Autistic women are overrepresented among people in treatment for Anorexia Nervosa (AN). The current study aimed to: (1) better understand how AN develops and persists in autistic individuals from the perspective of autistic women, parents and healthcare professionals; (2) derive a theoretical model of restrictive eating difficulties in autism. We conducted 44 semistructured interviews and used Thematic Analysis to identify patterns of meaning across the data. Themes related to sensory sensitivities, social interaction and relationships, sense of self and identity, difficulties with emotions, thinking styles, and a need for control and predictability. We developed a model of potential autism-specific mechanisms underlying restrictive eating difficulties. This study generated novel insights, which have the potential to inform treatment adaptations following empirical testing.

Distance running in humans has been associated with both positive and negative effects on the balance of bone remodelling. There is evidence to suggest that the negative effects may be linked to a failure to balance energy expenditure with an adequate energy intake. Energy restriction is known to reduce the synthesis and serum concentration of insulin-like growth factor 1 (IGF-1), which plays an important role in bone formation. The purpose of the present study was to compare the effects of repeated periods of prolonged treadmill running, under conditions of either energy balance or energy restriction, on markers of bone turnover and serum IGF-1 concentration in trained distance runners. Eight male distance runners [mean age 25.1 (SD 5.9) years, maximal oxygen uptake 61.8 (SD 4.9) ml x kg(-1) x min(-1)] undertook an exercise and diet regime on two separate occasions, 2 weeks apart. On each occasion they performed an intensive, 60 min treadmill run on 3 consecutive days. On one occasion their energy intake was restricted to approximately 50% of their estimated energy requirement (RES), whereas on the other occasion they remained in energy balance (BAL). The N-terminal pro-peptide of type 1 collagen (P1NP), osteocalcin and IGF-1 were measured in serum collected between 0800 and 0900 hours, when fasted and rested, on the day before and the day after each regime. The cross-linked N-telopeptides of type 1 collagen and deoxypyridinoline were measured from 24 h urine collections made on the day before and the final day of each regime and adjusted for creatinine excretion. The results showed that the serum concentration of both P1NP and IGF-1 declined by 15% (P = 0.008) and 17% (P = 0.007) respectively in response to RES, but did not change in response to BAL (P > 0.05). A strong relationship was observed between the magnitude of the reduction in the serum concentration of P1NP and IGF-1 after RES (r = 0.97; P < 0.001). There were no changes in the other bone markers in response to either regime. The results suggested that in trained distance runners, repeated periods of prolonged running do not affect the balance of bone turnover unless energy balance is simultaneously altered. These findings support the link between a negative energy balance, a reduced synthesis or serum level of IGF-1 and reduced collagen synthesis. They may also help to explain the bone remodelling imbalance that has been observed in some male and female distance runners.

This study explores autistic women’s experiences of eating disorder services. Estimates suggest that 20%–30% of women in treatment for anorexia nervosa display diagnostic features characteristic of autism. Research suggests that autistic individuals’ needs are not being met by standard anorexia nervosa treatments. In the current study, in-depth interviews were conducted with 15 autistic women with experience of anorexia nervosa, 12 parents of autistic women with anorexia nervosa, and 11 eating disorder healthcare professionals. Using thematic analysis, three overarching themes were identified: misunderstanding autism and autistic traits, one treatment does not fit all, and improving accessibility and engagement within services. We found that there were diverse barriers facing autistic women when in treatment for anorexia nervosa, and these were accentuated by a lack of autism understanding within eating disorder services. Future research should focus on developing interventions that are tailored to the specific needs of autistic individuals with anorexia nervosa. Lay Abstract This study explores autistic women’s experiences of eating disorder services. About 20%–30% of people with anorexia nervosa are also autistic, and current treatments seem not to work as well for them. We interviewed 15 autistic women with experience of anorexia nervosa, 12 parents of autistic women with anorexia nervosa, and 11 healthcare professionals working in eating disorder services. We asked autistic women and parents about their experiences of eating disorder services, and we asked healthcare professionals about their experiences treating autistic women with anorexia nervosa. Participants’ views were represented by three overall themes: misunderstanding autism and autistic traits, one treatment does not fit all, and improving accessibility and engagement within services. We found that autistic women face many barriers when in treatment for anorexia nervosa, often because of a lack of autism understanding within eating disorder services. Future research should look at developing anorexia nervosa treatments that can specifically help autistic individuals.

Strategies that enhance the acquisition of bone mass may be protective against osteoporosis. BMD was compared in 20 artistic gymnasts (10 boys; 10 girls) and 20 untrained children ages 7-8 years. Higher regional values of BMD were observed in female gymnasts than untrained girls. If retained to adulthood, this higher BMD may protect skeletal integrity in later life.Strategies that enhance the acquisition of bone mass in children may assist with the prevention of osteoporosis. This study explored the effects of regular high-impact and weight-bearing activity before the age of 7 years on total and regional bone mineral density (BMD). Twenty artistic gymnasts (10 boys and 10 girls) and 20 untrained children, 7-8 years of age, were recruited. The untrained children were matched to gymnasts by sex, height, weight, and age. Female gymnasts trained 8 -10 h per week and had trained regularly for 3-4 years. Male gymnasts trained 4 -6 h per week and had trained for 1-2 years. Measurements of bone mineral density were made using DXA for total body BMD (TBBMD); lumbar spine, both areal (aSBMD) and volumetric (vSBMD); total spine; pelvis; arms; and legs. Significant mean differences (8 -10%) in aSBMD, vSBMD, arm BMD, and TBBMD were observed between female gymnasts and untrained girls (p < 0.05: aSBMD, vSBMD, and TBBMD body mass (BM); p < 0.01: arm BMD). A nonsignificant trend toward a higher TBBMD/BM and arm BMD was observed in male gymnasts compared with untrained boys. Trends toward a higher BMD within the pelvis, legs, and total spine were also observed in gymnasts. There were no differences in total and regional BMD between untrained boys and untrained girls. The results suggest that gymnastics training before the age of 7 years enhances the acquisition of bone mass at selected skeletal sites.

