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Optimization of body weight and composition is a key priority for elite athletes striving for a competitive advantage. The present investigation was designed to characterize various parameters related to weight control in Olympic competitors.Cross-sectional study.Research unit at a University Hospital.223 athletes (125 men and 98 women, with only 1 drop-out), all members of the Swedish teams participating in the Olympic Games of 2002 and 2004.Self-reported body weight and height, from which BMI was calculated, variation in weight during the year prior to Olympic competition, and self-reported weight control strategies by questionnaire. The athletes were divided into two groups on the basis of whether their sporting discipline emphasized leanness or not.The athletes participating in disciplines that emphasize leanness demonstrated a lower mean BMI (22.7 ± 2.7 vs 3.7 ± 2.3 for nonlean athletes, P < 0.05), greater variation in weight (5.3% vs 4.7%, P < 0.05), more frequent attempts to lose weight (P < 0.001), longer total training time (P < 0.001), a higher training load yet weighed more than they desired at the time of competition. These differences were most evident in male athletes. Furthermore, 9.4% of lean athletes reported previously suffering from an eating disorder, in comparison to 2.7% of the nonlean athletes (P < 0.05). More athletes in disciplines emphasizing leanness also reported being ill during the prior 3 month period (38.5% vs 21.6%, P < 0.05).This investigation reveals that the weight control practices employed by Olympic athletes participating disciplines that emphasize leanness appear to be suboptimal. Counseling concerning weight control could be used as a tool to prevent illness and enhance performance.