{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T12:55:17Z","timestamp":1793451317690,"version":"4.5.0"},"reference-count":80,"publisher":"BMJ","issue":"21","license":[{"start":{"date-parts":[[2020,7,13]],"date-time":"2020-07-13T00:00:00Z","timestamp":1594598400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Br J Sports Med"],"accepted":{"date-parts":[[2020,3,23]]},"published-print":{"date-parts":[[2020,11]]},"abstract":"<jats:p>Identification, evaluation and management of disordered eating (DE) is complex. DE exists along the spectrum from optimised nutrition through to clinical eating disorders (EDs). Individual athletes can move back and forth along the spectrum of eating behaviour at any point in time over their career and within different stages of a training cycle. Athletes are more likely to present with DE than a clinical ED. Overall, there is a higher prevalence of DE and EDs in athletes compared with non-athletes. Additionally, athletes participating in aesthetic, gravitational and weight-class sports are at higher risk of DE and EDs than those in sports without these characteristics. The evaluation and management of DE requires a cohesive team of professional practitioners consisting of, at minimum, a doctor, a sports dietitian and a psychologist, termed within this statement as the core multidisciplinary team. The Australian Institute of Sport and the National Eating Disorders Collaboration have collaborated to provide this position statement, containing guidelines for athletes, coaches, support staff, clinicians and sporting organisations. The guidelines support the prevention and early identification of DE, and promote timely intervention to optimise nutrition for performance in a safe, supported, purposeful and individualised manner. This position statement is a call to action to all involved in sport to be aware of poor self-image and poor body image among athletes. The practical recommendations should guide the clinical management of DE in high performance sport.<\/jats:p>","DOI":"10.1136\/bjsports-2019-101813","type":"journal-article","created":{"date-parts":[[2020,7,13]],"date-time":"2020-07-13T17:17:05Z","timestamp":1594660625000},"page":"1247-1258","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":176,"title":["The Australian Institute of Sport (AIS) and National Eating Disorders Collaboration (NEDC) position statement on disordered eating in high performance sport"],"prefix":"10.1136","volume":"54","author":[{"given":"Kimberley R","family":"Wells","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikki A","family":"Jeacocke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renee","family":"Appaneal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hilary D","family":"Smith","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3996-3264","authenticated-orcid":false,"given":"Nicole","family":"Vlahovich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8866-5637","authenticated-orcid":false,"given":"Louise M","family":"Burke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Hughes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,7,13]]},"reference":[{"key":"2024101110251649000_54.21.1247.1","unstructured":"National Eating Disorders Collaboration . National practice standards for eating disorders, 2018. Available: https:\/\/www.nedc.com.au\/assets\/Final-NEDC-Practice-Standards.pdf [Accessed 12 Sep 2019]."},{"key":"2024101110251649000_54.21.1247.2","doi-asserted-by":"publisher","DOI":"10.1177\/0004867414555814"},{"key":"2024101110251649000_54.21.1247.3","unstructured":"National Institute for Health and Care Excellence . Eating disorders: recognition and treatment, 2017. Available: https:\/\/www.nice.org.uk\/guidance\/ng69 [Accessed 22 Jan 2020]."