Jorunn Kaiander Sundgot Borgen

• 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.
• 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. doi: 10.1002/ejsc.12129.
• Sundgot-Borgen, Jorunn; Torstveit, Monica Klungland; Mathisen, Therese Fostervold & Pensgaard, Anne Marte (2024). Nye retningslinjerfor syndrometrelativ energimangel i idrett(REDs). Tidsskrift for Den norske legeforening. ISSN 0029-2001. 144(6). doi: 10.4045/tidsskr.24.0181.
• 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.
• 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. doi: 10.1002/eat.24140.
• 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.

• 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. 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.

• 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.

• 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.

• 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. ISSN 2055-7647. 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.

• Mathisen, Therese Fostervold; Sundgot-Borgen, Jorunn & Sundgot-Borgen, Christine (2023). Nutrition and eating disorders in youth sport. In Armstrong, Neil & van Mechelen, Willem (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.
• 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. ISSN 2198-9761. 9. doi: 10.1186/s40798-023-00605-4. Full text in Research Archive
• 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.

• 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.

• 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. ISSN 1664-1078. 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.

• 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.

• 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.

• 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. ISSN 1124-4909. 28. 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.

• 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.

• 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. ISSN 2055-7647. 9. 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.

• 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). Intervention in professional dance students to increase mental health- and nutrition literacy: A controlled trial with follow up. Frontiers in Sports and Active Living. ISSN 2624-9367. 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.

• 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
• 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.

• 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.
• 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. ISSN 2075-4663. 10(5), p. 1–14. doi: 10.3390/sports10050068. Full text in Research Archive
• Tutu Dasa, Marcus Småvik; 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.

• 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.

• 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. ISSN 2055-0928. 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.

• 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. ISSN 1664-1078. 13. doi: 10.3389/fpsyg.2022.803654. Full text in Research Archive
• 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. ISSN 1664-1078. 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.

• 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. ISSN 2055-7647. p. 1–5. doi: 10.1136/bmjsem-2021-001219. Full text in Research Archive
• 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. ISSN 2212-6570. 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; Sølvberg, Nina; Sundgot-Borgen, Christine & Sundgot-Borgen, Jorunn (2021). Sexual Harassment in Fitness Instructors: Prevalence, Perpetrators, and Mental Health Correlates. Frontiers in Psychiatry. ISSN 1664-0640. 12, p. 1–8. doi: 10.3389/fpsyt.2021.735015.
• 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. ISSN 2624-9367. 3. doi: 10.3389/fspor.2021.727372. Full text in Research Archive
• 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.

• 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. ISSN 1471-2458. 21. doi: 10.1186/s12889-021-10550-0. Full text in Research Archive
• Collins, James; Maughan, Ronald J.; Gleeson, Michael; Bilsborough, Johann; Jeukendrup, Asker & Morton, James P [Show all 31 contributors for this article] (2020). UEFA expert group statement on nutrition in elite football. Current evidence to inform practical recommendations and guide future research. British Journal of Sports Medicine. ISSN 0306-3674. p. 1–27. doi: 10.1136/bjsports-2019-101961.
• Mathisen, Therese Fostervold; Aambø, Jenny Malene; Bratland-Sanda, Solfrid; Sundgot-Borgen, Christine; Svantorp-Tveiten, Kethe Marie Engen & Sundgot-Borgen, Jorunn (2020). Body figure idealization and body appearance pressure in fitness instructors. Frontiers in Psychology. ISSN 1664-1078. 11:585901, p. 1–11. doi: 10.3389/fpsyg.2020.585901. Full text in Research Archive
• Bratland-Sanda, Solfrid; Mathisen, Therese Fostervold; Sundgot-Borgen, Christine; Sundgot-Borgen, Jorunn & Tangen, Jan Ove (2020). The Impact of Covid-19 Pandemic Lockdown during spring 2020 on Personal Trainers’ Working and Living Conditions. Frontiers in Sports and Active Living. ISSN 2624-9367. 2. doi: 10.3389/fspor.2020.589702. Full text in Research Archive
• Sundgot-Borgen, Christine; Stenling, Andreas; Rosenvinge, Jan H; Pettersen, Gunn; Friborg, Oddgeir & Sundgot-Borgen, Jorunn [Show all 10 contributors for this article] (2020). The Norwegian healthy body image intervention promotes positive embodiment through improved self-esteem. Body image. ISSN 1740-1445. 35, p. 84–95. doi: 10.1016/j.bodyim.2020.08.014. Full text in Research Archive Show summary

