Objectives：The purpose of this study was to estimate the prevalence of eating disorders among college athletes.

Subjects and Methods：A questionnaire survey was administered to 443 college athletes who belonged to athletic club activities. The Japanese version of the Eating Disorder Diagnostic Screen DSM-5 version was used in this study.

Results：Overall, 7.0% of participants, 3.9% of men, and 12.2% of women met the diagnostic criteria for some type of eating disorder. By type of sport, males were more likely to have an eating disorder in the combat sports (13.3%), ball games (3.5%), and target sports (3.4%), while females were more likely to have an eating disorder in the aesthetic sports (17.4%), target sports (13.9%), and recording sports (10.0%), in that order. The prevalence was about twice as high when the degrees of life impairments were not considered.

Discussion：The significance of this study was to clarify the prevalence of eating disorders among male athletes in Japan and identify a type of sports with a high risk of eating disorders.

Conclusion：This study revealed that a certain number of eating disorders exist among Japanese college athletes and that support is needed based on the characteristics of high-risk sports types.

Historically, patients with anorexia nervosa had been metaphorically represented as a little pretty bird in the golden cage. However, family styles and patient features have diversified and now there have been an increase in other family styles such as stepfamilies and disintegration of the traditional family unit. Moreover, there have been increases in impulsivity, avoidant personality disorder (generalized social anxiety disorder), neurodevelopmental disorders, complex post-traumatic stress disorder/developmental trauma disorder, and/or attachment problems. As a result, both heterogeneity and therapeutic difficulties are increasing. Thus, a paradigm shift from inpatient to outpatient treatment has occurred, because isolation from families is not necessarily, anymore. To overcome these challenges, case formulation should be based on prototypical rather than categorical diagnosis and consider comorbidities of personality and neurodevelopmental disorders. Validation rather than empathic listening, and attitudes with radical genuineness rather than just genuineness should be applied to build solid therapeutic alliances.

The younger age of patients with eating disorders is attracting attention. Furthermore, the COVID-19 pandemic has led to a worldwide increase in the number of child and adolescent patients, and countermeasures for these patients have been highlighted as a medical and social issue. From the perspective of a pediatrician, this article discusses pediatric outpatient treatment (physical and psychological treatment) of child eating disorders. It is important to formulate a treatment plan for the patient at the initial visit. Attention to physical management in childhood is discussed, especially with regard to necessary tests. Major global guidelines for psychological treatment of children and adolescents are described; FBT is important in the treatment of children and is outlined. In patients who resist treatment, the coexistence of developmental disorders should be considered as a factor in the persistence of symptoms. The goal of treatment of eating disorders in children and adolescents is not only to overcome the physical crisis but also to enable the patient to lead a stress-free daily life with family and friends, and therapists need to take into account supports beyond eating behavior.

Nutritional therapy for patients with eating disorder is initiated in an ambulatory, emergency outpatient, intensive care or inpatient setting, with an overarching focus from early on in their treatment course on nutritional guidance, improvement of malnutrition, and weight recovery. Patients with anorexia nervosa are often found to be low carbohydrate diet, which is among the factors accounting for decreased energy intake in these patients, with no consensus reached on the lower limit for minimum carbohydrate intake. On the other hand, excessive intake of animal products, e.g., beef, pork and chicken, is shown to be associated with increased mortality risk. Patients with bulimia are often shown to be focused on curbing binge eating or self-induced vomiting or misuse of laxatives or diuretics, i.e., purging, while diet restriction can worsen binge eating or vomiting in these patients. Therefore, it is important to note that nutritional guidance should focus on encouraging affected patients to adhere to regular and appropriate meal portions and that managerial dietitians have an essential role in treatment planning for these patients.