Emma S. George

The aetiological pathway from societal pressure to meet appearance ideals to disordered eating through appearance-based concerns (e.g., drive for thinness) is well established in the general population; however, its relevance for elite athletes is unclear. This study investigated longitudinal predictors and mediation pathways for disordered eating in athletes, including sports and societal pressures as risk factors, and appearance-based concerns and athlete-specific cognitions as mediators. Elite athletes predominantly from Australia and the US completed online surveys at baseline between March-September 2023 (T1, N = 178, 72.4% female, Mage = 23.9, SDage = 7.0), with follow-ups at 6-months (T2, N = 110) and 12-months (T3, N = 91). The survey assessed disordered eating, weight pressures in sport, societal pressures for appearance, athlete-specific mediators (drive for leanness for performance, athletic identity), and body image concerns. Regression analyses employing multiple imputation were used to examine longitudinal predictors and mediation pathways with disordered eating as the outcome, adjusting for autocorrelations and gender. Increased disordered eating over 12-months was significantly predicted by higher levels of T1-weight pressures in sport (β = 0.18, p = .046) and T1-drive for leanness for performance (β = 0.21, p = .025). T1-Societal pressures, T1-athletic identity, and T1-body image concerns did not significantly predict increases in disordered eating over time. None of the indirect pathways were significant. It appears that weight pressures in sport and drive for leanness for performance contribute more to risk of disordered eating in elite athletes than traditional pathways of societal pressures and body image concerns. These findings, together with findings from previous research, were synthesised into a new model of disordered eating in elite athletes, providing targets for future intervention. Increased disordered eating in elite athletes over 12-months was predicted by greater weight-related pressures from within the sporting environment and performance-based cognitions at baseline. Contrary to existing models of disordered eating, broader societal pressures and appearance-based cognitions at baseline did not predict increased disordered eating in elite athletes over 12-months. This study hypothesises a new model of disordered eating in elite athletes, providing targets for intervention.

Background: Engaging Arab immigrant populations in health promotion interventions can be challenging due to their unique needs and preferences. Fewer studies have explored the experience of health and community workers on the factors influencing Arab‐Australians' engagement in health initiatives and health promoting behaviours. The aim of this study was to explore the perspectives of health and community workers on recruitment, engagement, and experiences with co‐design for health promotion initiatives targeting Arab‐Australian adults.Methods: This qualitative study sampled 10 health and community workers aged 42.6 ± 13.0 years from New South Wales, Australia, to participate in a semi‐structured interview during 2023–2024. The interview topic guide focused on exploring health and community workers' experiences with recruitment, engagement, and co‐design. Data were analysed using deductive and inductive thematic analysis techniques.Results: Recruitment strategies included using digital channels such as instant messaging or social media, directly engaging with established groups and networks, passive recruitment such as word‐of‐mouth, having or establishing trust with the community, and engaging community workers or champions. Engagement considerations included culture and religion, importance of family, importance of the facilitator, accessibility factors, content and approaches to delivery, and incentives. The themes related to co‐design and collaboration were importance, approaches, and barriers.Conclusions: The findings of this study provide a unique insight into the factors influencing recruitment, engagement, and co‐design approaches when targeting Arab‐Australian adults for health promotion initiatives. These findings could be used by researchers or those working in the community to inform the development of health promotion initiatives for Arab‐Australian adults.

The social identity approach to leadership contends that the most effective leaders represent, advance, create, and embed a shared social identity (i.e., a sense of ‘we’ and ‘us’) within the groups they lead. Building on previous research, our study examines whether the perceived identity leadership of coaches and athlete leaders is associated with a range of key performance indicators (notably team and individual performance and effort) through team identification and team cohesion. We also examine if these relationships are generalisable across WEIRD (Westernised, Educated, Industrialised, Rich, and Democratic) and non‐WEIRD countries while looking at whether they vary as a function of national culture (i.e., ingroup collectivism). To this end, we collected data from 3,135 football players across 211 teams in nine countries who engaged in an average of 4.02 sessions per week ( SD = 2.03). Data were analysed using multilevel (multigroup) regressions and indicated that coaches' and athlete leaders' perceived identity leadership was associated with all performance indicators via both team identification and cohesion. For the most part, these relationships held across WEIRD and non‐WEIRD countries. However, we also found some evidence that the relationships between identity leadership and performance varied cross‐culturally and were generally stronger in countries high on ingroup collectivism. Together, these data suggest that identity leaders—across geographical and cultural borders—can make teams more effective and that they achieve this by leveraging ‘our’ strength in ways that make ‘us’ more cohesive.

