Ferrand and Brunet 2004 [41] France 42 (M)21.8 ± 3.7 Only BMI reported. 20.5 ± 1.4 kg/m2Not reportedNot reportedAmateur classified as Regional (n = 12), National (n = 13) and elite (n = 17)Not reportedTo examine the associations between dimensions of perfectionism and eating disorder symptoms among 42 young male amateur cyclists (M = 21.8 yr., SD = 3.7) over the three performance categories (Elite, National, Regional).Cross-sectional self-reported surveyEating Attitudes Test (EAT-26); Multidimensional Perfectionism ScaleRiebl et al., 2007 [58]
USA124 (61 cyclists and 63 non cyclists as control) (M)31.6 ± 10.4 (cyclists) and 23 ± 6.3 (control)72.5 ± 7.6 (cyclists) and 80.5 ± 16.1 kg (control)Not reportedNot reportedNot reportedInclusion criteria included training a minimum of 5 h on a bicycle each week throughout the year; have participated in cycling for no less than 1 year.To determine the prevalence of subclinical disordered eating behaviours among male cyclists, whether male cyclists self-report having an eating disorder, and whether male cyclists meet the daily recommendations for the major food groups according to the Dietary Guidelines for Americans. Cross-sectional self-reported surveyThe Eating Attitudes Test-26 (EAT-26) (7–9), Survey of Eating Disorders Among Cyclists (SEDAC) (10), and a nutrition questionnaire were completed by the study participants.

The legitimacy of the responses from the nutrition questionnaire was specific to this study and was not validated. The format of the questionnaire may have caused some of the study participants to underreport their intake.

Oils and discretionary energy were not included, and the narrow list of foods provided composing each food group may have caused the cyclists to not meet the energy requirements and daily servings suggested by the Dietary Guidelines for Americans.

A more specific understanding of cyclists’ nutrition habits would result from direct comparison to a non-cycling control population.

Gorrell et al., 2019 [55] USA612 mixed sport (24 cyclists) (M)18–26 (M = 20.99)Not reportedNot reportedNot reportedNot reported. Sample from National College Athletics Association (NCAA) schoolsNot reportedTo characterise unhealthy exercise and eating behaviour according to competitive athlete status, as well as per sport type.Cross-sectional self-reported surveyEating disorder examination questionnaire EDE-Q

Findings should also be interpreted with caution, as they may also be considerably underpowered for the sports with small sample sizes (n = 8).

Furthermore, 42 individuals participated in a secondary competitive sport, but it is possible that participation in one sport led to sport-specific body dissatisfaction differing from the body ideal of a secondary sport; future work may investigate these individuals separately.

These analyses were secondary, and cross-sectional; therefore, findings cannot comment on the temporality of the development of these eating and exercise behaviours.

Finally, measures were self-reported, which may reveal less information than if participants were queried in a clinical interview.

Muros et al., 2020 [12] Spain 4037 cyclists and triathletes (cyclists = 2037) (F and M)37.72 ± 9.67Only BMI reported 23.74 ± 2.69 kg/m2Not reportedNot reportedNot reported. Federated cyclists in Spain 10.94 ± 4.64To describe and predict eating disorders according to sex, body mass index, age and sport discipline within a sample of athletes.Cross-sectional self-reported surveyThe revised restraint scale (RRS); the five-item SCOFF; the Mediterranean diet (MD) adherence screener (MEDAS)

The main limitation of the present study is its cross-sectional design as this cannot establish casual relationships. The results must be interpreted with caution because the study only had self-reported measurements. Although the sample was large, self-selection bias means that generalizability is limited. Further, the present study only assessed prevalence of ED via a self-reported questionnaire. Although SCOFF is a widely used screening tool with good sensitivity and specificity, it can only discern individuals at greater likelihood of developing ED, and complete diagnosis requires clinical follow-up.

