Disordered Eating Amenorrhea Osteoporosis

Girls and women should be encouraged to participate in sports and to strive for excellence, but there is also an obligation on the part of health professionals responsible for their well-being to understand the influence of nutrition on reproductive and skeletal health. Low energy availability, defined as an energy intake inadequate to meet energy expenditure as well as other physiological needs, can disrupt the reproductive cycle and result in amenorrhea (40, 41). There may be no overt signs of an energy deficit other than an irregular or absent menses. Other athletes may respond to pressure to meet unrealistic weight or body fat levels with excessive dieting. In both instances the unintended effect can be a cascade of events labeled the Female Athlete Triad. Some athletes may slip into disordered eating, which in turn can lead to a serious eating disorder such as anorexia nervosa or bulimia nervosa. An inadequate caloric intake and a decrease in endogenous estrogen eventually result in an imbalance in bone remodeling leading to low bone mass or osteoporosis (20, 32). Although any one of these problems can occur in isolation, inadequate nutrition for a woman’s level of physical activity often begins a cycle in which all three occur in sequence- hence the term “Female Athlete Triad”. Physicians, trainers, and other healthcare providers should educate athletes and coaches that weight loss does not necessarily ensure improvement in athletic performance. Muscle mass as well as fat is lost during extreme dieting and performance may actually deteriorate. Other side effects of poor nutrition such as fatigue, anemia, electrolyte abnormalities, and depression can also contribute to a poor performance and impair the athlete’s health. The Federation Internationale de Medecine du Sport (FIMS) Code of Ethics in Sports Medicine states clearl