic
symptamology while feelings of fear, hostility, or
sadness were unrelated.18 Bulimia nervosa can have a
detrimental affect on athletes in multiple ways. These
negative habits that are developed leading to an eating
disorder typically have an underlying origin.

Causes of Disordered Eating
According to researchers, disordered eating may be
an expression of internal turmoil. It has been reported
that those affected only want a way out. There have been
many of studies13,19-22 done to identify factors that are
related to and contribute to disordered eating. ArthurCameselle and Quatromoni19 identified some of the factors
discovered to be an influence on disordered eating after
individual interviews. The factors included negative mood
states, low self esteem, perfectionism/ drive for
achievement, desire for control, negative influences on

47
self-esteem, hurtful relationships, hurtful role models
and sport performance.19 There were similar factors that
affected non athletes but it was found that being in the
athletic arena posed a threat towards disordered eating
habits. This could be due to comments by a coach, fellow
athletes having an eating disorder, the pressure of sport
performance and many more.
Social pressures seem to be a prevalent issue in female
athletics when it comes to being a factor in disordered
eating.19 d’Arripe-Longueville, Maiano, and Scoffier20
used 227 elite level adolescent athletes and focused on
the effects of social relationships of the athletes and
acceptance of disturbed eating attitudes (DEA). Four
different surveys were used to test the social
relationships between their coach, friends and parents
and the acceptance of their peers. From these surveys it
was found that the relationship between the parents and
athletes as well as peer acceptance had a negative
influence on disturbed eating attitudes and acted as a
protective factor. Conversely, the relationship between
the coach and the athlete had the possibility of being a
risk factor for the development on DEA.20
Competitiveness is another factor that may possibly
be an affect on disordered eating. The relationship

48
between external pressures to excel, competitiveness,
eating disorder characteristics and body dissatisfaction
were evaluated through the use of surveys.21 This study
which was conducted by Peden et al21 consisted of both
male and female athletes. It was found that external
pressures and competitiveness both positively correlated
with eating disorder characteristics and body
dissatisfaction. It was also shown that the athletic
sample received more external pressure yet they saw less
eating disorder characteristics as well as body
dissatisfaction. In this case there was no relationship
between competitiveness and disordered eating.21
Media is another avenue that may contribute to
disordered eating. Young women may feel the need to want
to look like the beautiful, thin people that are
portrayed in TV shows and movies. A study was done by
Bissell et al22 to specifically investigate the exposure
of two different types of media (entertainment and
sports) and look at the correlations between it and body
image distortion and eating disorders.22 There were 78
female athletes that participated in this study. They
were each surveyed on how often they watch certain TV
shows in the following categories, televised sports or
sports media, entertainment media and thin media, as well

49
as body improvement magazines and their interest in
these. The Eating Attitudes test, as well as the Eating
Disorder Inventory survey were also given to each of the
subjects to look at the dependent variable. The results
showed that interest in “thin” TV shows and magazines was
a significant predicator for disordered eating. Sports
media only correlated with minor degrees of eating
disorder symptamology.22 This would prove that there is
some desire for any person, even athletes to want to be
like thinner people that they see on the television.
A final factor proven to have an affect on
disordered eating is body dissatisfaction. As stated
previously, Hasse13 did a study that look specifically at
the associations between weight perception and disordered
eating correlates and eating behavior in female athletes.
The results showed that female athletes that believed
they were overweight reported higher levels of disordered
eating.13 This suggests negative body image may be
associated with disordered eating. Disordered eating is
not something that should be taken lightly.

Prevalence in Athletics
Disordered eating has become a prevalent issue in
the world of female athletics. It has been found by

50
research that it is in fact more prevalent in athletics
then the general population.23-26 Torstveit et al23 did a
study to examine female athletes and the percentage of
them with disordered eating behaviors.23 It also was used
to investigate what the characteristics are of a typical
athlete with an eating disorder. It was found that 32.8%
of athletes and 21.4% of the controls or the general
population were found to have a clinical eating disorder.
There was more of a prevalence found in those athletes
that competed in lean sports compared to non-lean sports
when it came to disordered eating.23
Another study by Gordon et al24 focused on the
difference in eating disorder symptoms between women in
different levels of athletic ability from undergraduate
varsity athletes to non exercisers. There were 274
subjects that completed the necessary surveys to gather
data. It was once again found that it was more common to
see symptoms of disordered eating in women who were
athletes when compared to non exercisers. In higher
levels of competition it was seen that there was more
anxiety and therefore more cases seen of bulimic symptoms
and the drive to be thin. Also body dissatisfaction
correlated directly with higher levels of sport anxiety.24

