Mental Health and Symptoms of Energy Deficiency (REDs) in Young Biathletes

Mental Health and Symptoms of Energy Deficiency (REDs) in Young Biathletes.

Participation in weight-sensitive sports has been identified as a significant risk factor for low energy availability (LEA), relative energy deficiency in sport (REDs), and eating disorders. However, there is limited knowledge regarding the symptoms of LEA, REDs, and mental health issues in young biathletes. This study investigates the prevalence of these symptoms in young, talented biathletes from one of the leading nations in the sport. By including athletes of both sexes aged 16, 17, and 18, this study aim to determine whether symptom severity is associated with age, sex, or performance level. Furthermore, this study will explore the experiences of biathletes aged 18 and older with the new best practice guidelines for body composition assessment, designed by an IOC working group on the REDs consensus update of 2023 to safeguard athletes from negative experiences. The insights gained from this study may enhance the understanding of the frequency of health symptoms, the age or performance level at which symptoms typically increase, and the specific needs of athletes to ensure their safety and well-being in the sport.

Study Overview

• Status: Completed
• Conditions: Mental Health Issue; Physical Health

Detailed Description

Being physically active is associated with a range of positive mental, physical, and psychosocial health benefits. Although athletes might be expected to enjoy these positive health effects, studies also show that high-level competitive athletes have a similar prevalence of certain mental disorders as the general population. Beyond reflecting the normal occurrence of mental health challenges in the population, performance expectations related to participation in competitive sports may contribute to many athletes experiencing periods or persistent mental health issues. Despite the increased openness in recent years about top athletes experiencing mental stress and disorders, there is little knowledge about the overall prevalence, especially among younger athletes at sub-elite performance levels. In 2023, Norwegian media highlighted a serious concern about the mental health of young biathletes, underscored by an alarming and unexpectedly high incidence of suicide among young biathlon talents.

Ski sports are among many weight-sensitive sports challenged by a high prevalence of eating disorders, particularly among female athletes. Eating disorders are linked to a high risk of low energy availability (LEA) and the syndrome relative energy deficiency (REDs) in athletes. REDs involve a variety of health challenges that follow LEA, and mental health issues can be both contributing factors to and effects of LEA. Knowledge about the prevalence of LEA, eating disorders, and REDs specifically among biathletes is very limited. A recent study found that a group of young female skiers (17 years old), including biathletes, on average consumed too little energy and carbohydrates relative to their athletic needs, and that 17% had LEA. A previous study recruited female athletes aged 25 years with self-expressed concern for REDs. This study found an overall prevalence of eating disorders corresponding to 21.3%, and that 65% in the sub-group of biathletes had LEA. Athletes with LEA symptoms had both lower weight and BMI, and the highest prevalence of eating disorders. At the same time, there is a study with young male skiers (including biathletes) aged 16 years, which finds a high prevalence of low bone mass and loss of bone mass through puberty. Low bone mass is one of the cardinal signs of LEA and REDs.

There is a need to map the prevalence of mental health issues and symptoms of REDs in young biathletes. Such knowledge can be used to understand the extent, specific vulnerable periods, and potentially explain why some are more affected than others. This knowledge can be used to more easily identify those who may need help and to initiate early interventions before the severity and complexity increase. In this exploratory national cross-sectional study, the aim is to map mental health and symptoms of REDs in young biathlon talents aged 16-19 years. In connection with mapping the physical symptoms of REDs, this study also aim to evaluate athlete experiences when closely following the new proposed guidelines and recommendations for measuring body composition in athletes. The guidelines (three members of this project group contributed in producing those guidelines) were given to protect athletes from negative experiences with body evaluation, so fewer are at risk of developing a negative body image and disordered eating behaviors or eating disorders.

This study works from the following hypotheses: 1) The prevalence of body dissatisfaction, depression, eating disorders, and symptoms of REDs (hereafter: outcome measures) is low in 16-year-old biathletes; 2) the prevalence of outcome measures increases with age and is therefore higher in 18-year-old biathletes; 3) the prevalence of eating disorders and symptoms of REDs is higher in girls than boys in all age groups; 4) young biathletes aged 18 years experience a professional and safe implementation of body composition evaluation when recommended guidelines are followed.

• Study Type: Observational
• Enrollment (Actual): 28

Contacts and Locations

Study Locations

• Norway
  • Oslo, Norway, 0806
    • Norwegian School of Sport Sciences
  • Inland
    • Lillehammer, Inland, Norway, 2418
      • Inland Norway University of Applied Sciences

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

Young, competetive biathletes in age-range 16-20 years of age, living in Norway.

Description

Inclusion Criteria:

• competetive biathlete
• live in Norway, speaks or understand written and oral Norwegian

Exclusion Criteria:

• injured and prevented from regular training (3 months leading up to recruitement)

Study Plan

How is the study designed?