  We examined both direct and indirect effects of the Healthy Body Image (HBI) intervention on positive embodiment among Norwegian high school students. In total, 2446 12th grade boys (43 %) and girls (mean age 16.8 years) from 30 schools participated in a cluster-randomized controlled study with the HBI intervention and a control condition as the study arms. We tested mediation models using path analysis and found that among several hypothesized mediators, only self-esteem mediated a positive intervention effect on positive embodiment for both boys and girls. A direct effect of the intervention on positive embodiment was only found in girls. The study provides novel findings indicating that health promotion interventions to address a positive embodiment should focus on enhancing adolescent’s self-esteem. Serial mediation modeling might reveal more complex explanations of change mechanisms and could further evolve current knowledge.

• Bakland, Maria; Rosenvinge, Jan H; Wynn, Rolf; Sørlie, Venke; Sundgot-Borgen, Jorunn & Mathisen, Therese Fostervold [Show all 10 contributors for this article] (2020). A new treatment for eating disorders combining physical exercise and dietary therapy (the PED-t): experiences from patients who dropped out. International Journal of Qualitative Studies on Health and Well-being. ISSN 1748-2623. 15(1). doi: 10.1080/17482631.2020.1731994. Full text in Research Archive Show summary

  Purpose: Eating disorders (ED) are complex and severe illnesses where evidence-based treatment is needed to recover. However, about half of the patients with ED do not respond to treatments currently available, which call for efforts to expand the portfolio of treatments. The aim of this study was to explore experiences from patients who dropped out of a new treatment for bulimia nervosa and binge ED, combining physical exercise and dietary therapy (PED-t). Methods: We conducted open-ended face-to-face interviews. The interviews were transcribed verbatim and the data were analysed with a phenomenological hermeneutical approach. Results: Three themes emerged: “standing on the outside”, “unmet expectations” and “participation not a waste of time”. Feelings of standing on the outside were elicited by being different from other group members and having challenges with sharing thoughts. Unmet expectations were related to treatment content and intensity, as well as the development of unhealthy thoughts and behaviours. Finally, some positive experiences were voiced. Conclusion: A need to clarify pre-treatment expectations and refining criteria for treatment suitability is indicated. The findings have contributed to the chain of clinical evidence regarding the PED-t and may lead to treatment modifications improving the treatment and thereby reducing drop out.

• Mathisen, Therese Fostervold; Rosenvinge, Jan H; Friborg, Oddgeir; Vrabel, KariAnne; Bratland-Sanda, Solfrid & Pettersen, Gunn [Show all 7 contributors for this article] (2020). Is physical exercise and dietary therapy a feasible alternative to cognitive behavior therapy in treatment of eating disorders? A randomized controlled trial of two group therapies. International Journal of Eating Disorders. ISSN 0276-3478. 53(4), p. 574–585. doi: 10.1002/eat.23228. Full text in Research Archive Show summary

  Objective: To compare effects of physical exercise and dietary therapy (PED‐t) to cognitive behavioral therapy (CBT) in treatment of bulimia nervosa (BN) and binge‐eating disorder (BED). Method: The active sample (18–40 years of age) consisted of 76 women in the PED‐t condition and 73 in the CBT condition. Participants who chose not to initiate treatment immediately (n = 23) were put on a waiting list. Outcome measures were the eating disorder examination questionnaire (EDE‐Q), Clinical Impairment Assessment (CIA), Satisfaction with Life Scale (SWLS), Beck Depression Inventory (BDI), and numbers in remission at posttreatment, and at 6‐, 12‐, and 24‐months follow‐up. Results: Both treatment conditions produced medium to strong significant improvements on all outcomes with long‐term effect. The PED‐t produced a faster improvement in EDE‐Q and CIA, but these differences vanished at follow‐ups. Only PED‐t provided improvements in BDI, still with no between‐group difference. Totally, 30–50% of participants responded favorable to treatments, with no statistical between‐group difference. Discussion: Both treatments shared a focus on normalizing eating patterns, correcting basic self‐regulatory processes and reducing idealized aesthetic evaluations of self‐worth. The results point to the PED‐t as an alternative to CBT for BN and BED, although results are limited due to compliance and dropout rates. Replications are needed by independent research groups as well as in more clinical settings.

