International journal of Sport Nutrition, 1996,6, 255-262 O 1996 Human Kinetics Publishers. Inc.

Comparison of Eating Disorder Inventory (EDI-2) Scores of Male Bodybuilders to the

Male College Student Subgroup

Sara Long Anderson, Kate Zager, Ronald K. Hetzler, Marcia Nahikian-Nelms, and Georganne Syler

The intensity and effort of bodybuilding training suggest an overinvestment in body shape and physical appearance, which has been suggested to be a risk factor for developing eating disorders. The purpose of this study was to investigate the prevalence of eating disorder tendencies among a sample of collegiate male bodybuilders (BB, n = 68) and controls (C, n = 50) (nonbodybuilders), using the Eating Disorders Inventory 2 (EDI-2). T tests were used to test the hypothesis that bodybuilders' scores would be higher than those of controls. The mean scores on the EDI-2 did not indicate the presence of eating disorder tendencies for either group. Controls scored significantly higher than bodybuilders on the Body Dissatisfaction scale. Results indicate that when the EDI-2 is used, college-age male bodybuilders are not shown to be more likely to have eating disorders than agroup of college-age male controls.

Key Words: pathogenic weight control, body weight, body shape

Recreational bodybuilding has become an increasingly popular sport. It is a sport focused exclusively on improving body configuration and form, with little concern for subsequent athletic performance. The scientific literature describes health and training practices of competitive bodybuilders, suggesting that this group often uses extreme dietary patterns, dehydration practices, ergogenic aids (includ- ing anabolic steroids), and dietary supplements in addition to strict training regimens (3, 13-17,23,24,26).

Researchers have compared behavior and psychological characteristics of obligatory male runners with those of persons with anorexia nervosa (27).

S.L. Anderson is with the Department of Animal Science, Food and Nutrition, Mailcode 43 17, Southern Illinois University-Carbondale, Carbondale, IL 62901-4317. K. Zager is with Student Health Programs~Wellness Center, Southern Illinois University- Carbondale. R.K. Hetzler is with the Department of Health, Physical Education, and Recreation, University of Hawaii at Manoa, Honolulu, HI 96822. M. Nahikian-Nelms and G. Syler are with the Department of Human Environmental Studies, Southeast Missouri State University, Cape Girardea, MO 63709.

256 / Anderson, Zager, Hetzler, eta/.

Blumenthal et al. (2) defined an obligatory runner as someone who exercises compulsively, maintains a rigid schedule of intense exercise, resists temptations to lapse into nonexercising, feels guilty when the schedule is violated, increases exercise further to compensate for lapses, exercises even when ill or tired, is preoccupied with exercise, and keeps detailed records of exercise. The inten- sity and effort that bodybuilders put into their training suggest obligatory-type behavior, not unlike the behavior of those with eating disorders. In fact, Franco et al. (9) suggested that males who are overinvested in their bodies and physical appearance are at higher risk than other males for developing eating disorders. The critical factor in promoting an eating disorder is the desire to change body weight, body shape, or body composition in a person who is vulnerable to carrying the process of body change to excess (1). In a study of 108 male bodybuilders (21), 2.8% of the subjects reported a history of anorexia nervosa, a rate higher than the 0.02% rate typically described among the American male population. Therefore, as suggested by Garner and Rosen (12), more research is needed to evaluate possible eating disorder symptoms and body image among competitive bodybuilders.

Therefore, the purpose of the present study was to investigate the prevalence of concomitant eating problems (eating disorder tendencies and/or pathogenic weight control) among a sample of male bodybuilders. The present study surveyed unpaid volunteers and controls regarding eating behaviors using the Eating Disorders Inventory 2 (EDI-2), which is a reliable and valid instrument to screen for tendencies toward eating disorders (1 1). On the basis of the results of previous studies described above, we hypothesized that the bodybuilders would score significantly higher on the EDI-2 than the non- strength-training controls.

