Andrea Petróczi
23028646700
Publications - 10
Tracking the shift from health to harm: Development and validation of a short screening tool for orthorexia nervosa (STONE)
Publication Name: Appetite
Publication Date: 2025-10-01
Volume: 214
Issue: Unknown
Page Range: Unknown
Description:
Orthorexia Nervosa (ON), a problematic fixation on healthy eating, has captured researchers' attention for over a decade. We aimed to develop a brief screening tool for ON that captures physical appearance as a motivating factor, behavioural aspects (rigid control over food selection, consumption and preparation), and nutritional aspects (avoidance of foods considered “impure”). Using a sequential, iterative design, 687 participants completed a self-reported survey across four studies: item identification and selection through exploratory factor analysis (n = 248), testing factorial construct validity with confirmatory factor analysis (n = 127), discriminant validity via known group differences (n = 241), and test-retest reliability of two subsequent administrations of the selected items (n = 71). The final unidimensional version of the short Screening Tool for Orthorexia Nervosa (STONE) comprises eight items. It demonstrated excellent known-group validity and ability to differentiate ON from other types of strict dietary control (e.g., health-based or religious restrictions). Consistent with the view of ON as behaviours aimed at rigid dietary control, avoidance of “impure” foods, and motivation to enhance physical appearance, STONE scores positively related to measures of eating pathology and appearance orientation, while only weakly correlating with obsessive-compulsive tendencies. Based on its psychometric properties, STONE is recommended as a first-level screening tool for ON in research contexts and epidemiology studies among adults. Due to its brevity, it can be easily combined with other scales to explore ON or related phenomena. Future studies should examine convergent validity and test it among adolescents and in different cultural contexts.
Open Access: Yes
Numbers do not lie, but they can mislead: rethinking what doping prevalence statistics really mean
Publication Name: Journal of Sports Medicine and Physical Fitness
Publication Date: 2025-07-01
Volume: 65
Issue: 7
Page Range: 835-838
Description:
No description provided
Open Access: Yes
The impact of sample retention and further analysis on doping behavior and detection: evidence from agent-based simulations
Publication Name: Frontiers in Sports and Active Living
Publication Date: 2025-01-01
Volume: 7
Issue: Unknown
Page Range: Unknown
Description:
Introduction: Despite extensive testing efforts in anti-doping work, a persistent gap remains between low doping detection rates and substantially higher estimated doping prevalence in sports. Sample Retention and Further Analysis (SFA), which allows samples to be stored for up to ten years for future testing, offers a potential strategy to close this gap by increasing both detection and deterrence of doping. Methods: This study employs an agent-based modeling approach to simulate interactions among key stakeholders: athletes, anti-doping organizations, laboratories, and event organizers. The model captures athlete decision-making regarding doping, influenced by perceived sanction certainty and swiftness. SFA parameters, such as number of stored samples and duration of storage, were systematically varied to assess their impact. Results: Simulations show that increasing both the quantity of stored/retested samples and the storage duration reduces doping prevalence. A combined approach yields the strongest effect, with higher detection rates and lower doping behavior. However, regression analysis reveals diminishing returns at higher implementation levels, suggesting a non-linear effect. Discussion: The findings provide quantitative evidence that SFA enhances not only detection capacity but also deterrence by increasing the perceived long-term risk of sanctions. Effective SFA implementation requires strategic calibration to optimize impact. These results underscore the potential of SFA as a key component in anti-doping strategies and call for empirical validation and integration of additional behavioral factors in future research.