},{"key":"2024101110251649000_54.21.1247.4","doi-asserted-by":"publisher","DOI":"10.4085\/1062-6050-43.1.80"},{"key":"2024101110251649000_54.21.1247.5","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2019-100715"},{"key":"2024101110251649000_54.21.1247.6","doi-asserted-by":"publisher","DOI":"10.1097\/00042752-200401000-00005"},{"key":"2024101110251649000_54.21.1247.7","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2013-092966"},{"key":"2024101110251649000_54.21.1247.8","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1123\/ijsnem.2018-0142","article-title":"Pitfalls of conducting and interpreting estimates of energy availability in free-living athletes","volume":"28","author":"Burke","year":"2018","journal-title":"Int J Sport Nutr Exerc Metab"},{"key":"2024101110251649000_54.21.1247.9","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2014-093502"},{"key":"2024101110251649000_54.21.1247.10","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2018-099193"},{"key":"2024101110251649000_54.21.1247.11","doi-asserted-by":"crossref","first-page":"1113","DOI":"10.1249\/MSS.0000000000001603","article-title":"Female athlete issues for the team physician: a consensus Statement-2017 update","volume":"50","year":"2018","journal-title":"Med Sci Sports Exerc"},{"key":"2024101110251649000_54.21.1247.12","doi-asserted-by":"crossref","first-page":"S7","DOI":"10.1080\/02640414.2011.588958","article-title":"Energy availability in athletes","volume":"29 Suppl 1","author":"Loucks","year":"2011","journal-title":"J Sports Sci"},{"key":"2024101110251649000_54.21.1247.13","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1080\/17461391.2012.740504","article-title":"Eating disorders in athletes: overview of prevalence, risk factors and recommendations for prevention and treatment","volume":"13","author":"Bratland-Sanda","year":"2013","journal-title":"Eur J Sport Sci"},{"key":"2024101110251649000_54.21.1247.14","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2017-098958"},{"key":"2024101110251649000_54.21.1247.15","doi-asserted-by":"publisher","DOI":"10.1007\/s40279-017-0696-0"},{"key":"2024101110251649000_54.21.1247.16","unstructured":"National Eating Disorders Collaboration . Eating disorders: a professional resource for general practitioners, 2015. Available: https:\/\/www.nedc.com.au\/assets\/NEDC-Resources\/NEDC-Resource-GPs.pdf [Accessed 20 Jan 2020]."},{"key":"2024101110251649000_54.21.1247.17","doi-asserted-by":"crossref","DOI":"10.3390\/nu11061395","article-title":"Retired athletes and the intersection of food and body: a systematic literature review exploring compensatory behaviours and body change","volume":"11","author":"Buckley","year":"2019","journal-title":"Nutrients"},{"key":"2024101110251649000_54.21.1247.18","unstructured":"Jeacocke NA , Beals KA . Eating disorders and disordered eating in athletes. In: Burke L , Deakin V , eds. Clinical sports nutrition. Australia: McGraw-Hill Education, 2015: 213\u201333."},{"key":"2024101110251649000_54.21.1247.19","doi-asserted-by":"crossref","first-page":"383","DOI":"10.12968\/ijtr.2011.18.7.383","article-title":"Barriers and attitudes health professionals working in eating disorders experience","volume":"18","author":"Walker","year":"2011","journal-title":"Int J Ther Rehabil"},{"key":"2024101110251649000_54.21.1247.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.jada.2011.06.016"},{"key":"2024101110251649000_54.21.1247.21","doi-asserted-by":"publisher","DOI":"10.1002\/wps.20128"},{"key":"2024101110251649000_54.21.1247.22","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1016\/j.csm.2015.10.002","article-title":"Understanding eating disorders in elite gymnastics: ethical and conceptual challenges","volume":"35","author":"Tan","year":"2016","journal-title":"Clin Sports Med"},{"key":"2024101110251649000_54.21.1247.23","unstructured":"IOC Medical Commission . Olympic movement medical code, 2016. Available: https:\/\/stillmed.olympic.org\/media\/Document%20Library\/OlympicOrg\/IOC\/Who-We-Are\/Commissions\/Medical-and-Scientific-Commission\/Olympic-Movement-Medical-Code-31-03-2016.pdf [Accessed 22 Jan 2020]."},{"key":"2024101110251649000_54.21.1247.24","doi-asserted-by":"crossref","first-page":"1080","DOI":"10.1002\/eat.22960","article-title":"The athletes\" relationships with training scale (art): a self-report measure of unhealthy training behaviors associated with eating disorders","volume":"51","author":"Chapa","year":"2018","journal-title":"Int J Eat Disord"},{"key":"2024101110251649000_54.21.1247.25","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1007\/s00406-018-0891-5","article-title":"Sports psychiatry: mental health and mental disorders in athletes and exercise treatment of mental disorders","volume":"269","author":"Str\u00f6hle","year":"2019","journal-title":"Eur Arch Psychiatry Clin Neurosci"},{"key":"2024101110251649000_54.21.1247.26","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1007\/s40279-017-0790-3","article-title":"Low