Lauren Delany

Background Body mass and composition (fat and fat-free mass) manipulation is a common practice in sport, yet it can pose significant risks to athlete health and wellbeing. Practitioners must continually adapt to the growing body of evidence to implement safe, effective and context-specific practice. Objective This scoping review aimed to summarise dietary recommendations for altering body mass or composition in male and female, adult non-disabled athletes and appraise how these expert-group led recommendations have evolved over time. Methods Electronic databases, including SCOPUS, PubMed, SPORTDiscus, CINAHL Complete and APA PsycINFO were searched (last search 2 August 2024) without date restrictions. Papers were included if they provided dietary recommendations for altering body mass or composition in adult non-disabled athlete populations and were published by an expert organisation. Results From 6068 records screened, 73 documents were included, comprising 45 consensus statements, 27 position stands and 1 practice guideline, endorsed by 14 organisations and developed by 328 experts from 25 countries. Athletics (n = 19), aquatics (n = 7) and team sports (n = 5) were the most represented, leaving many sports underrepresented. A total of 50 documents were standalone rather than part of an updated series. Only 40 papers addressed specific targets, rates or timing of outcome changes. Individualised, realistic and health-focussed targets were recommended, aligned with the athlete’s sport, position, sex, age and competition phase, with gradual changes (e.g. 0.5–1.0 kg/week fat loss) to enhance performance. Common strategies for altering body mass and composition included creating an energy surplus (500–1000 kcal/day) or deficit (250–1000 kcal/day), maintaining energy availability above 30 kcal/kg fat-free mass/day, and periodising carbohydrate intake (3–12 g/kg/day) on the basis of training demands. Protein intake (1.6–2.4 g/kg/day) was recommended across 4–6 feeds from high-quality sources, alongside targeted supplements such as creatine, whey protein and a multi-vitamin and mineral. Recommendations focussed minimal attention on nutrients such as fats, fibre or micronutrients, and the language used was often vague, leaving significant room for interpretation. Conclusions Developing sport-specific, behaviourally anchored and regularly updated dietary recommendations, informed by athlete and multidisciplinary team input, is recommended. This approach would provide actionable, athlete-centred strategies that effectively support body composition goals whilst prioritising health, wellbeing and performance. OSF Registration https://doi.org/10.17605/OSF.IO/B4YJT

Background Athletes are recognised as being at elevated risk of disordered eating (DE), with particularly high prevalence observed in ‘weight-sensitive’ sports. However, limited research has examined this issue within contact sports such as rugby, where unique physical demands and cultural norms may shape eating behaviours differently. This study aimed to investigate the prevalence, characteristics, and contextual drivers of DE among national-level male and female rugby union and rugby league players in England. A mixed-methods, cross-sectional design was employed utilising an online questionnaire, incorporating the Eating Disorders Examination Questionnaire (EDEQ), the Muscularity Orientated Eating Test (MOET) and open-ended qualitative questions. Participants (n = 182) included current players from Premiership Women’s Rugby, Gallagher Premiership, Women’s Super League, and Men’s Super League. Quantitative data were analysed using descriptive and non-parametric statistics and qualitative responses underwent reflexive content analysis. Results Data from the EDEQ showed 28% of female and 9% of male players exceeded clinical thresholds for DE, with the highest prevalence among front-row forwards and players with a self-reported body mass index of >25 kg/m². Muscularity-oriented DE was similar in both sexes (MOET mean scores: females = 13.8; males = 13.0). Athletes reported DE behaviours including binge eating (40% of participants), compulsive exercise (33%), vomiting (2%), and laxative use (1%). Qualitative findings revealed a perceived link between body composition and performance, with 82% of players attempting to manipulate their bodies in the previous 12 months. 63% of players reported pressure to change their body composition, commonly driven by coaches (17%) or intrinsic motivations (16%). 44% experienced body-related comments in the rugby setting, frequently perceived as insults/jokes (19%), with players reporting emotional distress in response (11%). Conclusion National-level rugby players – particularly females, forwards, and individuals with self-reported high-BMI – are at elevated risk for DE. The findings reveal a high-pressure sporting culture in which physical size is paradoxically required and ridiculed. To address this complex issue, comprehensive and system-wide prevention strategies are urgently needed. These include challenging harmful cultural norms, cultivating psychological safety, and prioritising the holistic health and wellbeing of players across both men’s and women’s national-level rugby.