Open Access: Yes
Balancing Performance and Health in Elite Hungarian Athletes: The Relationship Among Disordered Eating Risk, Body Composition, and Nutrition Knowledge
Publication Name: Nutrients
Publication Date: 2025-01-01
Volume: 17
Issue: 2
Page Range: Unknown
Description:
Background: disordered eating (DE) and eating disorders (ED) can negatively impact athletes’ health, wellbeing, and athletic performance. Objective: this cross-sectional study aims to assess DE risk, body composition, and nutrition knowledge among elite Hungarian athletes. Methods: DE risk was assessed using DESA-6H and EAT-26 scales, nutrition knowledge through the Abridged Nutrition for Sport Knowledge Questionnaire (A-NSKQ), and body composition with the OMRON BF511 device. The data were analyzed using Kendall’s tau correlations, Mann–Whitney U tests, and ROC analysis. Results: a total of 71 athletes participated (39.4% males, mean age = 24.8 years, SD = 4.8 years and 60.6% females, mean age = 24.3 years, SD = 4.3 years). At-risk scores on the DESA-6H scale were recorded for nine athletes (12.7%), while 32.4% scored in the risk zone on the EAT-26, with female athletes in aesthetic, endurance and weight-dependent sports being most affected. Low BF was observed in four males and four females. Nutrition knowledge (49.1%) was below the acceptable threshold. DESA-6H significantly correlated with EAT-26 scores, BMI, sports nutrition knowledge, and A-NSKQ total scores. A statistically significant difference by gender was found in the EAT-26 total score (p = 0.019, d = 0.65). Risk groups significantly differed in A-NSKQ scores (p = 0.026, d = 0.511) and sport nutrition knowledge, specifically (p = 0.016, d = 0.491). Using EAT-26 to identify at-risk athletes and the DESA-6H recommended cut-off, the ROC analysis showed a sensitivity of 29.1% and a specificity of 95.7%. Conclusions: insufficient nutrition knowledge plays a role in being at-risk for DE and ED. These results underscore the need for early detection, early sport nutrition education across all elite athletes, with particular attention to female athletes in aesthetic, endurance and weight-dependent sports, and for monitoring these athletes to prevent DE. Further work is warranted to optimize screening tools such as EAT-26 and DESA-6H for elite athletes.
Open Access: Yes
DOI: 10.3390/nu17020231
Health and Performance Challenges in the Era of Human Enhancement: Insights from Sport Medicine Professionals
Emin Ergen
Francisco Arroyo
Mourad Ghrairi
Ana V. Cintrón
Petra Zupet
Marcelo Bichels Leitão
Umutcan Kayikci
Daniel Arkader Kopile
Fabio Pigozzi
Pedro Manonelles
Anca Ionescu
Bernd Wolfarth
José Antonio Casajús
Borja Muniz-Pardos
Luigi Di Luigi
Alessia Di Gianfrancesco
Kirill Micallef Stafrace
Chiara Fossati
Malav Shroff
Metin Ergün
William O. Roberts
Julio Motta-Pensabene
Rüdiger Reer
Konstantinos Natsis
Andrew Jowett
Victoriya Badtieva
Norbert Bachl
Jürgen Steinacker
Sergio Migliorini
Maher Zahar
Mark Stuart
Demitri Constantinou
Dina CJanse van Rensburg
James Bilzon
Ke Hu
Christian Schneider
Mark R. Hutchinson
Camille Tooth
Sandra Rozenštoka
Minhao Xie
Giuseppe Massazza
Andrea Petróczi
Michael Geistlinger
Iain Killoughery
Bülent Ülkar
Felix Albuquerque Drummond
Bertrand Fincoeur
Yannis Pitsiladis
Klaus Michael Braumann
Anna Jegier
Bruno Di Pietro
Khaled Massoud Hassan
José Kawazoe Lazzoli
Jane Seto
Xavier Bigard
André Debruyne
Theodora Papadopoulou
Jean François Kaux
Clea Hadjistephanou Papaellina
Peter Baumgartl
Roberto Lohn Nahon
Peter Baumgartl
Publication Name: Sports Medicine
Publication Date: 2025-10-01
Volume: 55
Issue: 10
Page Range: 2627-2640
Description:
Background: In the pursuit of sporting success, some elite athletes prioritise peak performance over long-term health, frequently resulting in significant and enduring health consequences. The Enhanced Games (TEG) position themselves as a bold experiment in transhumanism, advocating for the use of performance-enhancing drugs (PEDs), including methods banned by World Anti-Doping Agency (WADA), to push the boundaries of human athletic potential. Objectives: The aim of this study is to explore the perspectives of sport physicians, sport scientists, physiotherapists and other allied healthcare professionals on treating and supporting “enhanced athletes”, with the view of informing future guidelines. Methods: Participants were invited via email and personal contacts within sport medicine communities to complete a brief anonymous survey via QuestionPro™. Descriptive statistics were performed using Excel™ and RStudio™. Results: A total of 323 healthcare professionals responded (82% were sport physicians), among whom 74% expressed a willingness to treat acute lesions and/or chronic diseases in “enhanced athletes”. In comparison, a considerable minority (30%) expressed support for assisting athletes in their use of PEDs and methods under medically supervised conditions, with high consistency across professional roles. A relatively high readiness was observed in sport physicians treating acute (77% versus 58%; p < 0.01) and chronic (75% versus 63%; p = 0.11) diseases for “enhanced athletes”. As far as WADA rules and/or national anti-doping laws apply, this support presupposes compliance with the code and the respective national laws to protect physicians from serious professional, legal and personal consequences. Conclusion: The preliminary findings align with the broader goal of fostering a sport culture that values both peak performance and the short- and long-term health of all participants. These results emphasise the necessity of implementing professional guidelines and comprehensive support systems designed to safeguard the long-term well-being of all athletes and underscore the urgent need for further research into the impact of TEG on sport and its community.