• Müller, Wolfram; Fürhapter-Rieger, Alfred; Ahammer, Helmut; Lohman, Timothy G.; Meyer, Nanna L. & Sardinha, Luís B. [Show all 18 contributors for this article] (2019). Relative Body Weight and Standardised Brightness-Mode Ultrasound Measurement of Subcutaneous Fat in Athletes: An International Multicentre Reliability Study, Under the Auspices of the IOC Medical Commission. Sports Medicine. ISSN 0112-1642. doi: 10.1007/s40279-019-01192-9. Full text in Research Archive Show summary

  Introduction: Fat is a metabolic fuel, but excess body fat is ballast mass, and therefore, many elite athletes reduce body fat to dangerously low levels. Uncompressed subcutaneous adipose tissue (SAT) thickness measured by brightness-mode ultrasound (US) provides an estimate of body fat content. Methods: The accuracy for determining tissue borders is about 0.1–0.2 mm and reliability (experienced measurers) was within ± 1.4 mm (95% limit of agreement, LOA). We present here inter- and intra-measurer scores of three experienced US measurers from each of the centres C1 and C2, and of three novice measurers from each of the centres C3–C5. Each of the five centres measured 16 competitive adult athletes of national or international level, except for one centre where the number was 12. The following sports were included: artistic gymnastics, judo, pentathlon, power lifting, rowing, kayak, soccer, tennis, rugby, basketball, field hockey, water polo, volleyball, American football, triathlon, swimming, cycling, long-distance running, mid-distance running, hurdles, cross-country skiing, snowboarding, and ice hockey. SAT contour was detected semi-automatically: typically, 100 thicknesses of SAT at a given site (i.e., in a given image), with and without fibrous structures, were measured. Results: At SAT thickness sums DI (of eight standardised sites) between 6.0 and 70.0 mm, the LOA of experienced measurers was 1.2 mm, and the intra-class correlation coefficient ICC was 0.998; novice measurers: 3.1 mm and 0.988. Intra-measurer differences were similar. The median DI value of all 39 female participants was 51 mm (11% fibrous structures) compared to 17 mm (18%) in the 37 male participants. Discussion: DI measurement accuracy and precision enables detection of fat mass changes of approximately 0.2 kg. Such reliability has not been reached with any other method. Although females’ median body mass index and mass index were lower than those of males, females’ median DI was three times higher, and their percentage of fibrous structures was lower. The standardised US method provides a highly accurate and reliable tool for measuring SAT and thus changes in body fat, but training of measurers is important.

• Mathisen, Therese Fostervold; Heia, Josefine; Raustøl, Marius Løvic; Sandeggen, Mari; Fjellestad, Ingrid & Sundgot-Borgen, Jorunn (2019). Physical health and symptoms of relative energy deficiency in female fitness athletes. Scandinavian Journal of Medicine & Science in Sports. ISSN 0905-7188. 30(1), p. 135–147. doi: 10.1111/sms.13568. Full text in Research Archive Show summary

  Introduction: Competing in aesthetic sports increases the risk of low energy availability and associated health impairments. Fitness physique sport is a popular, but understudied aesthetic sport. We evaluated health and symptoms of relative energy deficiency in sport (RED‐s) in female fitness athletes (FA) and female references (FR) during a competitive season. Methods: Totally, 25 FA and 26 FR, mean (SD) age of 28.9 (5.7), were included. Assessments were at baseline (T1), 2‐weeks pre‐competition (T2), and 1‐month post‐competition (T3), by dual‐energy x‐ray absorptiometry scan, indirect calorimetry, diet registration, The Low Energy Availability in Females Questionnaire, The Beck Depression Inventory, and Eating Disorder Examination Questionnaire (EDE‐Q). Results: A history of eating disorders was reported by 35% FA and 12% FR. There were no between‐group differences at T1, besides less mean (99% CI) fat mass (FM) of 3.1 kg (−0.4, 6.5) in FA (P = .02). At T2, FA had lower BW of 6.7 kg (−12.0, −1.3), fat mass of −9.0 kg (−12.5, −5.5), and resting heart rate of −8.0 beats per minute (−14.5, −1.5) compared to FR (P ≤ .006). FA reduced resting metabolic rate by −191 kcal (−11, −371) and increased symptoms of gastrointestinal dysfunction (GD) by 1.4 points (0.3, 2.5) and prevalence of amenorrhea from 8% to 24%, (P < .003). At T3, there was a between‐group difference in fat mass, and a high number of FA with amenorrhea and GD. Conclusion: Manifestation of symptoms of RED‐s, some with persistence one‐month post‐competition, raises concern for the health of FA and those complying with the fit body ideal.

