Abstract
Keywords
Key Points
Female DanceSport undergraduates showed significantly higher ED risk and body shape concerns, reflecting the need for gender-sensitive screening and prevention programs.
Independent of BMI, weight suppression predicts ED risk, underscoring the importance of long-term weight monitoring throughout DanceSport training.
Long-term DanceSport participation is associated with chronic weight-control practices, with psychological vulnerability that may escalate over time.
Introduction
The intersection of aesthetic standards and athletic performance presents unique physiological and psychological demands for dancers, drawing growing interest in eating disorders (EDs) research. 1 While EDs have long been recognized as critical mental health concerns across athletic and artistic communities, recent evidence has emphasized the importance of gender differences, weight suppression, and discipline-specific cultural pressures. 2 Among these, DanceSport, as a form of competitive ballroom dance combining artistry and athleticism, presents a distinct yet understudied context.
Uniquely, DanceSport imposes multiple, intersecting pressures: the expectation to maintain technical excellence in partnership-based choreography, and to adhere to visual ideals influenced by both Western beauty norms and subjective judging criteria. 3 DanceSport dancers are judged not only on individual aesthetics and technical precision, but also on synchronized physical harmony with a partner. 4 This dynamic introduces compounded demands: maintaining personal leanness while conforming to expectations of aesthetic symmetry with a partner. The extra pressure may intensify vulnerabilities to body dissatisfaction and EDs, particularly as dancers internalize leanness as a prerequisite for both aesthetic appeal and competitive success. However, the existing research on dancers has focused on classical and solo dance forms, particularly ballet,5-8 leaving partnered aesthetic performance contexts, such as DanceSport, largely understudied.9,10
Unlike solo dance forms, 11 DanceSport involves a partnered format in which dancers are evaluated not only individually but also in terms of visual symmetry with their partner. This includes alignment in body proportions, height compatibility, and coordinated movement aesthetics. Such relational evaluation introduces a partner-based dimension of aesthetic judgment, where bodies are assessed relative to one another rather than against an individual ideal. 4 These compounded demands may exacerbate body-related pressures and reinforce sustained weight-control behaviors.
A growing body of research has highlighted weight suppression, the discrepancy between one’s highest past weight and current body weight, as a behaviorally derived risk factor in the pathology of EDs. Despite its relevance, weight suppression remains underexplored in DanceSport. No prior studies have conducted gender-stratified analyses in DanceSport populations, limiting insight into gender-specific vulnerabilities. Therefore, the current study addresses this gap by targeting DanceSport undergraduates and exploring the interplay between gender, body shape concerns, and ED risk.
Methods
This is a cross-sectional study conducted exclusively among students currently majoring in DanceSport across 5 sports universities, which offer accredited DanceSport programs that admit students through a formal, performance-based entrance examination, ensuring a pre-professional level of training prior to university enrollment.
Data collection took place between September 2022 and March 2023. All participants received written information about the procedures, requirements, and potential risks associated with the surveys. Ethical approval was obtained from the Sports Science Experiment Ethics Committee of Beijing Sport University (approval no 2022156H), and all participants provided written informed consent prior to participation. Part of the dataset was collected within previously published intervention trials,12,13 which were prospectively registered in the Chinese Clinical Trial Registry (ChiCTR2200066054). This study was conducted based on the guidelines of the STROBE checklist (shown in Supplement Table 1).
Participants
A total of 250 subjects aged 18 to 29 years voluntarily participated in this study. Participants were recruited using convenience sampling from Beijing Sport University, Nanjing Sport Institute, Capital University of Physical Education and Sports, Shanghai University of Sport, and Wuhan Sports University. The inclusion criteria are shown as follows:
Aged 18 to 29 years;
Current DanceSport undergraduates in a recognized university program;
Regular training ≥3 sessions/week;
Greater than or equal to two consecutive years of DanceSport training;
Participation in ≥1 official DanceSport competition within the past 12 months;
Ability to provide informed consent and complete questionnaires.
The exclusion criteria are listed below:
Current or prior diagnosis of EDs or severe psychiatric illness.
Participation in other aesthetic/weight-sensitive sports (eg, ballet, gymnastics).
Incomplete psychological or weight-history data.
Within each institution, eligible participants were invited through departmental announcements, in-class announcements, and personally invited by their DanceSport instructors.
Questionnaires
Gender, age, and years of DanceSport experience were self-reported via a survey. The Eating Attitudes Test-26 (EAT-26) was used to assess ED risk. 14 The EAT-26 contains 26 attitudinal statements and 5 behavioral items. A total score of ≥20 in eating attitudes or any endorsement in eating behaviors indicates high ED risk. 14
The original version of the Body Shape Questionnaire-34 (BSQ-34) was utilized to evaluate body shape concerns and dissatisfaction.15,16 Total score illustrated different categories of body shape concerns: (1) no concern with shape: score ≤80, (2) mild concern with shape: score between 81 and 110, (3) moderate concern with shape: score between 111 and 140, (4) marked concern with shape: score >140. The EAT-26 and the BSQ-34 measures used in this study are available in the Supplement Tables 2 to 4.
