CSSD Eating Disorders in Athletes 4 — Questions and Answers
Question 1: A track athlete reports eating 1,800 kcal/day while training 2 hours daily. Her estimated total energy expenditure is 3,200 kcal. What is her estimated energy availability (EA) if she weighs 55 kg with 45 kg FFM?
- 20 kcal/kg FFM/day
- 29 kcal/kg FFM/day (Correct answer)
- 32 kcal/kg FFM/day
- 40 kcal/kg FFM/day
Correct answer: 29 kcal/kg FFM/day
EA = (Energy intake − Exercise energy expenditure) / FFM = (1800 − 500) / 45 ≈ 29 kcal/kg FFM/day, below the 30 kcal threshold of concern.
Question 2: Which finding distinguishes anorexia nervosa (restricting type) from avoidant/restrictive food intake disorder (ARFID) in an athlete?
- Presence of food selectivity based on texture
- Distorted body image and intense fear of weight gain (Correct answer)
- Low body weight relative to age and height
- Absence of binge-purge behaviors
Correct answer: Distorted body image and intense fear of weight gain
ARFID involves food restriction without body image disturbance or fear of weight gain, which are hallmark features unique to anorexia nervosa.
Question 3: Which bone site is considered most clinically significant for monitoring stress fracture risk in runners with low bone mineral density?
- Distal radius
- Lumbar vertebrae
- Femoral neck (Correct answer)
- Calcaneus
Correct answer: Femoral neck
The femoral neck is a high-risk site for stress fractures in runners with low BMD; fractures here can lead to complete femoral neck fracture requiring surgery.
Question 4: Which of the following best describes the concept of 'sport-specific weight pressures' as a risk factor for eating disorders?
- Athletes naturally have lower body fat needs than non-athletes
- Environmental and cultural demands within certain sports that promote thinness or weight control (Correct answer)
- The physiological need for athletes to maintain low body weight for optimal VO2 max
- Peer influence from teammates to consume sports supplements
Correct answer: Environmental and cultural demands within certain sports that promote thinness or weight control
Sport-specific weight pressures refer to external demands—from coaches, judges, teammates, or the sport's nature—that promote thinness or weight cutting as performance enhancers.
Question 5: An athlete on a multidisciplinary treatment team for an eating disorder refuses to allow the dietitian to share nutritional assessment data with the team physician. How should the dietitian proceed?
- Share the data anyway if safety is at risk
- Honor confidentiality in all circumstances without exception
- Document refusal and explore the athlete's concerns; share only if imminent harm exists (Correct answer)
- Withdraw from the treatment team immediately
Correct answer: Document refusal and explore the athlete's concerns; share only if imminent harm exists
The dietitian should explore the athlete's concerns and honor confidentiality while understanding that imminent risk of harm may ethically and legally require disclosure.
Question 6: Which population of athletes is at uniquely elevated risk for eating disorders due to the combination of weight-class requirements and sport culture?
- Distance swimmers
- Combat sport athletes (wrestling, MMA, judo) (Correct answer)
- Team handball players
- Baseball pitchers
Correct answer: Combat sport athletes (wrestling, MMA, judo)
Combat sport athletes face weight-cutting pressures to make a lower weight class, combined with a culture that normalizes extreme restriction, elevating eating disorder risk.
Question 7: What is the minimum recommended energy availability (EA) to maintain basic physiological function and hormonal health in female athletes?
- 20 kcal/kg FFM/day
- 25 kcal/kg FFM/day
- 30 kcal/kg FFM/day (Correct answer)
- 45 kcal/kg FFM/day
Correct answer: 30 kcal/kg FFM/day
Research by Loucks et al. established 30 kcal/kg FFM/day as the threshold below which reproductive and other physiological functions begin to be compromised.
CSSD Eating Disorders in Athletes 4
A track athlete reports eating 1,800 kcal/day while training 2 hours daily.
Her estimated total energy expenditure is 3,200 kcal.
What is her estimated energy availability (EA) if she weighs 55 kg with 45 kg FFM?