Linda Lewis Griffith

Female athletes should avoid taking fitness to an unhealthy extreme

Extreme diets, excessive workouts and low bone density spell trouble for female athletes, who are then at risk of developing a potentially life-threatening medical condition. It’s called Female Athlete Triad.
Extreme diets, excessive workouts and low bone density spell trouble for female athletes, who are then at risk of developing a potentially life-threatening medical condition. It’s called Female Athlete Triad. jjohnston@thetribunenews.com

It’s important for girls and young women to be physically active. But some female athletes carry fitness to an unhealthy extreme, which puts them at risk of developing a potentially life-threatening medical condition.

Known as the Female Athlete Triad, it’s the interplay of three distinct concerns.

▪  The first is disordered eating. Young women, already feeling pressured to be thin, resort to extreme dietary practices. They may restrict their calories, skip meals or avoid foods with any fats. They may also induce vomiting or use appetite suppressants, diet pills or laxatives. Many are ashamed of their behavior and attempt to hide or deny that there’s a problem.

▪  Too few calories coupled with excessive physical workouts leads to the second feature of the triad: amenorrhea. Amenorrhea is a serious menstrual abnormality that is said to occur when three or more periods are missed in a row. When periods are missed, the body makes less estrogen, a hormone necessary for building strong bones.

▪  The third factor in the triad is low bone-density or losing bone mass faster than it can be created. This sets the stage for stress fractures and early-onset osteoporosis.

According to the American Council of Sports Medicine, any female athlete is susceptible to the disorder. But it’s especially prevalent in activities that emphasize leanness, such as gymnastics, running, ballet, diving or figure skating. It’s also found in sports that have a weight class, such as rowing, or those that require revealing uniforms, such as swimming or beach volleyball.

The Female Athlete Triad Coalition says that additional risk factors include dieting at an early age, chaotic eating habits, being unhappy about one’s body type and perfectionism.

Although it is difficult to assess how many young women are affected, a study in the journal Sports Health from July 2012 found that 4.3 percent of female athletes displayed all three of the components of the triad, and 5.4 percent to 26.6 percent demonstrated at least two of them.

How to treat the Female Athlete Triad

Treatment is complex and may involve a multidisciplinary approach:

  • Medical evaluation: An optimal time to screen for the triad is during a sports physical, a routine gynecological exam or an annual wellness visit. Physicians may also screen during acute visits for fractures, weight changes, arrhythmia or depression.
  • Psychotherapy: Counseling can be used to address such problems as unrealistic expectations, fear of failure, anxiety, depression and obsessive-compulsive behavior. Group or individual treatment may be appropriate.
  • Nutritional counseling: Nutritional counseling is useful for improving an athlete’s eating habits. Registered dietitians may be required to help with the treatment of eating disorders.
  • Emotional support: Coaches and family members play a key role for athletes by de-emphasizing their weight, not weighing them between competitions and expressing concern for the total athlete, not just her times or performance. They can also be on the lookout for signs of trouble, encouraging athletes to get appropriate help should it be needed.
  • Self-monitoring: Athletes can often avert problems by eating three real meals each day with two smaller snacks in between. They can track their menstrual cycles, making note of any changes. They can also limit the amount of exercise, being careful not to overtrain.
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