Body Weight
Following modified World Health Organization guidelines and clinical screening criteria,17,18 participants were categorized into underweight (BMI 17.6-18.5 kg/m2) or severely thin (BMI ≤17.5 kg/m2) based on their body mass index (BMI), calculated from their self-reported body weight (kg) and height (m), to estimate their body weight status.
Weight Suppression
Weight suppression is the discrepancy between the highest past weight and the current body weight 19 and has been validated as a risk indicator of eating pathology and weight management, reflecting long-term efforts to maintain body weight below historical maximum.8,20 The weight suppression level was computed by deducting the self-reported current weight (kg) from the self-reported highest past weight (kg).
Statistical Analyses
Descriptive data are presented in mean and standard deviation, or frequency and percentage with 95% confidence interval. The Shapiro-Wilk test was used for normality tests. The EAT-26 and BSQ-34 scores did not fit normal distributions. Therefore, non-parametric tests (Kruskal-Wallis and Mann-Whitney tests) were performed in the analysis. The effect size r and Φ were reported for the Mann-Whitney test and χ2 test.
Spearman correlation was computed to explore potential relationships between the years of DanceSport experience and weight suppression, ED risk, and body shape concerns. For regression analyses, gender was dummy-coded (0 = male, 1 = female), and gender differences in ED risk and body shape concerns were examined.
Multiple linear regression was performed to clarify the influences of variables. The strength of each regression model was assessed using the coefficient of determination (R2), which represents the proportion of variance in the dependent variable explained by the predictors. Adjusted R2 was also reported to account for the number of predictors in the model, providing a more conservative estimate of model fit. Age and BMI were entered as covariates in all regression analyses to control for potential confounding effects.
Cronbach’s α coefficient was 0.92 for the EAT-26 and 0.98 for BSQ-34, suggesting adequate internal consistency. The KMO test coefficient was 0.91 for the EAT-26 and 0.96 for the BSQ-34, both exceeding the 0.5 threshold (both P < .05), suggesting good structural validity. All 250 responses were complete; no imputation for missing data was necessary. All analyses were conducted with SPSS 25.0 (IBM, Armonk, NY, USA). The statistical significance was set at P < .05 for all comparisons.
Power Analyses
Post hoc power analyses were conducted using G*Power 3.1 (Heinrich Heine University Düsseldorf, Düsseldorf, Germany). The effect sizes were calculated as f2 = 0.181 for the EAT-26 model (R2 = 0.153) and f2 = 0.155 for the BSQ-34 model (R2 = 0.134). With a sample size of 250 participants, 8 predictors, and α = .05, both models achieved statistical power exceeding 0.99 (EAT-26: 0.9996; BSQ-34: 0.9981).
Results
A total of 250 subjects (122 males and 128 females) were recruited, with a mean age of 21.92 ± 2.26 years (range 18-29), BMI of 20.00 ± 2.13 kg/m2 (95% CI [19.74-20.27]), and 9.33 ± 3.26 years of dance experience (95% CI [8.80-9.86]). Table 1 summarizes the participant characteristics, ED risk, and body shape concerns. Overall, 7.2% were underweight and 26.1% were severely thin; 22.0% reported moderate-to-marked body shape concerns; 21.2% were identified as having high ED risk. A total of 50% met EAT-26 criteria for referral (score ≥20 or endorsement of any behavioral item), indicating the need for professional mental health evaluation.
Characteristics of the DanceSport Undergraduates.
Correlational Analyses
Spearman correlations were conducted as shown in Table 2. BMI was negatively, and BSQ-34 was strongly positively, correlated with EAT-26 scores. The highest past weight, the lowest past weight, and the ideal body weight had significantly negative correlations with the EAT-26 scores and the BSQ-34 scores. Years of dance experience and weight suppression demonstrated significantly positive correlations.
Spearman Correlation Matrix of Anthropometric and Psychological Variables in the DanceSport Undergraduates.
P < .05. **P < .01.