Methods

Male recreational and competitive bodybuilders (n = 68) and controls (nonbodybuilderslnon-weight lifters) (n = 50) were recruited from Southern Illinois University-Carbondale (SIUC), Southeast Missouri State University (SEMO), and the University of Hawaii at Manoa (UHM). The bodybuilders (BB) were recruited through announcements in three university weight-lifting clubs, announcements strategically placed on both campuses, and phone andlor personal contact by the researchers. The controls (C) were recruited from students in non- athletics-related classes from each university. Responses to demographic questions were used to confirm that control subjects were not bodybuilders. The research protocol was reviewed and approved by the Southern Illinois University-Carbondale Human Subjects Committee.

Permission was granted by Psychological Assessment Resources, Inc. (Odessa, FL) to add questions and reproduce the EDI-2 for use in this research project. Subjects in the BB and C groups were asked to complete a question- naire composed of the 64 questions from the Eating Disorders Inventory 2 (EDI-2) and an additional pool of six questions. Participants received an introductory letter explaining the research and stating that their completion of the instrument indicated voluntary consent to participate in the study. After the instruments were completed, data were individually coded onto abscan sheets for statistical analysis.

Eating Disorder Inventory / 257

Eating Disorders Inventory

The EDI-2 consists of eight subscales with a total of 64 items. Each EDI-2 item is rated on a six-point scale ranging from never to always. A short description of the subscales is presented below (1 1):

Drive for thinness: a 7-item subscale that measures excessive concern with dieting, preoccupation with weight, and fear of gaining weight Bulimia: a 7-item subscale that measures tendency toward episodes of uncontrollable overeating (bingeing) which may be followed by the impulse to engage in self-induced vomiting Body dissatisfaction: a 9-item subscale measuring body image disturbances Ineffectiveness: a 10-item subscale that measures feelings of inadequacy and negative self-evaluation Perfectionism: a 6-item subscale measuring excessive personal expectations of achievement Interpersonal distrust: a 7-item subscale measuring reluctance to form close relationships with others Interoceptive awareness: a 10-item subscale that measures lack of confidence in recognizing and identifying emotions and sensations of hunger or satiety Maturity fears: an 8-item subscale that measures avoidance of psychological maturity due to the overwhelming demands of adulthood

Data Analysis

The data were tabulated and analyzed statistically using the Statistical Package for the Social Sciences (SPSS, Inc., Chicago). Along with descriptive statistics, a two- tailed t test was used to examine mean scores between independent variables and between independent and dependent variables. For this study, the independent variable was control versus bodybuilder. The dependent variables were the sub- jects' scores on the Eating Disorders Inventory. A relationship was considered significant at the .05 alpha level. Z scores were used to determine significant differences (p < .05) between bodybuilders' andcontrols' mean scores on the EDI- 2 and between the male college group mean scores and EDI-2 eating disordered mean scores.

Results

The EDI-2 was used in this study as a screening tool to measure tendencies toward eating disorders among male recreational and competitive bodybuilders and to assess whether these tendencies were more common among bodybuilders than control subjects. The results, along with demographic data, are summarized in Table 1. All subscales received a score based on the group mean for each question. The results of the BB group are compared to the C group as well as the EDI-2 scores standardized for female eating disorder patients and male nonpatient college samples.

As the table indicates, mean scores on the EDI-2 for the BB and C groups were not significantly different from the male college student subgroup scales. All scores for the BB and C groups were well below the range of scores for the eating disorders group (i.e., significantly different) except for the Perfectionism, Interpersonal

258 / Anderson, Zager, Hetzler, et a/.