• Sundgot-Borgen, Jorunn; Sundgot-Borgen, Christine; Myklebust, Grethe; Sølvberg, Nina & Torstveit, Monica Klungland (2019). Elite athletes get pregnant, have healthy babies and return to sport early postpartum. BMJ Open sport & exercise medicine. ISSN 2055-7647. 5(1). doi: 10.1136/bmjsem-2019-000652. Full text in Research Archive Show summary

  Objectives: To enhance knowledge on pregnancy and return to sport in the postpartum period in elite female athletes. Methods: 34 Norwegian elite athletes (33.1 years) and 34 active controls (31.5 years) were asked about training and competitive history, pregnancy-related issues, injuries, body dissatisfaction (BD), drive for thinness (DT), eating disorders (ED) and practical experiences, through a questionnaire and interview. Independent samples T-tests or χ² tests for between-group differences and paired-samples T-tests and repeated measures analysis of variance for within group differences were used. Results: No group differences in fertility problems, miscarriage, preterm birth or low birth weight were found. Both groups decreased training volume all trimesters and the first two postpartum periods compared with prepregnancy, and more athletes returned to sport/exercise at week 0–6 postpartum. We found no group differences in complications during pregnancy and delivery, but athletes reported fewer common complaints. Four athletes experienced stress fracture postpartum. Athletes had higher BD and DT postpartum, while controls reduced DT score. Number of athletes with clinical ED was reduced postpartum, while constant in controls. Athletes were not satisfied with advice related to strength training and nutrition during pregnancy. Conclusion: Elite athletes and active controls get pregnant easily, deliver healthy babies and decrease training during pregnancy and the first postpartum periods compared with prepregnancy. Most athletes and every third control returned to sport or exercise at week 0–6 postpartum. Athletes report stress fractures and increased BD and DT, but decreased ED postpartum. However, since relatively few athletes were included these findings need further investigation.

• Sundgot-Borgen, Christine; Friborg, Oddgeir; Kolle, Elin; Torstveit, Monica Klungland; Sundgot-Borgen, Jorunn & Engen, Kethe Marie Elgesem [Show all 9 contributors for this article] (2019). Does the Healthy Body Image program improve lifestyle habits among high school students? A randomized controlled trial with 12-month follow-up. Journal of International Medical Research. ISSN 0300-0605. doi: 10.1177/0300060519889453. Full text in Research Archive
• Mathisen, Therese Fostervold & Sundgot-Borgen, Jorunn (2019). Mental health symptoms related to body shape idealization in female fitness physique athletes. Sports. ISSN 2075-4663. 7(11). doi: 10.3390/sports7110236. Full text in Research Archive Show summary

  Physical activity relates to optimal health, still the prevalence of mental health issues is high among athletes. Being young, female, and competing in aesthetic sports is a high-risk combination for mental health symptoms. Fitness physique athletes (FA) match this profile but are understudied. We aimed to study the intensity of mental health symptoms (i.e., body image, eating behaviour, relation to and routines for exercise, and perfectionism) in FA and in female references (FR), and to evaluate how preparing for fitness sport competitions affects these mental health symptoms. Before competition, FA had higher levels of drive for leanness (DFL) and eating restraint compared to FR. At the time of competition, eating restraint increased in FA only, concurrent with a reduction in symptoms of disordered eating. The levels of DFL, drive for muscularity, eating restraint, and exercising for figure toning were higher in FA compared to FR. At one-month post-competition, the differences between groups from competition time remained. Generally, perfectionism correlated with eating restrictions in FA and with disordered eating in FR. Overall, FA coped with the dieting, but self-control deteriorated post-competition with higher levels of disordered eating and an increased body shape concern. High DFL generally associated with more disordered eating behaviour, specifically in FR.