energy availability in athletes: a review of prevalence, dietary patterns, physiological health, and sports performance","volume":"48","author":"Logue","year":"2018","journal-title":"Sports Med"},{"key":"2024101110251649000_54.21.1247.27","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1123\/jsr.2014-0337","article-title":"The diagnostic accuracy of screening tools to detect eating disorders in female athletes","volume":"25","author":"Wagner","year":"2016","journal-title":"J Sport Rehabil"},{"key":"2024101110251649000_54.21.1247.28","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1123\/ijsnem.10.2.128","article-title":"Behavioral, psychological, and physical characteristics of female athletes with subclinical eating disorders","volume":"10","author":"Beals","year":"2000","journal-title":"Int J Sport Nutr Exerc Metab"},{"key":"2024101110251649000_54.21.1247.29","article-title":"Physiologic screening test for eating disorders\/disordered eating among female collegiate athletes","volume":"38","author":"Black","year":"2003","journal-title":"J Athl Train"},{"key":"2024101110251649000_54.21.1247.30","doi-asserted-by":"crossref","first-page":"1666","DOI":"10.1249\/MSS.0000000000000276","article-title":"The development of the brief eating disorder in athletes questionnaire","volume":"46","author":"Martinsen","year":"2014","journal-title":"Med Sci Sports Exerc"},{"key":"2024101110251649000_54.21.1247.31","first-page":"431","article-title":"Evaluation of a screening test for female college athletes with eating disorders and disordered eating","volume":"35","author":"Nagel","year":"2000","journal-title":"J Athl Train"},{"key":"2024101110251649000_54.21.1247.32","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1080\/10413200590907586","article-title":"Clinical and subclinical eating disorders: an examination of collegiate athletes","volume":"17","author":"Sanford-Martens","year":"2005","journal-title":"J Appl Sport Psychol"},{"key":"2024101110251649000_54.21.1247.33","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2013-093240"},{"key":"2024101110251649000_54.21.1247.34","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1123\/ijsnem.2018-0127","article-title":"Endocrine effects of relative energy deficiency in sport","volume":"28","author":"Elliott-Sale","year":"2018","journal-title":"Int J Sport Nutr Exerc Metab"},{"key":"2024101110251649000_54.21.1247.35","doi-asserted-by":"publisher","DOI":"10.1007\/s40279-015-0411-y"},{"key":"2024101110251649000_54.21.1247.36","doi-asserted-by":"publisher","DOI":"10.1359\/jbmr.1999.14.10.1672"},{"key":"2024101110251649000_54.21.1247.37","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1123\/ijsnem.2017-0313","article-title":"Low energy availability is difficult to assess but outcomes have large impact on bone injury rates in elite distance athletes","volume":"28","author":"Heikura","year":"2017","journal-title":"Int J Sport Nutr Exerc Metab"},{"key":"2024101110251649000_54.21.1247.38","doi-asserted-by":"publisher","DOI":"10.1249\/mss.0b013e318149f111"},{"key":"2024101110251649000_54.21.1247.39","doi-asserted-by":"publisher","DOI":"10.1007\/s12519-016-0076-0"},{"key":"2024101110251649000_54.21.1247.40","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-008-0606-2"},{"key":"2024101110251649000_54.21.1247.41","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-011-1801-0"},{"key":"2024101110251649000_54.21.1247.42","doi-asserted-by":"crossref","first-page":"109","DOI":"10.7326\/M14-1659","article-title":"Screening for vitamin D deficiency: a systematic review for the U.S. preventive services Task force","volume":"162","author":"LeBlanc","year":"2015","journal-title":"Ann Intern Med"},{"key":"2024101110251649000_54.21.1247.43","unstructured":"Australian government department of health, New Zealand Ministry of health. nutrient reference values, 2014. Available: https:\/\/www.nrv.gov.au\/nutrients\/calcium [Accessed 29 Jan 2020]."},{"key":"2024101110251649000_54.21.1247.44","unstructured":"Ross AC , Taylor CL , Yaktine AL , Institute of Medicine (US) Committee to Review Dietary Reference Intakes for Vitamin D and Calcium . Dietary reference intakes for calcium and vitamin D. Washington DC, USA: National Academies Press (US), 2011."