Jorunn Kaiander Sundgot Borgen

• Lundberg, Helge Einar; Larsen, Stig; Mathisen, Therese Fostervold; Borgen, Tove Tveitan & Sundgot-Borgen, Jorunn (2026). Propionibacterium cheese and bone turnover in active young adults: a randomized-controlled trial. Journal of Bone and Mineral Metabolism. ISSN 0914-8779. doi: 10.1007/s00774-026-01761-9. Full text in Research Archive Show summary

  Introduction Young physically active individuals exposed to prolonged physiological stress and low energy availability are prone to reduced gonadal steroid protection and increased bone turnover. Nutritional strategies that favor positive bone remodeling balance are of clinical interest. Jarlsberg cheese contains Propionibacterium freudenreichii (PF), which produces vitamin K₂ and 1,4-dihydroxy-2-naphthoic acid (DHNA), compounds with potential favorable effects on bone health. Materials and Methods In this 24-week sex-stratified randomized-controlled trial, 60 young physically active adults engaged in endurance training were allocated to daily intake of either Jarlsberg cheese or a nutritionally comparable control cheese without PF. The primary outcome was change in serum total osteocalcin (tOC). Secondary outcomes were changes in carboxylated osteocalcin (cOC), procollagen type 1 N-terminal propeptide (P1NP), cross-linked C-terminal telopeptide of type I collagen (CTX), P1NP/CTX ratio, lumbar spine bone mineral density (BMD), and trabecular bone score (TBS). Results After 24 weeks, serum tOC was significantly higher in the Jarlsberg group than in controls (38.0 vs. 26.8 ng/mL, p < 0.01). cOC and P1NP/CTX ratio increased in favor of the Jarlsberg group (p = 0.03). Lumbar spine BMD increased in the Jarlsberg group (mean change 0.012 g/cm2, p = 0.03), with a greater increase than in controls (p = 0.05), and TBS showed a positive trend in the Jarlsberg group. Conclusion Daily intake of cheese-containing PF was associated with favorable changes in bone turnover markers and increase in lumbar spine BMD. These findings suggest that PF-fermented cheese may support bone metabolism in young individuals exposed to reduced hormonal protection and high bone turnover.

• Mathisen, Therese Fostervold; Macnaughton, Lindsay; Mountjoy, Margo & Sundgot-Borgen, Jorunn (2026). Implementation gap: a 3-year reality check in body composition monitoring in sport. British Journal of Sports Medicine. ISSN 0306-3674. doi: https:/bjsm.bmj.com/content/early/2026/09/02/bjsports-2026-112287. Full text in Research Archive
• Øistuen, Gina Flugstad; Osborne, John Owen; Sundgot-Borgen, Jorunn; Noordhof, Dionne; Taylor, Madison Y. & Heikura, Ida [Show all 16 contributors for this article] (2026). Menstrual status and bone health in athletes from different sports – a retrospective analysis. BMC sports science, medicine and rehabilitation. doi: 10.1186/s13102-026-01781-y. Full text in Research Archive Show summary

  Abstract Background Relative energy deficiency in sport (REDs) is linked to low energy availability, menstrual disturbances (MD) and low bone mineral density (BMD; Z-score < -1.0). The prevalence of these symptoms across sports and their interrelationships requires further investigation. This study aimed to 1) investigate the prevalence of severe MD and low BMD among athletes from different sports, 2) compare BMD Z-scores at lumbar spine, total hip and whole-body between regularly menstruating (RM), severe MD and hormonal contraceptive (HC) users, and 3) examine factors related to BMD among endurance athletes, including menstrual status, athletic caliber and sport-specific loading characteristics. Methods Retrospective analysis of cross-sectional data from seven projects included 411 women from 34 sports (endurance: n = 257; non-endurance: n = 154). BMD was assessed using dual-energy X-ray absorptiometry. Menstrual status was defined by the three-step method, cycle tracking or questionnaire, and categorized as RM, severe MD or HC. Endurance sports were further grouped by loading characteristics (very low, low and medium). Results Among non-HC users (51%), the prevalence of severe MD was 37% in endurance, 34% in ball sport and 36% in power- and technical- sports. BMD was not different between menstrual status groups at either lumbar spine ( P  = 0.334), total hip ( P  = 0.079) or whole-body ( P  = 0.164). Endurance athletes had lower lumbar spine BMD Z-scores than non-endurance athletes (-0.0 ± 1.0 vs 1.2 ± 1.2, P  < 0.0001), with a higher prevalence of low BMD (17% vs 2%, P  = 0.015). Total hip BMD Z-scores were lower in endurance than non-endurance athletes (0.6 ± 0.9 vs 1.4 ± 1.2, P  < 0.05 for age < 27). Among endurance athletes, neither loading characteristics nor athletic caliber were associated with BMD. However, endurance athletes with severe MD had lower total hip BMD Z-scores compared to RM athletes ( P  = 0.008) and HC users ( P  = 0.021). Conclusions The prevalence of severe MD did not differ between sport types. Overall, BMD Z-scores did not differ across menstrual status categories. However, endurance athletes had lower BMD, with total hip BMD being lower in those with severe MD. Heterogenous menstrual assessment methods across the projects included in this study may have impacted the results. Future research should integrate comprehensive REDs assessments including detailed data on menstrual status, training history, bone-loading impact and injuries in female athletes from different sports.

• Sundgot-Borgen, Christine; Sundgot-Borgen, Jorunn & Mathisen, Therese Fostervold (2026). Appearance Pressure, Body Image, and Nutrition Practices in Youth Athletes: Implications for Performance. International Journal of Sports Physiology and Performance (IJSPP). ISSN 1555-0265. doi: 10.1123/ijspp.2025-0687. Full text in Research Archive Show summary

  Elite youth sport (12–19 y of age) exists at the intersection of increasing performance demands, rapid biological development, and growing appearance pressures. For many adolescent athletes, this convergence blurs the distinction between fueling to support performance and manipulating food intake to conform to perceived physique ideals. As cultural and digital body norms intensify through social media engagement, leanness is frequently misconstrued as a marker of success—despite clear evidence that inadequate fueling undermines the physiological and psychological systems required for athletic development.1 A recalibration is needed: nutrition in youth sport must be reframed as a biological prerequisite for growth, adaptation, resilience, sustained enjoyment of sport, and the sustainable development of athletic performance across the developmental years.

• Heradstveit, Siri; Garnweidner-Holme, Lisa; Winje, Brita Askeland; Sundgot-Borgen, Jorunn & Mathisen, Therese Fostervold (2026). Knowledge of Eating Disorders and Relative Energy Deficiency in Sports among Public Health Nurses at Elite Sport Schools. Sage Open Nursing. 12. doi: 10.1177/23779608251407784. Full text in Research Archive
• Mathisen, Therese Fostervold; Mountjoy, Margo & Sundgot-Borgen, Jorunn (2026). Strong Bodies, Unclear Guidelines—Navigating Pregnancy and Postpartum Without Tailored Resistance Exercise Guidelines. Women in Sport & Physical Activity Journal. ISSN 1063-6161. 34(1). doi: 10.1123/wspaj.2025-0112. Full text in Research Archive Show summary

  Objective: This study explored the experiences of female athletes performing heavy resistance exercise during pregnancy and postpartum (REX group) and reflected these against experiences of physically active women not engaging in heavy resistance exercise (REF group). Design: Secondary outcomes from a prospective, longitudinal study following two exercising groups of pregnant women through pregnancy and up to 12 months postpartum. Data were collected via questionnaires and analyzed using inductive content analysis. Results: Thirty-two women were included in the REX group and 17 were in the REF group. Of all participants, 35% reported receiving warnings against their usual training—most often from midwives. Although REX participants typically faced concerns related to heavy resistance exercise, REF participants also reported warnings, particularly about high-intensity exercise. Three key themes emerged from pregnancy responses: “training for two: joy, strength, and sanity through exercise”; “between warnings and worries: pregnant women’s struggle for reliable advice”; and “strength over strain: why resistance training works in pregnancy.” Two themes were identified postpartum: “new priorities, new physique” and “when experts fall silent.” Conclusion: Women training beyond standard health recommendations often encounter concerns from healthcare providers and others. Although the female athletes rely on personal experience, many express doubt and frustration due to the lack of tailored, evidence-based advice. Exercise, especially resistance exercise, was seen as vital for both mental and physical health, particularly when other forms of movement were limited by pregnancy or postpartum symptoms.

• Lundberg, Helge Einar; Larsen, Stig; Sundgot-Borgen, Jorunn & Mathisen, Therese Fostervold (2026). Seasonal changes in energy intake and emerging indicators of energy availability in young elite Nordic skiers. Journal of the International Society of Sports Nutrition (JISSN). 23(1). doi: 10.1080/15502783.2026.2634184. Full text in Research Archive Show summary

  Background Nordic skiing, an energy-demanding endurance sport, may be particularly susceptible to low energy availability (LEA) and relative energy deficiency in sport (REDs). The objective was to examine the nutritional practices and physical symptoms associated with (REDs among young elite Norwegian Nordic skiers during the off-season, with particular emphasis on energy and CHO intake, in the transition from the competitive season to preparation for the subsequent season. Methods Thirty female and thirty male Nordic skiers participated in a 24-week controlled clinical trial. The daily dietary intake variables were carbohydrates (CHO), protein, and calcium (Ca) intake and weekly training hours. The blood variables were vitamin D, total osteocalcin (tOC), procollagen type 1 N-terminal propeptide/cross-linked C-telopeptide type 1-collagen (PINP1/CTX1) ratio, heart rate (HR), resting metabolic rate (RMR), bone mineral density (BMD), lean body mass (LM), visceral adipose tissue (VAT), and body fat percentage (BF%). Results Energy intake increased by 25%, and CHO increased by 14.5% for both sexes during the study, and training volume increased by 41% for female athletes and 83% for male athletes, respectively. There were positive correlations between higher BMD, bone markers, RMR, and LM and negative correlations between VAT and REDs symptoms. VAT was correlated with RMR and bone markers. LM emerged as a key predictor for health variables, explaining variability across multiple REDs markers. Conclusions Nordic skiers seem unable to increase energy intake sufficiently during the preparation period, leading up to the competitive season, as demonstrated by a large discrepancy between changes in energy intake, especially CHO, and exercise volume. The correlations between energy intake and BMD, RMR, VAT, and HR underscore the clinical consequences of insufficient energy intake, which may arise if individuals focus on low body mass and body fat percentage without sufficient knowledge. VAT, tOC, and the P1NP/CTX-ratio are promising indicators for monitoring dietary interventions in individuals with REDs and should be considered in future research on REDs treatment strategies.

• Mathisen, Therese Fostervold; Sundgot-Borgen, Jorunn; Macnaughton, Lindsay; Rustaden, Anne Mette; Løkkevik, Inger Johanne & Lundberg, Helge Einar [Show all 7 contributors for this article] (2025). Knowledge of low energy availability in biathlon: Why coaches need more targeted education. Results from a national, cross-sectional study. International journal of sports science & coaching. ISSN 1747-9541. doi: 10.1177/17479541251407845. Full text in Research Archive Show summary

  This study explores the knowledge of coaches working with adolescent biathletes regarding eating disorders (ED), low energy availability (LEA), and Relative Energy Deficiency in Sport (REDs). METHODS: Recruited coaches completed a questionnaire assessing self-reported knowledge (scale 0–10) of ED, LEA and REDs, and secondly by articulating their knowledge (scored by three experts, scale 0–2). RESULTS: Thirty-three coaches participated (mean age 40.6 ± 12.2 years), most without formal coach education (n = 25, 75.8%), and 13 (39.4%) were female. Self-reported knowledge of LEA/REDs was lower than ED knowledge (4.75 ± 2.9 vs. 5.74 ± 2.5; p = 0.02, g = 0.4), with a similar pattern in expert-rated scores (0.72 ± 0.6 vs. 1.12 ± 0.6; p < 0.01, g = 0.8). A regression model explained 45% of variance in self-reported LEA/REDs knowledge, with education level and course participation positively associated, while sex had no significant effect. For expert-rated scores, the model explained 33% of variance, with only course participation significant. For knowledge of guidelines on addressing LEA/REDs concerns self-reported scores were 3.6 ± 2.9, and 4.5 ± 2.9 for ED concerns (p = 0.04, g = 0.4); and expert-assessed scores were 0.7 ± 0.7 and 0.9 ± 0.8 (p = 0.11), respectively. Regression models did not significantly explain variability in these scores CONCLUSION: Biathlon coaches are less aware of LEA/REDs symptoms and less confident in addressing them than symptoms of ED. Importantly, education and course attendance raised knowledge scores, and preferred learning methods were virtual or physical courses with experts over scientific papers.

