6 Eating disorders and the female athlete triad
Disordered eating describes a range of abnormal eating practices, but the most common among women who engage in physical activity are anorexia nervosa and anorexia bulimia. Disordered eating is more common among female athletes than in the general population and it is more common in sports such as gymnastics where a low body weight is desirable. Male athletes with eating disorders are less common, but cases are observed among jockeys, boxers and wrestlers.
Sources of support include b-eat (formerly the Eating Disorders Association). For guidelines in dealing with eating disorders you can visit the.The organisation offers advice and information sheets that can be downloaded from its website, for athletes, coaches, and family and friends who may be concerned about the problem.
Female athletes who have inappropriate low-energy diets and demanding exercise regimes are at risk of developing the female athlete triad syndrome.
The triad is associated with increased morbidity and mortality and is a syndrome of three interrelated conditions:
- disordered eating
- amenorrhoea (absence of periods)
- osteoporosis (loss of bone density).
These three conditions have a synergistic effect (i.e. the overall effect is greater than the sum of the three individual conditions).
Disordered eating increases the risk of muscle and tendon injury and decreases concentration. In addition, low body-fat levels may result in menstrual dysfunction including amenorrhoea, which is also more prevalent among female athletes than other women. Amenorrhoea athletica may be a consequence of a combination of factors such as an intense training regime with a strict weight-control diet that is too low in fat. Amenorrhoea is associated with low body fat and an associated lack of oestrogen that influences bone density. When hormone levels drop, the breakdown of old bone exceeds the formation of new bone and the result is a loss of bone minerals and bone density. This is a problem that affects young women (less than twenty years old), because at this time they should in fact be accumulating bone to achieve a healthy peak bone mass. Young adults with low bone density do not catch up bone density over time, and if a high peak bone mass is not achieved by the time they reach their mid-twenties it is not likely to be achieved at all. Bone density falls below the fracture threshold at a younger age in people with a low peak bone mass. Therefore amenorrhoea leads to poor bone health and the increased risk of stress fractures, and early osteoporosis as bone density declines.
Bone loss can occur quickly in young female athletes who have stopped having periods and treatment should not be delayed. Teenage girls who recover from anorexia nervosa and amenorrhoea continue to show thin spinal bone years after oestrogen levels have returned to normal (Goulding, 2007).