disordered eating

A number of recent studies have shown that disordered eating is common in female athletes in developed countries, particularly in endurance and aesthetic sports that emphasise the importance of a lean body. This disordered eating increases the risk of developing two associated disorders – amenorrhoea and osteoporosis – giving rise to what is known as the ‘female athlete triad’.

Now a study comparing the incidence of disordered eating in Japanese and Chinese female athletes sheds a fascinating new light on the sociocultural triggers of disordered eating and its links with menstrual irregularities.

The Eating Attitudes Test (EAT) and self-administered questionnaires were used to survey eating attitudes and menstrual status of large numbers of Japanese and Chinese collegiate female runners, rhythmic gymnasts and gymnasts, and compare them with each other and with non-athletic controls from each country.

The key findings were as follows:

• The prevalence of disordered eating (DE) was significantly higher in Japanese athletes (21% in runners, 19% in rhythmic gymnasts and 15% in gymnasts) than their Chinese counterparts (4%, 2% and 0% respectively);
• The prevalence of amenorrhoea (cessation or absence of menstruation) was very low in Chinese runners (1%), rhythmic gymnasts and gymnasts (both 0%) by comparison with their respective Japanese counterparts (22%, 10% and 8%);
• There were no significant differences in the prevalence of disordered eating (DE) and amenorrhoea between Japanese and Chinese non-athletes (3% and 1% respectively for disordered eating and 1% and 0% for amenorrhoea).

‘Reports suggest,’ comment the researchers, ‘that differences in levels of modernisation and the strength of relations with western culture are crucial factors responsible for these differences in DE between Chinese and Japanese athletes… Sociocultural emphasis on having a slim body and socio-economic causes of thinness may both be lower in China as compared with Japan and industrially advanced western countries, and this may be due to the fact that China is a country which is still in the developmental stage and has remained largely outside the cultural and economical hegemony of the West.’

And, although a cause-and-effect relationship has never been established between disordered eating and amenorrhoea, the researchers point out that their data ‘suggests that the low incidence of amenorrhoea in the Chinese athletes is partly due to their low prevalence of disordered eating (DE) ’.

Int J Sports Med 2005; 26:486-491