• Melin, Anna Katarina; Ritz, Christian; Faber, Jens; Skouby, Sven; Pingel, Jessica & Sundgot-Borgen, Jorunn [Show all 8 contributors for this article] (2019). Impact of menstrual function on hormonal response to repeated bouts of intense exercise. Frontiers in Physiology. ISSN 1664-042X. 10. doi: 10.3389/fphys.2019.00942. Full text in Research Archive Show summary

  Background: Strenous exercise stimulates the hypothalamic-pituitary (HP) axis in order to ensure homeostasis and promote anabolism. Furthermore, exercise stimulates a transient increase in the neurotrophin brain-derived neurotrophic factor (BDNF) suggested to mediate the anxiolytic effects of exercise. Athletes with secondary functional hypothalamic amenorrhea (FHA) have been reported to have lower BDNF, and a blunted HP axis response to exercise as athletes with overtraining syndrome. Aim: The aim of the study was to investigate the hormonal and BDNF responses to a two-bout maximal exercise protocol with four hours of recovery in between in FHA and eumenorrheic (EUM) athletes. Methods: Eumenorrheic (n = 16) and FHA (n = 14) endurance athletes were recruited from national teams and competitive clubs. Protocols included gynecological examination; body composition (DXA); 7-day assessment of energy availability; blood sampling pre and post the two exercises tests. Results: There were no differences between groups in hormonal responses to the first exercise bout. After the second exercise bout IGFBP-3 increased more in FHA compared with EUM athletes (2.1 ± 0.5 vs. 0.6 ± 0.6 μg/L, p = 0.048). There were non-significant trends toward higher increase in IGF-1 (39.3 ± 4.3 vs. 28.0 ± 4.6 μg/L, p = 0.074), BDNF (96.5 ± 22.9 vs. 34.4 ± 23.5 μg/L, p = 0.058), GH to cortisol ratio (0.329 ± 0.010 vs. 0.058 ± 0.010, p = 0.082), and decrease in IGF-1 to IGFBP-3 ratio (−2.04 ± 1.2 vs. 0.92 ± 1.22, p = 0.081) in athletes with FHA compared with EUM athletes. Furthermore, there was a non-significant trend toward a higher increase in prolactin to cortisol ratio in EUM athletes compared with athletes with FHA (0.60 ± 0.15 vs. 0.23 ± 0.15, p = 0.071). No differences in the hormonal or BDNF responses between the two exercise bouts as a result of menstrual function were found. Conclusion: No major differences in the hormonal or BDNF responses between the two exercise bouts as a result of menstrual function could be detected.

• Stornæs, Annett Victoria; Rosenvinge, Jan H; Sundgot-Borgen, Jorunn; Pettersen, Gunn & Friborg, Oddgeir (2019). Profiles of perfectionism among adolescents attending specialized elite- and ordinary lower secondary schools: A Norwegian cross-sectional comparative study. Frontiers in Psychology. ISSN 1664-1078. 10:2039, p. 1–12. doi: 10.3389/fpsyg.2019.02039. Full text in Research Archive Show summary

  The versatile construct of perfectionism has been heavily debated, e.g., its nature or measurement constituents, how it influences performances or, most importantly, our health. Conventional linear analyses seem inadequate to address such challenges. Hence, we used a latent variable and a person-centered approach to identify different patterns of perfectionism, and their relationships with psychological health as outcome among early adolescents (13–14 years) attending conventional or elite sports-/performance-oriented lower secondary schools (14 schools, 832 students, 53% girls). All students completed two perfectionism scales, i.e., the child-adolescent perfectionism scale (CAPS) and the frost multidimensional perfectionism scale (FMPS). The criterion-related variables of psychological health included anxiety, depression, eating disorder problems, self-worth and resilience, respectively. Exploratory and confirmatory factor analyses yielded a four-factor representation of perfectionism. Using latent class analysis extracted five profiles of perfectionism, which were related to the criterion variables. Three profiles were clear indicators of either low or high perfectionism score patterns. Two profiles showed a mixed picture of high and low scores, whereas one represented a psychological healthy subgroup. About four of ten adolescents in the ordinary schools matched the two most debilitating perfectionism profiles compared to two of ten in the elite schools. How these results align with international findings is discussed along with the relevance for early interventions aimed at preventing the potential downsides of perfectionism. Longitudinal studies are neeed to explore profile trajectories as well as possible health consequences.