Table 1 Demographic Data and Mean (+SD) Subscale Raw Scores for the EDI-2

Male EDI-2 eating college disorder

Bodybuilders Controls groupa scoresa (n = 68) (n = 50) (n = 101) (n = 889)

M SD M SD M SD M SD

Age (years) 25.1 Height (in.) 69.9 Weight (lb) 189.6 EDI-2 subscale scores

Drive for thinness 2.4' Bulimia 0.5' Body dissatisfaction 3.g2 Ineffectiveness 1 .02 Perfectionism 5.9 Interpersonal distrust 3.1 Interoceptive awareness 1.3' Maturity fears 2.7

-- - - - ..- - -- - - - -

"Standardi7ed scores obtained from Reference 10, pp. 17 and 20. hData not available. 'Difference with EDI-2, p 1.05. 2Difference with EDI-2, p S .01. 3Difference with BB, p 1.05.

Distrust, and Maturity Fears scales. Bodybuilders and controls had similar scores on all ED1 subscales except the Body Dissatisfaction scale, for which the mean score of the C group exceeded that of the BB group. The mean score of the C group was significantly different from the mean score of the BB group for the Body Dissatis- faction scale. Mean scores of the C group were higher for all subscales except Perfectionism.

Descriptive statistics are used in Table 2 to summarize responses to the six questions added to the EDI-2 instrument. These questions were aimed at the specific parts of the body that bodybuilders target for maximum muscular hypertro- phy and definition. The majority of bodybuilders indicated that they "often" think that they should have bigger or more defined muscles, while the majority of controls "never" think about this.

Discussion

The results of this study indicate that when using the Eating Disorders Inventory, male bodybuilders did not demonstrate characteristics similar to those of females with eating disorders. Additionally, the male bodybuilders were roughly identical to males in the control group. These results were frankly a surprise to us, based on individual contacts with bodybuilders over the years and reports of eating patterns for this group found in the literature (13, 15, 21). It is possible that college-age bodybuilders are not representative of older or professional bodybuilders. Limita- tions to the study include self-reported data and a self-selected bodybuilder group.

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Table 2 Frequencies and Percentages of Responses to Additional Questions of Bodybuilders (n = 68) and Controls (n = 50)

Question/group Never Rarely Sometimes Often Usually Always

I think my thighs are too small. BB 51 (75%) 6 (9%) 6 (9%) C 43 (86%) 0 (0%) 4(8%)

I am preoccupied with the desire to have bigger muscles and more definition.

BB 22 (32%) 12 (18%) 6 (9%) C 24 (48%) 9 (18%) 9 (18%)

I think my shoulders and arms are too small.

BB 37 (54%) 12 (18%) 9 (13%) C 34 (68%) 2 (4%) 11 (22%)

I think my chest (pecs) is too small.

BB 46 (68%) 5 (7%) 8 (12%) C 32 (64%) 5 (10%) 9 (18%)

I think my calves are too small.

BB 41 (60%) 5 (7%) 6 (9%) C 36 (72%) 0 (0%) 9 (18%)

Overall, I think I'm too small BB 49 (72%) 5 (7%) 9 (13%) C 39 (78%) 2 (4%) 6 (12%)

Note. Percentages may not add up to 100% due to missing data and rounding. BB = bodybuilders; C = control group.

Additionally, Garner et al. (1 1) reported that defensiveness of subjects completing the EDI-2 may invalidate or distort self-evaluation data. While some researchers have found male obligatory exercisers to exhibit tendencies similar to females with eating disorders (8, 20, 27), other studies (2, 19) have not reached the same conclusion. Data from the present study do not support the idea that bodybuilders are similar to females with eating disorders, despite the tendency to be obligatory exercisers. Another possible explanation for seeing no differences between the controls and the bodybuilders may be an increase in dieting behavior among college males during their freshman year (25) and the desire for normal-weight college males (freshmen) to lose weight (7). It may be that societal pressures from advertising and media affect the behavior of college-age males whether or not they are athletes. Thus, the similarity between groups in the present study may be accounted for by a similar desire for thinness.

