Women’s History Month is a time to celebrate the accomplishments of women and to recognize the unique challenges they face. For female student-athletes, this month is especially important as it provides an opportunity to focus on their mental health and well-being. One area of particular concern for female student-athletes is nutrition and eating disorders.

In a study of Division 1 NCAA athletes, over one-third of female athletes reported attitudes and symptoms placing them at risk for anorexia nervosa. For Division II NCAA female athletes, 25% had disordered eating, 26% reported menstrual dysfunction, 10% had low bone mineral density, 3% had all three symptoms.

Though most athletes with eating disorders are female, male athletes are also at risk—especially those competing in sports that tend to place an emphasis on the athlete’s diet, appearance, size, and weight requirements, such as wrestling, bodybuilding, crew, and running.

Risk Factors

Three risk factors are thought to particularly contribute to a female athlete’s vulnerability to developing an eating disorder: social influences emphasizing thinness, performance anxiety, and negative self-appraisal of athletic achievement. A fourth factor is identity solely based on participation in athletics.

The negative impacts of eating disorder behaviors on the female athlete are so common that ED treatment professionals refer to them as “Female Athlete Triad” syndrome.

The Female Athlete Triad includes:

disordered eating/low energy
amenorrhea (menstrual dysfunction)
and osteoporosis (reduced bone mineral density)

The lack of nutrition resulting from disordered eating can cause the loss of several or more consecutive periods. This in turn leads to calcium and bone loss, putting the athlete at greatly increased risk for stress fractures of the bones. Each of these conditions is a medical concern. Together they create serious health risks that may be life threatening. While any female athlete can develop the triad, adolescent girls are most at risk because of the active biological changes and growth spurts, peer and social pressures, and rapidly changing life circumstances that go along with the teenage years.

Approximately 26% of female athletes struggle with this syndrome and are 8X more likely to have an injury.

Prevention Help

Tips for women on how to avoid eating disorder behaviors while training:

exercise and train with a partner or in groups with other women (avoid isolation and secrecy around exercise and food)
replenish fluids and follow a well-balanced food plan (including enough protein, iron, calcium, and fat intake)
get guidance and help from a sports registered dietitian
contact your physician if you begin to experience menstrual irregularity or lose menses
take 1-2 days off per week
avoid looking at “calories burned” displays on cardio equipment
seek professional help if you start to experience unmanageability in your eating, exercise, or weight and/or body concerns
avoid using diuretics, laxatives, stimulants, steroids for performance or training enhancement

Recognizing the signs of eating disorder behaviors and following prevention skills, female student-athletes can protect themselves from developing an eating disorder and maintain their physical and mental health while performing at their best in sports.

References:

[1] Ghoch, M. E., et al. (2013). Eating disorders, physical fitness, and sport performance: a systematic review. Nutrients, 5:12. [2] Conviser, J. H., Schlitzer Tierney, A., Nickols, R. (2018). Essential for best practice: treatment approaches for athletes with eating disorders. Journal of Clinical Sports Psychology, 12. [3] Conviser, J. H., Schlitzer Tierney, A., Nickols, R. (2018). Assessment of Athletes with eating disorders: essentials for best practice. Journal of Clinical Sports Psychology, 12.

[4]The National Center on Addiction and Substance Abuse (CASA) at Columbia University. Food for Thought: Substance Abuse and Eating Disorders. The National Center on Addiction and Substance Abuse (CASA) Columbia University; New York: 2003.

[5] Sport Nutrition for Coaches by Leslie Bonci, MPH, RD, CSSD, 2009, Human Kinetics. Byrne et al. 2001; Sundot - Borgen & Torstviet 2004 [6] Jankowski, C. (2012). Associations Between Disordered Eating, Menstrual Dysfunction, and Musculoskeletal Injury Among High School Athletes. Yearbook of Sports Medicine, 2012, 394-395. doi:10.1016/j.yspm.2011.08.003 [7] Johnson, C. Powers, P.S., and Dick, R. Athletes and Eating Disorders: The National Collegiate Athletic Association Study, Int J Eat Disord 1999; 6:179. [8] Greenleaf, C., Petrie, T. A., Carter, J., & Reel, J. J. (2009). Female Collegiate Athletes: Prevalence of Eating Disorders and Disordered Eating Behaviors. Journal of American College Health, 57(5), 489-496. doi:10.3200/jach.57.5.489-496 [9] Beals KA, Hill AK. The prevalence of disordered eating, menstrual dysfunction, and low bone mineral density among US collegiate