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This chapter describes the disordered eating in sport problem and provides a critical overview of research in the area. It offers specific insights into how cultural practices in elite sport may be implicated.

In contrast to dominant medical perspectives, disordered eating in sport is discussed as a product of high-performance cultural contexts. The ways that practice commonplace in elite sport might contribute to disordered eating onset and maintenance are described. In turn, I also consider the experiential struggles of athletes with eating disorders and how this relates to dominant discourses in elite sport.

Elite sport culture, with its emphasis on surveillance, sacrifice, and success, reinforces disordered eating practices. Much of what is conventionally considered disordered eating, can be normalized when situated in the context of high-performance sport. Nevertheless, when functional disordered eating slides into mental illness, the mental toughness ethos works to silence and stigmatize athletes.

Research must broaden its focus to explore how social practices in elite sport normalize disordered eating and how prevention approaches can become more culturally informed and less individually driven.

To explore the discursive construction of disordered eating and athlete identity meanings within elite female athlete’s stories. Published athlete autobiographies were interrogated as cultural sites of analysis to accomplish this aim.

A critical social constructionist perspective on disordered eating is outlined along with narrative research findings on female athletes and disordered eating. A discursive psychological approach and critical discourse analysis (CDA) is then discussed to theorize and study meanings of disordered eating and athlete identities/subject positions. Next, the utility of studying two elite female athlete’s autobiographies is outlined followed by examples from a CDA of two athlete stories.

Two discourses and two identity/subject positions within each are outlined: discourse of performance and the “committed, controlled athlete” and a discourse of personal growth and the “empowered athlete in transition.” The features of each discourse and subject position are outlined and examples from each athlete’s story. The intention is to show the ways in which discursive resources construct the body, food and identities in sport and the implications.

The chapter is concluded with why studying “disordered eating and body talk” within discourses is useful to expand understanding of constraining and emancipative aspects of athlete identities, struggle and recovery.

The potential problems of Kho-Kho players have been less studied. Considering eating disorders a public health problem, but also in particular for athletes, as it can cause serious health and performance decrements if left unmonitored. This study aims to determine the prevalence of disordered eating attitude and their relationship with mental health among Indian Kho-Kho players.

Fifty-two male Kho-Kho players aged 16–31 years were assessed for disordered eating attitude using Eating Attitude Test (EAT)-26 and mental health using the Depression, Anxiety and Stress Scale (DASS-21) questionnaire. Descriptive statistics and t-test were computed to know the difference between positive and negative disordered eating attitude.

The disordered eating attitude was prevalent among 11.5% of players. The players with disordered eating attitudes showed a significantly (p < 0.01) higher score for EAT-26 subscales related to dieting and oral control. Players were involved in binging (21.2%), purging (5.8%), use of laxatives (1.9%), extra exercise (>1 h) (34.6%) and lost >20 pounds of body weight in the last six months (13.5%). Depression, anxiety and stress were higher in the group with a disordered eating attitude. However, a significant difference (p < 0.01) was found only for depression.

The disordered eating attitude was present among Kho-Kho Players and linked with depression. Health care service providers are encouraged to monitor and guide the players with disordered eating attitudes to take active measures to ensure optimum health and performance.

The present paper provides evidence of disordered eating attitude linked with depression among Kho-Kho players.

This study explores young people's perceptions of eating disorders, the risks and consequences of developing an eating disorder, and the effectiveness of education and prevention programmes. Eating disorder prevention programmes are predominantly school‐based, target young women, and are delivered in weekly sessions for a six or eight‐week period. There is evidence that programmes can increase short‐term knowledge but less evidence for their impact on attitudes and behaviours. Focus groups were undertaken with 96 male and female participants, aged 13‐18, drawn from schools and informal youth settings in three local authority areas in Scotland. Participants demonstrated good understanding of eating disorders; insight into the complexity of reasons for developing a disorder (with a belief that celebrity culture and associated thin imagery has the largest influence) and strong empathy for those who experience eating disorders (as opposed to people who are obese). Television and magazines were cited as the main sources of information, with parents and friends identified as key sources of support rather than professionals. Participants indicated a desire to discuss eating disorders and for this to be incorporated into school health education programmes. Key features of school‐based programmes indicated by participants include single gender discussion groups and development of critical thinking towards the media. The study supports the need for multi‐agency discussion‐based education programmes, long‐term evaluation of impact, and the enhancement of peer support and parental awareness of issues surrounding eating disorders. It also highlights a number of gaps in research in this field.