51
This comes to prove that there is a relationship between
pressure on athletes and disordered eating symptoms.
There is a drastic difference between collegiate
athletes and non athletes when it comes to personality.
Collegiate athletes are spending numerous hours at
practice, as well as with their classes, while the non
athlete mainly just has school and extracurricular
activities. A study overseen by Reinking et al25 was done
to compare disordered eating symptoms in female
collegiate athletes versus non athletes. The subjects
were either NCAA division 1 athletes or residence hall
females who volunteered for the study. Though there is a
difference seen between the two, it is more important to
be aware that it is possible for disordered eating to
appear in all females.25 There was another study done by
Williams et al26

to exam eating behaviors as well as body

image concerns and its prevalence in this population.
Data was gathered using a convenience sample from nine
different colleges/universities. The survey consisted of
three different sections, one simply to examine age,
athletic activity and other general demographic data. The
second was self reported weight and height as well as
desired weight and height. It also recorded any weight
control behaviors and the reasons for them. It also

52
contained the EAT-26. The final section consisted of the
Eating attitudes test which took a look at body image,
drive for thinness, and body dissatisfaction to name a
few. It was found that 20.1% were classified as having a
subclinical eating disorder, the mean age of this group
being 19.4 years old. There was no single sport that the
overall mean was at an at-risk criterion for desired
thinness or body dissatisfaction. Diving scored the
highest in both of these categories.26
We should be aware that at a higher level, the level
of competition and pressure is driving to disordered
eating. All in all it is important to know who you are
dealing with and the possibility of disordered eating
arising. Disordered eating has the possibility of
contributing to what we call the female athlete triad.

Effects of Disordered Eating
Disordered eating can be very harmful to an
athlete’s body. There are many health conditions that it
can lead to that can affect many things in the future.
Athletes with disordered eating consume less energy then
that required of the physical demands of the sport they
are competing in.27 When energy is low, the amount of
macro and micro nutrients that the athlete is getting is

53
also probably low. This reduced intake of macronutrients,
especially the essential amino acids and essential fatty
acids, can decrease the body’s ability to build bone,
maintain muscle mass, repair damaged tissue and recover
from injury.27 Micronutrients are important for building
bones and muscles tissue, replacing red blood cells, and
providing co-factors for the energy producing metabolic
pathways.27 Not getting enough of these will make theses
processes inefficient.
Menstrual irregularities and poor bone health are
both common effects of disordered eating.27-29 Amenorrhea,
or lack of a menstrual cycle is one of the side effects
of disordered eating.28 While it is common for a late
onset in high intensity level athletes, it has been
suggested that it is also results from low energy
availability. If this level imbalance is extreme or
persistent, it causes the body to suppress physiological
functions that are necessary for normal growth and
development. In this case, the hypothalamus turns off the
reproductive system leading to amenorrhea.29
The combination of both amenorrhea and malnutrition
associated with disordered eating can lead to loss of
bone mineral density.28 Low bone mineral density can lead
to numerous complications such as an increase in stress

54
fractures as well as the long term health problem of
osteoporosis.28 This condition is caused by low energy
availability and decreased endogenous estrogen due to
amenorrhea because without estrogen, bone resorption
exceeds bone formation causing low bone mass. These three
conditions, disordered eating, amenorrhea, and low bone
density, combined make up the female athlete triad and
can be very detrimental to athletes both now and in the
future.
A study done by Thompson29 examined the
characteristics of the female athlete triad in collegiate
cross country runners. It was found that 19.3% of the
subjects surveyed said they perceived or had been told
that they had an eating disorder.29 23% of the women
reported current menstrual dysfunction. More then 50% of
these women reported not taking in an adequate amount of
calcium and there is a positive relationship between
calcium intake and premenopausal bone density.29
The effects of disordered eating can be both
damaging now as well as later in life. A study done by
Rubenstein et al30 examined the relationship between
attempts to lose weight as an adolescent to disordered
eating habits as an adult. There was a positive
relationship found between those who attempted weight

55
loss strategies as an adolescent and disordered eating as
an adult. This is important to notice because it would be
easy to pass these practices down to their children.
Another serious side effect of disordered eating is
osteoporosis that can develop from low bone density.28
This can increase the risk of stress fractures during
adulthood into the elderly. Finally Maxwell et al30
examined the association of menstrual irregularities with
the inability to reproduce when disordered eating was
involved. The findings were noteworthy and that women who
have suffered from menstrual irregularities and
disordered eating are less likely to reproduce. This is
due to the fact that during amenorrhea, a female does not
ovulate, therefore not creating an egg to be fertilized.31
All of these issues are long term effects of disordered
eating that are detrimental to the health of adults.