Background: Elite athletes experience unique pressures and cognitions associated with disordered eating, which may not be appropriately captured by existing tools. The Athletic Disordered Eating (ADE) scale is a recently developed and first measure of disordered eating specifically developed and validated in current and former athletes. This study aimed to provide further validation for the ADE in an independent sample of elite athletes.Method: Participants were 237 elite athletes (M _Age = 26.1, SD_Age = 8.6; 75.9% female; 73.0% current athletes) participating in various sports across Australia and the United States. Participants completed an online survey including the ADE, demographic questions, and other measures of eating disorder symptoms (Eating Disorder Examination—Questionnaire Short‐form, Clinical Impairment Assessment), and related constructs. Twenty‐five athletes also completed a clinical interview to determine eating disorder caseness.Results: The four‐factor structure of the ADE from the original validation was confirmed. Further, the ADE demonstrated adequate measurement invariance across male and female current and former athletes; internal consistency for the total score and each subscale; convergent and discriminant validity; and criterion‐related validity—with a score of 40 balancing sensitivity and specificity against other scales with established cut‐offs for a likely eating disorder. The high‐risk cut‐off (ADE ≥ 33) had high sensitivity but low specificity in identifying eating disorder cases, as confirmed by the clinical interview.Discussion: The ADE is a low‐time‐burden screening tool for disordered eating, validated in independent samples of diverse athletes. It should be considered for future use in screening, early identification, and monitoring treatment progress in elite athletes.

Background/Objectives: Several systematic reviews and meta-analyses have been conducted to date indicating a high prevalence of disordered eating in elite athletes and associated risk factors. However, the substantial time burden associated with locating and comparing these reviews, which are varied in methodology and sampling focus, may be a barrier for informing policy and best practice as well as directing future research. This umbrella review aimed to provide a summary of evidence across published reviews regarding the prevalence and risk factors for disordered eating (including body image concerns and eating disorders) in elite athletes. Methods: Five databases (CINAHL, PsycINFO, MEDLINE, Scopus, and SPORTDiscus) were systematically searched for peer-reviewed systematic reviews and meta-analyses that met the following inclusion criteria: (1) investigated prevalence and risk factors for disordered eating, (2) included a sample of elite athletes, and (3) available in English. The included studies underwent data extraction and risk of bias assessment using the AMSTAR 2. Results: The initial search identified 1828 articles that were screened for title and abstract and then full text, leaving 24 systematic reviews (including 10 meta-analyses). Disordered eating was prevalent across elite athletes, including males and females and across sport type. Elite athletes were at elevated risk for disordered eating and eating disorders but at lower risk for body image concerns versus non-athlete controls. Several risk factors were identified, including female gender, competing in lean sports, and experiencing career changes. Few reviews or meta-analyses examined perceived pressures within the sporting environment, and most had substantial risk of bias concerns. Conclusions: Elite athletes are at risk for the spectrum of disordered eating, and all should be considered for primary prevention and screening. Further research is needed regarding sport-specific versus general pressures and mediators of risk to better inform interventions.

Objective: Elite athletes are at elevated risk for disordered eating and eating disorders; however, little is known about risk and maintaining factors, or barriers and facilitators of help‐seeking in this cohort. This systematic review synthesized qualitative findings regarding possible risk and maintaining factors for disordered eating, as well as barriers to and facilitators of help‐seeking in elite athletes.Method: We conducted a search for qualitative studies that included experiences with body image concerns or disordered eating in elite athletes. A systematic search of CINAHL, PsychINFO, MEDLINE, and Scopus databases identified 828 articles, with 87 retained after title and abstract screening, and 38 included in the review. Quality appraisal was conducted using the checklist for appraising qualitative research (CASP). Data were extracted from each article, including demographic information (e.g., biological sex, age, sport type, level of competition, current, or former athlete) and the text under the “results” or “findings” section. Meta‐themes were identified using inductive thematic meta‐synthesis.Results: The extracted data indicated that most studies sampled female athletes from the United States and UK. Eight meta‐themes were identified: (1) the power imbalance; (2) hyperfocus on body, food, and exercise; (3) rigidity; (4) the athlete's balance; (5) the athlete identity; (6) overvaluation and oversimplification; (7) shame, fear, and stigma; and (8) knowledge, education, and self‐identification.Discussion: These findings highlighted gaps in the demographic representation of specific groups in this research (e.g., males, para‐athletes, and ethnic diversity) and propose hypotheses of how sport pressure might contribute to athletes' experiences with disordered eating.Public Significance: Disordered eating and body image concerns are prevalent and can have debilitating impacts for elite athletes; however, help‐seeking is rare for this population. It remains unclear what factors contribute to disordered eating and/or inhibit help‐seeking among elite athletes versus the general population. Understanding athletes' perspectives will inform the modification of prevention and treatment strategies to address athlete‐specific factors.

