Last week’s blog was about student athletes, and when my wife read it she mentioned something to me that I confess I had never heard of: The female athlete triad. My interest was piqued, so I decided to search for some information. The female athlete triad is something that can happen with highly active, athletic females who are also driven to be thin or keep their weight down. According to an article* on WebMD, sometimes these girls and young women can see the following three conditions:
Reduced energy with or without an eating disorder
Disruption to their menstrual cycle, or a complete stop to their cycle
Decreased bone density and/or osteoporosis
When thin teen girls exercise* at a very high level, and their bodies aren’t receiving the calories that they need to handle this level of exertion, they can develop amenorrhea, which is the absence of a period. This, in turn, messes with their estrogen levels, which is a likely reason for the loss of bone density.
As far as prevalence, the American Academy of Pediatrics has an article** that estimates up to 1.2% of all high school girls and up to 16% of female athletes have the female athlete triad, and unfortunately, some doctors aren’t aware of this combination of problems.
Sports** that have a heavy emphasis on looks, endurance, or weight can be especially prone to girls developing the female athlete triad, such as:
Wrestling
Rowing
Gymnastics
Dance
Figure skating
Cheerleading
Long/middle distance running
Pole vaulting
My intention in listing these sports isn't to scare any parents, but it is to point out an increased risk to be aware of. If parents notice their highly athletic daughters beginning to restrict their diets, it would be a good idea to start paying close attention to their food intake. A teen that changes their eating habits isn’t abnormal, and maybe she is making healthy eating choices like eating more vegetables or reducing processed foods. By being aware, parents can determine if teens are eating healthier or simply not eating enough. If she starts to cut out dairy because she thinks it is unhealthy, help her to understand that calcium is a very important part of her nutrition that should definitely be in her diet.
*If a teen girl suffers a bone break without a major injury, consider a bone density test. If she stops menstruating, it is time to involve a doctor. A teen or young woman who stops menstruating for 4 years will have the bone density of a woman in her 50’s. Doctors will likely recommend calcium supplements and monitoring her caloric intake, making sure that her body fat percentage doesn’t dip below 12%.
If a parent starts to suspect that their daughter has an eating disorder, such as anorexia nervosa (characterized by extreme dietary restriction, intense fear of gaining weight, and distorted body image) or bulimia nervosa (impulsively eating much more than they would normally eat and then some form of purging to rid the food from the body), these conditions will typically require specialized treatment. Also, keep in mind that excessive exercise to work off the food, even when the eating seems to be healthy, can actually be a sign of an eating disorder. I once read an article about a professional football player whose daily exercise routine was leaps and bounds above the normal levels of exertion for the average healthy and fit person. In order to enable himself to do this, he couldn’t eat normal amounts of food. He actually had to force himself to eat a lot of extra food (even when he didn’t want it) so that his body wouldn’t shut down from the ridiculous amount of work he was putting himself through. If a teen is spending multiple hours each day working out (as though she was an elite athlete) while just eating regular amounts of food, this may be a sign of a problem. It is an especially tricky sort of problem because, on the surface, everything looks like healthy behavior. Parents should try to keep an open, non-judgmental line of communication with daughters if they begin to worry about eating disorders.
I’ve focused on female athletes, but males can also feel pushed to stay thin in sports, and they can even develop eating disorders as well. Symptoms are less obvious for males because the hormone changes that they experience don’t have as much impact on bone density, but there is still the possibility of risk to their reproductive systems. This also means that those whose identified gender doesn’t match the gender they were assigned at birth can still have health complications due to excessive exercise and lack of proper nutrition. The point that I was attempting to make last week was that our teen athletes have a lot of pressure to perform and succeed. On top of that might be the pressure to be thin as well. It is normal for teens to be preoccupied with their appearance. However, it isn’t good for them to harm themselves in the long run to achieve these body-image goals.
*https://teens.webmd.com/female-athlete-triad