Summary

The female athlete is a unique individual who can
experience both benefits as well as consequences of
participation in sport. Two consequences that can be seen
are distorted body images and disordered eating.

56
Distorted body image can be the effect of many
different precursors. From perfectionism and the
pressures of high level competition to what is seen in
the media and social norms. It can occur in the most
sound minded of athletes. Distorted body image can lead
to unhealthy behaviors that can have an affect on their
athletics as well as just normal every day life.
Disordered eating is just one of these unhealthy
habits that can occur from having a poor body image. This
topic can be combined with excessive exercise and dieting
techniques. Disordered eating includes anorexia nervosa,
bulimia nervosa, and any other form of food limitation.
The effects of disordered eating can haunt someone for
the rest of their life because they are so detrimental.
Body image and disordered eating are just two
variables that can be harmful to female athletes, and two
go hand in hand with each other. There is not just one
cause of distorted body image and disordered eating but a
knowledgeable athletic trainer should be able to
recognize signs and symptoms of these two conditions and
identify the source of the issue.

57

APPENDIX B
The Problem

58
STATEMENT OF THE PROBLEM

The purpose of this study is to examine the
relationship between body image and disordered eating in
female collegiate athletes. It has been found that there
is a prevalence of disordered eating as well as body
image disturbances that are seen in the female athletic
population.

2-4,8-12,15,17-26

Some of these studies have

focused on the factors that effect body image and
disordered eating individually. They have looked at
multiple levels of athletes from NCAA division I to club
level and intramural sport athletes.
This study will examine the correlation between body
image and disordered eating as measured by the body
esteem survey for adolescents and adults and the EAT-26
respectively. It will also examine the differences of
these two variables in team and individual sport
athletes. It is important to examine this relationship
because if we find that the two affect one another we may
be able to reduce the occurrences of negative body image
and disordered eating in female athletes. Disordered
eating can be very detrimental to an athlete on a
physical and emotional level.

59

Definition of Terms
The following definitions of terms will be defined
for this study:
1. Anorexia Nervosa- according to the Diagnostic and
Statistic Manual of the American Psychiatric
Association, anorexia nervosa is defined as
a. Refusal to maintain body weight at or about a
minimal normal weight for age and height(e.g.,
weight loss leading to maintenance of body
weight less than 85% of that expected; or
failure to make expected weight gain during
period of growth, leading to body weight less
than 85% or expected
b. Intense fear of gaining weight or becoming fat
even when underweight.
c. Disturbance in the was one’s body weight or
shape is perceived; undue influence of body
weight or shape on self-evaluation, or denial
of the seriousness of current low body weight
d. In post-menarchal females, a woman is
considered to have amenorrhea if her periods
occur only following hormone, e.g., estrogen,
and administration

60
2. Body Image- Is an opinion of one’s physical
appearance based on both the way one sees
him/herself as well as opinions of others
3. Bulimia Nervosa (BN) – according to the Diagnostic
and Statistical Manual of the American Psychiatric
Association, bulimia nervosa is defined as
a. Recurrent episodes of binge eating. An episode
of binge eating is characterized by both of the
following
i. Eating in a discrete period (e.g., within
any two-hour period) amount of food that
is definitely larger than most people
would eat during a similar period of time
and under similar circumstances, and
ii. A sense of lack of control over eating
during the episode(e.g., a feeling that
one cannot stop eating or control what or
how much one is eating).
b. Recurrent, inappropriate compensatory behavior
to prevent weight gain, such as self-induced
vomiting, misuse of laxative, diuretics, or
other medication, fasting, or excessive
exercise

61
c. The binge eating and compensatory behaviors
both occur, on average, at least twice a week
for three months.
d. Self-evaluation is unduly influenced by body
shape and weight
e. The disturbance does not occur exclusively
during episodes of anorexia nervosa.
4. Disordered eating- a term that places emphasis on
the spectrum of pathological patters of eating. A
person does not consume the healthy amount of
nutrients needed to sustain life.
5. Eating Disorder- harmful practices of weight control
that result in undue harm to the body.
6. Individual Sport- Refers to a sport where
participates compete as individuals.
7. Team Sport- a sport that involves competition
between teams of players.

