A comparative meta-analysis of the prevalence of exercise addiction in adults with and without indicated eating disorders

Abstract

Background: Exercise addiction is associated with multiple adverse outcomes and can be classified as co-occurring with an eating disorder, or a primary condition with no indication of eating disorders. We conducted a meta-analysis exploring the prevalence of exercise addiction in adults with and without indicated eating disorders.Methods: A systematic review of major databases and grey literature was undertaken from inception to 30/04/2019. Studies reporting prevalence of exercise addiction with and without indicated eating disorders in adults were identified. A random effect meta-analysis was undertaken, calculating odds ratios for exercise addiction with versus without indicated eating disorders.Results: Nine studies with a total sample of 2140 participants (mean age = 25.06; 70.6% female) were included. Within these, 1732 participants did not show indicated eating disorders (mean age = 26.4; 63.0% female) and 408 had indicated eating disorders (mean age = 23.46; 79.2% female). The odds ratio for exercise addiction in populations with versus without indicated eating disorders was 3.71 (95%CI 2.00-6.89; I 2 = 81; p=<0.001). Exercise addiction prevalence in both populations differed according to the measurement instrument used.Discussion: Exercise addiction occurs more than three and a half times as often as a comorbidity to an eating disorder than in people without an indicated eating disorder. The creation of a measurement tool able to identify exercise addiction risk in both populations would benefit researchers and practitioners by easily classifying samples.

Prevalence and Correlates of Exercise Addiction in the Presence vs. Absence of Indicated Eating Disorders

“…As hypothesized, the strength of associations of the two variables that could be interpreted as "sudden or progressively intolerable life-stress" (eating disorder status and BDD status) in the Interactional Model of EA were among the strongest. This concurs with several studies that have shown that eating disordered subjects suffer from higher EA (Fietz et al, 2014;Trott et al, 2020b), and several studies that show that negative self-body image is positively correlated with exercise addiction (Klein et al, 2004;Ertl et al, 2018). Moreover, this provides initial evidence that these two conditions could be listed in the Interactional Model as possible intolerable life-events.…”

“…Prevalence rates differed largely according to eating disorder status, with participants with indicated eating disorders yielding more than double the prevalence rates than those with no indicated eating disorders. These results are broadly in agreement with a recent meta-analysis that showed subjects with indicated eating disorders are over 3.5 times more likely to also have exercise addiction (Trott et al, 2020b). The overall exercise addiction prevalence rate is higher than in several reviews that have estimated prevalence between 3 and 14% (Di Lodovico et al, 2019;Marques et al, 2019).…”

“…One of the key determinants of EA in the Interactional Model is "sudden or progressively intolerable life-stress." The most researched of these is the presence (or absence) of eating disorders, with recent evidence concluding that subjects with indicated eating disorders have 3.5x higher risk of developing EA than subjects without indicated eating disorders (Trott et al, 2020b) broadly supporting this model. Further evidence to support this hypothesis, however, is sparse, mainly because the majority of EA literature fails to screen for the presence of eating disorders (Di Lodovico et al, 2019;Marques et al, 2019;Symons Downs et al, 2019).…”

Prevalence of Risk of Eating Disorders and its Association with Obesity and Fitness

“…Different studies have suggested that higher levels of fitness might have a protective effect on the risk of FEDs in adolescents [18] and young adults [16]. Conversely, it should not be neglected that high levels of physical activity have been associated with FEDs in such a way that the risk of eating behavior disorders, both in men and women, is higher in athletes than in nonathletes and those considered with an exercise addiction [19,20]. Moreover, higher levels of physical activity could not only accelerate weight loss but also elicit a more severe FED psychopathology [21].…”

Treatment of Compulsive Exercise in Eating Disorders and Muscle Dysmorphia: Protocol for a Systematic Review

“…However, to date, there is no consensus on what constitutes problematic exercise in the context of eating disorders (Noetel et al, 2017). Indeed, an array of terminology has been used to describe the unhealthy relationship with exercise often observed in people with eating disorders, such as compulsive exercise (Bratland-Sanda et al, 2019;Dittmer et al, 2018;Lichtenstein et al, 2017), exercise addiction (Adams & Kirkby, 2002;Gri ths et al, 2005;Trott et al, 2020), exercise dependence (Blaydon & Lindner, 2002; Hausenblas & Downs, 2002), and obligatory exercise (Steffen & Brehm, 1999). A recent Delphi study indicated that 60% of international experts in the treatment of eating disorders preferred the term compulsive exercise, although it must be noted that 60% agreement did not meet their threshold for consensus (≥ 85% agreement) or near consensus (≥ 75% agreement; Noetel et al, 2017).…”