The United States Olympic Committee and the American College of Sports Medicine have launched an initiative to improve recognition, prevention, and treatment of the female athlete triad (disordered eating, amenorrhea, and osteoporosis). Most girls and women who engage in vigorous sports derive enormous health and psychological benefits from participation. The types of sports that are associated with the female athlete triad include:
Sports where performance is subjectively judged (i.e., diving, gymnastics, dance, figure skating, cheerleading)
Endurance sports (i.e., distance running, cycling, cross-country skiing)
Sports where athletes wear revealing clothing (i.e., volleyball, figure skating, swimming, diving, cross-country skiing, track and field, cheerleading)
Sports with weight categories (i.e., wrestling, weightlifting, rowing, some martial arts)
Sports where a prepubescent body is emphasized (i.e., figure skating, gymnastics, diving)
The three components of the female athlete triad are: disordered eating, amenorrhea (loss of normal periods), and osteoporosis.
Disordered eating
The primary eating disorders are anorexia and bulimia nervosa. Anorexia nervosa is a visible eating disorder which includes severe weight loss, an intense fear of gaining weight, and a person's sense of self-worth or self-esteem being linked to how thin they are. Girls with anorexia nervosa may not start menstruating, or once they have started, they might find that their periods stop. Bulimia nervosa is not visible-it occurs in women (and men) of all sizes and shapes. Bulimia is recognized by binge-eating followed by purging, excessive exercise, fasting, or severe dieting. A person doesn't have to have one of these eating disorders in order to suffer from disordered eating. Countless girls and women suffer from less severe disordered eating (such as chronic dieting, being preoccupied with how much they weigh, thinking that they will only succeed if they are at a certain weight) which can have as far-reaching effects on the body and the mind.
Amenorrhea
Amenorrhea is not having a menstrual period for an extended time. Primary amenorrhea is not having a period by the age of 16. Secondary amenorrhea is missing three or more consecutive periods once normal periods have been established. The chief cause of amenorrhea in female athletes is an energy imbalance caused by not eating enough to balance the energy expended in training. This energy imbalance - the net result of
under eating and hard workouts -- negatively affects the body's regulatory systems, which leads to amenorrhea.
Osteoporosis
We often think of osteoporosis as a disorder of the elderly. Unfortunately, female athletes with disordered eating or amenorrhea are at increased risk even at young ages. In the short term this increases the risk of stress fractures and broken bones. Osteoporosis in youth also increases the risk of severe bone density problems in older age.
How to be On the Lookout
It is somewhat paradoxical that the girls most at risk for the female athlete triad are the ones who are most dedicated to the sport. Girls who are perfectionistic about training and technique, self-critical, self-reliant, and who train harder and longer than expected are often at greatest risk.
Warning signs of disordered eating
Frequent bathroom visits, especially after meals (could indicate vomiting)
Frequent comments about weight, appearance, and food
Hoarding or hiding food
Binging and/or purging
Dieting or restricting food intake, especially during hard training
Not being honest about food
Feeling fat when normal or thin
Using diet pills, water pills or laxatives
Unexplained weight loss or fluctuations
Moving food around the plate without eating it
Commenting about teammates eating patterns
Eating alone
Public eating patterns not consistent with body weight (e.g. eats a lot, but is too thin)
Always being cold
Developing fine hair on the body
Bloodshot eyes and puffy cheeks
Warning signs of amenorrhea
Decreased frequency of periods
Decreased duration of periods
Total cessation of menstruation
Coaches and parents must always be aware that loss of menstrual function is NEVER a desirable side effect of sport participation
Warning Signs of Osteoporosis
Stress fractures (athletes with repeat stress fractures should be evaluated for female athlete triad)
Broken bones
Prevention
Both coaches and parents are in excellent positions to assist with the prevention of the female athlete triad. Coaches and parents need to take great caution not to convey the message that "winning" is contingent on being at a certain body weight. More importantly, "dieting" should not be introduced to young athletes, regardless of their body size. Positive emphasis on healthy eating and appropriate nutrition is less likely to lead the athlete down the path of disordered eating. Particularly with children and adolescents, coaches need to plan for developmental changes and growth spurts and help the athlete to tailor her (or his) technique for the ever-changing shape and size of their body. Parents can play an important role by monitoring the attitudes of their child's coach towards eating, weight, and physical appearance.
Tips from the American College of Sports Medicine on prevention include:
Giving athletes the message that sports participation is about having fun and being physically and mentally
healthy
The message that "winning at all costs" is not a program philosophy
Nutrition education for athletes, coaches, and parents
Emphasizing strength and fitness over thinness and body weight
Information about normal maturation and development processes
Encouraging athletes to discuss eating, maturation and menstruation and personal issues with a confidential contact person
Treating the Female Athlete Triad
Any of the three components of the Female Athlete Triad requires treatment. Great care must be taken if a coach or parent suspects disordered eating or the female athlete triad and the issue must be raised gently and compassionately with the athlete. Immediate consultation with a health care professional is required. Competent care requires medical, psychological, and nutritional consultation. Athletic involvement can be of enormous physical benefit to young girls and women. Maintaining healthy attitudes towards weight, fitness, and eating can ensure that the benefits far outweigh the risks.
What to do if you suspect a teammate might have an eating disorder
Symptoms of the female athlete triad cannot be ignored. You may hear other athletes, coaches or parents dismiss the loss of menstruation, or disordered eating behavior as "just a phase", or normalize these signs as "part of the game of being an athlete". Simply, this is not true. Eating disorders and female athlete triad are real and very serious medical problems.
If you suspect a teammate might have an eating disorder, she needs to get help from health professionals as soon as possible. Discuss your concerns with her and encourage her to seek treatment. If she denies the problem or refuses to seek treatment, you may need to seek other sources of support to provide reinforcement. Mention your concern to her parent, coach, athletic trainer, teacher, or an athletic director.
It is normal to worry about being intrusive, but don't: Confronting your teammate is a sign that you're a concerned and caring friend, and she may even welcome you listening to her. However, if your teammate reacts with anger or denial, don't be put-off. Often people with these disorders are not ready to confront their problem. It is important to remember that in the long run, you are helping your friend get the help she needs to overcome an eating disorder---a potentially severe illness, and get back in the game as a healthy woman!
What to do if you think you might have an eating disorder or female athlete triad symptoms
If you think you may have a problem with eating, or signs of the female athlete triad, it is very important to seek professional help.
Eating disorders are serious health conditions with long term consequences. Early detection and treatment significantly improves chances of recovery, and if left untreated, eating disorders can become chronic, incapacitating, and life-threatening.
If you have any questions about treatment options for yourself or a friend, please contact UNC Student Health Services, or the UNC Eating Disorders Program at (919) 966-7012.
