Tumbling Down

Eating Disorders and the Female Athlete

In 1988, 15-year-old gymnast Christy Henrich was striving to make the Olympic team. Early that year, though, a judge at a national competition reportedly told Henrich that if she expected to make the team, she would have to lose some weight. That advice proved devastating. At 4-10 and 95 pounds, Henrich was hardly overweight. But in the world of gymnastics and other sports that stress body image and weight consciousness—diving, figure skating, and distance running, among others—female athletes have traditionally been prescribed a less-is-more fitness regimen.

Henrich would soon develop a severe eating disorder; she struggled with anorexia and bulimia for six years before dying at age 22. She was only 47 pounds when she passed away, and when she did, she became the poster child for a syndrome known as the Female Athlete Triad.

Two years before Henrich's death, Female Athlete Triad was first recognized at a conference organized by a group of researchers, physicians, and sports officials from the National Institutes of Health and the American College of Sports Medicine. "In the early '80s, I started seeing women coming in and talking about bulimia, depression, eating disorders, and other weight-related problems," says UCLA team physician Dr. Carol Otis, who was chairperson and lead author of the 1992 NIH-ACSM conference report that first identified the syndrome. There are three interrelated components to the Triad, says Otis: eating disorders or "disordered eating"—poor nutritional habits that are less severe than anorexia or bulimia—which leads to amenorrhea, the loss of regular menstrual cycles, and finally the early onset of bone-density loss or osteoporosis, a condition that is irreversible for women between the ages of 18 and 30. The report concluded that the syndrome is triggered by the eating disorders coupled with the overtraining involved in many sports.

A number of surveys of female college athletes have found that at least six in 10 experience some kind of disordered eating and as many as two-thirds had some form of amenorrhea, depending on the sport and the competition level. According to Otis, symptoms of the Triad syndrome first became noticeable during the influx of women into sports that came after Title IX. "In 1972, when Title IX was first passed, there weren't many women involved in organized sports," says Otis, who is also author of The Athletic Woman's Survival Guide. "As we began to see women training year-round, that's when the Triad symptoms became more evident."

The first sign that she noticed was the increased number of stress fractures in female athletes. "The symptoms were more a problem with athletes in gymnastics, running, even rowing—sports that emphasize meeting certain weight requirements, where there might be frequent weigh-ins or coaches that admonish athletes to lose weight."

But, adds Otis, "We even noticed it in sports that don't really emphasize weight—like softball." This follows from the gender-defined pressures that go with athletics in general. "In sports, girls are told to lose weight, while guys are told to lift weights and build muscles," Otis says. This leads to male athletes using anabolic steroids, while female athletes fall into the eating disorder trap.

However some argue that the problem is not specific to sports, but is in fact part of the larger problem of eating disorders in women. "I think the female Triad has gotten too much attention," says Judy Mahle Lutter, president of the Melpomene Institute in St. Paul, Minnesota. The institute has done extensive research into eating disorders. "The Triad exists for anyone with eating disorders. Girls that are goal-driven are likely to be involved in sports, and that's also who is likely to suffer from eating disorders. They may already have body-image issues that are exacerbated by athletics. However, I don't want to give the impression that being involved in sports leads women to eating disorders," says Lutter. "It may be that sports attracts that personality type—the perfectionist, the highly disciplined, focused girl, who is more likely to suffer with eating disorders."

Lutter sees different, more positive factors influencing female athletes today. "Part of the cohort that you're beginning to see in women's professional sports like tennis, soccer, and basketball are role models who are not diminutive and childlike. You can't be strong and anorexic," she says, a fact made evident by sports icons like Serena Williams, Cynthia Cooper, and Mia Hamm.

But the findings are still alarming. Psychologist Craig Johnson, who runs the eating disorders program at the Laureate Psychiatric Clinic in Tulsa, Oklahoma, conducted a survey of more than 1400 college athletes, both men and women. Johnson's 1997 study concluded that 58 percent of female athletes were at-risk for an eating disorder, making it the "No. 1 health concern . . . for women athletes." The study also found that 77 percent of female athletes surveyed indicated that their coach was concerned about what they weighed, while 43 percent had been cautioned by their coach about gaining weight.

Statistically, female athletes most at-risk are those in endurance sports and those where appearance is considered important—distance running, gymnastics, diving, and figure skating head the list. Various surveys have found that as many as 62 percent of female college gymnasts and 15 percent of swimmers suffered from eating disorders. Among female cross-country runners, as many as 33 percent had eating disorders.

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