I sin debattartikel i Läkartidningen (7 jan 2025) argumenterar Anna Melin och Lykke Tamm för att relativ energibrist inom idrott (REDs) är ett allvarligt och vanligt problem som bör tas på allvar.

Vi instämmer i att nutrition är en av flera grundläggande förutsättningar för idrottslig utveckling, prestation samt fysisk och psykisk hälsa. Det är självklart att träningsbelastning och energiintag måste anpassas och balanseras på alla nivåer av idrottsutövande. Däremot ifrågasätter vi författarnas framställande av REDs som ett väletablerat »syndrom«, särskilt i Läkartidningen, som riktar sig till den svenska hälso- och sjukvården.

Figure skating is a popular sport enjoyed by millions worldwide; however, research has largely overlooked the health challenges its participants face. Supported through an athlete’s maturation process from childhood to adulthood, participation in sports such as figure skating cultivates lifelong benefits for individuals and the sports community, improving long-term health and well-being.

However, athletes also face the risk of injuries and other health issues. This concern is particularly relevant for young athletes and female participants, often underrepresented in sports medicine research. Poor health can be devastating for the affected athlete and detrimental to the sports movement, which loses active participants.

Swedish figure skating has the world’s second-largest number of participants per capita, with over 51,000 participants, predominantly young girls. The sport continually evolves, increasing physical and mental demands on athletes. Despite its popularity, there is a notable gap worldwide in research on figure skaters' health. Media investigations and external reports often highlight injuries, violence, and unhealthy environments. Recent reports in Sweden have drawn attention to the exposure to violence in figure skating, including cases that violate children’s rights.

This dissertation explored the health of young Swedish figure skaters, identified risk factors for physical and mental health issues, and explored future ways to promote health and safety in figure skating.

Papers I and II were based on a cross-sectional study conducted via a questionnaire among a community population (N=400) of licensed competitive Swedish figure skaters of all levels. In total, 137 female skaters aged 12.9 years (SD 3.0) were included in the analysis.

Paper I investigated factors associated with sport injuries. It found that one-third of young skaters had sustained a severe injury episode in the past year, and one-fifth had an ongoing injury at the time of the study. Injury episodes primarily affected the lower extremities. Reported sport injury episodes were associated with being older and skipping more main meals per week.

Paper II examined mental health and associated factors. It showed that nearly half of the participants reported anxiety caseness, while one in ten reported depression caseness. Older participants exhibited poorer mental health, and anxiety caseness was associated with being older and with displaying a negative body image perception.

Papers III and IV employed reflexive thematic analysis of qualitative interviews with twenty Swedish licensed competitive figure skaters aged 12 to 25 (median age: 16).

Paper III focused on the athletes’ health-related experiences and how they balanced these with athletic performance. Young figure skaters held a positive view of their sports participation. They desired sustainability in their development and requested agency in decision-making. Young figure skaters sought accountability from adult stakeholders.

Paper IV explored young figure skaters' knowledge, experiences, and attitudes towards violence against children when participating in sports. Athletes struggled to recognise and report violence against children in sports, which was seen to perpetuate the normalisation and legitimisation of such behaviour.

In conclusion, very young athletes at the community level presented with a high degree of sport-related ill health that appeared to worsen with age, both physically and mentally. Repeated load, insufficient energy intake, negative body image perceptions and inadequate adult support contributed to adverse health consequences. This dissertation highlights the need for improved safety measures and consistent implementation of protection systems engaging collaborative resolutions across ecological levels within figure skating in Sweden and internationally.

This research emphasises the importance of addressing figure skaters' health needs, listening to young athletes’ experiences, and working towards creating safer and healthier environments for all sports participants.

