Identifying latent classes of Relative Energy Deficiency in Sport (RED-S) consequences in a sample of collegiate female cross country runners.

OBJECTIVE: The purpose of this study was to identify patterns of clustering of the 10 health consequences identified in the Relative Energy Deficiency in Sport (RED-S) framework among collegiate female Cross-Country runners. We also assessed risk characteristics associated with each cluster. METHODS: This randomly sampled population included 211 current National Collegiate Athletics Association (NCAA) Division I (DI) female cross country runners who completed a quantitative survey. We used latent class analysis (LCA) to group athletes into mutually exclusive classes based on shared response patterns of RED-S consequences. We computed descriptive statistics to identify demographics, personal characteristics, disordered eating and emotional health characteristics associated with each class. RESULTS: The average age of the sample was 21 years with mean body mass index 20.4 kg/m2. The LCA identified three unique classes of potential RED-S presentations: (1) low probability of RED-S consequences; (2) complex physical and psychological concerns with a higher burden of cardiovascular concern and (3) very high probability of anxiety with high burden of menstrual disturbance, bone injury and gastrointestinal concern. All classes were characterised by high levels of menstrual disturbance and distinguished by the number and burden of other potential RED-S consequences and in reported abuse history, emotional regulation and perfectionism. CONCLUSION: This study identified a high burden of menstrual disturbance in NCAA D1 cross country runners, and three unique presentations of RED-S consequences. Future research is warranted to better understand how early prevention and intervention strategies may mitigate RED-S consequences in distance runners.

Cultural and environmental associations with body image, diet and well-being in NCAA DI female distance runners: a qualitative analysis.

OBJECTIVE: We aimed to describe current and former National Collegiate Athletic Association (NCAA) Division One (DI) female distance runners' experiences of perceived norms of body image and disordered eating in their sport, as well as the emergence and influence of coach-athlete power dynamics.This manuscript reports a qualitative research study (consisting of interviews and thematic analysis) of women athletes' experiences of perceived norms of body image and disordered eating in their sport. We also report athletes' experiences of coach-athlete power dynamics. METHODS: The study sample included 29 current and former female NCAA DI female distance runners, defined as competing in 800-metre distance or greater. Interviews were conducted, audio-recorded and hand transcribed. A thematic analysis was performed and presented. RESULTS: Two major themes emerged: (1) sport body ideals and body image norms and myths that exist in the sport, and (2) the power dynamic between athletes and coaches. It is not clear whether sport body ideals and culture of running influences coaching culture, or whether the coaches-who maintain positions of power in the sport-perpetuate the culture. These themes likely feed into each other and reinforce the existing and dominant mentalities of the sport. CONCLUSION: Sport body image ideals and the power dynamic between coach and athlete may contribute to female athlete's risk of disordered eating and body image disturbance. We call for the NCAA and athletic departments to develop and implement prevention and intervention programmes to prevent eating and body image disorders in this high-risk population.