Among a sample of competitive adolescent female figure skaters, most had appropriate weights-for-heights. One-quarter of the skaters had an EAT-40 score above 30 which is indicative of clinically significant eating pathology. The skaters did report low intakes of energy and bone-building nutrients, but the majority (70%) reported no recent weight loss and all biochemical measures indicative of iron status were within the normal range. Although the mean EAT-40 score did not indicate risk of disordered eating, there were several athletes (24%) who were at high risk and, among the entire sample, the response pattern did suggest that skaters had heightened awareness of eating restraint and potential preoccupation with weight and food. Like other lean-build athletes, these athletes are at elevated risk for disordered eating, caloric restriction, low-nutrient intakes and weight-loss behaviors [5, 16–18, 29]. Prior studies with similar athletes report that dietary inadequacies and inappropriate behaviors to control weight are common [2, 7, 8, 11–15, 30]. Lean-sport athletes, especially females, report greater pressure to maintain a thin, lithe figure and low body weight than athletes in sports with less emphasis on such builds, and they are at risk of developing preoccupation with weight and body shape that may increase the likelihood of adopting extreme weight loss methods and patterns of disordered eating [11, 12].
The elite adolescent female skaters in this study were of normal body weight, despite their low reported energy intakes. Only one of the 36 skaters was classified as “underweight” by BMI-for-age and the mean BMI of 19.8 ± 2.1 SD of the group was similar to that reported in prior studies with elite adolescent skaters [5–8, 14–16, 30]. However, 38% of the skaters who reported weight history considered themselves to be overweight, and 22% reported being told by others they were overweight. Skaters are involved in a lean-build sport and may perceive pressure to alter their appearance, even if they are of healthy weights. Prior research suggests that training staff (coaches, officials, partners) are integral to skaters self-perceptions on body weight and stature [6, 29]. Therefore, it is important for training staff and skaters to understand healthful BMI ranges for elite athletes. Nutrition education efforts should focus on helping skaters understand the relationship between weight and health and learn methods to maintain optimal weight-for-height while meeting the physical demands of the sport with nutrition intervention. In addition, training staff should monitor skaters’ BMIs as undesirable BMI changes may be a warning sign of unnecessary energy restriction and weight loss.
The mean dietary intakes of energy, macro- and micronutrients recorded by skaters in this study were similar to intakes previously reported by elite skaters [5, 8, 15–17], but were lower than average when compared to normative age- and gender-matched intake data from NHANES 1999–2000 [20–23]. Based on reported EI and EER, the skaters had a reported energy deficit of 1204 ± 531 SD kcal/day. However, skaters’ body weights and BMIs were within normal range and the majority reported no downward trends in weight over time. Therefore, it is likely the dietary intake data were subject to either underreporting of food intake or overestimation of physical activity level. The degree of underreporting in this study (44%) was very high when skaters’ reported EIs were compared to their EERs; the usual degree of underreporting is estimated between 10-20% . Underreporting on food intakes is common, particularly among adolescents and athletes, and the process of recording food intake may cause individuals to alter their dietary patterns [31, 32]. The large discrepancy reported in this group may be due to the inevitable limitations involved in having adolescents keep unsupervised food records or, perhaps, to skaters’ attempts to record intakes they perceive their coaches and peers will deem desirable.
The percent contribution of each macronutrient to total intake was similar to recommendations for athletes of 55-60% carbohydrate, 12-15% protein and 20-35% fat [10, 33] and similar to results from previous skater studies [15, 30]. The main contributors to energy and bone-building nutrients, similar to other studies [14, 30], were the grain, meat, milk and sugary food groups. Skaters in the current study reported an average 91 g/day of sugar. While sugary foods may be low in micronutrients, for athletes who need calorie-dense sources of energy, such intakes should not be discouraged . High-sugar, high-fat foods are often the most efficient way to achieve the high-energy diet required to meet the dual energy demands of intense training and growth . Nutrition education efforts should focus on informing athletes and training staff on the macronutrient guidelines for athletes. Current guidelines recommend that athletes, with reference to body weight, should consume 6–10 g/kg carbohydrate and 1.2-1.7 g/kg protein . Intakes below these levels, or intakes that restrict one or more macronutrient, place athletes at risk of micronutrient deficiencies . Particular attention should be paid to the intake of bone-building nutrients like calcium, phosphorus and vitamin D, as female athletes with low energy intakes are at risk for low bone-mineral density . Current guidelines recommend 1000–1500 mg calcium and 400–800 IU Vitamin D for athletes ; adequate intake in addition to weight-bearing activity like figure skating may help promote bone strength in these young skaters .
The mean EAT-40 score was below the cut-off score of 30 that indicates risk of disordered eating attitudes, and it was comparable to scores of control subjects in the EAT-40 validation study . Ziegler et al.  reported a similar mean EAT-40 score of 14.4 in a study of elite skaters; higher EAT-40 scores in that study were associated with lower intakes of micronutrients but not with energy intake. In the current study, elevated EAT-40 scores were associated with older age and BMI but not with reported energy intake. Age and BMI are reported correlates of eating disorder risk among female skaters, as physical changes related to puberty may cause negative self-perceptions [6, 29]. Even though the mean EAT-40 score of this young group of skaters was not elevated, they did agree with many items related to restrained eating and preoccupation with weight and food and one-quarter of the skaters had elevated scores. In comparison, the lifetime prevalence of anorexia nervosa and bulimia nervosa in a nationally representative sample of US adolescent females was only 0.3% and 1.3%, respectively . Therefore, skaters need anticipatory guidance to avoid unhealthy weight control behaviors and they should be monitored for signs of caloric restriction or pathogenic weight control. Research suggests nutrition education should consider more than BMI when assessing for energy restriction . Instead, athletes should be encouraged to discuss their body image and body weight concerns to enhance understanding of their dietary practices and satisfaction with current weight and body composition . Training staff should encourage the development of realistic weight and body composition goals and should monitor their own comments or views on appearance to prevent the development of negative self-perceptions among young skaters [6, 10].
Limitations of the present study include the reliance on self-reported data and the use of three-day food records. Food and activity records were reviewed with a study staff member, however the collection and review of data were separated by two months. Records may have contained missing or incomplete records that led to misrepresentation of dietary intake and physical activity level. Future studies may combine written instructions with in-person education on the completion of dietary and physical activity records to maximize accuracy. In addition, they may consider shortening the span between collection and review of records, perhaps even utilizing daily review of records to minimize missing or misreported data. Finally, data were collected during training season; the findings of this study may not be generalized to off-season.