ORIGINAL RESEARCH Body Mass Index, Nutritional Knowledge, and Eating Behaviors in Elite Student and Professional Ballet Dancers Matthew A. Wyon, PhD,*† Kate M. Hutchings, MSc,‡ Abigail Wells, MSc,* and Alan M. Nevill, PhD* Objective: It is recognized that there is a high esthetic demand in ballet, and this has implications on dancers’ body mass index (BMI) and eating behaviors. The objective of this study was to examine the association between BMI, eating attitudes, and nutritional knowl- edge of elite student and professional ballet dancers. Design: Observational design. Setting: Institutional. Participants: One hundred eighty-nine participants from an elite full-time dance school (M = 53, F = 86) and from an elite ballet company (M = 16, F = 25) volunteered for the study. There were no exclusion criteria. Interventions: Anthropometric data (height and mass), General Nutrition Knowledge Questionnaire (GNKQ), and the Eating Attitude Test—26 (EAT-26) were collected from each participant. Main Outcome Measures: Univariate analysis of variance was used to examine differences in gender and group for BMI, GNKQ, and EAT-26. Regression analyses were applied to examine inter- actions between BMI, GNKQ, and EAT-26. Results: Professional dancers had significantly greater BMI than student dancers (P , 0.001), and males had significantly higher BMI scores than females (P , 0.05). Food knowledge increased with age (P , 0.001) with no gender difference. Student dancers had a significant interaction between year group and gender because of significantly higher EAT-26 scores for females in years 10 and 12. Regression analysis of the subcategories (gender and group) reported a number of significant relationships between BMI, GNKQ, and EAT-26. Conclusions: The findings suggest that dancers with disordered eating also display lower levels of nutritional knowledge, and this may have an impact on BMI. Female students’ eating attitudes and BMI should especially be monitored during periods of adolescent development. Key Words: ballet, eating disorders, body mass index, nutrition knowledge (Clin J Sport Med 2014;24:390–396) INTRODUCTION It is recognized that athletic performance is enhanced by optimal nutrition and adequate recovery from exercise. 1 Energy requirements must be met to maintain body weight, replenish glycogen stores, and provide essential components for tissue regeneration and repair. 2 However, dietary inade- quacies and nutrition-related knowledge deficits continue to persist among many athletes. 2 The prevalence of low body weight body mass index (BMI) and disordered eating in the field of ballet is documented in the medical literature, 3 and female elite dancers have been reported to weigh between 10% and 14% below their ideal weight for height. 4 The esthetic demand of dance can generate high levels of body dissatis- faction and a motivation to be thin, 5 and this creates a conflict between achieving an “acceptable” body image and acquiring optimal aerobic endurance and muscular strength. 6 These contrasting goals may predispose the dancer to an increased risk of disordered eating behaviors that are confounded by psychosocial stressors. 7 In addition, ballet, as a form of exer- cise, can be an inefficient method of burning calories, 8,9 and therefore dietary constraint may be used for weight control in a drive to maintain a lean physique. 10 The constant require- ment of a lean physique has also been linked to increased healing times; dancers with low percentage of body fat are more prone to injury and take longer to recover than their healthier counterparts. 11 The prevalence of eating disorders (ED) and disordered eating patterns (DE) in athletes varies significantly in the literature with estimates between 1% and 62%. 12 Esthetic sports that require leanness or a specific body weight are at higher risk of developing DE than nonesthetic sports. 13 One of the largest studies to date 14 has shown a significant increase in ED in females competing in endurance, weight category, and esthetic sports, and these characteristics have also been seen within dance populations, especially ballet 2–4,15 but also in other genres. 6 The reasons for the increased prevalence of ED among certain subgroups of athletes have been open to considerable speculation; 16 the most common view has been that the pres- sures to diet and become thin may actually trigger ED in those with specific vulnerabilities. 17 Alternatively, it may be that they attract people with preexisting ED or certain personal- ities that may predispose them to develop ED. 18 The concept of disordered eating behaviors must be distinguished from a clinical diagnosis of an ED. Disordered eating patterns are defined as a continuum from ED (eg, anorexia nervosa bulimia nervosa) to preoccupations with Submitted for publication March 11, 2013; accepted October 8, 2013. From the *Research Centre for Sport, Exercise and Performance, University of Wolverhampton, Walsall, United Kingdom, †National Institute for Dance Medicine and Science, Birmingham, United Kingdom, and ‡English Insti- tute of Sport, Bisham Abbey, Marlow, United Kingdom. The authors report no conflicts of interest. Corresponding Author: Matthew A. Wyon, PhD, Research Centre for Sport, Exercise, and Performance, University of Wolverhampton, Gorway Rd, Walsall, West Midlands, United Kingdom WS1 3BD (m.wyon@wlv.ac.uk). Copyright © 2013 by Lippincott Williams & Wilkins 390 | www.cjsportmed.com Clin J Sport Med  Volume 24, Number 5, September 2014