• Pettersen, Gunn; Rosenvinge, Jan H; Skomakerstuen, Tone; Sørdal, Solveig; Mathisen, Therese Fostervold & Sundgot-Borgen, Jorunn (2019). Patient expectations of a new treatment for eating disorders combining guided physical exercise and dietary therapy: An interview study of women participating in a randomised controlled trial at the Norwegian School of Sport Sciences. BMJ Open. ISSN 2044-6055. 9(4). doi: 10.1136/bmjopen-2018-025344. Full text in Research Archive Show summary

  Objectives To study the expectations women with bulimia nervosa (BN) or binge eating disorder (BED) had to a new treatment programme based on guided physical exercise and dietary therapy. Design and participants Semistructured interviews were conducted with six women with BN and four women with BED following a group-based therapy programme. Transcribed interviews were analysed using a text-condensing analytic approach. Results The analysis resulted in three main categories, that is, expectations about (1) increased knowledge, (2) symptom changes and (3) therapeutic expertise. The women expected that learning more about nutrition and physical exercise would give them more energy, less fear of food, physical and mental symptoms and a negative body focus. They also expected therapists to be professional and competent, and able to take care of them. Conclusion The overall high and positive treatment expectation can, to some extent, reflect enthusiasm about a new and innovative approach to treatment. However, the results also reflect generic and highly adequate outcome expectations, which for the purpose of effectiveness should be incorporated into all treatment efforts at least for patients with eating disorders.

• Bakland, Maria; Rosenvinge, Jan H; Wynn, Rolf; Sundgot-Borgen, Jorunn; Mathisen, Therese Fostervold & Liabø, Kristin [Show all 8 contributors for this article] (2019). Patients' views on a new treatment for Bulimia nervosa and binge eating disorder combining physical exercise and dietary therapy (the PED-t). A qualitative study. Eating Disorders. ISSN 1064-0266. doi: 10.1080/10640266.2018.1560847. Full text in Research Archive Show summary

  A new group based treatment for patients with bulimia nervosa (BN) and binge eating disorder (BED), combining guided Physical Exercise and Dietary therapy (PED-t), has shown the capacity to alleviate BN and BED symptoms. The PED-t is run by therapists with a professional background in sport sciences and nutrition, which in many clinical settings is an uncommon group of professionals. The symptom reduction effects using the PED-t need validation from patients who have been given this kind of treatment, as negative experiences may impinge further clinical implementation. To explore such experiences, semistructural interviews were conducted with 15 participants. The interviews were transcribed and analyzed using a systematic text condensation approach. Overall, patients experienced the format and content of the PED-t as beneficial and as providing tools to manage BN- and BED symptoms. The patients’ experiences of therapist credibility was enhanced by their appreciation of the therapists’ professional background. Finally, some treatment modifications were suggested. Overall, the PED-t may thus be offered to patients with BN and BED, by a new set of professionals, and in uncommon settings. This possibility calls for future effectiveness studies integrating both parametric and experiential data.

• Sundgot-Borgen, Christine; Friborg, Oddgeir; Kolle, Elin; Engen, Kethe Marie Elgesem; Sundgot-Borgen, Jorunn & Rosenvinge, Jan H [Show all 10 contributors for this article] (2019). The healthy body image (HBI) intervention: Effects of a school-based cluster-randomized controlled trial with 12-months follow-up. Body image. ISSN 1740-1445. 29, p. 122–131. doi: 10.1016/j.bodyim.2019.03.007. Full text in Research Archive Show summary

  We examined the effects of the Healthy Body Image (HBI) intervention on positive embodiment and health-related quality of life among Norwegian high school students. The intervention comprised three interactive workshops, with body image, media literacy, and lifestyle as main themes. In total, 2,446 12th grade boys (43%) and girls (mean age 16.8 years) from 30 high schools participated in a cluster-randomized controlled study with the HBI intervention and a control condition as the study arms. Data were collected at baseline, post-intervention, 3- and 12-months follow-up, and analysed using linear mixed regression models. The HBI intervention caused a favourable immediate change in positive embodiment and health-related quality of life among intervention girls, which was maintained at follow-up. Among intervention boys, however, weak post-intervention effects on embodiment and health-related quality of life vanished at the follow-ups. Future studies should address steps to make the HBI intervention more relevant for boys as well as determine whether the number of workshops or themes may be shortened to ease implementation and to enhance intervention effects.

