Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
, 7 (7)

Towards a Sustainable Nutrition Paradigm in Physique Sport: A Narrative Review


Towards a Sustainable Nutrition Paradigm in Physique Sport: A Narrative Review

Eric R Helms et al. Sports (Basel).


Physique athletes strive for low body fat with high lean mass and have higher body image and eating disorder rates than the general population, and even other weightlifting populations. Whether athletes with a background or tendency to develop these issues are drawn to the sport, or whether it drives these higher incidences, is unknown. However, the biological drive of cyclical energy restriction may contribute to binge-eating behavior. Additionally, requisite monitoring, manipulation, comparison, and judgement of one's physique may contribute to body image concerns. Contest preparation necessitates manipulating body composition through energy restriction and increased expenditure, requiring dietary restraint and nutrition, exercise, and physique assessment. Thus, competitors are at mental health risk due to (1) pre-existing or predispositions to develop body image or eating disorders; (2) biological effects of energy restriction on eating psychology; and (3) dietary restraint attitudes and resultant physique, exercise, and nutrition monitoring behavior. In our narrative review we cover each factor, concluding with tentative best-practice recommendations, including dietary flexibility, slower weight loss, structured monitoring, gradual returns to offseason energy intakes, internal eating cues, appropriate offseason body compositions, and support from nutrition and mental health professionals. A mental health focus is a needed paradigm shift in bodybuilding nutrition practice and research.

Keywords: binge-eating; body composition; body image; bodybuilding; eating disorder; muscle hypertrophy; nutrition; physique; psychology.

Conflict of interest statement

The authors declare no conflict of interest.


Figure 1
Figure 1
Theoretical drivers of potential harm. Based on the available literature, there are three known potential overarching factors with related sub-factors contributing to the higher risks of body image and eating disorders observed among physique athletes: (1) a predisposition towards these disorders, related to certain personality traits; (2) the biological response to energy restriction and low energy availability, potentially resulting in Relative Energy Deficiency in Sport (RED-S) and the female athlete triad, further exacerbated by low body fat; and (3) the monitoring behaviors used to exert the restraint necessary to follow and ensure the effectiveness of competition preparation diets.

Similar articles

See all similar articles

Cited by 1 PubMed Central articles


    1. Chapman D.L. Sandow the Magnificent: Eugen Sandow and the Beginnings of Bodybuilding. University of Illinois Press; Champagne, IL, USA: 1994.
    1. Fair J.D. Mr. America: The Tragic History of a Bodybuilding Icon. University of Texas Press; Austin, TX, USA: 2015.
    1. Fitschen P., Wilson C. Bodybuilding: The Complete Contest Preparation Handbook. Human Kinetics; Champagne, IL, USA: 2019.
    1. Helms E., Aragon A., Fitschen P. Evidence-based recommendations for natural bodybuilding contest preparation: Nutrition and supplementation. J. Int. Soc. Sports Nutr. 2014;11:20. doi: 10.1186/1550-2783-11-20. - DOI - PMC - PubMed
    1. Rossow L.M., Fukuda D.H., Fahs C.A., Loenneke J.P., Stout J.R. Natural bodybuilding competition preparation and recovery: A 12-month case study. Int. J. Sports Physiol. Perform. 2013;8:582–592. doi: 10.1123/ijspp.8.5.582. - DOI - PubMed