• Lundberg, Helge Einar; Larsen, Stig; Mathisen, Therese Fostervold & Sundgot-Borgen, Jorunn (2025). Comparison of cheese with and without Propionibacterium freudenreichii subsp. shermanii LMGT 2951 on off-season muscle strength and VO2 max development in Nordic skiers: a randomized clinical trial. Journal of the International Society of Sports Nutrition (JISSN). 22(1). doi: 10.1080/15502783.2025.2566373. Full text in Research Archive Show summary

  Background and objective: Nordic skiers represent a low-impact, weight-sensitive sport and may be inclined to engage in weight-controlling behavior, hence increasing their risk for low energy availability and impairment in health and performance. Jarlsberg cheese (J) is rich in vitamin K₂ from fermentation by Propionibacterium freudenreichii subsp. shermanii LMGT 2951 (Pf) and lactic acid bacteria and increases the osteocalcin (OC) level. Vitamin K is essential for activating OC, which is described to be associated positively with muscle strength, whereas propionic acid bacteria are found to enhance endurance. Except for Pf and its by-products, J and Norvegia (N) cheeses have almost identical nutrient content. The objective of this study was to compare the effects of Jarlsberg and N as potential supplements to training on muscle strength (MS), lean body mass (LBM) and VO2 max. Methods: Thirty female and 30 male Nordic skiers were block randomized 1:1 to either J or N and studied during a 24-week offseason training schedule. The Norvegia group served as a control group. Females and males were treated with 75 and 90 grams/day, respectively. MS by seated pulldown and half-squat, LBM by DXA, and VO2 max were measured at baseline and after the 24 weeks off-season period. Dietary intake and training hours were registered and monitored at baseline and every eight weeks during the study. Results: MS significantly increased in both groups after 24 weeks (p < 0.01). The mean increase difference in MS-upper body favored Jarlsberg by 0.95 kg (95% CI: −0.02–1.46), approaching significance (p = 0.06). No significant difference was found between groups in MS-lower body. LBM and VO2-max both increased significantly in each group (p ≤ 0.05), with no notable differences between groups. Correlation analysis identified LBM as the dominant outcome variable at both baseline and 24 weeks. Endurance training was the dominant input variable and correlated significantly positively both multiply and partially to LBM, (p = 0.04, p = 0.02), respectively. At baseline and 24-weeks sex, endurance training along with OC-level explained 65% and 68% of the LBM variations, respectively. Conclusion: Both Jarlsberg cheese, characterized by its unique Propionibacterium freudenreichii content, and Norvegia cheese, when combined with off-season training, led to increases in LBM, VO₂ max, and MS, with no significant differences observed between groups. However, there was a trend toward greater improvements in MS in the Jarlsberg group. Overall, increases in LBM through structured training appear to be a key driver of gains in both muscle strength and aerobic capacity.

• Dalhaug, Emilie Frederikke Mass; Sanda, Birgitte; Bø, Kari; Brown, Wendy J.; Sundgot-Borgen, Jorunn & Haakstad, Lene Annette Hagen (2025). Exceeding the guidelines: A descriptive study of exercise, pregnancy, maternal and neonatal health outcomes in elite and recreational athletes. BMC Pregnancy and Childbirth. 25(1). doi: 10.1186/s12884-025-07572-6. Full text in Research Archive Show summary

  Background Exercise during pregnancy is associated with numerous health benefits. However, guidelines for elite and recreational athletes, who often exceed general recommendations regarding intensity, duration, and frequency are lacking, and potential risks remain unclear. The aim of the study was to describe exercise levels, pregnancy, and maternal and neonatal health outcomes in elite and recreational athletes. Method This study was part of the Strong Mama research project, which was carried out in Oslo, Norway, between October 2022 and February 2024. Sixty athletes (10 elite and 50 recreational) participated in the study. They completed an online survey during late pregnancy and participated in a structured telephone interview six weeks postpartum. The survey and interview collected data on exercise habits, pregnancy experiences, and maternal and neonatal health outcomes. Results The athletes maintained high exercise levels during pregnancy, with elite athletes exercising an average of 11.6 h per week (SD 3.2) and recreational athletes exercising 7.0 h per week (SD 2.4). Most athletes resumed exercising within six weeks postpartum. Almost all pregnancies were planned, including six which involved fertility treatment. Most women (76.7%) had spontaneous onset of labor and vaginal deliveries to term (between 36 and 42 weeks). The mean birthweight was 3487 (SD 519.4, range 2600–4775) grams. Two of the elite athletes were diagnosed with gestational diabetes mellitus and two with hypertension during pregnancy. None of the 50 recreational athletes reported any pregnancy complications. Conclusion High levels of exercise during pregnancy did not seem to negatively impact maternal or neonatal health in this descriptive sample of Norwegian elite and recreational athletes. However, more research is needed to confirm these findings

• Sundgot-Borgen, Christine; Sundgot-Borgen, Jorunn; Sølvberg, Nina; Torstveit, Monica Klungland; Mountjoy, Margo & Mathisen, Therese Fostervold (2025). Factors predicting disordered eating and the prevalence of eating disorders in adolescent elite athletes, trained athletes and a reference group: a prospective controlled two-step study. British Journal of Sports Medicine. ISSN 0306-3674. 59(15), p. 1043–1054. doi: 10.1136/bjsports-2024-108808. Full text in Research Archive Show summary

  Abstract Objective To prospectively examine the prevalence of diagnosed eating disorders (ED-diagnosis), ED-symptoms and factors predicting ED-symptoms in three male and female high school student groups: elite athletes, trained athletes and a non-athlete reference group at baseline (T1) and 1-year follow-up (T2). Methods A survey was administered at baseline (T1) (n=1186) and 1-year follow-up (T2) (n=1144) (step-one). Participants classified with ED-symptoms by the Eating Disorder Examination Questionnaire (EDEQ 6.0) at T2 were invited to a diagnostic interview (step-two). Results Prevalence of ED-diagnosis for males and females were 6.9% and 9.3% in elite athletes, 5.9% and 11.2% in trained athletes and 3.0% and 11.9% in references, respectively. No group differences were statistically significant. Male references had more ED-symptoms compared with elite and trained male athletes (EDEQ-global score 0.81 vs <0.55), while elite female athletes had fewer ED-symptoms compared with trained female athletes and female references (EDEQ-global score 1.14 vs >1.59). Trained female athletes increased ED-symptoms over time, whereas elite female athletes consistently had fewer ED-symptoms in comparison. High ED-symptom presentation was predicted by high body mass index and more psychological distress in males, whereas for females, ED-symptoms were predicted by lower resilience, more psychological distress and being a non-athlete reference. Conclusion No statistically significant group differences in the prevalence of ED-diagnosis were observed between elite athletes, trained athletes and a non-athlete reference group. Female elite athletes had fewer ED-symptoms compared with other female groups, and male references had more ED-symptoms compared with male athlete groups. Preventive measures that address psychological resilience and distress should be considered.

• Mathisen, Therese Fostervold; Hubin, Aliaksandr; Mountjoy, Margo & Sundgot-Borgen, Jorunn (2025). Safety of Heavy Resistance Exercise During Pregnancy and Postpartum: A Controlled, Prospective Cohort Study. Women in Sport & Physical Activity Journal. ISSN 1063-6161. doi: 10.1123/wspaj.2025-0010. Full text in Research Archive Show summary

  Objective: To address the knowledge gap on the influence of heavy free-weight resistance exercise on the health of the pregnant athlete and infant. Design: This is a prospective, controlled cohort study with two groups of pregnant women; those engaging in mainly heavy free-weight resistance exercise (REX, n = 33) and those regularly physically active (REF, n = 20). Data originate from eight questionnaires answered prospectively throughout pregnancy and 12 months postpartum. Variables cover exercise routines, pregnancy symptoms and complications, fetal growth, delivery, and mother and infant’s health. Results: Bayesian logistic regression with random and fixed effects identified group membership as a significant predictor of proteinuria, with REX having higher exposure (posterior inclusion probability [PIP] = 1.00; β1 = 197.07, 95% credible interval [CrI] [163.05, 231.08]). Further, Bayesian logistic regression with random and fixed effects confirmed a higher risk of urinary incontinence in the REF group during pregnancy (PIP = 0.98; β1 = −1.17, 95% CrI [−1.89, −0.46]). Gas incontinence was also found more common in the REF group during pregnancy (PIP = 1.00; β1 = −7.62, 95% CrI [−8.68, −6.57]) and postpartum (PIP = 0.91; β1 = −49.39, 95% CrI [−53.57, −45.43]). There were no significant differences in the postpartum period for fecal and urinary incontinence, injuries, infant health outcomes (all PIP < 0.01), or need for assisted delivery (PIP = 0.33). Conclusion: Female athletes experienced in heavy resistance exercise, who continue training during pregnancy and postpartum, do not face increased pregnancy complications. These findings provide evidence supporting safety of such exercise. Yet we highlight the need for a confirmatory study under full clinical supervision.

• Sundgot-Borgen, Jorunn; Torstveit, Monica Klungland; Mathisen, Therese Fostervold & Pensgaard, Anne Marte (2024). Nye retningslinjer for syndromet relativ energimangel i idrett (REDs). Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 144(6), p. 462–462. doi: 10.4045/tidsskr.24.0181. Full text in Research Archive Show summary

  Lav energitilgjengelighet gir dårligere prestasjoner og flere skader. I mange idretter har utøvere et betydelig energibehov for å opprettholde effekten av nødvendig treningsmengde og ønskede konkurranseprestasjoner. Innen idrettsmedisin anvendes uttrykket lav energitilgjengelighet (Low Energy Availability, LEA) for å beskrive en tilstand der energiinntaket er for lavt til å dekke basale energibehov dersom trening tar for mye av energitilførselen. Når eksponeringen for dette er langvarig eller av betydelig størrelse, kalles det problematisk lav energitilgjengelighet (1). Dette vil over tid bidra til ulike negative fysiologiske og psykologiske helse- og prestasjonsrelaterte effekter, en tilstand som omtales som relativ energimangel i idrett (Relative Energy Deficiency in Sport, REDs) (2). Ifølge Den internasjonale olympiske komité (IOC) sin konsensusrapport fra 2023 er relativ energimangel et klinisk diagnostisert, multifaktorielt syndrom karakterisert ved en samling av negative helse- og prestasjonsutfall som følge av eksponering for problematisk lav energitilgjengelighet.

• Lundberg, Helge Einar; Sundgot-Borgen, Jorunn; Mathisen, Therese Fostervold; Holo, Helge; Whist, Anne Cathrine & Larsen, Stig (2024). Cheese positively affects serum osteocalcin levels, bone turnover markers and bone mineral density in cross-country skiers: a dose-response study. International Journal of Clinical Trials (IJCT). ISSN 2349-3240. 11(2). doi: 10.18203/2349-3259.ijct20240961. Full text in Research Archive
• Mountjoy, Margo; Melin, Anna; Sundgot-Borgen, Jorunn & Torstveit, Monica Klungland (2024). Relative energy deficiency in sport a clinical approach for athletics athletes. ASPETAR Sports Medicine Journal. ISSN 2304-0904. 13. Full text in Research Archive
• Mathisen, Therese Fostervold; Pettersen, Gunn; Rosenvinge, Jan Harald; Schmidt, Ulrike H. & Sundgot-Borgen, Jorunn (2024). Expectations of a new eating disorder treatment and its delivery: Perspectives of patients and new therapists. International Journal of Eating Disorders. ISSN 0276-3478. 57(3), p. 695–702. doi: 10.1002/eat.24165. Full text in Research Archive Show summary

  Background: A significant number of people with bulimia nervosa (BN) or binge-eating disorder (BED) do not seek professional help. Important reasons include limited knowledge of eating disorders (EDs), feelings of shame, treatment costs, and restricted access to specialized healthcare. In this study, we explored if a novel therapy delivered in a primary care setting could overcome these barriers. We investigated factors such as motivation and expectations and included the patients' and newly trained therapists' perspectives. Method: We interviewed 10 women with BN (n = 2) or BED (n = 8), enrolled in the Physical Exercise and Dietary therapy (PED-t) program, in a Healthy Life Center (HLC) located in a primary healthcare facility. Interview topics discussed were motivations for and expectations of therapy, and the treatment location. In addition, 10 therapists from HLC's were interviewed on their experiences with the PED-t training program and expectations of running PED-t within their service. The semi-structured interviews were analyzed using reflexive thematic analysis. Results: Most patients had limited knowledge about EDs and first realized the need for professional help after learning about PED-t. Patients exhibited strong motivations for treatment and a positive perception of both the PED-t, the new treatment setting, and the therapists' competencies. The therapists, following a brief training program, felt confident in their abilities to treat EDs and provide PED-t. With minor operational adjustments, PED-t can seamlessly be integrated into national HLC service locations. Conclusion: PED-t is an accessible therapeutic service that can be delivered in a primary care environment in a stepped-care therapy model. Public Significance: This study investigates the views and experiences of patients and newly trained therapists of PED-t (Physical Exercise and Dietary therapy), a new program-led primary care therapy for binge-eating spectrum eating disorders. The treatment and the locations for the intervention, that is, local health care centers, were found to be highly acceptable to both patients and therapists, thus PED-t could easily be integrated as a first step into a step-care delivery model.

• Dasa, Marcus Småvik; Friborg, Oddgeir; Kristoffersen, Morten; Pettersen, Gunn; Sagen, Jørn Vegard & Torstveit, Monica Klungland [Show all 8 contributors for this article] (2024). Risk and prevalence of Relative Energy Deficiency in Sport (REDs) among professional female football players. European Journal of Sport Science (EJSS). ISSN 1746-1391. 24(7), p. 1032–1041. doi: 10.1002/ejsc.12129. Full text in Research Archive Show summary

  A high prevalence of low energy availability (LEA) has been reported in female football players. This is of concern as problematic LEA may evolve into a syndromic pattern known as relative energy deficiency in sport (REDs). Given the difficulties in accurately assessing LEA, our study shifts emphasis to measurable indicators of REDs, serving as proxies for health detriments caused by LEA. The present cross-sectional study aimed to quantify the risk of REDs and to assess the prevalence of indicators indicative of the syndrome. 60 players (tiers 3 and 4) from three Norwegian football teams were analyzed as a single cohort but also stratified based on player position and menstrual status. The proportion of players at risk for REDs was 22%, that is, 17% with mild, 3% with moderate to high, and 2% with very high/extreme risk, respectively. The majority of the cohort (71%) presented with no primary indicators, while 20%, 7%, and 2% presented with one, two, and three primary indicators, respectively. Regarding secondary indicators, 57% had none, 33% had one, and 10% had two indicators. For associated indicators, 30% had none, 42% had one, 18% had two, 8% had three, and 2% had four indicators. Player position did not affect the prevalence of REDs indicators. Among noncontraceptive users (n = 27), secondary amenorrhea (AME) was reported by 30%. These findings indicate that health and performance teams should prioritize universal health promoting strategies rather than selective or indicative strategies. Particularly, focus on nutritional periodization to secure sufficient energy availability, mitigating the risk of problematic LEA and REDs should be addressed.

