You’ve heard of people who take up exercise to lose weight and then, their appetites stoked, erase their losses by overeating.
But among some female athletes, coaches are working to head off a different problem: players jeopardizing their performance and their health by eating too little.
The problem is known as female athlete triad syndrome, and traditionally it has been diagnosed when an athlete has disordered eating, osteoporosis – weak and brittle bones – and absence of menstrual bleeding. But the symptoms coaches are more likely to see are weight loss, lack of energy, declining performance and increasing injuries.
“It basically comes from dedicated athletes who just want to take being the best to an extreme and lose focus on the balance between the nutrition that you need and the effort that you give,” said Dan Quigley, who has been an athletic trainer with Manheim Township School District for 27 years.
Jessica Hoenich, who has been an athletic trainer since 1999, agreed. She has worked with groups ranging from the USA field hockey team to U.S. Olympic women’s bobsledders to her current assignment at Cocalico High School.
“Sometimes health is the last thing they’re thinking about,” she said. Some may simply be caught up in trying to achieve their next athletic goal; others are following bad advice. And still others might be influenced by the widespread unrealistic body-image messaging in American popular culture.
The trainers like to take a preventive approach by incorporating information about recommended calorie ranges into their beginning-of-year talks about the importance of good nutrition for athletic performance and health. Sometimes it’s an eye-opener for their players.
For instance, said Quigley, a cross-country runner may need up to 3,500 calories a day.
“Some of them will look at me like, ‘Oh my god, this is so many calories,'” Quigley said. “They don’t realize how much they’re burning off.”
That said, Hoenich noted, given the plethora of opinions on what constitutes a healthy diet these days, it’s easy to understand how athletes could get off-track.
“It’s very confusing even for the health professional to say what’s absolutely right other than saying you should have a balanced diet of everything that’s out there,” she said. “You want to make sure that you’re at least having a mixture of everything – protein, carbs, fats.”
Cammie Atwater, a clinical nutritionist at Lancaster YWCA, said individual needs vary depending on the person, sport and metabolism, and that calculators are available to help people estimate how many calories they should be consuming.
“I played sports when I was in high school, and none of the coaches ever really mentioned anything about nutrition,” Atwater said, noting that she thinks awareness has improved since then.
“It’s kind of a hot topic right now,” said Francesca Kirk, an athletic trainer who works for CPRS Physical Therapy. Her company offers continuing education for trainers, she said, and female athlete triad syndrome is a topic that they keep getting asked to address.
The awareness is partially a function of more girls and women playing competitive sports, the trainers said: According to Women’s Sports Foundation, their numbers have increased by 990 percent at the high school level and 550 percent at the college level since 1972.
Another factor is in a new, broader definition of the syndrome that encourages earlier action.
“The longer it goes undiagnosed, the more severe symptoms become,” Atwater said. “It almost mimics what happens to older ladies when they go through menopause. It can actually throw off their hormonal balance.”
That said, the trainers said they think public understanding of the issue is improving.
“I don’t see it as a widespread problem,” Quigley said. “All the schools in Lancaster County and the surrounding areas have athletic trainers at their schools who can see this; people like myself can pick this up, literally, and intervene.
“I’ve talked to certain athletes who I thought were on the cusp of this and have been able to give them some information, education, direct them towards better nutrition, better choices, direct them to professional dietitians if needed.”