Gender Differences Analyses
As shown in Table 3, females demonstrated higher levels of weight suppression (Z = −2.038, P = .042, 95% CI [−0.249 to −0.005]), ED risk (Z = −5.555, P < .001, 95% CI [−0.456 to −0.238]), and body shape concerns (Z = −7.209, P < .001, 95% CI [−0.549 to −0.352]) than males. More female than male participants reported the use of laxatives, diet pills, or diuretics (χ2 = 19.278, P < .001, 95% CI [0.159 to 0.388]), recent weight loss of 20 pounds or more (χ2 = 4.264, P = .039, 95% CI [0.007 to 0.251]), and with a need for professional evaluation (χ2 = 10.822, P = .001, 95% CI [0.086 to 0.324]). More females than males were classified as severely thin (χ2 = 29.16, P < .001, 95% CI [0.227 to 0.447]) and expressed marked body shape concerns (χ2 = 41.290, P < .001, 95% CI [0.297 to 0.505]). Such findings highlight pronounced gender disparities in both ED risk and body shape concerns among DanceSport undergraduates.
Mann-Whitney Tests and χ2 Tests for Gender Differences in the DanceSport Undergraduates.
Regression Analyses
Multiple linear regression analyses were conducted as shown in Table 4. Predictors accounted for respective 15.3% (R2 = 0.153, adjusted R2 = 0.122) and 13.4% (R2 = 0.134, adjusted R2 = 0.102) of the variance in the EAT-26 model and the BSQ-34 model, indicating a modest but meaningful proportion of variance.
Multiple Linear Regression of Eating Disorder Risk and Body Shape Concerns in the DanceSport Undergraduates.
Gender was a significant predictor of both the EAT-26 (P = .003) and the BSQ-34 scores (P < .01). Weight suppression predicted the EAT-26 (P = .018) and the BSQ-34 (P = .020) scores. Additionally, BMI (P = .001) and the highest past weight (P = .035) were significant predictors of the BSQ-34 scores.
Conceptual Mediation Model
To integrate the relationships observed across both measures, a conceptual mediation model (Figure 1) was developed to illustrate the hypothesized mediation pathway through which years of dance experience influences ED risk and body shape concerns via weight suppression. Supporting this model, Spearman correlation showed a significant positive association between years of dance and weight suppression (r = 0.214, P < .01), and multiple regression confirmed that weight suppression significantly predicted both the EAT-26 (B = 0.865, P = .018) and the BSQ-34 scores (B = 2.497, P = .020).

Conceptual model linking years of dance experience, weight suppression, and eating disorders outcomes. Path a represents the Spearman correlation between years of dance experience and weight suppression (r = 0.214, P < .01). Paths b2 and b2 reflect unstandardized regression coefficients from weight suppression to EAT-26 scores (B = 0.865, P = .018) and BSQ-34 scores (B = 2.497, P = .020), respectively. Gender was controlled in all regression models.
Discussion
This study builds on existing aesthetic-sport literature by uniquely examining weight suppression as a mediator in DanceSport undergraduates, providing the first gender-stratified model linking long-term dance experience with ED risk and body shape concerns. It provides the first large-scale, gender-stratified evidence in pre-professional DanceSport dancers, who are often overlooked in evaluations of EDs, despite their exposure to dual pressures of athletic performance and presentation. 4 Although the psychological vulnerabilities have been previously acknowledged in classical or solo dance forms, 4 our findings underscore the influence of mental health vulnerabilities among partnered dancers.
We observed that female DanceSport undergraduates reported significantly higher levels of ED risk, weight control behaviors, and body shape concerns compared with their male counterparts, consistent with existing research in aesthetic sports. 21 Male dancers may be subject to performance expectations that prioritize strength over leanness, such as above-the-shoulder assisted lifts, 22 which may buffer against chronic weight suppression. Additionally, gender-specific expectations within partnered dance may place disproportionate aesthetic scrutiny on female dancers, contributing to higher vulnerability.23,24 Similar patterns have been reported in partnered ballet contexts, where female dancers may experience pressure to maintain thinness in relation to male partners. 25
Our study identified gender and weight suppression as significant and independent predictors of both ED risk and body shape concerns, after adjusting for BMI and age, suggesting that maintaining a lower weight relative to the highest adult weight may induce chronic psychological distress independent of body size and age. Such findings align with emerging evidence supporting weight suppression as a key construct in chronicity and severity of EDs. 20
A robust correlation between years of dance experience and weight suppression was noted, suggesting that long-term engagement in DanceSport may progressively widen the discrepancy between the peak and current weight. In DanceSport, athletes are evaluated not only individually but also in relation to their partner, introducing compounded pressures related to symmetry, proportion, and coordinated aesthetics. These relational demands, combined with competitive expectations, may contribute to sustained weight-control behaviors and increased psychological vulnerability.12,26
The interpersonal emphasis on visual symmetry in partnered dance may drive sustained efforts to suppress weight, especially among female dancers who strive to match leaner ideals shaped by partners, 23 coaches (choreographers),23,27 judges, 27 parents, 23 peers, and environmental factors. 23 The introduced mediation model, in which years of dance experience were associated with ED risk and body shape concerns indirectly through weight suppression, further underscores how accumulated exposure to aesthetics and performance might reinforce long-term weight suppression in DanceSport dancers.
