American Fitness Professionals & Associates

By Susan Henry

At fourteen and a half, Jenna just reaches the five-foot mark. She weighs 87 pounds and her coach orders her not to gain under any circumstance. She has never menstruated. Jenna, a high school freshman in Oregon, is a serious, competitive gymnast.
Or perhaps it’s her coach who is competitive.

Jenna may be an outstanding gymnast and dedicated to her sport, and even a winning competitor, but as a result she has a serious (and preventable) disorder. It’s called the Female Athlete Triad, and the American College of Sports Medicine (ACSM) has just launched a public information campaign warning female athletes and their coaches and parents of its dangerous lifelong consequences.

“Some women and girls are at risk for the newly defined syndrome known as the Female Athlete Triad. Alone or in combination, the preventable disorders that comprise the Triad — disordered eating, amenorrhea, and osteoporosis — can decrease performance and cause debilitating illnesses and even death,” warns ACSM. Some of the risks of the Triad include cardiac irregularities, dehydration, erosion of tooth enamel, gastrointestinal difficulties, depression, and psychological problems.

Unfortunately, almost everyone assumes that vigorously athletic females in their teens, twenties, thirties are just naturally stick-shaped and don’t menstruate regularly if at all. Just goes along with the training program. In fact, “some believe amenorrhea is an indicator of adequate training intensity,” and it’s even a braggable point of pride. Wrong, says ACSM. Amenorrhea, delayed onset of menstruation or the absence of three or more consecutive cycles after the onset, “is neither a desirable nor a normal result of exercise; it is a symptom of an underlying medical problem,” warns ACSM.

Disordered eating patterns often arise when athletes or their coaches assume unrealistic expectations for individuals’ body weight. Leaner is more aerodynamic for skaters, racers, and divers; and there are those unrelenting weight classifications for wrestlers. Eating disorders include more than anorexia and bulimia. Jenna’s coach, for instance, demands a subminimal calorie intake, severely limited complex carbohydrates, and little protein.

Contrary to our image of osteoporosis as a condition of the elderly, the loss of bone mass can occur by the early twenties.
One cause is poor nutrition. But the amenorrheic athlete is even more susceptible. She produces very low levels of ovarian hormones, and that lack of estrogen reduces bone mass more quickly and more severely than the lack of calcium does. (That is why estrogen is so widely used to combat osteoporosis in postmenopausal women.) The medical community generally agrees that bone loss is irreversible, so the concern is not only for athletes’ risk for fractures but for their lifelong skeletal structure.

Women and girls at risk for the Triad are those who participate in sports in which body appearance is emphasized or which require contour-revealing clothing for participation or competition; endurance sports; those using weight categories for participation; and those which emphasize a preadolescent body build for success.

The ACSM emphasizes that “serious female athletes” are not the only ones at risk for Athlete Triad, however. Symptoms frequently appear among models, beauty pageant contestants, people in show biz, cheerleaders, and women who just worry about their appearance.

Male athletes, particularly those in weight-regulated and endurance sports, are likewise at risk for disordered eating and osteoporosis. “Extensive exercise and anorexia nervosa in men have been associated with hypogonadism (low male hormone levels) and osteoporosis,” warns ACSM.

In the male domain, it is a decades-old practice to keep junior high and high school weight-class wrestlers on diets with too few calories and too little nutrition. Three years ago, The President’s Council on Physical Fitness and the American Association for Sports, Physical Education and Dance warned wrestling coaches, teachers, physicians, and parents: Stop it.

Though Athlete Triad was not then a coined term, the principle was the same: Depriving adolescents of a nutritious, filling diet is a certain formula for future health problems.

Meanwhile, back in Oregon, Lynne Edwards, an elementary teacher and an acquaintance of Jenna’s parents, is concerned about the health of the young gymnast. “For everyone concerned, it’s obviously a matter or winning at any cost,” Mrs. Edwards says. “Maybe Jenna and her parents are only following the coach’s orders; maybe they don’t realize the child is at such enormous risk. But a coach certainly ought to know better.”

Mrs. Edwards wonders what she could — or should — do without appearing to be a busybody. The American College of Sports Medicine can help, in a pragmatic way. In May 1997 the organization released its Position Stand: The Female Athlete Triad.

It describes the disorder, explains its symptoms and dangers, and advises preventions and treatments. And the College wants to get the word out to “coaches, trainers, parents, athletes, athletic administrators, officials of sport governing bodies, and health care providers who work with physically active individuals.”

Mrs. Edwards now plans to ask ACSM to send its informational material directly to Jenna’s parents, and another copy to her coach. The document, The Female Athlete Triad, and/or the Triad Slide Lecture Series are free. Send your request to ACSM Public Information Dept., c/o Triad, P.O. Box 1440, Indianapolis, IN 46206-1440. Enclose a self-addressed, stamped (55c postage) business-sized envelope.