• Lichtenstein, Mia Beck; Hertz, Søren Peter Thygesen; Johansen, Karen Krogh; Rytter, Josefine; Sundgot-Borgen, Jorunn & Torstveit, Monica Klungland [Show all 8 contributors for this article] (2024). Are Sub-elite Athletes at Higher Risk of Eating Disorders, Exercise Addiction, Depression, and Low Energy Availability Compared with Elite Athletes? Clinical Journal of Sports Medicine. ISSN 1050-642X. doi: 10.1097/JSM.0000000000001257. Full text in Research Archive
• Johansson, Fred; Edlund, Klara; Sundgot-Borgen, Jorunn; Björklund, Christina; Côté, Pierre & Onell, Clara [Show all 8 contributors for this article] (2024). Sexual harassment, sexual violence and subsequent depression and anxiety symptoms among Swedish university students: a cohort study. Social Psychiatry and Psychiatric Epidemiology. ISSN 0933-7954. 59(12), p. 2313–2322. doi: 10.1007/s00127-024-02688-0. Full text in Research Archive Show summary

  Purpose: To determine the gender-specific impact of recent exposure to different forms of sexual harassment and sexual violence (SHV) on depression and anxiety symptoms three, six, and nine months later. Methods: We recruited 2229 women and 1274 men studying at Swedish universities and followed them with web-surveys every three months over one year. We estimated mean differences (MDs) of depression and anxiety symptoms between exposed and unexposed at each follow-up, adjusting for prior SHV, prior depression and anxiety symptoms and potential confounders. Results: For women, sexual harassment (wide subjective definition) was associated with higher symptom levels of depression (MD 1.0 [95% CI: 0.3; 1.7]) and anxiety (MD 0.8 [95% CI: 0.3; 1.4]) three months later. Unwanted sexual attention was associated with higher symptom levels of anxiety three (MD 0.5 [95% CI: 0.1; 0.8]) and six months later (MD 0.4 [95% CI: 0.0; 0.7]). Exposure to sex against ones will was associated with higher depression symptoms three (MD 1.7 [95% CI: 0.1;3.4]), and six months later (MD 3.1 [95% CI: 1.0; 5.2]). Trends indicated that associations with subsequent mental health differed between forms of SHV among women, and that most associations were more pronounced in temporal proximity to the exposures. For men, we refrain from interpreting the results since they showed high variability and were not robust to sensitivity analyses using multiple imputation to account for missing outcome data. Conclusions: Among women, several forms of SHV were associated with higher subsequent depression and anxiety symptoms.

• Sundgot-Borgen, Christine; Wisting, Line Norøm; Sundgot-Borgen, Jorunn; Lied, Karoline Steenbuch; Skrede, Jenny Vik & Nilsen, Karoline [Show all 8 contributors for this article] (2024). The “Young Athlete Body Project”—A pilot study evaluating the acceptability of and results from an eating disorder prevention program for adolescent athletes. International Journal of Eating Disorders. ISSN 0276-3478. 57(3), p. 568–580. doi: 10.1002/eat.24140. Full text in Research Archive Show summary

  Background: The high frequency of eating disorders (EDs) in sports speaks of a need for early-stage preventive measures. Objectives: This study evaluated the acceptability of an age, sex, and sports adapted version of the “Body Project” and changes in mental health symptoms. Methods: This noncontrolled pilot study included a class of athletes from 18 sports (N = 73, 13–14 years) at a sport-specialized junior high school in six small-group workshops. We interviewed 34 athletes on program acceptability, and all athletes responded to questionnaires at pretest, posttest, and 6-month follow-up including the Body Appreciation Scale 2–Children, Social Attitudes towards Appearance Questionnaire-4 revised, Eating Disorder Examination Questionnaire Short form-12 modified, and questions about body appearance pressure (BAP). Results: Athletes found the program acceptable and beneficial, but some missed physically oriented activities or did not identify with the focus, particularly boys. There were acceptable levels in mental health constructs before the workshops. There were temporary changes in the percentage of boys experiencing “BAP in society” by −14.8% points (95% CI: −.6 to .0, p = .04), % in total group experiencing “BAP at school” by +11% points (95% CI: .0–.2, p = .05), thinness idealization by girls (g = .6, p = .002) and total group (g = .4, p = .006), and muscularity idealization by boys (g = .3, p = .05) and total group (g = .23, p = .04). Discussion: Athletes experienced benefits from the Young Athlete Body Project. Seeing stabilization in outcomes may mean a dampening of the otherwise expected worsening in body appreciation and ED symptoms over time. Public Significance: Adolescent athletes are at risk for developing EDs. Due to lack of prevention programs for this group, we adapted and evaluated a well-documented effective program, the Body Project, to fit male and female athletes

• Stornæs, Annett Victoria; Sundgot-Borgen, Jorunn; Pettersen, Gunn; Rosenvinge, Jan H & Nordin-Bates, Sanna M. (2023). Self-Expectations, Socially Prescribed Expectations, and Wellness in 14- to 15-Year-Old Athletes, Ballet, and Music Students in Norwegian Talent Schools—An Interview Study. The Sport Psychologist. ISSN 0888-4781. 37(2), p. 92–105. doi: 10.1123/tsp.2022-0133. Full text in Research Archive Show summary

  Talent-school settings may generate stress via demanding expectations. To investigate students representing Norway’s growing phenomenon of early adolescent talent schools, we interviewed twenty-seven 14- to15-year-old boys and girls about their experiences with self- and socially imposed expectations. Students were recruited from two sports schools (n = 14) and one school each with talent classes for ballet (n = 7) and music (n = 6). Using reflexive thematic analysis, we found four main themes representing the performers’ accounts of (a) self-oriented expectations of persistent hard work, evoking self-doubts, and never-give-up attitudes; (b) coaches’/teachers’ socially prescribed expectations, stimulating hard work, and pursuit of approval and opportunities; (c) parental expectations, reflected as helpful support, concerns of letting parents down, and negotiating independence; and (d) struggles with balancing expectations, reflected by demanding workloads, difficulties with prioritizing recovery, and ill-being. Early interventions targeting unhealthy self- and socially imposed expectations in high-expectation settings may be required to safeguard youth performers’ healthy development.

• Mathisen, Therese Fostervold; Sundgot-Borgen, Jorunn; Rosenvinge, Jan H; Bratland-Sanda, Solfrid; Svendsen, Mette & Pettersen, Gunn [Show all 8 contributors for this article] (2023). Metabolic profile in women with bulimia nervosa or binge-eating disorder before and after treatment: secondary analysis from the randomized PED-t trial. Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity. ISSN 1124-4909. 28(1). doi: 10.1007/s40519-023-01567-y. Full text in Research Archive Show summary

  Purpose: Chaotic eating and purging behavior pose a risk to the metabolic health of women with bulimia nervosa (BN) and binge-eating disorder (BED). This study reports on one-year changes in blood markers of metabolic health and thyroid hormones in women with BN or BED attending two different treatments. Methods: These are secondary analyses from a randomized controlled trial of 16-week group treatment of either physical exercise and dietary therapy (PED-t) or cognitive behavior therapy (CBT). Blood samples collected at pre-treatment, week eight, post-treatment, and at 6- and 12-month follow-ups were analyzed for glucose, lipids (triglycerides (TG), total cholesterol (TC), LDL cholesterol (LDL-c), HDL cholesterol (HDL-c), apolipoprotein A (ApoA) and apolipoprotein B (ApoB) lipoproteins), and thyroid hormones (thyroxine (T4), thyroid stimulating hormone (TSH), and thyroperoxidase antibodies). Result: The average levels of blood glucose, lipids and thyroid hormones were within the recommended range, but clinical levels of TC and LDL-c were detected in 32.5% and 39.1%, respectively. More women with BED compared with BN had low HDL-c, and a larger increase over time in TC and TSH. No significant differences occurred between PED-t and CBT at any measurement. Exploratory moderator analyses indicated a more unfavorable metabolic response at follow-up among treatment non-responders. Conclusion: The proportion of women with impaired lipid profiles and unfavorable lipid changes, suggests active monitoring with necessary management of the metabolic health of women with BN or BED, as recommended by metabolic health guidelines.

• Mathisen, Therese Fostervold; Pettersen, Gunn; Rosenvinge, Jan H; Schmidt, Ulrike H. & Sundgot-Borgen, Jorunn (2023). Effectiveness and acceptability of the physical exercise and dietary therapy in a healthy life center. International Journal of Eating Disorders. ISSN 0276-3478. 56(10), p. 1931–1940. doi: 10.1002/eat.24020. Full text in Research Archive Show summary

  Objective: The high burden of eating disorders (EDs) and limited availability of treatment speaks of a need to explore new avenues for treatment delivery. To understand if new treatment avenues are helpful and acceptable to patients, we investigated the effectiveness of Physical Exercise and Dietary Therapy (PED-t) in participants with bulimia nervosa or binge-eating disorder, and acceptability when the PED-t was implemented in a Healthy Life Center in a municipal primary healthcare service. Method: Exercise physiologists and one dietitian were trained in ED literacy and to run PED-t, before screening women for eligibility. Effectiveness (n = 16) of PED-t and participants' experiences (n = 8) were evaluated by a mixed methods study design. Results were analyzed by relevant statistics and reflexive thematic analysis. Results: Of 19 eligible participants, 16 completed treatment. At post-treatment, the Eating Disorder Examination Questionnaire global score, binge-eating frequency, and symptoms of depression were lower, and nine (56% of completers) were in remission. Participants' treatment experiences were classified into two overarching themes: “competence” and “emotional support.” Participants reported high acceptance for PED-t, the local venue and group format, and felt that PED-t provided them with coping tools and increased mental strength. However, many also spoke of an unmet need to address emotional eating. Discussion: Findings point to a potential for making an effective ED therapy more accessible, and that participants find the local low-threshold delivery within a group-format helpful. With small adjustments, the PED-t could emerge as a promising first-line treatment for bulimic EDs. Public Significance Statement: Limited access to treatment for EDs, patients' high barriers to help-seeking, and the high rates of limited efficacy from psychotherapy speak of a need to explore new therapies and avenues for delivery. In this study, we build on findings from a controlled ED treatment trial and replicate the beneficial effects and find a high patient acceptance of “physical exercise and diet therapy” implemented in a real, non-clinical setting.

• Torstveit, Monica Klungland; Ackerman, Kathryn E.; Constantini, Naama; Holtzman, Bryan; Koehler, Karsten & Mountjoy, Margo L. [Show all 8 contributors for this article] (2023). Primary, secondary and tertiary prevention of Relative Energy Deficiency in Sport (REDs): a narrative review by a subgroup of the IOC consensus on REDs. British Journal of Sports Medicine. ISSN 0306-3674. 57(17), p. 1119–1126. doi: 10.1136/bjsports-2023-106932. Full text in Research Archive Show summary

  Relative Energy Deficiency in Sport (REDs) is common among female and male athletes representing various sports at different performance levels, and the underlying cause is problematic low energy availability (LEA). It is essential to prevent problematic LEA to decrease the risk of serious health and performance consequences. This narrative review addresses REDs primary, secondary and tertiary prevention strategies and recommends best practice prevention guidelines targeting the athlete health and performance team, athlete entourage (eg, coaches, parents, managers) and sport organisations. Primary prevention of REDs seeks to minimise exposure to and reduce behaviours associated with problematic LEA. Some of the important strategies are educational initiatives and de-emphasising body weight and leanness, particularly in young and subelite athletes. Secondary prevention encourages the early identification and management of REDs signs or symptoms to facilitate early treatment to prevent development of more serious REDs outcomes. Recommended strategies for identifying athletes at risk are self-reported screening instruments, individual health interviews and/or objective assessment of REDs markers. Tertiary prevention (clinical treatment) seeks to limit short-term and long-term severe health consequences of REDs. The cornerstone of tertiary prevention is identifying the source of and treating problematic LEA. Best practice guidelines to prevent REDs and related consequences include a multipronged approach targeting the athlete health and performance team, the athlete entourage and sport organisations, who all need to ensure a supportive and safe sporting environment, have sufficient REDs knowledge and remain observant for the early signs and symptoms of REDs.

