Assessment of disordered eating and orthorexia nervosa in endurance athletes following gluten and wheat-free diets (GWD)

Endurance athletes recognize that a leaner and lighter body can improve performance outcomes. Currently, there is limited data assessing disordered eating, including orthorexia nervosa, in endurance athletes choosing to adhere to GWDs. Purpose: The aim of this study was to assess disordered eating, including orthorexia behaviors, in endurance athletes following GWDs compared to athletes following a normal diet (ND). Methods: Endurance athletes (ages 18-55y) were invited to participate in a web-based questionnaire via multiple sporting websites. The survey included demographic information, questions regarding beliefs and attitudes about GWDs, and two validated disordered eating and orthorexia questionnaires: Three Factor Eating Questionnaire (TFEQ-R18) and the ORTO-15. Athletes following GWDs were combined. Descriptive statistics and independent sample t-tests comparing groups using SPSS with significance set at p<0.05. Results: Of the athletes responding (n=100), only 73 had usable data (63 females; 9 males; 1 transgender). One-third (37%; n=27) reported being on GWDs (clinically diagnosed gluten sensitivity (n=10); celiac (n=1)). ND’s were significantly older (44+11 y) than GWD (39+12 y, p=0.05). There were no differences between groups for self-reported body mass index (GWD=22+3 vs. ND=24+4 kg/m2), orthorexia scores (GWD=37.1+6.9 vs. ND=39.0+6.3), and TFEQ subscale scores for emotional eating (GWD=8.2+2.1 vs. ND=8.2+2.2), dietary restraint (GWD=14.4+4.1 vs. ND=15.8+3.9) and uncontrolled eating (GWD=24.7+5.3 vs. ND=25.1+4.8). Athletes classified with orthorexia (75.3%; n=55) had significantly lower TFEQ scores in restrained, emotional, and cognitive disordered eating than those not categorized as having orthorexia (24.7%; n=18) (p<0.001). Conclusion: This sample of endurance athletes displayed high levels of orthorexia and disordered eating behaviors but there were no differences between GWD and ND diet groups. Further studies are needed to determine the extent of nutritional and behavioral risk in endurance athletes presenting with orthorexia.