Number of groups / cohorts

3

Cohorts and Interventions

Group / Cohort
Biathletes 16 years of age; Norwegian, competetive biathletes of both sexes, aged 16 years of age
Biathletes 17 years of age; Norwegian, competetive biathletes of both sexes, aged 17 years of age
Biathlete 18 years of age; Norwegian, competetive biathletes of both sexes, aged 18 years of age

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Diagnosis of Eating Disorder	Number of athletes with a diagnosable eating disorder, and type of eating disorder. Evaulation will be by a clinical interview following the validated Eating Disorder Examination Inverview.	September 2024
Symptom of Eating Disorders	Number of athletes with symptoms of eating disorders, and type of eating disorder. Evaulation will be by a selfreport responding to the Eating Disorder Examination Questionnaire.	September 2024
Symptoms of Depression	Severity in symptoms of depression and number of athletes with symptoms of depression. Evaulation will be by selfreport, responding to the Beck Depression Inventory v-2	September 2024
Symptoms of Low Energy Availability (LEA)	Severity in symptoms of LEA, evaluated by selfreport, responding to the Low Energy Availability for Females Questionnaire, and Low Energy Availiability for males Questionnaire.	September 2024
Body composition	Body composition (fat mass and lean body mass) measured by DXA, as part of the evaluation of fitness in biathletes 18 years or older	September 2024
Bone mineral Density	Bone mineral density in biathletes 18 years or older, as a fitness evaluation and symptom of LEA	September 2024

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Blood work, energy metabolism	Hormone T3 measured by blood sample to evaluate energy metabolism as a symptom of LEA	September 2024
Blood pressure, orthostatic	The orthostatic blood pressure, as a symptom of LEA	September 2024
Blood pressure, resting	The resting blood pressure, as a symptom of LEA	September 2024
Resting heart rate	Resting heart rate, as a measure of cardiovascular fitness and symptom of LEA	September 2024
Indirect calorimetry	Indirect calorimetry as a measure of energy metabolism, serving as a symptom of energy availability	September 2024

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Body appreciation	Evaulation of body appreciation by the Body Appreciation Scale (BAS, version 2), as a measure for protective/posiitive trait versus risk for Eating Disorders	September 2024
Blood work, iron status	Serum ferritin, transferrin, and serum-iron will be measured as a complete evaluation of iron status	September 2024
Blood work, cholesterol	Total cholesterol and low density lipoprotein (LDL cholesterol) will be measured for evaulation of health and symptoms of LEA	September 2024
Experience from body composition assessment	Interview of biathletes 18 years or older who participate in DXA measurements. Focus is on how they experience the total body composition assessment as we follow the best practice guidlines. Interview is based on a semi-structured interview guide.	September 2024
Demographics	Demographic description of the biathletes (age, competition level, training volume, history of bone fractures, history of menstrual cycle, history of any eating disorder diagnosis)	September 2024
Urinary incontinence	Question on experience with urinary incontinence, as a symptom of LEA. Question is a yes/no response to any experience, and a positive response is further detailed about context (urge or stress)	September 2024

Collaborators and Investigators

• Sponsor: Ostfold University College
• Collaborators: Norwegian School of Sport Sciences; Inland Norway University of Applied Sciences; International Biathlon Union
• Investigators: Principal Investigator: Therese F Mathisen, PhD, Associate Professor

Study record dates

Study Major Dates

• Study Start (Actual): August 21, 2024
• Primary Completion (Actual): December 10, 2024
• Study Completion (Actual): December 10, 2024

Study Registration Dates

• First Submitted: June 27, 2024
• First Submitted That Met QC Criteria: June 27, 2024
• First Posted (Actual): July 5, 2024

Study Record Updates

• Last Update Posted (Estimated): September 12, 2025
• Last Update Submitted That Met QC Criteria: September 7, 2025
• Last Verified: September 1, 2025

More Information

Terms related to this study

• Keywords: Mental health; DXA; Eating Disorders; REDs; biathlon; biathletes; nordic skiing; LEA; IBU; Blood work
• Additional Relevant MeSH Terms: Mental Disorders; Signs and Symptoms, Digestive; Pathological Conditions, Signs and Symptoms; Behavior; Signs and Symptoms; Personal Satisfaction; Feeding and Eating Disorders; Psychological Well-Being
• Other Study ID Numbers: 733966

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Undisclosed data can be shared upon reasonable request.
• IPD Sharing Time Frame: Available after 31.12.2025
• IPD Sharing Access Criteria: Any researcher that contacts the project group with a reasonable request (e.g. need of data for review, metaanalyses etc)

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No