• Pensgaard, Anne Marte; Sundgot-Borgen, Jorunn; Edwards, Carla; Jacobsen, Astrid Urenholdt & Mountjoy, Margo (2023). Intersection of mental health issues and Relative Energy Deficiency in Sport (REDs): a narrative review by a subgroup of the IOC consensus on REDs. British Journal of Sports Medicine. ISSN 0306-3674. 57(17), p. 1127–1135. doi: 10.1136/bjsports-2023-106867. Full text in Research Archive Show summary

  Overall athlete health is a stated priority by the International Olympic Committee (IOC), yet it can be difficult for athletes to safely balance nutritional needs, training load, recovery, social interactions, expectations and other demands. The effect of energy intake and, especially, low energy availability (LEA) on athlete mental health, is understudied. In this narrative review, we examine research that has included psychological factors and mental health variables when investigating the effect of LEA, dieting/restrictive eating and Relative Energy Deficiency in Sport (REDs), since the 2018 IOC consensus statement on REDs. Based on currently available data, early psychological indicators associated with problematic LEA are mood changes, fatigue and psychological conflict. More severe mental health outcomes associated with REDs are reduced well-being, elevated anxiety, depressive symptoms and eating disorders. We propose a psychological model that helps structure how possible risk factors (eg, body dissatisfaction, environmental demands or increased training load) and moderating (eg, gender, sport) and/or potential mediating (eg, social climate, self-esteem) factors are associated with LEA and ultimately REDs. The current scientific literature underscores the importance of including mental health factors when screening for REDs and for developing a clinical approach to address the psychological sequelae of REDs once diagnosed. An interdisciplinary perspective is recommended. Lastly, and importantly, the athlete perspective urges clinicians to not underestimate the drive for success and denial of health consequences that athletes demonstrate when pursuing their sport goals.

• Øvrebø, Tom Henning; Ivarsson, Andreas; Sundgot-Borgen, Jorunn; Knudsen, Ann Kristin Skrindo; Reneflot, Anne & Pensgaard, Anne Marte (2023). Mental health problems in elite sport: the difference in the distribution of mental distress and mental disorders among a sample of Norwegian elite athletes. BMJ Open sport & exercise medicine. 9(3). doi: 10.1136/bmjsem-2023-001538. Full text in Research Archive Show summary

  Objectives: To, based on diagnostic interviews, investigate the distribution of mental disorders among a sample of Norwegian elite athletes with ‘at-risk scores’ on a self-report questionnaire measuring symptoms of mental health problems. Then, to investigate the relationship between ‘at-risk scores’ and diagnosed mental disorders. Methods: A two-phase, cross-sectional design was used. In phase 1, 378 elite athletes completed a questionnaire, including validated self-report psychiatric instruments assessing symptoms of mental disorders. In phase 2, we assessed the 30-day presence of the same disorders through diagnostic interviews with the athletes with ‘at-risk scores’ using the fifth version of the Composite International Diagnostic Interview. Results: Two hundred and eighty athletes (74.1%) had an ‘at-risk score,’ and 106 of these athletes (37.9%) completed diagnostic interviews. Forty-seven athletes (44.3%) were diagnosed with a mental disorder. Sleep problems (24.5%) and obsessive-compulsive disorder (OCD) and OCD-related disorders (18.9%), mainly represented by body dysmorphic disorder (BDD), were most common. Anxiety disorders (6.6%), eating disorders (5.7%) and alcohol use disorder (≤4.7%) were less frequent. Affective disorders, gambling and drug use disorder were not present. Results from self-report questionnaires did not, in most cases, adequately mirror the number of mental disorders identified using diagnostic interviews. Conclusions: Using self-report questionnaires to map mental distress among elite athletes can be beneficial. If the aim, however, is to investigate mental disorders, one should move beyond self-report questionnaires and use diagnostic interviews and diagnostic instruments. In our study, sleep problems and BDD were the most prevalent. Longitudinal studies are needed to investigate these findings further.

• Dasa, Marcus Småvik; Friborg, Oddgeir; Kristoffersen, Morten; Pettersen, Gunn; Plasqui, Guy & Sundgot-Borgen, Jorunn [Show all 7 contributors for this article] (2023). Energy expenditure, dietary intake and energy availability in female professional football players. BMJ Open sport & exercise medicine. 9(1). doi: 10.1136/bmjsem-2023-001553. Full text in Research Archive Show summary

  Objectives: To quantify energy expenditure and intake in professional female footballers playing on a national and/or international level. Second, to determine the prevalence of low energy availability among these players, defined as <30 kcal/kg fat-free mass (FFM)/day. Methods: Fifty-one players completed a 14-day prospective observational study during the 2021/2022 football season. Energy expenditure was determined using the doubly labelled water method. Energy intake was assessed using dietary recalls, while global positioning system determined the external physiological load. Descriptive statistics, stratification and the correlation between explainable variables and outcomes were conducted to quantify the energetic demands. Results: The mean energy expenditure for all players (22±4 years) was 2918±322 kcal. Mean energy intake was 2274±450 kcal, resulting in a discrepancy of ~22%. Carbohydrate intake was below the recommended guidelines on match day at 4.5±1.9 g/kg. The mean energy availability was 36.7±17.7 kcal/kg FFM/day on matchday and 37.9±11.7 kcal/kg FFM/day on training days, resulting in a prevalence of 36% and 23% for low energy availability during the observational period, respectively. Conclusion: These elite female football players displayed moderate energy expenditure levels and failed to meet the recommended levels of carbohydrate intake. In conjunction with inadequate nutritional periodisation, this will likely hamper performance through inadequate muscle glycogen resynthesis. In addition, we found a considerable prevalence of low energy availability on match and training days.

• Mathisen, Therese Fostervold; Sundgot-Borgen, Jorunn & Sundgot-Borgen, Christine (2023). Nutrition and eating disorders in youth sport. In Armstrong, Neil & Mechelen, Willem van (Ed.), Oxford Textbook of Children’s Sport and Exercise Medicine. Fourth Edition. Oxford University Press. ISSN 9780191926556. p. 691–707. doi: 10.1093/med/9780192843968.001.0001. Full text in Research Archive
• Stornæs, Annett Victoria; Sundgot-Borgen, Jorunn; Pettersen, Gunn; Rosenvinge, Jan H & Nordin-Bates, Sanna M. (2023). Mental health profiles among 13-16-year-Old Norwegian talent and mainstream students - A prospective person-centered analytical approach. Psychology of Sport And Exercise. ISSN 1469-0292. 68. doi: 10.1016/j.psychsport.2023.102474. Full text in Research Archive Show summary

  Objectives: To contribute further knowledge about symptoms of anxiety, depression, body concerns, and self-worth among young talent development (TD) and mainstream students by exploring the indicators within-person combinations prospectively, aiming to identify distinct profiles. Methods: We included 946 students, n = 168 (45% girls) from three TD sports schools and one ballet class, n = 778 (52% girls) from ten mainstream schools. All were 13–14 years at T1 and 15–16 years at T2. Descriptive statistics were examined via variable-centered approaches: ANOVA and cross-tabulations. Mental health profiles were explored via person-centered approaches: latent profile and latent transition analysis, including profile stability over two years and school type, gender, and perfectionism association with profiles. Results: TD girls’ and boys’ anxiety and depression scores did not differ, but girls reported more weight-shape concerns. Mainstream schoolgirls fared worse compared to all others. Four retained profiles (distressed-body concerned, dissatisfied, moderate mentally healthy, mentally healthy) showed distinct patterns of co-occurring anxiety, depression, weight-shape concerns, and self-worth. Profile stability was high overall (72–93%). The highest proportion of TD boys was in the mentally healthy, TD girls and mainstream boys in moderate, and mainstream girls within the dissatisfied profile. Noteworthy transitions: TD boys who transitioned were likely changing to healthier profiles and girls to unhealthier. Unhealthier profiles were associated with socially prescribed perfectionism. Conclusion: TD students fared relatively better than mainstream students. Still, considerable proportions of girls were identified in the unhealthiest profiles. These findings involving young TD and mainstream students propose a need for specific follow-up measures to promote mental health.

• Mountjoy, Margo; Ackerman, Kathryn E.; Bailey, David M.; Burke, Louise M.; Constantini, Naama & Hackney, Anthony C. [Show all 17 contributors for this article] (2023). 2023 International Olympic Committee's (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs). British Journal of Sports Medicine. ISSN 0306-3674. 57(17), p. 1073–1097. doi: 10.1136/bjsports-2023-106994. Full text in Research Archive Show summary

  Relative Energy Deficiency in Sport (REDs) was first introduced in 2014 by the International Olympic Committee’s expert writing panel, identifying a syndrome of deleterious health and performance outcomes experienced by female and male athletes exposed to low energy availability (LEA; inadequate energy intake in relation to exercise energy expenditure). Since the 2018 REDs consensus, there have been >170 original research publications advancing the field of REDs science, including emerging data demonstrating the growing role of low carbohydrate availability, further evidence of the interplay between mental health and REDs and more data elucidating the impact of LEA in males. Our knowledge of REDs signs and symptoms has resulted in updated Health and Performance Conceptual Models and the development of a novel Physiological Model. This Physiological Model is designed to demonstrate the complexity of either problematic or adaptable LEA exposure, coupled with individual moderating factors, leading to changes in health and performance outcomes. Guidelines for safe and effective body composition assessment to help prevent REDs are also outlined. A new REDs Clinical Assessment Tool-Version 2 is introduced to facilitate the detection and clinical diagnosis of REDs based on accumulated severity and risk stratification, with associated training and competition recommendations. Prevention and treatment principles of REDs are presented to encourage best practices for sports organisations and clinicians. Finally, methodological best practices for REDs research are outlined to stimulate future high-quality research to address important knowledge gaps.

• Sølvberg, Nina; Torstveit, Monica Klungland; Solstad, Bård Erlend; Mountjoy, Margo; Rosenvinge, Jan Harald & Pettersen, Gunn [Show all 7 contributors for this article] (2023). Risk factors for sexual harassment and abuse victimization among adolescent athletes and non-athletes: A one-year follow-up study. International Journal of Child Abuse & Neglect. ISSN 0145-2134. 147. doi: 10.1016/j.chiabu.2023.106592. Full text in Research Archive Show summary

  Background: The association between SHA and negative mental health increases the need to understand risk factors for SHA victimization, which is important for future development of prevention programs. Objective: To examine which combinations of demographic- and mental health factors were associated with subsequent SHA victimization, and the prevalence of elite athletes, recreational athletes, and reference students who experienced sexual revictimization. Participants and setting: Norwegian elite athletes and recreational athletes attending sport high schools, and reference students attending non-sport high schools (mean age: 17.1 years) were eligible for participation. Methods: The participants answered an online questionnaire at two measurement points one year apart, T1 and T2 (n = 1139, 51.1 % girls). After testing for measurement invariance, data were analyzed with Classification and Regression Tree analysis (CRT) using demographic- and mental health variables from T1 as independent variables, and SHA at T2 as outcome. Results: The combination of being a girl with high level of symptoms of eating disorders and other psychological symptoms was associated with subsequent reporting of SHA. Among the students with lifetime experience of SHA at T1 (n = 533, 58.3 %), 49.5 % reported revictimization at T2 (60.9 % girls, 32.2 % boys, p ≤ .001). The prevalence of SHA revictimization was lower among elite athletes (44.3 %) compared with recreational athletes (49.1 %) and reference students (59.4 %, p = .019). Conclusion: The combination of female gender and mental health symptoms are risk factors for subsequent SHA victimization. These findings, and the high prevalence of SHA revictimization is important knowledge for developing preventive programs targeting elite athletes, recreational athletes, and reference students.

• Nordin-Bates, Sanna M.; Lundström, Petra; Melin, Anna Katarina; Sundgot-Borgen, Jorunn & Edlund, Klara (2023). Preventing Disordered Eating in Teenage Ballet Students: Evaluation of DancExcellent, a Combined CBT and Nutrition Education Intervention. Medical Problems of Performing Artists. ISSN 0885-1158. 38(2), p. 71–79. doi: 10.21091/mppa.2023.2009. Full text in Research Archive Show summary

  BACKGROUND: Disordered eating (DE) behaviors are relatively common among high-level dancers, especially in classical ballet. At the same time, interventions aimed at reducing DE behaviors in this population are scarce. METHODS: An 8-week exploratory preventive intervention for DE behaviors was carried out in a high-level ballet school for 40 teenagers aged 12–15 years (77.5% female). Both risk factors (perfectionism) and potentially protective factors (self-esteem, self-compassion) for the development of DE behaviors were considered. The intervention was created specifically for this study and consisted of five cognitive behavior therapy (CBT) workshops and four nutrition workshops. Additional components included newsletters for pupils and educational sessions and social media interactions with staff and parents. The intervention comprised two phases (control and intervention periods), with students acting as their own controls. Standardized questionnaires were completed before and after both phases. RESULTS: Questionnaire results did not indicate any changes in reported perfectionism, self-esteem, or self-compassion, nor were symptoms of DE affected during either the control or intervention periods. CONCLUSIONS: The intervention did not yield any discernible impact. However, it was affected by the onset of the COVID-19 pandemic, which limits our ability to draw conclusions about intervention effectiveness. Evaluations with pupils offer several considerations for future improvements.

• Dasa, Marcus Småvik; Friborg, Oddgeir; Kristoffersen, Morten; Pettersen, Gunn; Sagen, Jørn Vegard & Sundgot-Borgen, Jorunn [Show all 7 contributors for this article] (2023). Evaluating the Suitability of the Low Energy Availability in Females Questionnaire (LEAF-Q) for Female Football Players. Sports Medicine - Open. 9. doi: 10.1186/s40798-023-00605-4. Full text in Research Archive Show summary

  Background The Low Energy Availability in Females Questionnaire (LEAF-Q) is a screening tool developed to detect endurance athletes and dancers at risk for development of persistent low energy availability (LEA) and the female athlete triad (Triad). This study investigated the applicability of the LEAF-Q in a cohort of sixty professional female football players. Methods The participants were classified as at risk (≥ 8) or not at risk (< 8) for persistent LEA and the Triad according to their LEAF-Q score, before being compared. Receiver operating curves were then conducted to examine the ability of the overall LEAF-Q and subcategories to correctly determine the presence of clinically defined markers of the Triad. Additionally, Youden’s index was calculated to determine the best fitting cut-off values. Results Thirty-two percent of participants were classified as at risk by the LEAF-Q. We found no statistically significant differences between the two groups for any markers associated with persistent LEA. Except for acceptable accuracy in determining menstrual status, all other LEAF-Q components exhibited poor accuracy and predictive values. Youden’s index scores imply that increasing the overall and injury cut-off values to ≥ 10 and ≥ 5 respectively, would yield increased performance. Conclusions Our findings do not support the use of the LEAF-Q for the purpose of detecting LEA and Triad conditions among female football players.