Background Figure skaters typically jump in only one direction, landing on the same leg. Current prevention programs in figure skating lack knowledge about the importance of jumping direction in injury etiology.Objective To describe lateralisation (handedness, footedness, jumping direction) in female competitive figure skaters and its association with injury risk.Design One-year retrospective cohort study.Setting All licensed competitive figure skaters (n=400) in the southeastern region of Sweden.Participants 137 female figure skaters (mean age 12.9 (SD 3.0) years). Assessment of Risk Factors Lateralisation data and significant sports injury episodes for one year were reported by skaters. Associations were analyzed between handedness and jump-landing leg and between lateralization (right-sided/left-sided/mixed) and injury-sidedness (right/left/bilateral).Main Outcome Measurements Significant sports injury episode with time loss from sports >21 days. Results Most skaters reported right-side handedness (93%), footedness (87%) and landing leg (85%). The jumping direction (landing leg) was associated with handedness/footedness (p=0.035). Forty-two skaters (31%) had suffered a significant sports injury episode. Fifty-nine injuries (64% overuse/36% traumatic) were reported; 48 (83%) were located to the lower extremities; 35% of the lower extremity injuries involved only the landing leg. No association between left-sidedness and overuse injury episode (p=0.463) or traumatic injury (p=0.760) incidence during the study period was observed. Neither was any association found between lateralisation and distribution of injury to sides (p=0.328).Abstract 863 Figure 1 DAGitty on theoretically potential pathways between lateralisation, asymmetrical loading and injury aetiology. In figure skating, you specialise very early in jumping/spining in only one direction(thus all jumps on the sme leg). Accumulated load (skating level, years as a figure skater, training hours) may contribute to a component of exhaustion and more asymmertical loading enhancing lateralisation. The degree of laterlisation may affect balance, coordination and injury location. Athletes prone to left-wise dexterity skate with their “creative” brain and may be more prone to injury when exhaused, as well as having worse mental health in terms of body image, anxiety and depressin indicators. Blue node = outcome and ancestors of the outcome.Green node = exposure. Light grey node = unobserved (latent). Green arrow = casual path.View this table:Abstract 863 Table 1 Localization of injuries sustained in the last 12 months (n=59) with regard to lateralization injuries categorized into overuse and traumatic injuries, respectively.Conclusions Right-side handedness, footedness, and jump landing leg dominated in female competitive figure skaters. No association was found between the side that injury was sustained and the skater’s jumping direction. The relatively small size of the study implies that the risk of type 1 error must be considered. The results can be used to inform injury prevention programs for figure skaters. More research is needed on the contribution of laterality and asymmetric loading.

Background Elite athletes are role models for young sportspersons regarding social media use. Self-objectification, including self-sexualizing, contributes to body dissatisfaction and body shame, especially in young females. For efficient prevention of self-objectification, knowledge is needed about elite athletes’ self-presentation on social media.

Objective To compare social media postings indicative of self-objectification among female elite athletes in an aesthetic and a non-aesthetic individual sport and by age.

Design Cross-sectional quantitative visual content analysis study.

Setting Instagram on October 1st, 2021.

Participants All Swedish elite female athletes aged 16 years or older with open Instagram accounts in figure skaters (n=26) and athletics (track and field) athletes (n=40).

Assessment of Risk Factors The 30 most recently posted images were identified from each athlete’s Instagram account (Figure). Following exclusion of non-topical images, a panel (4 women/4 men) individually scored factors indicative of self-objectification in the remaining images. The scores were analyzed quantitatively by sport (figure skating/athletics) and age group (age-cut at 21 years).

Main Outcome Measurements Proportion of sexually suggestive images in Instagram postings.

Results In total, 1,869 images were analyzed; 669 posted by figure skaters and 1200 by athletics athletes. Seventy-four images (4%) were classified as containing sexually suggestive content. Figure skaters posted more images with sexually suggestive content (p=0.032) than athletics athletes (especially images with sexual posing (p=0.005) and sexualized body parts in focus (chest (p=0.049); hip-region (p=0.001)). Younger athletes published more images interpreted to contain sexual suggestion than older athletes (p<0.001) (especially images focusing on the chest (p=0.008)). 

Conclusions Prevention of self-objectification in young female sportspersons should include moderation of self-presentation practices on social media among female elite athletes in aesthetic sports and young elite athletes in their upper teens. Further research on the role of social media in the etiology of mental unhealth in sportspersons is warranted. 