We use what we call collaborative autoethnography in this article to tell the story of “Lindsey,” a person for whom sport and physical activity have been both friend and enemy throughout her life. Our intention is to place stories about disordered eating and over-exercising alongside modern panics about obesity and to wonder how children are likely to process the different things they are told about body weight, sport, and physical activity. We do this not to pathologize Lindsey’s behavior but rather to pathologize the moral universe that makes the moral superiority of the fit, athletic body possible.

Objective-To explore relations between biochemical markers of bone turnover, indices of nutritional status, and serum oestradiol concentration in women distance runners. Methods-Thirty three women distance runners of mean age (SD) 27.2 (1.8) years participated. Eighteen were defined as eumenorrhoeic, nine as amenorrhoeic, and six as oligomenorrhoeic. Mean (SD) running distance was 47.6 (22.4) km/week. Using bivariate correlation and regression analysis, serum levels of osteocalcin and bone alkaline phosphatase (BAP) and also urine deoxypyridinoline/creatinine (Dpyr/ Cr) were correlated with mean daily energy balance, body mass index (BMI; kg/m 2 ), and serum levels of total 3,5,3'-triiodothyronine and oestradiol within each group by menstrual status. Results-All the amenorrhoeic women were in negative energy balance; they had a lower BMI, lower serum levels of oestradiol, triiodothyronine, osteocalcin and BAP and a lower urine Dpyr/Cr than any of the oligomenorrhoeic or eumenorrhoeic women. These variables were also lower in oligomenorrhoeic than in eumenorrhoeic women. Positive correlations were observed between serum levels of osteocalcin or BAP and both BMI and serum oestradiol concentration in amenorrhoeic, but not in oligomenorrhoeic or eumenorrhoeic women. Urine Dpyr/Cr did not correlate with any other variable within any group. Serum oestradiol concentration correlated positively with BMI in amenorrhoeic and oligomenorrhoeic, but not eumenorrhoeic women. Conclusions-Positive correlations between serum levels of bone formation markers, BMI and serum oestradiol concentration in our amenorrhoeic runners suggested that their reduced bone formation was linked to a low BMI and an oestrogen deficiency. Reduced bone turnover in amenorrhoeic distance runners has not previously been shown. These findings emphasise the importance of body mass and its possible link with a chronic energy deficit and hypothalamic dysfunction on bone remodelling balance in amenorrhoeic runners. (Br J Sports Med 1998;32:167-171)

Few studies have examined the effects of retirement from sports involving regular, high impact and weight bearing activity on bone mass. This cross-sectional study compared total body and regional areal bone mineral density (aBMD, g/cm(2)) within female former gymnasts and women who had never participated in structured sport or exercise, and explored relations between aBMD of these former gymnasts and their duration of retirement. Eighteen sedentary female former gymnasts (GYM) and 18 sedentary controls (CON) were recruited. GYM displayed a broad range of duration of retirement (3-12 years) and a wide age range (20-32 years). GYM and CON were paired individually to match for age, body mass and stature. GYM had commenced training at least 3 years pre-menarche and had trained post-menarche for 2 or more years. They had trained continuously for 5-12 years and had retired between age 14 and 22 years. Measurements of aBMD and body composition were made using dual energy X-ray absorptiometry (DXA). Group mean values of physical and skeletal characteristics were compared using paired t-tests. Linear regression was used to explore possible relations of aBMD within GYM to duration of retirement. GYM displayed a higher aBMD than CON at all measurement sites, which ranged in magnitude from 6% for the total body ( P=0.004), to 11% for the total femur ( P=0.006). Elevations of aBMD within GYM equated to T-scores ranging from +0.8 (arms) to +1.7 (legs). There were no differences in body composition or age of menarche between groups, although 11 of 18 GYM reported a history of irregular menses. There was no significant decline of aBMD with increasing duration of retirement in GYM. The results suggested that an elevated bone mass in female former gymnasts was retained during early adulthood, in spite of a cessation of training for up to 12 years.

Female athletes are susceptible to both disordered eating and menstrual cycle disturbances (MCDs). Disordered eating in combination with high energy expenditure from exercise can lead to energy deprivation. Current theories suggest that MCDs are caused by energy deprivation rather than by exercise alone. A number of endocrine adaptations occur with energy deprivation and MCDs, which are concomitant with imbalanced bone turnover, reduced bone density and potentially increased fracture risk. This chapter reviews current evidence concerning the disruption of bone metabolism that accompanies disordered eating and MCDs in physically active girls and young women, including high-performance athletes. Initially, an overview of the aetiology of exercise-associated MCDs and their link with disordered eating is provided. Thereafter, studies reporting changes in areal bone mineral density (aBMD) in female athletes with MCDs are considered in conjunction with change in athletes' physical activity, nutritional status and menstrual histories. A comprehensive overview of the disruption of bone metabolism that accompanies nutritionally related MCDs is also provided. Emphasis is placed upon the role of energy deprivation and its endocrine effects, which, when sustained, result in imbalanced bone turnover and low aBMD. Based on current evidence, recommendations are made for the prevention and treatment of disturbed bone metabolism and low BMD in female athletes with MCDs. Finally, consideration is given to the effects of intense training and energy deprivation on endocrine function and skeletal health in men.