• Moore, Isabel S.; Crossley, Kay M.; Bø, Kari; Mountjoy, Margo; Ackerman, Kathryn E. & Antero, Juliana da Silva [Show all 25 contributors for this article] (2023). Female athlete health domains: A supplement to the International Olympic Committee consensus statement on methods for recording and reporting epidemiological data on injury and illness in sport. British Journal of Sports Medicine. ISSN 0306-3674. 57(18), p. 1164–1174. doi: 10.1136/bjsports-2022-106620. Full text in Research Archive Show summary

  The IOC made recommendations for recording and reporting epidemiological data on injuries and illness in sports in 2020, but with little, if any, focus on female athletes. Therefore, the aims of this supplement to the IOC consensus statement are to (i) propose a taxonomy for categorisation of female athlete health problems across the lifespan; (ii) make recommendations for data capture to inform consistent recording and reporting of symptoms, injuries, illnesses and other health outcomes in sports injury epidemiology and (iii) make recommendations for specifications when applying the Strengthening the Reporting of Observational Studies in Epidemiology-Sport Injury and Illness Surveillance (STROBE-SIIS) to female athlete health data. In May 2021, five researchers and clinicians with expertise in sports medicine, epidemiology and female athlete health convened to form a consensus working group, which identified key themes. Twenty additional experts were invited and an iterative process involving all authors was then used to extend the IOC consensus statement, to include issues which affect female athletes. Ten domains of female health for categorising health problems according to biological, life stage or environmental factors that affect females in sport were identified: menstrual and gynaecological health; preconception and assisted reproduction; pregnancy; postpartum; menopause; breast health; pelvic floor health; breast feeding, parenting and caregiving; mental health and sport environments. This paper extends the IOC consensus statement to include 10 domains of female health, which may affect female athletes across the lifespan, from adolescence through young adulthood, to mid-age and older age. Our recommendations for data capture relating to female athlete population characteristics, and injuries, illnesses and other health consequences, will improve the quality of epidemiological studies, to inform better injury and illness prevention strategies.

• Mathisen, Therese Fostervold; Ackland, Timothy; Burke, Louise M.; Constantini, Naama; Haudum, Judith & Macnaughton, Lindsay [Show all 10 contributors for this article] (2023). Best practice recommendations for body composition considerations in sport to reduce health and performance risks: a critical review, original survey and expert opinion by a subgroup of the IOC consensus on Relative Energy Deficiency in Sport (REDs). British Journal of Sports Medicine. ISSN 0306-3674. 57(17), p. 1148–1160. doi: 10.1136/bjsports-2023-106812. Full text in Research Archive Show summary

  Background: The assessment of body composition (BC) in sport raises concern for athlete health, especially where an overfocus on being lighter or leaner increases the risk of Relative Energy Deficiency in Sport (REDs) and disordered eating. Methods: We undertook a critical review of the effect of BC on performance (29 longitudinal, prospective or intervention studies) and explored current practice related to BC considerations via a follow-up to a 2013 internationally distributed survey. Results: The review found that a higher level of body fat was negatively associated with endurance performance, while a gain in muscle mass resulted in performance benefits across sports. BC did not contribute to early talent identification, and no unique cut-off to signify a performance advantage for BC was identified. BC appears to be one of an array of variables impacting performance, and its influence should not be overstated. The survey (125 practitioners, 61 sports and 26 countries) showed subtle changes in BC considerations over time, such as an increased role for sport dietitian/nutrition practitioners as BC measurers (2013: 54%, 2022: 78%); less emphasis on reporting of body fat percentage (2013: 68%, 2022: 46%) and reduced frequency of BC assessment if ≥every fourth week (2013: 18%, 2022: 5%). Respondents remained concerned about a problematic focus on BC (2013: 69%, 2022: 78%). To address these findings, we provide detailed recommendations for BC considerations, including an overview of preferable BC methodology. Conclusions: The ‘best practice’ guidelines stress the importance of a multidisciplinary athlete health and performance team, and the treatment of BC data as confidential medical information. The guidelines provide a health focus around BC, aiming to reduce the associated burden of disordered eating, problematic low energy availability and REDs.

• Sølvberg, Nina; Torstveit, Monica Klungland; Mountjoy, Margo; Rosenvinge, Jan H; Pettersen, Gunn & Sundgot-Borgen, Jorunn (2023). Sexual harassment and abuse; disclosure and awareness of report- and support resources in Norwegian sport- and non-sport high schools: a prospective exploratory study. Frontiers in Psychology. 14. doi: 10.3389/fpsyg.2023.1168423. Full text in Research Archive Show summary

  Purpose: To examine high school students’ disclosure of sexual harassment and abuse (SHA), and awareness of reporting systems and support mechanisms in school among students, leaders, and coaches. Method: Norwegian 17-year-old high school elite athletes (n = 630), recreational athletes (n = 307), and reference students (n = 263) responded to an online questionnaire at two measurement points, 1 year apart (T1 and T2). Leaders and coaches (n = 249) at the participating high schools responded to an adapted version of the questionnaire at T1. Data were analyzed using ANOVA or Welch test, Pearson Chi-Square test, and McNemar test. Results: In total, 11.4 and 34.0% of the adolescents were aware of reporting systems and support mechanisms, respectively, in their schools. Nearly all the leaders, and half of the coaches were aware of these resources. Among the adolescents with lifetime experience of SHA, 20.1% had disclosed their experiences to someone. Girls disclosed more frequently than boys. The eliteand recreational athletes disclosed less often compared with the reference students. A negative change from T1 to T2 was found in disclosure of SHA and awareness of support mechanisms. At T2, 6.5% of the adolescents reported that their school had implemented measures against SHA during the last 12 months. Conclusion: The results emphasize a need for institutional effort to improve information about available report- and support resources and increase the relevance of use of such systems for adolescents.

• Sundgot-Borgen, Christine; Mathisen, Therese Fostervold; Torstveit, Monica Klungland & Sundgot-Borgen, Jorunn (2022). Explanations for use of dietary- and muscle enhancing dietary supplements among university students: a national cross-sectional study. BMC Nutrition. 8. doi: 10.1186/s40795-022-00510-1. Full text in Research Archive Show summary

  Background: Use of dietary supplements (DS) and muscle enhancing dietary supplements (MEDS) is frequent among students despite the lack of evidence of effects and health risks related to consumption. We need to increase our understanding of students’ motivation, examine potential gender differences, and explore explanatory factors, to address preventive measures related to use. Therefore, this study aimed to explore the frequency of, and the reasons for, DS use among university students, as well as explanatory factors for use of MEDS. Method: Male and female students from nine Norwegian universities participated in this cross-sectional study. Participants responded to questions about demographics, DS and MEDS use, internalization of body ideals, physical activity- and exercise level, motives for exercise, and exercise context. Independent t-test, Chi-square test, Pearson’s correlation, and logistic regression were used to investigate between group differences, associations, and explanatory factors for use, respectively. P-values ≤ 0.05 were defined as significant. Results: A total of 1001 males (34%) and females, with a mean(sd) age of 24.21(4.76) years, participated. The frequency of DS use was 42% and 40% (p = .414) in males and females, respectively, in which more males than females used DS to improve physical or mental performance (p =  < .001), increase muscle mass (p =  < .001) and weight for health (p = .014), and improve appearance (p =  < .001). In males and females, respectively, 25% and 10% used MEDS (p =  < .001). In males, being a fitness center member (OR:3.80), exercising to improve muscle mass (OR:1.96), and a higher physical activity level (OR:1.09) positively explained MEDS use, while exercising to increase endurance (OR:0.49) and being an exercise science student (OR:0.47) negatively explained MEDS use. In females, internalizing the athletic body ideal (OR:1.78) and exercising to improve muscle mass (OR:1.74) positively explained MEDS use. Conclusions: Our main findings indicate that a surprisingly high percentage of male and female Norwegian students use DS and MEDS, and that reasons for use, and variables explaining the variability in frequency of use, differ between genders. Longitudinal studies to investigate direction of associations are needed in future research.

• Forsdick, Victoria K.; Harris, Rachel; Saw, Richard; Hayman, Melanie; Buckling, Hannah & Sundgot-Borgen, Jorunn [Show all 8 contributors for this article] (2022). Exploring Australian high-performance athletes’ perceptions and experiences of sport participation during pregnancy and post-pregnancy: Development and test-retest reliability of the Mum-Alete Survey. Physical Therapy in Sport. ISSN 1466-853X. 58, p. 80–86. doi: 10.1016/j.ptsp.2022.09.003. Full text in Research Archive Show summary

  Objectives: To develop and assess the test-retest reliability of a survey exploring high-performance athletes’ perceptions and experiences during and post-pregnancy. Design: Cross-sectional mixed-methods survey. Methods: A three-phase approach was employed to develop the Mum-Alete survey. Relevant domains and questions were identified through a review of the literature and gap analysis (Phase 1). The face and content validity were assessed during Phase 2. The survey was modified, and the final survey included 113 questions. The test-retest reliability was assessed during Phase 3. Seven athletes aged ≥18 years who were currently pregnant and/or given birth since 1 July 2016 were recruited. The survey was administered via Qualtrics and completed on two occasions. Intraclass correlation coefficient (ICC) were determined to assess test-retest reliability (excellent, good, moderate, and poor). Results: The average ICC of all items was 0.962 (95% CI 0.957–0.966) demonstrating excellent test-retest reliability. The test-retest reliability was excellent for the demographic and general questions domain (ICC = 0.967 95% CI 0.955–0.977) and good for the exercise (ICC 0.762 95% CI 0.707–0.811), physical health (ICC 0.841 95% CI 0.810–0.868) and well-being (ICC 0.827 95% CI 0.784–0.865) domains. Conclusions: The high test-retest reliability of the survey indicates excellent consistency of measures between the two time-points.

• Mathisen, Therese Fostervold; Sundgot-Borgen, Christine; Anstensrud, Beate & Sundgot-Borgen, Jorunn (2022). Mental health, eating behaviour and injuries in professional dance students. Research in Dance Education. ISSN 1464-7893. 23(1), p. 108–125. doi: 10.1080/14647893.2021.1993171. Full text in Research Archive Show summary

  A high frequency of mental health challenges and injuries in professional dancers necessitate a better understanding of the complexity of such symptoms, and to explore differences according to sex, academic year and performance levels. Professional dance students were recruited to evaluate symptoms of depression and anxiety (SCL-10), resilience (RSA), self-esteem (RSS), perfectionism (CAPS), body appreciation (BAS-2), and symptoms of low energy availability (LEA, LEAF-q) and eating disorders (ED) (EDE-q). Totally 20–54% of the dancers had symptoms of anxiety or depression, LEA (in females), ED and/or injuries, and 12% had a self-reported history with ED. In females, 44% of the variability in SCL-10 was explained by CAPS and RSS; 15% of variability in LEA was explained by EDE-q and training volume; while BMI, academic year and LEA increased the odds ratio of an injury. In all, BAS-2 reduced the odds ratio of EDE-q by -3.33. Totally 50% reported that they could identify personal mental health problems, still <45% would consult a health professional. Enhanced body acceptance may reduce the frequency of mental health challenges in dancers, and improved knowledge of nutrition and body weight regulation may reduce the high frequency of LEA, disordered eating behaviour, and injuries.

• Mathisen, Therese Fostervold; Kumar, Radhika Singh; Svantorp-Tveiten, Kethe Marie Engen & Sundgot-Borgen, Jorunn (2022). Empowered, Yet Vulnerable: Motives for Sport Participation, Health Correlates, and Experience of Sexual Harassment in Female Combat-Sport Athletes. Sports. 10(5), p. 1–14. doi: 10.3390/sports10050068. Full text in Research Archive Show summary

  Background: To explore motives for combat sport participation, weight regulation practices, symptoms of low energy availability (LEA), disordered eating (DE) or eating disorders (ED), and any experiences with sexual harassment (SH) among female combat-sport athletes. Methods: In total, 29 athletes were recruited by social media and in clubs. Participants responded to a questionnaire on health behavior and mental health and completed diet registration and a DXA-scan. Results: Most athletes started combat sports to feel empowered and experienced an inclusive milieu, but the frequency of health issues was high. A total of 21–67% had symptoms of ED, suffered from injuries, had low site-specific BMD, and/or symptoms of LEA. Athletes had insufficient intake of energy and nutrients, and <50% received any dietary information or guidance from their clubs. Most athletes complied with favorable weight-loss strategies; still, >20% used unfavorable methods and rapid weight-loss periods. A total of 70% of the athletes had experienced SH, of which 41% experienced SH within the combat-sport context. Conclusion: Combat sport offers an inclusive milieu, which may increase women’s health and confidence; still, our results indicates a need for actions to safeguard female combat-sport athletes’ mental and physical health, implying a cultural change within the community of combat sport and a need for increased health and nutrition literacy.