Open Access: Yes
Do Antidoping Interventions Work?
Publication Name: Journal of Sport and Social Issues
Publication Date: 2026-04-01
Volume: 50
Issue: 2
Page Range: 145-172
Description:
A multitude of interventions have been designed to tackle doping in sport. Despite significant advances in understanding the role of motivation, the environment, policies and education in addressing doping, there is a lack of nuanced knowledge concerning the design and implementation of these interventions. The present study adopted an intervention mapping evaluation perspective, critically evaluating a selection of 12 antidoping programs across three sports in Austria, Russia, South Africa, and the United Kingdom, using a mixed-methods, sequential, explanatory design. Findings confirm that the antidoping intervention landscape is diverse and complicated, incorporating multiple strands, sites, ambitions and stakeholders. It also suggests that the drive for policy compliance led by WADA has promoted considerable isomorphism across diverse cultural and economic communities and sports. Antidoping educational interventions appear to have been informed more by the moral imperatives for clean and fair sport rather than sound theoretical bases. While the theoretical basis on which most interventions were based can operate across culturally and economically divergent contexts, this is undermined by differences in their interpretation and the context of their implementation. Several lacunae in the design and implementation of antidoping interventions are also identified and discussed.
Open Access: Yes
Mapping doping-related criminal legislation together: An informed stakeholder consultation
Publication Name: Performance Enhancement and Health
Publication Date: 2026-05-01
Volume: 14
Issue: 2
Page Range: Unknown
Description:
Access to reliable, jurisdiction-specific information on the existence and scope of doping-related criminal legislation is essential for understanding how anti-doping policies are interpreted and enforced globally. While the globally adopted World Anti-Doping Code provides a private regulatory framework for sporting sanctions, governments have introduced doping-related criminal laws that vary in scope, legal form, and underlying rationale. In the absence of a centralised legal resource, navigating this policy space becomes complex and challenging. This study addresses this gap by combining desk research with a multilingual, semi-structured informed stakeholder consultation to map the presence and scope of doping-related criminal legislation, identifying at least thirty-seven jurisdictions that have criminalised doping-related behaviours and enabling the development of five legislative typologies: comprehensive, trafficking-focused, child protection, context-specific, and fraud-based models. These typologies reveal variations in the behaviours targeted, definitions employed, and penalties applied. Such divergences raise important questions about the coherence of global anti-doping efforts, particularly regarding the definition of doping and the interaction between public and private sanctioning. This study also demonstrates the potential viability of a distributed, multi-actor approach to legal data gathering and supports the development of a dynamic, centralised legal database to advance transparency, equity, and evidence-informed anti-doping governance.
Open Access: Yes
Doping Prevalence in Sport from Indirect Estimation Models: A Systematic Review and Meta-analysis
Publication Name: Sports Medicine Open
Publication Date: 2026-12-01
Volume: 12
Issue: 1
Page Range: Unknown
Description:
Background: To our knowledge, no previous systematic review and meta-analysis of doping prevalence in sport from indirect estimation models (IEM) exists. Objective: To conduct a systematic review and meta-analysis of empirical IEM-based studies of admitted doping prevalence in sport. Methods: We conducted electronic database and ad hoc searches up to March 2025, and estimated lifetime and past year prevalence rates through a cross-classified model including prevalence (lifetime vs. past year), sample (competitive vs. recreational) and sports (multi-sport vs. single-sport) types. Results: Forty-six records (K) were included in the review (k [subset records included in the meta-analysis] = 30, n [independent studies from the records] = 34). The World Anti-Doping Agency’s definition of doping use was applied for data collection in most studies (k = 18), and doping prevalence was mostly assessed as past year/season (k = 20). Studies included in the meta-analysis were mostly conducted in Europe (k = 22) and applied the Unrelated Question (k = 8) and Forced Response with Cheater Detection (k = 6) models. Study participants were mostly multi-sport (k = 20) and competed at diverse levels, and most data (k = 28) was collected outside sport events. The corpus included articles that re-analysed existing data (k = 4). Lifetime prevalence was highest for multi-sport competitive athletes (22.6%) and lowest for single-sport competitive athletes (12.7%), whereas past year prevalence was highest for single-sport recreational sportspersons (15.5%) and lowest for multi-sport recreational sportspersons (8.7%). Conclusions: Under IEM, about one of five multi-sport competitive athletes admitted to ever doping whereas about one of six of single-sport recreational sportspersons admitted to doping in the past year. Furthermore, multi-sport (vs. single-sport) competitive athletes show relatively higher doping prevalences, whereas single-sport (vs. multi-sport) recreational sportspersons report relatively higher doping prevalences. Secondary (re-)analysis presents a novel methodological challenge for meta-analyses. Registration PROSPERO: CRD42022373691.
