Examination of Energy Balance, Eating Disorder Risk, and Pathogenic Behaviors among Athletic Trainers

CONTEXT: Research exists on energy balance (EB) and eating disorder (ED) risk in physically active populations and occupations by settings, but EB and ED in athletic trainers (ATs) has not been investigated. OBJECTIVE: To assess ATs' energy needs, including macronutrient profile, and to examine ED risk and pathogenic behavior between sex (males, females), job status (part-time=PT-AT; full-time=FT-AT) and setting (college/university, high school, non-traditional). DESIGN: Cross-sectional and descriptive. SETTING: Free-living in job settings. PARTICIPANT: ATs (n=46; males PT-AT n=12, males FT-AT n=11; females PT-AT n=11, female FT-AT n=12) in Southeastern United States. MAIN OUTCOME MEASURES: Anthropometric measurements (age, height, weight, body composition), resting metabolic rate (RMR), energy intake (EI), total daily energy expenditure (TDEE), exercise energy expenditure (EEE), EB, macronutrients (carbohydrates, protein, fats), Eating Disorder Inventory-3, and the Eating Disorder Inventory-3 Symptom Checklist. RESULTS: Majority (84.8%, n=39) had ED risk, with 26.1% (n=12) engaging in at least 1 pathogenic behavior, 50% (n=23) in 2 pathogenic behaviors, and 10.8% (n=5) in more than 2 pathogenic behaviors. 82.6% of ATs (n=38) presented in negative EB (EI<TDEE). Significant differences were found for sex and job status for RMR (F(1,45)=16.48, P=.001), EI (F(1,45)=12.01, P=.001), TDEE (F(1,45)=40.36, P<.001) and EEE (F(1,38)=5.353, P=.026). No significant differences were found in EB, sex and job status (F(1.45)=1.751, P=.193); Chi-squared analysis revealed no significant differences between ATs' sex and EB [χ2(1,46)=0.0, P=1.00] and job status and EB χ2(1,46) = 2.42, P= 0.120]. No significant difference found between Daily Reference Intakes recommendations for all macronutrients and sex or job status. CONCLUSIONS: Athletic trainers experience negative EB, similar to other high-demand occupational professions. Regardless of sex or job status, ATs have a high ED risk and participate in unhealthy pathogenic behaviors. The physical and mental concerns associated with these findings indicates a need for interventions targeted toward ATs' health behaviors.