• Mathisen, Therese Fostervold; Sundgot-Borgen, Jorunn; Rosenvinge, Jan Harald & Bratland-Sanda, Solfrid (2018). Managing risk of non-communicable diseases in women with bulimia nervosa or binge eating: A randomized trial with 12-months follow-up. Nutrients. ISSN 2072-6643. doi: 10.3390/nu10121887.
• Mathisen, Therese Fostervold; Bratland-Sanda, Solfrid; Rosenvinge, Jan H; Friborg, Oddgeir; Pettersen, Gunn & Vrabel, Kari-Anne [Show all 7 contributors for this article] (2018). Treatment effects on compulsive exercise and physical activity in eating disorders. Journal of Eating Disorders. ISSN 2050-2974. 6, p. 1–9. doi: 10.1186/s40337-018-0215-1. Full text in Research Archive Show summary

  Background: Dysfunctional thoughts- and use of physical activity (PA) are core symptoms of the eating disorders (ED) bulimia nervosa (BN) and binge eating disorder (BED). The compulsive desire for PA complicates a favourable treatment outcome; hence, regular, adapted PA led by personnel with competence in exercise science is rarely part of treatment of BN and BED. The present study compared cognitive behaviour therapy (CBT) with a new treatment combining physical exercise and dietary therapy (PED-t) with respect to the short- and long-term changes in the level of compulsive exercise and actual level of PA in women with BN or BED. Methods: We enrolled 187 women with BN or BED, aged 18–40 years, with BMI 17.5–35, in an outpatient randomised controlled therapy trial. Participants were randomised to PED-t or CBT, while waitlist participants served as a control group during the treatment period. The treatment covered 16 weeks, with 6- and 12 months follow-up, and outcomes included self-reported compulsive exercise (CE) and objectively measured PA, analysed by linear mixed regression models. Results: Both CBT and PED-t reduced CE from baseline (P < 0.01, Hedges g ~ 0.4), but with no difference to control group. Compared to baseline, only PED-t significantly reduced the number of patients who scored above cut-off rating for CE, but with no between-group differences. The proportion of participants complying with the official recommendation for PA neither changed following treatment, nor emerged different between the treatment arms. Conclusion: Both therapies resulted in significant improvements in compulsive exercise, a change not found in the control group, however there were no between-group differences. The findings are tempered by the low statistical power due to a small control group size. The number of participants complying with the recommendation for PA were stable throughout the study, and no change in total PA was found. Presence and intensity of CE decline with treatment, but a need to increase PA towards healthy levels remains unsolved.

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• Gaarder, Jorun; Mathisen, Therese Fostervold; Sundgot-Borgen, Jorunn & Martinsen, Marianne (2024). Refser idrettstopper: - Meler sin egen kake. [Internet]. Dagbladet.
• Mathisen, Therese Fostervold; Sundgot-Borgen, Jorunn & Sandholt, Ragna Kristine (2024). Rasar mot Norges idrettsforbund etter rapport: – Dette er alvorleg. [Internet]. Nrk.no.
• 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.
• Mathisen, Therese Fostervold; Sundgot-Borgen, Jorunn & Hubin, Aliaksandr (2023). Tung styrketrening i svangerskap og barseltid – helt greit? Preliminære data fra en prospektiv, kontrollert kohortstudie. .
• Mathisen, Therese Fostervold & Sundgot-Borgen, Jorunn (2023). Kroppssammensetning i idretten – grunn til bekymring? Nye retningslinjer fra IOC.
• Mathisen, Therese Fostervold; Sundgot-Borgen, Jorunn; Torstveit, Monica Klungland & Bratland-Sanda, Solfrid (2023). TRENERSTUDENTEN EPISODE 45: LEA og REDs. [Radio]. Spotify Podcast.
• 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.
• 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. British Journal of Sports Medicine. ISSN 0306-3674. 57(17), p. 1063–1064. doi: 10.1136/bjsports-2023-106749.
• 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.
• 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.
• 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.
• Mathisen, Therese Fostervold; Rosenvinge, Jan H; Pettersen, Gunn & Sundgot-Borgen, Jorunn (2023). Erfaringsseminar om behandling av spiseforstyrrelser i Frisklivssentralen.
• 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.
• 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 .
• Mathisen, Therese Fostervold; Sundgot-Borgen, Jorunn & Sandholt, Ragna Kristine (2022). Skreddersyr kroppen i jakten på gull. [Internet]. Nrk.no.
• 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.
• Mathisen, Therese Fostervold & Sundgot-Borgen, Jorunn (2022). Er det mulig å forebygge spiseforstyrrelser? Dagens medisin. ISSN 1501-4290.
• 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.
• Mathisen, Therese Fostervold & Sundgot-Borgen, Jorunn (2022). Low energy availability and eating disorders in athletes.
• 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.
• 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. 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; 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? 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 (2021). Eating habits in weight sensitive sport athletes. 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.