After studying eating attitudes of male college students via the Eating Attitudes Test (EAT-26), Franco et al. (9) suggested that male bodybuilders and other groups of men who place a great deal of emphasis on body and physical

260 / Anderson, Zager, Hetzler, et a/.

appearance are at higher risk for developing eating disorders. These authors linked the risk for eating disorders to an "increased narcissistic investment in their bodies" (p. 287). In fact, Carroll (6) found that bodybuilders scored significantly higher on the Self-Absorption subscale of the Narcissistic Personality Inventory when com- pared to male and female athletes (field hockey, basketball, track, and baseball) and psychology students. This is probably best illustrated by the wall-to-wall, mirror- lined weight rooms where bodybuilders work out.

It was interesting to note similarities between groups for the additional questions targeting muscular development reported in Table 2. Unfortunately, the desire to be slim and fit is not always rooted in the desire to be healthy, but rather stems from a desire to be perceived as attractive by others (4). While being attractive is extremely important in our society, until recently it was uncom- mon for men in Western societies to be judged by physical appearance. A quick review of magazines and television illustrates the celebration of young, lean, and muscular male bodies (22). This may explain why even members of the control group, albeit a small percentage, "sometimes" or "often" thought parts of their body were too small. Cases of a "reverse anorexia" syndrome have been reported and described (21) whereby male bodybuilders believed that they ap- peared small and weak even though they were actually large and muscular. This suggests that bodybuilders may be at greater risk than most men for body image disorders. Although results of the present study failed to support this suggestion, there is need for further research in the following areas: (a) overconcern with body weight and shape, (b) the relationship between appearance and self-worth, and (c) the relationship between an increase in body focus and preoccupation with weight, shape, and body image (12,22).

Bodybuilders, especially competitive bodybuilders, do exhibit bouts of weight loss and weight gain (13,15, 16,23,24,26). While this probably does not meet the true definition of the term weight cycling (18), bodybuilders do have significant weight fluctuations when preparing for competition. Recent evidence (5) suggests that weight cycling appears to be linked with increased psychopathol- ogy, more disturbed eating, and perhaps increased risk for binge eating. Therefore, we expected to see differences in EDI-2 results between groups.

Conclusions

Results of the present study lead to the conclusion that, as assessed by the EDI-2, college-age male bodybuilders are not more likely to have eating disorders than a group of college-age male controls. This is in contrast to findings of previous studies. Pope et al. (21) believed that the "reverse anorexia7' they observed in bodybuilders might have been an analogous response of males who are influenced by social pressures to increase muscle size as indicated in the gym subculture, in bodybuilding magazines, and in Hollywood movies with bodybuilder heroes. We agree with Garner and Rosen (12) that "clearly, more research is needed to evaluate possible eating disorder symptoms and body image among competitive weightlifters (both powerlifting and bodybuilding) and those who engage in more causal [sic] strength and weight training" (p. 102).

Weight obsessions, dieting, and purging are thought to indicate low self- esteem, especially in women (19). While bodybuilders' motivations may be different, they also exhibit some tendencies of low self-esteem as demonstrated by

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narcissistic behavior. Both groups probably believe that with the right combination of dieting and exercise, every person can reach "the ideal," and that once the ideal is achieved, the individual will be rewarded (4). Therefore, it seems reasonable that both groups would score similarly on the EDI-2. Based on previous research and results of the present study, i t is possible that while the EDI-2 may be an appropriate scale to measure females with eating disorders, it may not be an appropriate scale to measure males, especially bodybuilders. It is unknown whether bodybuilders do indeed demonstrate psychological problems similar to those of females or whether they simply are fortunate to possess extremely good discipline habits. Eating disorders and dieting that result from weight cycling are usually chronic in nature. It is not quite clear whether the weight gains and losses of bodybuilders are chronic or acute tendencies. Longitudinal studies are needed to determine how often and for how long bodybuilders manipulate their diets.

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Acknowledgments

We are grateful for the assistance of Dawn C. Bloyd, M.S., R.D., RainaChildres, R.D., and Irina Soderstrom for their help with data coding and analysis.

Manuscript received: September 11, 1995 Accepted for publication: April 9, 1996