Exploring a positive screen for eating disorders among 7,993 elite sport pupils in Sweden and its association with everyday food practices, demographics, and sports

BACKGROUND: Eating disorders can seriously affect athletes' health and athletic performance. Negative consequences may also arise from suboptimal food practices and barriers in everyday life causing inadequate energy intake. Despite research about eating and health in various athletic populations, large-scale surveys of the Swedish elite sport school system have been lacking. Therefore, this study's first aim was to explore Swedish elite sport pupils' everyday food lives in terms of eating practices and perceived practical barriers to handling their daily food actions. A subset of these everyday eating practices and barriers was subsequently explored in relation to a positive eating disorder screen to answer the second aim which was to assess the prevalence of screening positive for eating disorder, and different associated factors. METHODS: A cross-sectional survey was conducted together with the Swedish Sports Confederation in spring 2023, where we had added 20 food-related questions including a screening tool for eating disorders, SCOFF, at the end of the main survey. Nearly 8,000 pupils across Sweden responded to both parts of the survey. Following descriptive and bivariate analyses, we performed a multiple binary logistic regression to assess associations between demographic-, food-, and sports-related variables and a positive eating disorder screen. RESULTS: Results showed that 9.5% of the pupils had a positive eating disorder screen. The factors most strongly associated with a positive screen were being female (OR = 3.50); regularly skipping meals (OR = 2.31); having a vegetarian or vegan diet (OR = 1.87); using dietary supplements (OR = 1.69); having more practical barriers (OR = 1.28); and practising an individual sport (OR = 1.40). Perceived higher levels of knowledge about what to eat to optimize health was inversely associated with a positive eating disorder screen (OR = 0.73). Half of the pupils perceived at least one practical barrier to handling their daily food actions, typically lack of time. CONCLUSIONS: Our findings underscore the importance of better support to prevent, identify, and address problematic eating behaviours in the elite sport schools, as well as implementing time-saving efforts. Eating disorders can harm athletes' health and their performance in sports. Negative effects can also come from not eating enough food because of poor eating habits or practical difficulties with food and meals. Up until now, no large studies focusing on eating and health among pupils at Swedish upper secondary elite sport schools have been made. This survey studied eating habits, food-related difficulties, and used the SCOFF-instrument as a screening tool for likely eating disorders among nearly 8,000 pupils. Almost one in ten pupils showed signs that could suggest an eating disorder. This was more common among girls, pupils who often skipped meals, those who did not eat meat, those with more practical difficulties related to eating, and those doing individual sports. Around half of the pupils said they had at least one practical problem, most often not having enough time. The study shows that elite sports schools need to give better support so pupils can manage food and eating in a healthy way. HIGHLIGHTS: • Almost ten per cent (9.5%) of the Swedish elite sport pupils screened positive for EDs. The strongest factors associated with a positive ED screen were being of female sex, regularly skipping meals, and excluding meat from the diet. • Half of the pupils (49.1%) experienced at least one practical barrier in their everyday food lives, commonly lack of time and cooking skills. A higher number of barriers also increased the likelihood of a positive ED screen. • These findings highlight the need for support from the schools; to prioritize initiatives to prevent ED risk among the pupils, and that all school and sport personnel should be able to identify problematic eating behaviour. Finally, practical education and additional school meals free of charge can further help support the pupils.