• Sundgot-Borgen, Jorunn (2021). Primary prevention of eating disorders/ disordered eating.
• Mathisen, Therese Fostervold; Sundgot-Borgen, Jorunn; Rasmussen, John; Oksnes, Bernt Jakob; Garder, Jorun & Godø, Øyvind (2021). Viktig melding til ledelsen. [Newspaper]. Dagbladet.
• 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. [Newspaper]. Dagbladet.
• 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. [Newspaper]. Dagbladet.
• Mathisen, Therese Fostervold; Sundgot-Borgen, Jorunn & Kihle, Anne Elisabeth Løberg (2021). Dystre funn om psykisk helse blant dansere. [Newspaper]. Aftenposten.
• 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 .
• Sundgot-Borgen, Jorunn; Bratland-Sanda, Solfrid; Torstveit, Monica Klungland; Mathisen, Therese Fostervold & Sundgot-Borgen, Christine (2021). Sannheten om spiseforstyrrelser i idretten. VG : Verdens gang. ISSN 0805-5203. 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; Stedal, Kristin; Fuglset, Tone Seim; Svantorp-Tveiten, Kethe Marie Engen; Bergestuen, Bent Egil & Joseph, Kent Lois [Show all 9 contributors for this article] (2021). Infografikk om veien til hjelp for spiseforstyrrelser. Show summary

  En infografikk som viser veien til behandling for spiseforstyrrelser i det norske behandlingssystemet.

• Mathisen, Therese Fostervold & Sundgot-Borgen, Jorunn (2021). Low energy availability, measures of body composition, and eating disorders in athletes.
• 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. [Newspaper]. Dagbladet.
• 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.
• Collins, James; Maughan, Ronald J.; Gleeson, Mike; Bilsborough, Johann; Jeukendrup, Asker & Morton, James P. [Show all 31 contributors for this article] (2020). Infographic. UEFA expert group 2020 statement on nutrition in elite football. British Journal of Sports Medicine. ISSN 0306-3674. doi: 10.1136/bjsports-2020-103410.
• Sundgot-Borgen, Jorunn (2019). Toppidrettsutøvere, svangerskap og mammarollen.
• Sundgot-Borgen, Jorunn (2019). For mye av det gode - trening og infertilitet.
• Mathisen, Therese Fostervold; Rosenvinge, Jan H; Friborg, Oddgeir; Vrabel, KariAnne R.; Bratland-Sanda, Solfrid & Pettersen, Gunn [Show all 7 contributors for this article] (2019). Physical exercise and dietary Therapy (PED-t) as treatment for BN and BED - a farfetched idea or exciting News?
• Mathisen, Therese Fostervold & Sundgot-Borgen, Jorunn (2019). Exercise is Medicine: Approaching Dysfunctional Exercise and Including Healthy Exercise in The Treatment of Eating Disorders.
• Mathisen, Therese Fostervold; Bratland-Sanda, Solfrid; Rosenvinge, Jan H; Pettersen, Gunn; Stensrud, Trine & Hansen, Bjørge Hermann [Show all 12 contributors for this article] (2019). Fysisk helse og risikoprofil for ikke-smittsomme sykdommer hos kvinner med bulimia nervosa eller overspisingslidelse.
• Sundgot-Borgen, Jorunn (2019). How to help the pregnant athlete stay healthy and perform at her best.
• Bratland-Sanda, Solfrid; Mathisen, Therese Fostervold; Sundgot-Borgen, Jorunn & Rosenvinge, Jan H (2019). Defining compulsive exercise in eating disorders: acknowledging the exercise paradox and exercise obsessions. Journal of Eating Disorders. ISSN 2050-2974. 7(8), p. 1–3. doi: 10.1186/s40337-019-0238-2.
• Mathisen, Therese Fostervold; Rosenvinge, Jan H; Friborg, Oddgeir; Pettersen, Gunn; Vrabel, Kari-Anne & Bratland-Sanda, Solfrid [Show all 7 contributors for this article] (2019). How do physical exercise and dietary therapy compare to cognitive behavior therapy in outpatient treatment of women with BN or BED?
• 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.

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