The purpose of this paper is to describe the development of an eating disorder care pathway for adults with eating disorders, in a northern borough town. It arose out of a need to reduce and address inconsistent access to services and treatment pathways.

The development involved a mapping exercise of current service delivery, a review of the literature on eating disorder care pathways, consultation workshops, the engagement of service users and carers, and the development of draft pathways for patients and carers.

Significant emphasis was on raising awareness, prevention, identification and assessment, treatment and recovery. Two pathways were proposed, one for service users focusing on awareness raising/prevention, identification and assessment, treatment, stabilisation and relapse prevention and one for carers/families focusing on carers being identifiable in their own right to receive support for caring for someone with an eating disorder.

A limitation of the care pathway under development was the difficulty obtaining an accurate figure of the true number of cases of eating disorders in the local area. This, together with the lack of any form of systematic review or meta-analysis of care pathways made identifying the number of people suffering from eating disorders and developing an effective model difficult.

The proposed pathway places significant emphasis on increasing knowledge, incorporating the patient perspective, and enhancing the recognition and understanding of eating disorders in the community. A model was created that could be implemented successfully and identify patients suffering from eating disorders, when the true incidence of eating disorders remains hidden.

To evaluate the effectiveness of an adaptation of Interpersonal Group Psychotherapy (IPT-G), in facilitating short- and longer-term improvements in eating disorder symptomology, psychosocial impairment, anxiety, depression and attachment difficulties among adults living with overweight and diagnosed with binge eating disorder (BED).

In total, 24 participants completed measures at the start of IPT-G, mid-treatment, discharge and six-month follow-up. Quantitative outcomes were analysed utilising one-way repeated measures analysis of variance.

Treatment retention was 100%. Significant improvements in binge-eating frequency, psychosocial impairment and depression were achieved at mid-treatment and maintained at post-treatment and six-month follow-up, and with large effect sizes. Attachment anxiety had reduced significantly at post-treatment and was maintained at six-month review. Body mass index (BMI) had stabilised by mid-treatment and was maintained at post-treatment and six-month follow-up. All hypotheses were supported, with the exception that attachment avoidance did not improve significantly and following a post-treatment reduction, anxiety symptoms deteriorated slightly by six-month follow-up, such that they were no longer significantly different from pre-treatment levels.

Despite being the most prevalent of the eating disorders (compared to anorexia nervosa and bulimia nervosa), BED is under-recognised and under-treated in clinical settings. Results indicate the sustained effectiveness of IPT-G in improving eating disorder and comorbid symptomology associated with BED.

This is the first UK study to investigate the effectiveness of IPT-G at treating BED. Unlike previous studies in the field, this study did not exclude participants based on age, BMI or psychiatric comorbidity.

Pro‐eating disorder websites are online communities of individuals who do not consider eating disorders to be serious mental illnesses requiring treatment. People visit these websites to meet other like‐minded individuals, to share tips and tricks on how to lose weight and how to otherwise maintain the symptomatology of the disorder. This paper aims to review what is actually known about the risks associated with visiting these websites and provides recommendations for dealing with pro‐eating disorder material.

Relevant peer‐reviewed papers were located by means of searching three online journal databases (SCOPUS, PubMed, Web of Knowledge), and through carrying out reference checking. Key words for the search were: pro‐anorexia, pro‐ana, pro‐bulimia, pro‐mia and pro‐eating disorders.

Pro eating disorder websites are common and visited by a significant proportion of patients with eating disorders and non‐patients. The sites may be perceived beneficial, as they provide support and a sense of community. Although there is evidence for the harmfulness of pro‐eating disorder content on the internet, there is no clear indication that such sites promote the development or maintenance of eating disorders. Therefore, banning pro eating disorder websites seems inappropriate and unpractical, but measures for web‐hosting companies should be in place allowing them to remove such content. Instead, bodies creating alternative websites for young people should be supported. Clinicians and parents should be made aware of the existence of pro eating disorder websites and how to deal with them.

This paper provides an overview of the research in this field and discusses possible ways in which health professionals and the general public may respond to the existence of these web sites.