},{"key":"2024101110251649000_54.21.1247.45","doi-asserted-by":"publisher","DOI":"10.1016\/S8756-3282(02)00866-9"},{"key":"2024101110251649000_54.21.1247.46","first-page":"254","article-title":"Vitamin D screening and supplementation in community-dwelling adults: common questions and answers","volume":"97","author":"LeFevre","year":"2018","journal-title":"Am Fam Physician"},{"key":"2024101110251649000_54.21.1247.47","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2011-0385"},{"key":"2024101110251649000_54.21.1247.48","doi-asserted-by":"publisher","DOI":"10.1249\/00005768-199307000-00003"},{"key":"2024101110251649000_54.21.1247.49","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2018-099723"},{"key":"2024101110251649000_54.21.1247.50","doi-asserted-by":"publisher","DOI":"10.1249\/JSR.0000000000000077"},{"key":"2024101110251649000_54.21.1247.51","doi-asserted-by":"publisher","DOI":"10.1249\/MSS.0b013e31823fe4ef"},{"key":"2024101110251649000_54.21.1247.52","doi-asserted-by":"crossref","first-page":"1237","DOI":"10.1017\/S0033291718003549","article-title":"Suicide attempts in eating disorder subtypes: a meta-analysis of the literature employing DSM-IV, DSM-5, or ICD-10 diagnostic criteria","volume":"49","author":"Mandelli","year":"2019","journal-title":"Psychol Med"},{"key":"2024101110251649000_54.21.1247.53","doi-asserted-by":"publisher","DOI":"10.1001\/archgenpsychiatry.2011.74"},{"key":"2024101110251649000_54.21.1247.54","doi-asserted-by":"publisher","DOI":"10.1097\/YCO.0b013e328365a24f"},{"key":"2024101110251649000_54.21.1247.55","first-page":"22","article-title":"The Mini-International neuropsychiatric interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10","volume":"59 Suppl 20","author":"Sheehan","year":"1998","journal-title":"J Clin Psychiatry"},{"key":"2024101110251649000_54.21.1247.56","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/2050-2974-1-38","article-title":"Assessing motivation to change in eating disorders: a systematic review","volume":"1","author":"Hoetzel","year":"2013","journal-title":"J Eat Disord"},{"key":"2024101110251649000_54.21.1247.57","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1111\/j.1600-0838.2010.01190.x","article-title":"Aspects of disordered eating continuum in elite high-intensity sports","volume":"20","author":"Sundgot-Borgen","year":"2010","journal-title":"Scand J Med Sci Sports"},{"key":"2024101110251649000_54.21.1247.58","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2015-094873"},{"key":"2024101110251649000_54.21.1247.59","unstructured":"Dobinson A , Cooper M , Quesnel D . The Safe Exercise at Every Stage (SEES) guideline - A clinical tool for treating and managing dysfunctional exercise in eating disorders, 2019. Available: https:\/\/static1.squarespace.com\/static\/5b6112bd365f028c9256b26d\/t\/5d1447cd6fdb9400017b5240\/1561610213659\/SEES+full+guideline+-+2019+JUNE+copy.pdf [Accessed 20 Jan 2020]."},{"key":"2024101110251649000_54.21.1247.60","doi-asserted-by":"crossref","first-page":"105","DOI":"10.2147\/OAJSM.S36528","article-title":"Prevention of eating disorders in female athletes","volume":"5","author":"Coelho","year":"2014","journal-title":"Open Access J Sports Med"},{"key":"2024101110251649000_54.21.1247.61","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/2050-2974-2-15","article-title":"Changing the course of comorbid eating disorders and depression: what is the role of public health interventions in targeting shared risk factors?","volume":"2","author":"Becker","year":"2014","journal-title":"J Eat Disord"},{"key":"2024101110251649000_54.21.1247.62","doi-asserted-by":"publisher","DOI":"10.1111\/1467-8721.00144"},{"key":"2024101110251649000_54.21.1247.63","doi-asserted-by":"publisher","DOI":"10.2165\/11597140-000000000-00000"},{"key":"2024101110251649000_54.21.1247.64","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1002\/eat.22369","article-title":"Clinicians\" practices regarding blind versus open weighing among patients with eating disorders","volume":"48","author":"Forbush","year":"2015","journal-title":"Int J Eat Disord"},{"key":"2024101110251649000_54.21.1247.65","unstructured":"Englaish SM . Weighing the options: professionals\" weighing procedures in the treatment of eating disorder patients. masters thesis. Northampton, MA, USA: School for Social Work, Smith College, 2016."