• Jonvik, Kristin Lundanes; Torstveit, Monica Klungland; Sundgot-Borgen, Jorunn & Mathisen, Therese Fostervold (2022). Last Word on Viewpoint: Do we need to change the guideline values for determining low bone mineral density in athletes? Journal of applied physiology. ISSN 8750-7587. 132(5), p. 1325–1326. doi: 10.1152/japplphysiol.00227.2022. Full text in Research Archive
• Mathisen, Therese Fostervold; Sundgot-Borgen, Christine; Anstensrud, Beate & Sundgot-Borgen, Jorunn (2022). Intervention in professional dance students to increase mental health- and nutrition literacy: A controlled trial with follow up. Frontiers in Sports and Active Living. 4. doi: 10.3389/fspor.2022.727048. Full text in Research Archive Show summary

  Introduction: There is a need to change the culture within the art of dance, as it has been associated with injuries and mental health consequences. This study evaluates an intervention designed to increase mental health literacy, enhance nutritional knowledge, reduce symptoms and effects of low energy availability, and strengthen understanding of sports nutrition and recovery strategies, in dance students of mixed genders. Material and methods: A total of 125 dance students received three workshops, with 39 arts and crafts students serving as references. The results were evaluated by the Eating Disorder Examination questionnaire, the Low Energy Availability in Females questionnaire, the Hopkins Symptom Check List, and questions on mental health literacy, sports nutrition, and recovery knowledge. Results: Dance students achieved sustained improvements in mental health and nutrition knowledge and temporary improvements in driven exercise (i.e., performing exercise because of a compulsive drive). No other benefits were identified from the intervention. Conclusion: Our findings indicate the need for an ongoing education program to reduce the occurrence and development of negative mental health outcomes and low energy availability in professional dance students. Such approaches may not only improve the mental health of dance students but also potentially prevent the high frequency of injuries.

• Rosenvinge, Jan H; Dasa, Marcus Småvik; Kristoffersen, Morten; Pettersen, Gunn; Sundgot-Borgen, Jorunn & Sagen, Jørn Vegard [Show all 7 contributors for this article] (2022). Study protocol: Prevalence of low energy availability and its relation to health and performance among female football players. BMJ Open sport & exercise medicine. 8, p. 1–5. doi: 10.1136/bmjsem-2021-001219. Full text in Research Archive Show summary

  Enduring low energy availability (LEA) is associated with several potentially serious physiological and mental conditions. LEA has been found highly prevalent among female elite athletes within endurance sports, thus hampering athletes’ health and performance. The prevalence and the underpinning risk factors of LEA among female elite football players are less studied. One reason is that the existing self-report measures and technological devices to monitor energy intake and expenditure are inadequately adapted to capture the nature of the physical activity and energy expenditure among football players and are thus inaccurate. The present paper outlines a study protocol addressing the prevalence of LEA, the measurement of LEA and the correlations of LEA in terms of health and performance in female football players. Four studies will be conducted with the following aims (1) to evaluate the accuracy of global positioning systems (GPS)-based devices to monitor energy expenditure with indirect calorimetry as the gold standard, (2) to assess energy intake, quantify energy expenditure and investigate energy availability through self-report instruments, double labelled water (DLW) and GPS monitoring devices, (3) to determine the point prevalence of LEA using self-report instruments, DLW, dual-X-ray-absorptiometry (DXA) to quantify muscle and bone mass distribution and density, and a battery of hormonal analyses, and (4) to explore whether the prevalence of LEA varies across a full football season. Measures covering mental symptoms and psychological resources will be included, and a selection of biological measures derived from study 3. Measurements of DXA and DLW are resource-demanding and will be collected from one professional club (N~20 women). In contrast, the remaining data will be collected from four professional clubs (N~60 women) located in Bergen, the largest city within the Western region of Norway. Overall procedures and biobank storage procedures have been approved for data collection that will end in December 2024.

• Reinboth, Michael Sæther; Sundgot-Borgen, Jorunn & Bratland-Sanda, Solfrid (2022). Exercise Dependence and Body Image Concerns Amongst Group Fitness Instructors: A Self-Determination Theory Approach. Frontiers in Psychology. 12. doi: 10.3389/fpsyg.2021.816287. Full text in Research Archive Show summary

  Introduction: Despite the fact that group fitness instructors serve as significant role models with potentially great impact on class participants' motivation for exercise, they are a very under-researched group. The aim of this study was therefore to examine group fitness instructors' motivational regulations for exercise, and how these motivational regulations can predict symptoms of exercise dependence and body image concerns. Methods: Group fitness instructors from the largest fitness companies in Norway (n = 837, response rate: 57%) completed an online survey with reference to the Situational Motivation Scale (SIMS), the Exercise Dependence Scale (EDS), the Eating Disorders Inventory subscales drive for thinness (EDI-DT) and body dissatisfaction (EDI-BD), and their weekly amount of exercise and instruction. Results: The instructors scored high on identified regulation and intrinsic regulation for exercise. EDS total score was positively correlated with all SIMS subscales and weekly instruction was positively correlated with Intrinsic regulation. Multiple hierarchical regression analyses found that both self-determined motivational regulations as well as external regulation positively predicted their EDS score. External regulation positively predicted EDI-DT, and EDI-BD. Conclusion: Group fitness instructors seem highly intrinsically motivated for exercise, which is hypothesized to have a positive impact on group fitness class participants. High self-determined exercise behavior does not seem to buffer against symptoms of exercise dependence within this specific population. There is a need for awareness of group fitness instructors who show high exercise dependency scores due to the link to body image concerns, amotivation and external regulated motivation.

• Jonvik, Kristin Lundanes; Torstveit, Monica Klungland; Sundgot-Borgen, Jorunn & Mathisen, Therese Fostervold (2022). Do we need to change the guideline values for determining low bone mineral density in athletes? [Viewpoint]. Journal of applied physiology. ISSN 8750-7587. 132(5), p. 1320–1322. doi: 10.1152/japplphysiol.00851.2021. Full text in Research Archive
• Dasa, Marcus Småvik Tutu; Friborg, Oddgeir; Kristoffersen, Morten; Pettersen, Gunn; Sundgot-Borgen, Jorunn & Rosenvinge, Jan H (2022). Accuracy of Tracking Devices’ Ability to Assess Exercise Energy Expenditure in Professional Female Soccer Players: Implications for Quantifying Energy Availability. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 19(8). doi: 10.3390/ijerph19084770. Full text in Research Archive Show summary

  The purpose of the study was to assess the accuracy of commonly used GPS/accelerometer-based tracking devices in the estimation of exercise energy expenditure (EEE) during high-intensity intermittent exercise. A total of 13 female soccer players competing at the highest level in Norway (age 20.5 ± 4.3 years; height 168.4 ± 5.1 cm; weight 64.1 ± 5.3 kg; fat free mass 49.7 ± 4.2 kg) completed a single visit test protocol on an artificial grass surface. The test course consisted of walking, jogging, high-speed running, and sprinting, mimicking the physical requirements in soccer. Three commonly used tracking devices were compared against indirect calorimetry as the criterion measure to determine their accuracy in estimating the total energy expenditure. The anaerobic energy consumption (i.e., excess post-exercise oxygen consumption, EPOC) and resting time were examined as adjustment factors possibly improving accuracy. All three devices significantly underestimated the total energy consumption, as compared to the criterion measure (p = 0.022, p = 0.002, p = 0.017; absolute ICC = 0.39, 0.24 and 0.30, respectively), and showed a systematic pattern with increasing underestimation for higher energy consumption. Excluding EPOC from EEE reduced the bias substantially (all p’s becoming non-significant; absolute ICC = 0.49, 0.54 and 0.49, respectively); however, bias was still present for all tracking devices. All GPS trackers were biased by showing a general tendency to underestimate the exercise energy consumption during high intensity intermittent exercising, which in addition showed a systematic pattern by over- or underestimation during lower or higher exercising intensity. Adjusting for EPOC reduced the bias and provided a more acceptable accuracy. For a more correct EEE estimation further calibration of these devices by the manufacturers is strongly advised by possibly addressing biases caused by EPOC.

• Sølvberg, Nina; Torstveit, Monica Klungland; Rosenvinge, Jan H; Pettersen, Gunn & Sundgot-Borgen, Jorunn (2022). Sexual Harassment and Abuse among Young Elite Athletes, Recreational Athletes, and Reference Students: A Prospective Study. Medicine & Science in Sports & Exercise. ISSN 0195-9131. 54(11), p. 1869–1878. doi: 10.1249/MSS.0000000000002972. Full text in Research Archive Show summary

  Purpose: To examine the 12-months prevalence and 12-months prospective change in reported sexual harassment and abuse (SHA)-victimization among young elite athletes, recreational athletes, and reference students in three different social settings and identify the perpetrators. Methods: In total, 919 adolescents responded to an online questionnaire in 12th grade (T1) and 13th grade (T2). The sample consisted of elite athletes (n = 482) and recreational athletes (n = 233) attending Norwegian elite sport high schools (n = 26), and reference students (n = 200) attending ordinary high schools with no sport specialization (n = 6). Data were analyzed using Independent sample t-test, Pearson Chi-Square for independence/Fisher’s Exact test, McNemar test and logistic regression analysis. Results: The total 12-months prevalence of SHA was 38.6% at T1 and 35.1% at T2. Most of the participants (74.6-85.0%) reported no change in SHA from T1 to T2. The prevalence of SHA was higher for girls compared to boys, and elite athletes reported less SHA than recreational athletes and reference students, respectively. SHA occurred most often in a free time setting. Verbal SH, non-verbal SH, and physical SHA were reported by 24.6%, 27.0%, and 14.0%, respectively. Peers were reported as perpetrators by 83.1%, trainer/teacher/health personnel by 20.1%, and “other” perpetrators by 56.4%. Conclusions: As one in three elite athletes and nearly one in two recreational athletes and reference students, respectively, reported SHA-victimization within a 12-months period, well-targeted preventive measures are needed for both young athletes and non-athletes.

• Svantorp-Tveiten, Kethe Marie Engen; Ivarsson, Andreas; Torstveit, Monica Klungland; Sundgot-Borgen, Christine; Mathisen, Therese Fostervold & Bratland-Sanda, Solfrid [Show all 10 contributors for this article] (2022). The Healthy Body Image Intervention and Reduction in Eating Disorder Symptomatology and Muscle Building Supplement Use in High School Students: A Study of Mediating Factors. Frontiers in Psychology. 13. doi: 10.3389/fpsyg.2022.803654. Full text in Research Archive Show summary

  Background: Mediation analysis is important to test the theoretical framework underpinning an intervention. We therefore aimed to investigate if the healthy body image (HBI) intervention’s effect on eating disorder (ED) symptomatology and use of muscle building supplements was mediated by the change in risk and protective factors for ED development and muscle building supplement use. <p> <p>Methods: This study used data from the HBI intervention: a cluster randomized controlled universal intervention aiming to promote positive body image and embodiment and reduce the risk for ED development including 30 schools in Norway. A total of 1,713 (37% boys) participants were included in the analyses. Conditional latent growth curve analyses were performed to test for indirect effects on ED symptomatology and weekly frequency of protein and creatine supplement use measured at the 12-month follow-up via change in the proposed mediators. Results: In girls, the reduction in ED symptomatology was mediated by positive changes in protective factors (self-esteem and body image flexibility) and reductions in risk factor scores (perceived media pressure and thin appearance internalization). Comparable changes in protective and risk factors among boys played no mediating role. <p> <p>Conclusion: Interventions aiming to reduce the risk of ED development in girls may benefit from aiming to enhance self-esteem and body image flexibility and reduce perceived media pressure and thin appearance internalization. Future studies should investigate the casual relationship between muscle building supplement use and risk and protective factors for ED development in both girls and boys.

• Sundgot-Borgen, Christine; Sundgot-Borgen, Jorunn; Bratland-Sanda, Solfrid; Kolle, Elin; Torstveit, Monica Klungland & Svantorp-Tveiten, Kethe Marie Engen [Show all 7 contributors for this article] (2021). Body appreciation and body appearance pressure in Norwegian university students comparing exercise science students and other students. BMC Public Health. 21. doi: 10.1186/s12889-021-10550-0. Full text in Research Archive Show summary

  Body image is considered a core issue for public health and associates with university students’ overall health. Due to positive associations between exercise and body image, it has been suggested that students within an exercise science program might be more body appreciative compared to other students. On the other hand, the strong societal idealization of the athletic body may expose them to a pressure of having a specific body appearance, which may result in unfavorable health consequences. Nevertheless, studies investigating these hypotheses are lacking. We therefore aimed to explore the level and associations of body appreciation, body appearance pressure, body image related mental health constructs, physical activity, and exercise, in Norwegian university exercise science and non-health reference students.

• Svantorp-Tveiten, Kethe Marie Engen; Torstveit, Monica Klungland; Rosenvinge, Jan H; Sundgot-Borgen, Christine; Friborg, Oddgeir & Bratland-Sanda, Solfrid [Show all 8 contributors for this article] (2021). Effect of A Healthy Body Image intervention on risk- and protective factors for eating disorders: A cluster randomized controlled trial. Mental health & prevention. 24. doi: 10.1016/j.mhp.2021.200225. Full text in Research Archive Show summary

  Objective: To investigate the immediate and 12-months effects of a school-based intervention aiming to reduce risk and enhance protective factors for eating disorder development in high school boys and girls. Method: In total, 4,149 adolescents from 30 high schools were eligible for inclusion and 2,446 consented to participate and were randomly allocated to the Healthy Body Image (HBI) intervention or a control group (classes as usual). The HBI intervention is multicomponent consisting of three workshops targeting body image, social media usage and lifestyle. Linear mixed model and intention-to-treat analyses were applied to investigate the effects of group, time, and gender at posttest, 3-, and 12-months follow-up. The main outcome variable was weight and shape concerns, and secondary outcome variables were self-esteem, mental distress, body image flexibility, thin internalization, muscular internalization, drive for leanness, perceived media pressure, protein- and creatine supplement use, and diet aid use. Results: The HBI intervention significantly reduced eating disorder risk factor scores related to ED pathology, thin internalization and perceived pressure from media, which was particularly pronounced in girls. Positive intervention effects on body image flexibility were only observed at posttest for boys but grew increasingly larger for girls across the 12-month follow-up time span. Favorable intervention effects on protein and creatine supplement use were only present at 3-months follow-up in boys solely. A general favorable intervention effect was observed for self-esteem, mental distress, muscular internalization, and drive for leanness. Conclusion: The HBI intervention produced consistent reductions in risk factors and enhancements in protective factors associated with eating disorder development in adolescents.