Filaire et al., 2007 [40] France15 cyclists (44 full sample) (M)21.2 ± 2.868.0 ± 6.5 kg180 ± 0.06 cmRoad cyclingNationalWeekly distance covered ranged between 600 and 750 km. The athletes took part in races each weekend, with distance ranging from 100 to 150 km.To test the hypothesis that male athletes who feel pressured to maintain a specific body weight present an elevated risk of subclinical eating disorders.Cross-sectional self-reported surveyEating Attitudes Test (EAT-26); Multidimensional Perfectionism Scale; Body Esteem Scale; Profile of Mood States

46% of cyclists reported feeling pressured to lose weight, and 41% and 10% of cyclists reported using fasting and laxatives as a weight loss method, respectively

First, as with any study using self-reported measures, findings may be susceptible to selective or erroneous reporting. Self- reported measures always carry risks, especially with athletes who might not be forthcoming in their answers for fear of being eliminated from the team if they appear to be eating-disordered.

Second, the EAT-26 alone does not yield a specific diagnosis of an eating disorder. However, the use of a self-administered questionnaire, which incorporates Diagnostic and Statistical Manual of Mental Disorders as in our study, increases the advantages of using this questionnaire, which has been used in many epidemiological or screening studies, even if each subscale should be interpreted independently.

Finally, although the number of participants was small, there have been very few studies of eating attitudes in male athletes, since this is a relatively under-recognised problem.

Yates et al., 2003 [60] Not reported190 (36 cyclists) (F and M)Not reportedNot reportedNot reportedNot reportedNot reportedNot reportedTo differentiate groups of highly conditioned, competitive athletes on the basis
of Exercise Orientation Questionnaire (EOQ) scores and self-reported psychiatric symptoms.Cross-sectional self-reported surveyExercise Orientation Questionnaire (EOQ)

Study was based on relatively small samples of athletes who volunteered, often in the context of a sport’s club. Larger, more diverse, samples could yield different results. Other athletic groups could be included, especially those with known high and low rates of ED symptoms.

Symptom self-reports are subjective and may contain retrospective and other distortions. Further study should include semi-structured interviews to confirm and further describe problems or disorders.

Haakonssen et al., 2015 [25] Australia37 (F)18–3658.4 ± 5.9 kg170 ± 7 cmRoad cyclingProfessional and amateurNot reportedTo investigate the satisfaction of elite female cyclists with their body weight (BW) in the context of race
performance, the magnitude of BW manipulation, and the association of these variables with menstrual function.Cross-sectional self-reported surveyFemale Cyclist Weight Management Questionnaire (Created by research team)

Five cyclists (14%) reported having previously diagnosed ED

Energy and macronutrient restriction, skipping meals, training without eating, purging, wearing additional clothes and plastic wraps whilst training and taking supplements or medication identified as body mass reduction techniques

Hoon et al., 2019 [24] Australia97 (M)32.0 ± 1.773.1 ± 1.4 kg180.4 ± 1.0 cmRoad, Track and Mountain BikeParticipants were categorized as Local, National (i.e., top domestic competition) or International level13.9 ± 0.8 hTo investigate the perceptions and practices of achieving ‘race weight’ in a population of trained male cyclists. A secondary focus was to investigate the use of gym-based strength training, a possible attenuator of the side effects associated with weight reduction.Cross-sectional self-reported surveySurvey created by research team

Although the questionnaire employed in the present study enabled the authors to capture a wealth of data from a wider network of participants, they acknowledge that it had not been validated and was a limitation of the study. The self-reporting nature of the survey carries a risk of inaccurate data being submitted and having predetermined options for participants to select in certain questions may have imprinted some answers and influenced responses.