},{"key":"2024101110251649000_54.21.1247.66","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3999(02)00488-9"},{"key":"2024101110251649000_54.21.1247.67","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1016\/j.bodyim.2015.04.001","article-title":"What is and what is not positive body image? conceptual foundations and construct definition","volume":"14","author":"Tylka","year":"2015","journal-title":"Body Image"},{"key":"2024101110251649000_54.21.1247.68","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2018\/6835751","article-title":"Body image of highly trained female athletes engaged in different types of sport","volume":"2018","author":"Kantanista","year":"2018","journal-title":"Biomed Res Int"},{"key":"2024101110251649000_54.21.1247.69","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1123\/wspaj.10.1.17","article-title":"Body image concerns in female exercisers and athletes: a feminist cultural studies perspective","volume":"10","author":"Krane","year":"2001","journal-title":"Women Sport Phys Act J"},{"key":"2024101110251649000_54.21.1247.70","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1177\/101269099034003005","article-title":"Some contradictions and tensions in elite sportsmen\"s attitudes towards their bodies","volume":"34","author":"Loland","year":"1999","journal-title":"Int Rev Sociol Sport"},{"key":"2024101110251649000_54.21.1247.71","doi-asserted-by":"publisher","DOI":"10.1007\/s11199-004-5466-4"},{"key":"2024101110251649000_54.21.1247.72","first-page":"32","article-title":"The relationship between gender, type of sport, body dissatisfaction, self Esteem and disordered eating behaviors in division I athletes","volume":"8","author":"Milligan","year":"2006","journal-title":"Athl Insight"},{"key":"2024101110251649000_54.21.1247.73","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.psychsport.2016.12.004","article-title":"Team weigh-ins and self-weighing: relations to body-related perceptions and disordered eating in collegiate male athletes","volume":"29","author":"Galli","year":"2017","journal-title":"Psychol Sport Exerc"},{"key":"2024101110251649000_54.21.1247.74","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2014.8040"},{"key":"2024101110251649000_54.21.1247.75","doi-asserted-by":"publisher","DOI":"10.2337\/diaspect.20.3.141"},{"key":"2024101110251649000_54.21.1247.76","doi-asserted-by":"publisher","DOI":"10.1097\/01.ogx.0000243772.33357.84"},{"key":"2024101110251649000_54.21.1247.77","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1097\/JSM.0b013e3181635664","article-title":"Weight control strategies of Olympic athletes striving for leanness: what can be done to make sport a safer environment?","volume":"18","author":"Mountjoy","year":"2008","journal-title":"Clinical Journal of Sport Medicine"},{"key":"2024101110251649000_54.21.1247.78","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association . Diagnostic and statistical manual of mental disorders (DSM-5\u00ae. 5th edn. American Psychiatric Pub, 2013.","DOI":"10.1176\/appi.books.9780890425596"},{"key":"2024101110251649000_54.21.1247.79","doi-asserted-by":"crossref","first-page":"S101","DOI":"10.1080\/02640414.2011.565783","article-title":"Elite athletes in aesthetic and Olympic weight-class sports and the challenge of body weight and body compositions","volume":"29 Suppl 1","author":"Sundgot-Borgen","year":"2011","journal-title":"J Sports Sci"},{"key":"2024101110251649000_54.21.1247.80","doi-asserted-by":"publisher","DOI":"10.1136\/bjsm.2009.064394"}],"container-title":["British Journal of Sports Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bjsports-2019-101813","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,11]],"date-time":"2024-10-11T13:27:40Z","timestamp":1728653260000},"score":1,"resource":{"primary":{"URL":"https:\/\/bjsm.bmj.com\/lookup\/doi\/10.1136\/bjsports-2019-101813"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,7,13]]},"references-count":80,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2020,10,19]]},"published-print":{"date-parts":[[2020,11]]}},"alternative-id":["10.1136\/bjsports-2019-101813"],"URL":"https:\/\/doi.org\/10.1136\/bjsports-2019-101813","relation":{},"ISSN":["0306-3674","1473-0480"],"issn-type":[{"value":"0306-3674","type":"print"},{"value":"1473-0480","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,7,13]]}}}