• Mathisen, Therese Fostervold; Sundgot-Borgen, Jorunn; Bulik, Cynthia M. & Bratland-Sanda, Solfrid (2021). The neurostructural and neurocognitive effects of physical activity: A potential benefit to promote eating disorder recovery. International Journal of Eating Disorders. ISSN 0276-3478. doi: 10.1002/eat.23582. Full text in Research Archive Show summary

  Accumulating evidence suggests that supervised and adapted physical activity provides cognitive benefits for individuals with eating disorders (EDs). The mechanisms underlying the benefits of physical activity are poorly understood. Addressing this knowledge gap may inform the appropriate integration of structured physical activity into eating disorders treatment and recovery. We draw attention to recent findings in the study of the impact of physical activity on the brain, and we describe the neurostructural and neurocognitive changes associated with physical activity observed in various clinical and nonclinical populations. Considering the identified impairment in brain volume- and/or neurocognitive function in various EDs, we propose that positive effects of physical activity may play a meaningful role in successful ED treatment. Accordingly, we outline research steps for closing the knowledge gap on how physical activity may aid in ED recovery, and emphasize the need to combine measures of cognitive and behavioral responses to physical activity, with technology capable of measuring changes in brain structure and/or function.

• Svantorp-Tveiten, Kethe Marie Engen; Friborg, Oddgeir; Torstveit, Monica Klungland; Mathisen, Therese Fostervold; Sundgot-Borgen, Christine & Rosenvinge, Jan H [Show all 9 contributors for this article] (2021). Protein, creatine and dieting supplements among adolescents: Use and associations with eating disorder risk factors, exercise- and sports participation, and immigrant status. Frontiers in Sports and Active Living. 3. doi: 10.3389/fspor.2021.727372. Full text in Research Archive Show summary

  Objective: This study aimed to estimate the number of weekly users of protein, creatine, and dieting supplements and to explore whether weekly use was related to eating disorder (ED) risk factors, exercise, sports participation, and immigrant status.<p><p> Methods: In total, 629 and 1,060 high school boys and girls, respectively, self-reported weekly frequency of protein, creatine, and dieting supplement use, and weight and shape concerns, appearance internalization and pressure, self-esteem, mental distress, physical activity level, exercise context, and the type and weekly frequency of sport played. Multiple hierarchical regression analyses were performed to investigate explanatory factors for supplement use.<p> Results: More boys than girls used protein and creatine supplements. Immigrant boys had more frequent use of all supplements than non-immigrant boys, and immigrant girls used creatine supplements more frequently than non-immigrant girls. In total, 23–40 and 5–6% of the variation in the weekly frequency of supplement use in boys and girls, respectively, was explained by immigrant status, ED risk factors, and exercise and sports participation. More frequent use of protein, creatine and dieting supplements in boys was significantly explained by more weight and shape concerns, fitness center exercise, and weight-sensitive sports participation. Depending on the type of supplement, more frequent use of supplements in girls was significantly explained by lower self-esteem, more engagement in weight-sensitive sports, and less engagement in general sport and exercise activities. Conclusion: Weekly supplement use was common and more frequent among boys than girls. The weekly use of protein, creatine, and dieting supplements was related to ED risk factors, exercise and sports participation, and immigrant status in boys but not in girls.

• Mathisen, Therese Fostervold; Sølvberg, Nina; Sundgot-Borgen, Christine & Sundgot-Borgen, Jorunn (2021). Sexual Harassment in Fitness Instructors: Prevalence, Perpetrators, and Mental Health Correlates. Frontiers in Psychiatry. 12. doi: 10.3389/fpsyt.2021.735015. Full text in Research Archive Show summary

  Introduction: This paper explores frequency of experiences of sexual harassment (SH) among fitness instructors, outlines the typical perpetrator, and explores associated mental health symptoms. Design: Cross-sectional survey. Materials and Methods: A total of 270 Norwegian fitness instructors, recruited in social media, responded to an electronic questionnaire in 2019/2020 on experiences of body appearance pressure, SH, and mental health symptoms. Outcomes included in this publication are experiences of SH, and symptoms of mental health issues based on the Hopkins symptom checklist, SCL-10; Beck Depression Inventory, BDI-1a; and Eating Disorder Examination Questionnaire, EDE-q. Results: The frequencies of SH experiences were 30% among 211 women and 22% among 59 men, respectively, with customers being the most frequent source of such approaches and personal trainers (PTs) more often reporting such experiences compared to group instructors (GIs) and to those operating as both PT and GI. Women having experienced SH had significantly higher scores in symptoms of depression, anxiety, and eating disorders compared to women with no such experience. Conclusion: The high frequency of SH experiences among fitness instructors, with customers emerging as perpetrators and typically in the context of personal training, necessitates increased awareness of SH in the fitness industry. To reduce the occurrence of SH, the fitness centers need to communicate countermeasures with high level of compliance.

View all works in NVA

• Sundgot-Borgen, Jorunn; Mathisen, Therese Fostervold & Merryweather, Alice (2026). Body Composition and Mental Health Concerns in Athletes. doi: https:/promiseconference.co.uk/view-program/. Full text in Research Archive Show summary

  Potential Mental Health Implications of Assessing Body Composition in Athletes; Assessment of Body Composition in Athletes: Best Practices and Pitfalls; The Athlete Voice

• Sundgot-Borgen, Jorunn; Mathisen, Therese Fostervold & Stensrud, Eva Berg (2026). Preventing body dissatisfaction progressing to eating disorders. doi: https:/promiseconference.co.uk/view-program/. Full text in Research Archive Show summary

  This workshop provides an evidence-based and practice-oriented overview of how to prevent body dissatisfaction, disordered eating, and eating disorders among athletes. It integrates knowledge on risk factors with applied prevention strategies and emphasizes interdisciplinary collaboration across sport medicine, psychology, nutrition, and coaching.

• Sundgot-Borgen, Jorunn & Mathisen, Therese Fostervold (2026). LEA and Eating Disorders in Sport. Full text in Research Archive Show summary

  About Eating Disorders in sport; symptoms, causes and how to address your concern

• Sundgot-Borgen, Jorunn & Mathisen, Therese Fostervold (2026). Hva er REDs, årsaksforhold, identifisering og konsekvenser, for trenere. Full text in Research Archive Show summary

  Om risikofaktorer og årsaker til REDs, symptomer og konsekvenser.

• Sundgot-Borgen, Jorunn & Mathisen, Therese Fostervold (2026). Hva er REDS, årsaksforhold, identifisering og konsekvenser. Full text in Research Archive Show summary

  Om risikofaktorer og årsaker til lav energitilgjengelighet og relativ energimangel i idretten (REDs), samt symtpomer og konsekvenser

• Mathisen, Therese Fostervold; Sundgot-Borgen, Jorunn & Holmlund, Heidi (2025). «Ta din del av krafttaket for positiv energi» -forebygging av kroppsmisnøye i idretten. Full text in Research Archive Show summary

  Webinar med fokus på hva idretten gjør bra, hva den gjør lite bra, og hva den trenger gjøre mer av for å forebygge kroppsmisnøye og spiseforstyrrelser

• Mathisen, Therese Fostervold; Hubin, Aliaksandr; Mountjoy, Margo & Sundgot-Borgen, Jorunn (2025). Safety of Heavy Resistance Exercise During Pregnancy and Postpartum: A Controlled, Prospective Cohort Study. doi: https:/scs.academy/scs-annual-meeting/. Full text in Research Archive Show summary

  Objective: To address the knowledge gap on the influence of heavy free-weight resistance exercise on the health of the pregnant athlete and infant. Design: This is a prospective, controlled cohort study with two groups of pregnant women; those engaging in mainly heavy free-weight resistance exercise (REX, n = 33) and those regularly physically active (REF, n = 20). Data originate from eight questionnaires answered prospectively throughout pregnancy and 12 months postpartum. Variables cover exercise routines, pregnancy symptoms and complications, fetal growth, delivery, and mother and infant’s health. Results: Bayesian logistic regression with random and fixed effects identified group membership as a significant predictor of proteinuria, with REX having higher exposure (posterior inclusion probability [PIP] = 1.00; β1 = 197.07, 95% credible interval [CrI] [163.05, 231.08]). Further, Bayesian logistic regression with random and fixed effects confirmed a higher risk of urinary incontinence in the REF group during pregnancy (PIP = 0.98; β1 = −1.17, 95% CrI [−1.89, −0.46]). Gas incontinence was also found more common in the REF group during pregnancy (PIP = 1.00; β1 = −7.62, 95% CrI [−8.68, −6.57]) and postpartum (PIP = 0.91; β1 = −49.39, 95% CrI [−53.57, −45.43]). There were no significant differences in the postpartum period for fecal and urinary incontinence, injuries, infant health outcomes (all PIP < 0.01), or need for assisted delivery (PIP = 0.33). Conclusion: Female athletes experienced in heavy resistance exercise, who continue training during pregnancy and postpartum, do not face increased pregnancy complications. These findings provide evidence supporting safety of such exercise. Yet we highlight the need for a confirmatory study under full clinical supervision.

• Mountjoy, Margo L.; Ackerman, Kathryn E.; Bailey, David M.; Burke, Louise M.; Constantini, Naama & Hackney, Anthony C. [Show all 17 contributors for this article] (2025). Yes: Relative Energy Deficiency in Sport (REDs) Does Exist! Sports Medicine. ISSN 0112-1642. doi: 10.1007/s40279-025-02219-0. Full text in Research Archive
• Mathisen, Therese Fostervold; Sundgot-Borgen, Jorunn; Torstveit, Monica Klungland & Dasa, Marcus Småvik (2024). Strategier for primær forebygging (The Young Athlete Body Project + IOC Guidelines for Body Comp Management) in seminar: Preventing & treatment of REDs. Full text in Research Archive
• Mathisen, Therese Fostervold; Sundgot-Borgen, Jorunn; Hubin, Aliaksandr & Mountjoy, Margo (2024). Kan vi anbefale kvinnelige utøvere å trene tung frivekts-styrketrening under graviditet og barseltid? Full text in Research Archive
• Mathisen, Therese Fostervold & Sundgot-Borgen, Jorunn (2024). Idrettens ignoranse koster liv. Full text in Research Archive
• Mathisen, Therese Fostervold & Sundgot-Borgen, Jorunn (2024). REDs – Suboptimal ernæring. Treatment of energy availability. REDsCAT2 – tool for health personnel. Full text in Research Archive
• Torstveit, Monica Klungland; Mathisen, Therese Fostervold; Pensgaard, Anne Marte & Sundgot-Borgen, Jorunn (2024). Oppdatert kunnskap om syndromet REDs (Relative Energy Deficiency in Sport). Verdt å vite for helsepersonell i idretten. Tidsskrift for Norsk Idrettsmedisin. Full text in Research Archive
• Mathisen, Therese Fostervold; Sundgot-Borgen, Jorunn & Sandholt, Ragna Kristine (2024). Rasar mot Norges idrettsforbund etter rapport: – Dette er alvorleg. [Internet]. Nrk.no. Full text in Research Archive
• Gaarder, Jorun; Mathisen, Therese Fostervold; Sundgot-Borgen, Jorunn & Martinsen, Marianne (2024). Refser idrettstopper: - Meler sin egen kake. [Internet]. Dagbladet. Full text in Research Archive
• Mountjoy, Margo; Ackerman, Kathryn E.; Bailey, David M.; Burke, Louise M.; Constantini, Naama & Hackney, Anthony C. [Show all 17 contributors for this article] (2023). Avoiding the ‘REDs Card’. We all have a role in the mitigation of REDs in athletes. 57(17), p. 1063–1064. doi: 10.1136/bjsports-2023-106749. Full text in Research Archive
• Mathisen, Therese Fostervold & Sundgot-Borgen, Jorunn (2023). Forebygging og behandling av spiseforstyrrelser i idrett. In Sandbakk, Øyvind Bucher; Solli, Guro Strøm & Staff, Hanne Cesilie (Ed.), Den kvinnelige idrettsutøveren. Fagbokforlaget. ISSN 9788245036930. p. 221–232. Full text in Research Archive
• Mathisen, Therese Fostervold; Sundgot-Borgen, Jorunn & West, Liam (2023). To measure or not to measure – the body composition question for athletic individuals. EP#540. [Radio]. Spotify Podcast. Full text in Research Archive
• Mathisen, Therese Fostervold; Sundgot-Borgen, Jorunn & Hubin, Aliaksandr (2023). Tung styrketrening i svangerskap og barseltid – helt greit? Preliminære data fra en prospektiv, kontrollert kohortstudie. Full text in Research Archive
• Mathisen, Therese Fostervold & Sundgot-Borgen, Jorunn (2023). Kroppssammensetning i idretten – grunn til bekymring? Nye retningslinjer fra IOC. Full text in Research Archive
• Mathisen, Therese Fostervold; Sundgot-Borgen, Jorunn; Torstveit, Monica Klungland & Bratland-Sanda, Solfrid (2023). TRENERSTUDENTEN EPISODE 45: LEA og REDs. [Radio]. Spotify Podcast. Full text in Research Archive
• Mathisen, Therese Fostervold; Rosenvinge, Jan H; Pettersen, Gunn & Sundgot-Borgen, Jorunn (2023). Erfaringsseminar om behandling av spiseforstyrrelser i Frisklivssentralen. Full text in Research Archive
• Mathisen, Therese Fostervold; Schmidt, Ulrike; Pettersen, Gunn; Rosenvinge, Jan H & Sundgot-Borgen, Jorunn (2023). Implementing Evidence-Based treatment for ED in primary healthcare: effectiveness study of the PED-t. Full text in Research Archive
• Mathisen, Therese Fostervold; Pettersen, Gunn; Rosenvinge, Jan H; Schmidt, Ulrike & Sundgot-Borgen, Jorunn (2023). Understanding motivation for and experiences from ED-therapy in an ECR in primary healthcare. Full text in Research Archive
• Mathisen, Therese Fostervold; Sundgot-Borgen, Jorunn; Lohman, Tim G; Meyer, Nanna & Macnaughton, Lindsay (2023). Update on Body Composition as Antecedent of REDs in Weight Sensitive Sports. Full text in Research Archive
• Mathisen, Therese Fostervold; Schmidt, Ulrike; Pettersen, Gunn; Rosenvinge, Jan H & Sundgot-Borgen, Jorunn (2023). Implementing Evidence-based Treatment For Eating Disorders In Primary Healthcare: Effectiveness Study Of The PED-t. Full text in Research Archive
• Dasa, Marcus Småvik; Rosenvinge, Jan Harald; Friborg, Oddgeir; Pettersen, Gunn; Torstveit, Monica Klungland & Kristoffersen, Morten [Show all 8 contributors for this article] (2023). PREVALENCE OF MARKERS ASSOCIATED WITH RED-S IN ELITE-LEVEL FEMALE FOOTBALL PLAYERS. Full text in Research Archive
• Mathisen, Therese Fostervold; Sundgot-Borgen, Jorunn & Sølvberg, Nina (2022). A body to present and to perform with. Challenges with eating disorders in young, athlete populations. Full text in Research Archive Show summary