Venous thromboembolism (VTE) is a leading cause of morbidity and mortality in the geriatric post-surgical population, and its prevention is a public health priority. The aim of this study was to assess the use of VTE risk screening and training protocols, and VTE awareness in the Australian residential aged care sector. A cross-sectional survey was conducted that was directed at facility and policy managers of community aged care facilities with >= 10 residents in two Australian states and territories. Forty-nine of 301 (16.3%) providers responded, representing 249/871 (28.6%) aged care facilities and 20,958/66,121 (31.7%) residents. VTE risk screening protocols were used by 1.2% of facilities (3/249), and 79.5% (198/249) were unaware that VTE is an issue in this population. Only 0.8% (2/249) were aware that risk screening and prophylaxis is required to prevent VTE; none were acting upon this. No facility had specific VTE risk assessment or prevention processes in place. Most residential aged care facilities surveyed do not have VTE risk screening protocols and were unaware of the risk that may be associated with this omission. These results have implications for development and implementation of national and international VTE risk screening guidelines in community care.

Background: Researchers are capitalising on the strong connections that sport fans have with their teams for health promotion programmes, yet no existing systematic reviews have evaluated the effectiveness of interventions delivered through professional sport. Objective: The aim of this study was to systematically collate, evaluate, and synthesise the evidence on health promotion interventions implemented in professional sport settings. Methods: Randomised controlled trials reporting on adult health promotion initiatives delivered in professional sport settings were identified through electronic database searches in CINAHL, MEDLINE, SPORTDiscus, Scopus, the Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar. Data on health-related outcomes (e.g., weight, physical activity, dietary intake) were extracted and synthesised, and random effects meta-analyses were conducted to examine effects for weight and waist circumference. Risk of bias was examined using the Cochrane risk-of-bias tool for randomised controlled trials (RoB 2). Results: Six studies reporting on five unique interventions met the inclusion criteria, and all included studies were gender-sensitised and exclusively targeted men. Intervention effects were observed for several health outcomes, including physical activity, dietary intake, and psychosocial health. All studies aimed to reduce weight, and for most studies (n = 4), weight was a primary outcome, either of the included study or to inform a future definitive trial. Findings from the meta-analysis revealed an overall significant difference in change in weight of − 3.2 kg (95% confidence interval [CI] − 4.6 to − 1.8) and waist circumference of − 3.9 cm (95% CI − 4.9 to − 2.8), both in favour of the intervention group at 12 weeks. Intervention effects were also reported for several other health outcomes (e.g., physical activity, dietary intake, psychosocial health); however, they were not consistently measured across the studies and thus were not meta-analysed. Conclusion: Health promotion interventions delivered through professional sporting organisations can significantly improve weight- and lifestyle-related health outcomes. Representation across the socioeconomic spectrum and across culturally and linguistically diverse groups was limited. As only a limited number of studies met the inclusion criteria for this review, a need exists for rigorously designed interventions, standardised intervention approaches, with long-term follow-up, and the potential for scalability. PROSPERO Registration Number: CRD42019123295.

Individual associations between lifestyle behaviours and mental health have been established; however, evidence on the clustering of these behaviours and the subsequent impact on mental health is limited. The purpose of this study was to examine cross-sectional and longitudinal associations between combined unhealthy lifestyle behaviours (physical activity, sitting time, sleep duration, processed meat consumption, vegetable consumption, fruit consumption, smoking status, alcohol consumption) and the development of psychological distress (measured using the Kessler Psychological Distress Scale) in a large Australian sample. Participants were 163,707 Australian adults from the 45 and Up Study. Data from baseline (2006–2009) and follow-up wave 1 (2012) were analysed using binary logistic regression. The odds of reporting high or very high psychological distress at follow-up were significantly higher for those reporting five (AOR = 2.36; 95% CI 1.41–3.97, p = 0.001) or six or more (AOR = 3.04; 95% CI 1.62–5.69, p = 0.001) unhealthy lifestyle behaviours, in comparison to those reporting no unhealthy lifestyle behaviours at baseline. These findings suggest that a holistic, multi-faceted lifestyle approach addressing multiple behaviours may be required to support and promote positive mental health and to reduce the likelihood of psychological distress.