Sousa Fortes et al., 2017 [57] Brazil43Risk of ED: 21.33 ± 1.84
No risk of ED: 21.49 ± 1.75Not reportedNot reportedRoad cyclingNot reportedRisk of ED: 10.23 ± 1.12
No risk of ED: 10.26 ± 1.07 per weekThe aim of this study was to compare the maximum oxygen consumption
(VO2max) between road cyclists with and without risk for eating disorders.Cross-sectional self-reported surveyEating Attitudes Test 26 (EAT-26)Hale and Divin [61] 2011 USA98 (M)34 ± 4.1Not reportedNot reportedNot reportedAmateur to professionalNot reportedTo examine eating behaviours in competitive male cyclists across racing categories.Cross-sectional self-reported surveyEating Attitudes Test 26 (EAT-26)Viner et al., 2015 [35] USA10 (F and M)Male: 42.0 ± 7.7 Female: 38.4 ± 10.3Male: 72.4 ± 6.8 kg
Female: 62.8 ± 12.2 kgMale: 177.9 ± 4.2 cm
Female: 165.4 ± 6.4 cmRoad cycling and mountain bikingCompetitiveMale: 1.4 ± 0.6 Female: 0.8 ± 0.4 per dayTo analyse eating behaviours that may contribute to LEA.Cross-sectional self-reported surveyThe Three-Factor Eating Questionnaire (TFEQ)—participants who scored 10 or higher were considered restrained eaters (RE) who consciously limit EI as a means of weight control

Most cyclists were identified as restricted eaters (100% road cyclists, 40% mountain bikers, 67% male and 75% female cyclists)

de Bruin and Oudejans 2018 [39] Netherlands8 mixed sport (1 cyclist) (F)Not reportedNot reportedNot reportedNot reportedInternationalNot reportedTo explore the role of contextual body image in the development of EDs in female athletes participating in at-risk sports. QualitativeInterview

Challenge for some participants to distinguish the different influences on their ED history as revealed by the narrative analysis

In the present study, the authors combined a content analysis and narrative inquiry, which seems quite uncommon compared to other qualitative studies, and might also be taken as undesirable from a methodological point of view.

Cook and Dobbin 2022 [36] UK36 (M)23.1 ± 3.9 (18–30)70.4 ± 7.1 kg180.5 ± 6.1 cmRoad cyclingElite (n = 8), category 1 (n = 9), category 2 (n = 19)16.4 ± 3.2 (10–22) per weekTo assess the association between sports nutrition knowledge, nutrition intake, energy availability and training characteristics with the risk of an eating disorder amongst highly trained, competitive male cyclists.Cross-sectional self-reported surveyThe Brief Eating Disorder in Athletes Questionnaire (BEDA-Q)

The data collected in this study were self-reported by the participant due to this being conducted during a pandemic; therefore, the data may have been misreported by the participants. This is particularly important with the food dairy where participants could, either deliberately or accidentally, fail to record certain foods on the food diary.

The participants may have altered their habitual diet to improve the perception of what they were eating and therefore altered their energy intake.

Another limitation is the various methods to calculate each component (intake, expenditure, lean muscle mass) of the energy availability formula used in this study, as each of these may bring about a degree of error when compared to a criterion measure (e.g., indirect calorimetry, DXA). We note that the method used to estimate lean body mass has not been validated in athlete populations such as cyclists where lean mass is likely to constitute a larger proportion of total mass.

Finally, the authors did not ask about the participants’ educational background, previous or current socioeconomic status or currently living arrangements—all of which might be important when considering educational resources or developing workshops to improve knowledge and energy availability.

Cook and Luke 2017 [56] USA 179 (F and M)32.5 ± 12.9 Not reported Not reported Not reported High school to professional Not reported To establish prevalence rates for primary and secondary EXD in a sample of cyclists. Our secondary purpose was to examine potential differences in EXD and level of competition, competition history and exercise amount.Cross-sectional self-reported surveyDrive for Thinness subscale of the Eating Disorder Inventory-2

Low drive for thinness scores in at-risk, symptomatic, and asymptomatic secondary exercise-dependent cyclists

First, the study used a cross-sectional design and therefore cannot provide causal inferences about EXD in cyclists.

Second, passive recruitment was used to obtain participants, which limits the ability for the results to be reflective of all cyclists. For example, the sample was overwhelmingly amateur-level athletes.

Third, while the relatively low N is a limitation, it is within the range of previously published adequately powered cross-sectional sport and exercise psychology studies and previous EXD prevalence studies.