Basic Assumptions
The following are basic assumptions of this study:
1) The use of a valid and reliable assessment tool
(EAT-26) will be a valid and reliable predictor of
individuals who currently possess a risk for eating

62
disorders due to symptoms, behaviors and attitudes
of disordered eating.
2) The use of a valid and reliable assessment tool (The
Body Esteem Scale for Adolescents and Adults) will
be a valid and reliable predictor of an individual’s
body image.
3) It is assumed that the female athletes will answer
all questions honestly and completely and will not
look for input from others.

Limitations of the Study
The following are possible limitations of the study:
1)

The study will consist of Division II and III
collegiate female athletes.

2)

The study will be restricted to those sports
specific to the schools that participate.

Significance of the Study
Athletic trainers should have an adequate amount of
knowledge on this topic when working with female
athletics. Distorted body images as well as disordered
eating are both prevalent in this arena. These conditions
require proper and prompt management, and in order for

63
this to happen it requires athletic trainers to be
educated on the conditions of female athletes.
This study will evaluate the body images as well as
eating attitudes of female athletes from both individual
and team sports.
This study is important to female athletes and
athletic trainers. An increase in known prevalence of
distorted body image and disordered eating habit will
increase awareness of both parties.

64

APPENDIX C
Additional Methods

65

APPENDIX C1
Survey Cover Letter

66
Dear Student -athlete:
My name is Lacie Johnson and I am currently a graduate student at California
University of Pennsylvania pursing a Master of Science in Athletic Training.
Part of the graduate study curriculum is to complete a research thesis. I am
conducting survey research to determine if there is a relationship between
body image and disordered eating among female collegiate athletes at
division II and division III universities.
Your participation is voluntary and you have the right to choose not to
participate. You also have the right to discontinue participation at any time
during the survey completion process at which time your data will be
discarded. The California University of Pennsylvania Institutional Review
Board has reviewed and approved this project. The approval is effective 1-262012 and expires 1-25-2013.
All survey responses are anonymous and will be kept confidential. Informed
consent to use the data collected will be assumed upon return of the survey.
Aggregate survey responses will be housed in a password protected file on
the CalU campus. Minimal risk is posed by participating as a subject in this
study. I ask that you please take this survey at your earliest convenience as it
will take approximately 10 minutes to complete. If you have any questions
regarding this project, please feel free to contact the primary researcher,
Lacie Johnson as joh5004@calu.edu. You can also contact the faculty
advisor for this research, Shelly Fetchen DiCesaro, PhD, ATC, CSCS, 724938-4562, dicesaro@calu.edu. Thanks in advance for your participation.
Please click the following link to access the survey
https://www.surveymonkey.com/s/YST89RV.
Thank you for taking the time to take part in my thesis research
Sincerely,

Lacie Johnson, ATC
Primary Researcher
California University of Pennsylvania
250 University Ave
California, PA 15419
Joh5004@calu.edu

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APPENDIX C2
Demographic Questions

68
Demographic Questions
1. Are you male or female?
2. Are you over the age of 18?
3. What college or university do you attend?
a. California University of Pennsylvania
b. Bloomsburg University
c. Kutztown University
d. Marymount University
e. Shippensburg University
f. Frostburg State University
g. Lock Haven University
4. What year are you in school?
a. Freshman
b. Sophomore
c. Junior
d. Senior
e. Graduate
5. What sport(s) do you play?
a. Soccer
b. Volleyball
c. Cross country
d. Tennis
e. Swimming/diving
f. Track and Field

69
g. Basketball
h. Softball
i. Field Hockey
j. Gymnastics
k. Lacrosse
l. Water Polo
m. Other
6. Height?
7. Current Weight?
8. Highest weight (after 12 years of age)?
9. Lowest weight (after 12 years of age)?
10. Ideal Weight?

70

APPENDIX C3
Eating Attitudes Test (EAT-26)

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72

APPENDIX C3
Body Esteem Survey for Adolescents and Adults (BESAA)

73
Body-Esteem Scale for Adolescents and Adults
Beverley K. Mendelson, Donna R. White, and Morton J. Mendelson
Indicate how often you agree with the following statements ranging from "never" (0) to
"always" (4). Circle the appropriate number beside each statement.
SomeNever Seldom times Often
1. I like what I look like in pictures.
0
1
2
3
2. Other people consider me good looking.
0
1
2
3
3. I'm proud of my body.
0
1
2
3
4. I am preoccupied with trying to change my body weight.
0
1
2
3
5. I think my appearance would help me get a job.
0
1
2
3
6. I like what I see when I look in the mirror.

