Study reveals high prevalence among high school athletes

Since launching Fuel Aotearoa last week we have had lots of great feedback from women (and some men) from around the world. Thanks so much to all of those that took the time to write to us!

One of the questions asked since the launch is ‘how prevalent is this issue?’ With so much public discussion and media attention dedicated to the so-called ‘obesity epidemic’, it is understandable that many without personal experiences within contemporary sporting and exercise cultures, wonder if the issues we are raising on this website are really issues at all. While the risks of the Female Athlete Triad and energy deficiency are certainly less visible in society than health concerns related to obesity, we believe this does not mean the issues facing female athletes and exercisers are not relevant and deserving of further academic, professional and public attention.

Unfortunately, there is no reliable information on the prevalence of the Female Athlete Triad or energy deficiencies among New Zealand girls and women. The outpouring of emails we have received over the past week, however, suggest this has been a private concern for many women in the past and present. Many coaches and health professionals have also expressed their gratitude for a site that they can refer their athletes and clients toward to facilitate their discussions.

In response to those who want ‘statistics’ on the prevalence of the Female Athlete Triad among populations of women, here are a few studies that suggest this is something health professionals, educators, coaches and parents, should (at least) start thinking about, if they aren’t already:

1. An article published in the Clinical Journal of Sports Medicine in 2009 titled ‘Prevalence of the female athlete triad in high school athletes and sedentary students’ set out to determine the prevalence of the female athlete triad (low energy availability, menstrual dysfunction, and low bone mineral density) in high school varsity athletes in a variety of sports compared with sedentary students/control subjects. The authors drew the following conclusions from their study: “A substantial number of high school athletes (78%) and a surprising number of sedentary students (65%) have 1 or more components of the triad. Given the high prevalence of triad characteristics in both groups, education in the formative elementary school years has the potential to prevent several of the components in both groups, therefore improving health and averting long-term complications” (Hoch, et. al. 2009, p. 421)

2. A study of Norwegian female athletes in ball sports published in the British Journal of Sports Medicine in 2007 titled ‘The female football player, disordered eating, menstrual function, and bone health’ revealed a surprisingly high prevalence among the athletes surveyed.

Results showed that 32% of the athletes met the criteria for clinical eating disorders. The authors suggested “This high prevalence among ball game players might be explained by the increased focus on body composition and leanness in ball sports” (Sundgot-Borgen & Torstveit, 2007).

In their discussion of exercise-related menstrual ‘dysfunction’** and hormonal changes, the authors’ summarize research reports “that menstrual dysfunction occurs in 6–79% of women engaged in athletic activity”, adding that “Prevalence depends on the definition of menstrual dysfunction, the sport and the competitive level of the athletes investigated”. In their own study, 17% of the athletes reported current menstrual ‘dysfunction’.

Discussing bone health of female athletes, the researchers noted that although “the prevalence of osteopenia and osteoporosis among female athletes is low… a number of studies have reported a significant decrease in vertebral BMD among young female athletes with menstrual dysfunction”. Previous work conducted by the authors on Norwegian athletes, showed 11% of athletes met the criteria for low bone mass. In this study, thirteen percent of football players reported a history of stress fracture, but upon further investigation these were not all clinically diagnosed.

The authors conclude: “As some female athletes and non‐athletes do not consider training or exercise to be sufficient to achieve their idealised body shape or level of thinness, a significant number diet and use harmful, though ineffective, weight‐loss practices such as restrictive eating, vomiting, laxatives and diuretics. Although dieting, EDs and menstrual dysfunction are less common in football than in many other sports, it is important to be aware of the problem as EDs in female athletes can easily be missed. … Energy deficiency seems to be an important factor associated with menstrual dysfunction in athletes. The amount of bone loss seems to be correlated with the severity and length of menstrual dysfunction, nutritional status and the amount of skeletal loading during activity. Due to the severe consequences of EDs, menstrual dysfunction and low BMD, it is important to identify athletes at risk of the triad as early as possible” (para. 43).


 ** Please note, although the authors of this paper use the term ‘dysfunction’, we are critical of this phrasing. Throughout this website we try to avoid using this term, except where it is used by researchers or professionals in their published work.