  Aim: To present findings on the prevalence of disordered eating (DE) and eating disorders (EDs) in different understudied young, athlete population samples, to present activity specific contexts/cultures in order to understand the findings, and to discuss evidence based preventive strategies and treatment approaches. Content: EDs are found to be more prevalent among high level athletes compared to athletes at lower level and the general population. In the sport context, EDs may be understood by other means than the traditional held theories of thinness internalization or inadequate impulse control. Nevertheless, the prevalence in groups of the population practicing sport at different recreational and professional levels or sorted by age and gender, is understudied. Here, we present findings from cross-sectional studies in young recreational, sub-elite and elite populations, compromising students at elite sport high school, university exercise science students, professional dance students, and professionals from the fitness industry (competing fitness athletes and professional instructors in fitness centres). During the presentations, we will introduce the specific context which may facilitate the progress towards developing DE or an ED in each of these groups, suggestions for preventive measures, and necessary considerations for treatment and recovery in athletes. In the second part of this workshop, we will interact with the audience, and experiences from similar populations, will be up for discussion. Contribution of each speaker: PhD student Nina Sølvberg (15 min) will present findings from her research in elite sport high school athletes, recreational athletes and ordinary high school students aged 16-17 years of age, including a presentation of the context in which the young student athletes study and practice. (15 min). Professor Jorunn Sundgot-Borgen (15 min) will present findings from a survey compromising almost the full sample of professional dance students in Norway, and from a survey among students in exercise physiology from six different Norwegian Sport Universities. Both samples compromise students in the age span of 18 to 50, who are studying to become professionals within their specific area of expertise. The respective, specific conditions under which they practice will be described to understand the theoretical expectations of an increased risk for EDs. PhD Therese Fostervold Mathisen (15 min) will present findings from young adults in the fitness industry aged 18-40 years, either competing as female fitness athletes, or working as professional instructors. In the fitness industry, profiles profit on services argued to improve health, and often fitness athletes and fitness instructors act as role models for healthy lifestyles, contrasting the lifestyle and somatic health issues typically seen in the modern societies. The three presentations aim to increase the awareness of context-specific ED risk factors, and thereby increase the understanding for causes to DEs and EDs in different sporting populations samples. The audience is invited to share experiences from similar population samples, and suggestions for preventive measures. Time for discussion: 45 minutes

• Mathisen, Therese Fostervold; Rosenvinge, Jan H; Pettersen, Gunn & Sundgot-Borgen, Jorunn (2022). Bypassing the clinics’ waitlists: ED-therapy in exercise referral centres - from RCT to implementation. Full text in Research Archive
• Mathisen, Therese Fostervold; Sundgot-Borgen, Jorunn & Svantorp-Tveiten, Kethe M.E. (2022). Prevention of disordered eating and eating disorders in young athletes, dance students and ordinary high school students: what works and what are the effects? Full text in Research Archive Show summary

  Aim: To increase our understanding of effective interventions in preventing disordered eating (DE) and eating disorders (EDs) in adolescents and young adults from the athletic and general population. Content: The majority of EDs and other mental health problems develop during adolescence and manifests before the mid-twenties, making the adolescent years an important period for preventive efforts. Additionally, irrespective of age, athletes are at specifically high risk for EDs, but the transition from junior-level to senior/elite level is a susceptible period, and especially athletes performing weight-sensitive- and aesthetic sports are vulnerable. Early action, like quick access to treatment, is essential to limit the severity of DE/EDs, still with limited treatment access, preventive initiatives is necessitated. Preventive programs have been conducted with positive results in different settings, showing that EDs and DE can be prevented in adolescents and young adults from both the athlete and general adolescent population. Current experience and evidence-based findings highlight several success criteria, including highlighted challenges, which will be discussed during the workshop. Systematic and general reviews in the field of ED prevention have provided several hallmarks of effective prevention interventions for athletes and general adolescents. The evidence in athletic population are limited, with few studies with small sample sizes. The additional needs to specifically adapt interventions to the specific sport, competitive level, culture and demands will be addressed and exemplified during the presentation. Further, there is a need to explore effects from early preventive initiatives in adolescent athlete populations from high-risk sports before the transition to senior/elite level. A planned early intervention program for high school athlete students, shortly up for test, will be elaborated. Finally, targeting and developing successful programs for males are especially warranted, as programs in general are less effective for males. Reasons for this gender difference, and possible ways to circumvent this shortcoming, will be addressed during the final part of the presentations in this workshop. Contribution of each speaker: Professor Jorun Sundgot-Borgen (15 min) will provide an overview of current knowledge and experience with regards to preventive initiatives in athlete populations; Associated professor (PhD) Therese Fostervold Mathisen (15 min) will continue by presenting the upcoming preventive initiative in an elite sport high school, targeting a susceptible athlete sample; and PhD student Kethe M. E. Svantorp-Tveiten (15 min) will present findings from the Healthy Body Image study, a preventive initiative in general high schools, specifically focusing on how to reduce risk factors for- and enhance protective factors against, ED development and use of susceptible sports supplement in high school boys and girls. Finally, the audience is invited for discussion and experience sharing. Time for discussion: 45 minutes

• Mathisen, Therese Fostervold; Sundgot-Borgen, Jorunn & Bratland-Sanda, Solfrid (2022). Exercise is Medicine in treatment of Eating Disorders: From Compulsive Exercise to Physical and Psychologcial improvement. Full text in Research Archive
• Mathisen, Therese Fostervold & Sundgot-Borgen, Jorunn (2022). Er det mulig å forebygge spiseforstyrrelser? Full text in Research Archive
• Mathisen, Therese Fostervold; Bratland-Sanda, Solfrid & Sundgot-Borgen, Jorunn (2022). Are we overlooking potential neurocognitive effects from guided physical exercise during therapy of EDs? Experiences from the treatment of AN, BN, BED & elite athletes. Full text in Research Archive
• Mathisen, Therese Fostervold & Sundgot-Borgen, Jorunn (2022). Low energy availability and eating disorders in athletes. Full text in Research Archive
• Mathisen, Therese Fostervold; Sundgot-Borgen, Jorunn & Sandholt, Ragna Kristine (2022). Skreddersyr kroppen i jakten på gull. [Internet]. Nrk.no. Full text in Research Archive
• Sundgot-Borgen, Jorunn; Bratland-Sanda, Solfrid; Torstveit, Monica Klungland; Mathisen, Therese Fostervold & Sundgot-Borgen, Christine (2021). Sannheten om spiseforstyrrelser i idretten. Full text in Research Archive Show summary

  «Det er bare å ta seg sammen», «Hun bare klusser med maten», «De i idretten som får spiseforstyrrelser er uansett ikke vinnermateriale!» Mytene rundt spiseforstyrrelser i idretten er mange. Etter 30 år med forskningsbasert kunnskap om disse utfordringene er det på tide at uvitenhet adresseres og myter avlives.

• Mathisen, Therese Fostervold; Sundgot-Borgen, Jorunn; Rasmussen, John; Oksnes, Bernt Jakob; Garder, Jorun & Godø, Øyvind (2021). Viktig melding til ledelsen. [Journal]. Dagbladet. Full text in Research Archive
• Mathisen, Therese Fostervold; Sundgot-Borgen, Jorunn; Stedal, Kristin; Fuglset, Tone Seim; Bergestuen, Bent Egil & Engen, Kethe Marie Elgesem [Show all 7 contributors for this article] (2021). Inn med mer kunnskap om veien til hjelp for spiseforstyrrelser! Dagens medisin. ISSN 1501-4290. Full text in Research Archive
• Mathisen, Therese Fostervold; Torstveit, Monica Klungland; Sundgot-Borgen, Jorunn; Melin, Anna Katarina; Pettersen, ingvild & Andersen, Øystein [Show all 10 contributors for this article] (2021). Alarmfunn om norske skijenter. [Journal]. Dagbladet. Full text in Research Archive
• Mathisen, Therese Fostervold; Sundgot-Borgen, Jorunn; Andersen, Øystein; Rasmussen, John; Garder, Jorun & Oksnes, Bernt Jakob [Show all 7 contributors for this article] (2021). BMI-funn vekker oppsikt. [Journal]. Dagbladet. Full text in Research Archive
• Sundgot-Borgen, Jorunn & Mathisen, Therese Fostervold (2021). Mangler evne til å prioritere. NIF kan ikke ha som et hovedmål å redusere forekomsten av spiseforstyrrelser uten å vite hva forekomsten er. [Journal]. Dagbladet. Full text in Research Archive
• Mathisen, Therese Fostervold & Sundgot-Borgen, Jorunn (2021). Eating habits in weight sensitive sport athletes. Full text in Research Archive Show summary

  A lower body weight or specific body composition has beneficial effects on athletic performance in leanness and weight sensitive sports. Depending on the sport/event, the respective body shape, body composition and perceived “ideal” body appearance varies. Athletes from endurance sports usually seek low body fat and a thinner appearance, while athletes from strength-, power- and aesthetic sports aim for low body fat, high muscle mass, and/or a defined appearance. To achieve the desired outcome, these athletes often comply with rigid diet routines to control body weight and composition, and some varies considerably in body weight during their competitive season. Consequentially, the drive towards a certain body appearance or lower body weight may result in chronic or repeated periods with relative energy deficiency (REDs) and high risk of eating disorders. Practice of large shifts in within daily energy availability, chronic energy restriction, and use of purging methods to control body weight, may negatively impact performance, health, and wellbeing of the athlete. Additionally, if athletes do not comply with basic nutritional recommendations, unbalanced and insufficient diets may impair both short- and long-term health. The dieting behavior in sport is often dominated by specific longstanding traditions within each sport discipline, but other than the range of different weight cutting strategies, the seasonal eating habits have been less well described in the literature. In this lecture we will focus on seasonal and periodic eating habits- and diet behavior in leanness- and weight sensitive sport athletes by specifically look into the nutritional regimes in different weight sensitive sports (ski jumpers, rhythmic gymnasts, material arts athletes, fitness physique athletes, and professional dance students), and point out important challenges and how to address them.

• Mathisen, Therese Fostervold & Sundgot-Borgen, Jorunn (2021). Low energy availability, measures of body composition, and eating disorders in athletes. Full text in Research Archive
• Sundgot-Borgen, Jorunn (2021). Primary prevention of eating disorders/ disordered eating. Full text in Research Archive
• Mathisen, Therese Fostervold; Sundgot-Borgen, Christine; Anstensrud, Beate & Sundgot-Borgen, Jorunn (2021). Symptomer og kunnskap om psykisk helse og restitusjon hos profesjonelle dansestudenter: en kartlegging og intervensjonsstudie. Full text in Research Archive
• Mathisen, Therese Fostervold; Sundgot-Borgen, Jorunn & Kihle, Anne Elisabeth Løberg (2021). Dystre funn om psykisk helse blant dansere. [Journal]. Aftenposten. Full text in Research Archive
• Mathisen, Therese Fostervold & Sundgot-Borgen, Jorunn (2022). Psykens byggesteiner. Kosthold og fysisk aktivitet. (i rapporten "Psykisk Oppvekst" ved Rådet for Psykisk Helse). Rådet for Psykisk Helse. Full text in Research Archive

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