Always
4
4
4
4
4

0

1

2

3

4

7. There are lots of things I'd change about my looks if I
could.
8. I am satisfied with my weight.
9. I wish I looked better.
10. I really like what I weigh.
11. I wish I looked like someone else.
12. People my own age like my looks.
13. My looks upset me.

0

1

2

3

4

0
0
0
0
0
0

1
1
1
1
1
1

2
2
2
2
2
2

3
3
3
3
3
3

4
4
4
4
4
4

14.
15.
16.
17.
18.
19.
20.
21.
22.
23.

0
0
0
0
0
0
0
0
0
0

1
1
1
1
1
1
1
1
1
1

2
2
2
2
2
2
2
2
2
2

3
3
3
3
3
3
3
3
3
3

4
4
4
4
4
4
4
4
4
4

I'm as nice looking as most people.
I'm pretty happy about the way I look.
I feel I weigh the right amount for my height.
I feel ashamed of how I look.
Weighing myself depresses me.
My weight makes me unhappy
My looks help me to get dates.
I worry about the way I look.
I think I have a good body.
I'm looking as nice as I'd like to.

Three subscales: BE-Appearance (1, 6, 7*, 9*, 11*, 13*, 15, 17*, 21*, 23); BE-Weight (3,
4*, 8, 10, 16, 18*, 19*, 22); and BE-Attribution (2, 5, 12, 14, 20). [* negative items, which
must be recoded for scoring by reversing the scale (i.e., 0 = 4, 1 = 3, 2 = 2, 3 = 1, 4 = 0).]

74

APPENDIX C4
Institutional Review Board –
California University of Pennsylvania

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84

85

86

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96
Institutional Review Board
California University of Pennsylvania
Morgan Hall, Room 310
250 University Avenue
California, PA 15419
instreviewboard@calu.edu
Robert Skwarecki, Ph.D., CCC-SLP,Chair

Dear Lacie Johnson:
Please consider this email as official notification that your
proposal titled "The relationship between body image and disordered
eating in individual and team female collegiate sports” (Proposal #11035) has been approved by the California University of Pennsylvania
Institutional Review Board as submitted,
The effective date of the approval is 1-26-2012 and the expiration date is
1-25-2013. These dates must appear on the consent form .

(1)

(2)
(3)
(4)

Advisory note: For an individual with an eating disorder, completion of
this survey may increase self awareness or other personal
introspection. It is recommended that the survey include a brief
statement providing information to such a participant about how to
obtain help. (e.g. a statement that they should contact their physician,
psychologist, or other appropriate health care practitioner). Any factual
information should be derived from peer-reviewed sources only.
Please note that Federal Policy requires that you notify the IRB promptly
regarding any of the following:
Any additions or changes in procedures you might wish for your study
(additions or changes must be approved by the IRB before they are
implemented)
Any events that affect the safety or well-being of subjects
Any modifications of your study or other responses that are
necessitated by any events reported in (2).
To continue your research beyond the approval expiration date of 1-252013 you must file additional information to be considered for
continuing review. Please contact instreviewboard@calu.edu
Please notify the Board when data collection is complete.
Regards,
Robert Skwarecki, Ph.D., CCC-SLP
Chair, Institutional Review Board

97

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related to the onset of eating disorders reported by
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101
ABSTRACT
Title:

THE RELATIONSHIP BETWEEN BODY IMAGE AND
DISORDERED EATING IN INDIVIDUAL AND TEAM
FEMALE COLLEGIATE SPORTS

Researcher:

Lacie N. Johnson

Advisor:

Dr. Shelly DiCesaro

Date:

May 2012

Research Type: Master’s Thesis
Purpose:

The purpose of this study was to determine
a relationship between body image and
disordered eating and observe and
differences between individual sport and
team sport athletes.

Problem:

Distorted body image and disordered eating
are prevalent in world of female collegiate
athletics. It is important to examine and
determine if the two are in fact related to
each other.

Method:

A descriptive type of research was
conducted. One hundred and six female
athletes from California University of
Pennsylvania, Frostburg State University,
Kutztown University, Shippensburg
University, and Lock Haven University, who
participated in volleyball, soccer, track
and field, basketball, lacrosse, field
hockey, tennis, swimming and diving, cross
country, softball, and golf volunteered.
The instruments that were used were the 26
question Eating Attitudes test and the Body
esteem survey for adolescents and adults.

Findings:

There was a significant moderate negative
correlation between body image scores and
disordered eating score. There was no
significant difference established between
scores found for individual and team sport
athletes.

102
Conclusion:

Body image and disordered eating are
related in female collegiate athletics.