The WHO1 defines mental health as ‘a state of well-being in which an individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to his or her community’ (p. 12). According to this definition, mental health is more than a lack of symptoms of mental ill-being or disorders. Variations in mood and perception of symptoms, also with aversive valence, may occur during regular participation in competitive sports. This editorial discusses the importance of acknowledging nuances in studies of mental health and psychiatric disorders in sports medicine and calls for a deepened understanding of ‘mental health’ and how various mental health symptoms and disorders are reported.

Background Although figure skating attracts several hundred thousand participants worldwide, there is little knowledge about physical health and sports injuries among young skaters.Objective To describe the health status of a geographically-defined Swedish population of licensed competitive figure skaters and to examine injury determinants.Design Cross-sectional.Setting All licensed competitive skaters in the south-eastern region of Sweden.Participants In total, 142 (36%) of 400 skaters participated, 137 (96%) of whom were girls (mean (SD) age: 12.9 (SD 3.0) years). Participating boys (n=5) were excluded from further analysis.Assessment of Risk Factors Age, skating level, eating habits, relative energy deficiency indicators, and training habits were assessed.Main Outcome Measurements The primary outcome measure was the one-year prevalence of a severe sports injury episode (time loss&gt;21 days). The secondary outcome measure was the point prevalence of an ongoing sports injury.Results The one-year prevalence of a severe sports injury episode was 31%, which in the multiple model, was associated with older age (odds ratio (OR) 1.2, 95% confidence interval (CI) 1.1–1.4; p=0.002) and an increased number of skipped meals per week (OR 1.1, 95% CI 1.0–1.3; p=0.014). The point prevalence of an ongoing injury episode was 19%, which was associated with older age (OR 1.4, 95% CI 1.2–1.7; p&lt;0.001) and an increased number of skipped meals per week (OR 1.1, 95% CI 1.0–1.3; p=0.049).Conclusions One-third of young female Swedish competitive figure skaters had sustained a severe injury episode during the past year, and a fifth reported an ongoing episode. Older age and an increased number of skipped meals per week were associated with a sports injury episode. Further prospective studies of injury determinants among competitive figure skaters are warranted before the findings are broadly applied in intervention programs.

Introduction: Although figure skating attracts several hundred thousand participants worldwide, there is little knowledge about physical health and sports injuries among young skaters. The present study aimed to describe the health status of a geographically defined Swedish population of licensed competitive figure skaters and to examine injury determinants. Methods: All licensed competitive skaters in the southeastern region of Sweden were in April 2019 invited to participate in a cross-sectional study using an online questionnaire. Multiple binary logistic regression was used for the examination of injury determinants. The primary outcome measure was the 1-year prevalence of a severe sports injury episode (time loss &gt;21 days). The secondary outcome measure was the point prevalence of an ongoing injury. The determinants analyzed were age, skating level, relative energy deficiency indicators, and training habits. Results: In total, 142 (36%) skaters participated, 137 (96%) girls [mean (SD) age: 12.9 (SD 3.0) years]. Participating boys (n = 5) were excluded from further analysis. The 1-year prevalence of a severe sports injury episode was 31%. The most common injury locations for these injuries were the knee (25%), ankle (20%), and hip/groin (15%). In the multiple model, having sustained a severe injury episode was associated with older age (OR 1.2, 95% CI 1.1-1.4; p = 0.002) and an increased number of skipped meals per week (OR 1.1, 95% CI 1.0-1.3; p = 0.014). The point prevalence of an ongoing injury episode was 19%. The most common locations were the knee (24%), ankle (24%), and foot (24%). Having an ongoing injury episode was associated with older age (OR 1.4, 95% CI 1.2-1.7; p &lt; 0.001) and an increased number of skipped meals per week (OR 1.1, 95% CI 1.0-1.3; p = 0.049). Conclusion: One-third of young female Swedish competitive figure skaters had sustained a severe injury episode during the past year, and a fifth reported an ongoing episode. Older age and an increased number of skipped meals per week were associated with a sports injury episode. Long-term monotonous physical loads with increasing intensity and insufficient energy intake appear to predispose for injury in young female figure skaters. Further examination of injury determinants among competitive figure skaters is highly warranted.