Open Access: Yes
Charting the Scientific Landscape of Indirect Estimation Models in Doping Prevalence Research: A Bibliometric Analysis with Narrative Appraisal
Publication Name: Sports
Publication Date: 2026-06-01
Volume: 14
Issue: 6
Page Range: Unknown
Description:
Interpreting doping prevalence estimates generated through indirect estimation models (IEMs) remains challenging for sport policy and governance due to the wide variation in reported rates and methodological complexity. In this study, we combined a critical appraisal of the methodological and epistemic developments of IEM applications to doping prevalence with a bibliometric analysis of publication trends, citation patterns, and collaboration networks, using a convergent parallel mixed-methods design. Across 52 records published between 2002 and 2026, this study maps the scientific landscape of IEM-based doping prevalence research. Findings show that IEM-based prevalence research is methodologically sophisticated yet institutionally dispersed and largely Eurocentric, reflecting a field still consolidating its standards and disciplinary identity. Over time, the focus has shifted from reporting prevalence rates to methodological critique and re-analysis of existing datasets. Reported prevalence estimates, ranging from 0 to 57.1%, are highly sensitive to modelling assumptions about athlete behaviour in complex survey environments. While this trend strengthens rigour, it also complicates evidence synthesis for policy actors and risks undermining trust in IEM-based estimates if poorly communicated. Anti-doping organisations and researchers should treat IEM-derived prevalence as bounded indicators rather than definitive rates and integrate prevalence evidence with contextual data for transparent policy and public communication.
Open Access: Yes
Exploring the perceptions of athletes and DCOs on the remote sampling procedure in anti-doping testing: shifting control to burden
Publication Name: Frontiers in Sports and Active Living
Publication Date: 2026-06-04
Volume: 8
Issue: Unknown
Page Range: Unknown
Description:
Introduction – The approach of remotely collecting anti-doping samples from athletes by utilizing a Remote Sampling System (RSS) presents a technological innovation in anti-doping work, offering a potential solution to the logistical limitations of traditional in-person testing. Even though the implementation decision obliges Anti-Doping Organizations (ADOs), successful implementation hinges on whether athletes as the key stakeholders of anti-doping work perceive an RSS as legitimate. Furthermore, the perceptions of DCOs who are the key users operating an RSS and having to adapt to new sample collection procedures are largely unexplored. This study adopted an exploratory qualitative design to investigate the perceptions of athletes and DCOs. Methods – We conducted semi-structured interviews with 16 elite athletes and 22 professional DCOs. Data were analyzed using template analysis to identify their key themes and considerations associated with procedural steps of remote sampling applied in anti-doping testing. Results – Our findings reveal challenges in user-system integration, which we conceptualize as a shift from DCO control to athlete burden. For athletes, the transfer of specific sample-handling responsibilities inherent to the remote sampling procedure is perceived as an unjust burden of personal risk, logistical effort, and procedural anxiety. Key concerns include the management of test kits and the liabilities associated with taking responsibility for unobserved sample shipment. Conversely, DCOs interpret this transfer as a critical loss of control over procedural integrity and professional oversight, focusing on the inability to uphold an unbroken chain of custody. Discussion – The study concludes that RSS implementation is not merely a technological challenge but one of trust management that must consider user perceptions and concerns on how remote sampling can be designed as a legitimate procedure of anti-doping work. It must reconcile the shift from control to burden by simultaneously mitigating the athletes' burden while empowering DCOs with reliable tools, enabling them in their role as guarantors of anti-doping testing's procedural integrity. These insights provide actionable recommendations for anti-doping organizations to pilot new remote sampling protocols that are not only efficient but also perceived as legitimate, trustworthy, and effective.
Open Access: Yes