Despite these contributions, some limitations must be acknowledged: (1) Reliance on self-reported weight history and calculated weight suppression could introduce possible recall bias, despite strong internal consistency metrics. (2) Some participants may have had limited years of DanceSport experience, potentially affecting the variability of recalled weight history. (3) The cross-sectional design precludes causal inference or formal mediation testing. Accordingly, the pathway in the proposed model should be interpreted as an exploratory mechanism. (4) The EAT-26 and the BSQ-34 questionnaires could limit diagnostic precision. Although the BSQ-34 is widely used and demonstrates excellent internal consistency, it was originally validated for female populations and may not assess equivalently across genders.
Future studies should examine the longitudinal trajectory of weight suppression and its psychological consequences in DanceSport. Integrating nutritional, psychological, and performance metrics may help establish a comprehensive framework for dancer health that balances competitive demands with sustainable well-being.
Practical and Clinical Implications
Despite years of dance experience not directly predicting ED risk or body shape concerns, it was significantly correlated with weight suppression, which, in turn, predicted both in the regression, suggesting long-term involvement in DanceSport may increase psychological risk through chronic weight control behaviors. Specifically, each 1 kg increase in weight suppression was associated with an ~2.5-point increase in body shape concerns (B = 2.497), or a 0.87-point increase in ED risk scores (B = 0.865). Therefore, even modest, sustained discrepancies between current and highest past weight may contribute to meaningful elevations in body shape concerns over time. While a single kg change may appear small, cumulative weight suppression across multiple years could shift dancers into higher BSQ-34 categories, increasing vulnerability to body dissatisfaction and eating pathology.
For practitioners, these findings underscore the importance of monitoring weight history and long-term weight control behaviors, rather than relying solely on current BMI or weight status. Weight suppression may act as a cumulative byproduct of years in DanceSport that carries psychological consequences. Such a mechanism may explain why even dancers with similar BMI or weight profiles could differ in risk levels, particularly when chronic weight control practices are present. The introduced mediation pathway could be critical for coaches and health professionals, as it highlights the need for early interventions targeting weight suppression behaviors before translating into entrenched psychological distress.
Importantly, the findings of our study are consistent with prior intervention-based randomized controlled trials in DanceSport populations. A 6-week time-restricted eating protocol improved body composition and lipolytic hormone regulation and preserved performance without exacerbating ED risk.12,13 Given the harmful weight control practices revealed by the current study, these existing results suggest that structured nutritional strategies like time-restricted eating may offer a feasible, low-risk alternative to extreme or psychologically harmful weight control practices commonly observed among DanceSport dancers. Raising awareness of, and implementing, such evidence-based nutritional strategies could play an important role in protecting health and reducing the prevalence of ED risk in dancers.
Conclusion
DanceSport undergraduates, particularly women, exhibit heightened ED risk and body shape concerns, with gender and weight suppression emerging as significant predictors. Long-term participation in DanceSport may reinforce restrictive weight control behaviors. Further studies are needed to validate these findings and to inform holistic health strategies for DanceSport dancers.
Supplemental Material
sj-doc-1-dmj-10.1177_1089313X261452406 – Supplemental material for Weight Suppression and Gender as Predictors of Eating Disorder Risk and Body Shape Concerns in DanceSport Undergraduates
Supplemental material, sj-doc-1-dmj-10.1177_1089313X261452406 for Weight Suppression and Gender as Predictors of Eating Disorder Risk and Body Shape Concerns in DanceSport Undergraduates by Yanbing Zhou, Xian Guo and Xinxin Li in Journal of Dance Medicine & Science
Supplemental Material
sj-docx-2-dmj-10.1177_1089313X261452406 – Supplemental material for Weight Suppression and Gender as Predictors of Eating Disorder Risk and Body Shape Concerns in DanceSport Undergraduates
Supplemental material, sj-docx-2-dmj-10.1177_1089313X261452406 for Weight Suppression and Gender as Predictors of Eating Disorder Risk and Body Shape Concerns in DanceSport Undergraduates by Yanbing Zhou, Xian Guo and Xinxin Li in Journal of Dance Medicine & Science
Footnotes
Acknowledgements
The authors would like to sincerely thank the following instructors for helping contact the participants in this study: Tao Geng, from Nanjing Sport Institute; Tao Wu, from Capital University of Physical Education and Sports; Ying Wang, from Wuhan Sports University; Zhenghao Sun, from Shanghai University of Sport; Hong Shen, Lu Li, Bei Chen, Chang Liu, and Bo Luan, from Beijing Sport University.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Supplemental Material
Supplemental material for this article is available online.
References
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