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chapter 20 Three Spokes: The Female Athlete Triad It’s time to give three big hurrahs to celebrate the enticing and increasing prospects for girls and women in sports. The physical, social, mental, emotional , and spiritual benefits are many. Physically, the athletes are more likely to maintain a healthy weight, which can help lower blood sugar levels , cholesterol, triglycerides, and blood pressure, thereby decreasing the incidence of obesity-related diseases like diabetes, hypertension, and heart disease. Two more advantages of participating in sport are preventing osteoporosis and decreasing the risk of breast cancer. In general, female athletes are more likely not to smoke or abuse drugs and alcohol and, if single, they become pregnant at less than half the rate of non-athletes. They benefit socially as well and are more apt to be successful academically and graduate from high school. Sports teach women how to take risks, be aggressive, set goals, and maintain the focus needed to achieve them. Involvement in sports develops leadership skills, teamwork, strategic thinking , and the pursuit of excellence in performance—all skills necessary for success in the workplace. The mental and emotional benefits are also significant . Among them are a more positive body image, higher self-esteem, and reduced stress and depression. Athletes report being happier, more energetic , and having a better overall quality of life. However, the demands of sport can negatively impact them in some serious ways. When their participation lacks balance, they may have low energy, fatigue, and susceptibility to illness; easy bruising; stress reactions; stress fractures; and irregular or absent menstrual cycles. All are the signs and symptoms of the Female Athlete Triad, three interrelated conditions that include energy-deficiency/disordered eating; menstrual disturbances/ amenorrhea; and bone loss/osteoporosis, on a continuum of severity. In essence, the Triad creates a domino effect that typically starts with energy-deficiency. An issue of balance, it may be in the form of insufficient Three Spokes 160 calorie consumption, purging, or over-exercising. When the body’s energy needs are not being met over time, the menstrual cycle becomes irregular or ceases and hormonal function is altered. This in turn compromises bone strength. Each component of the continuum may have its own level of severity. Energy-deficiency/disordered eating can range from inadequate calorie intake based on energy expenditure needs to grave eating disorders such as anorexia and bulimia. Menstrual disturbances can vary from irregular to absent, and bone loss/osteoporosis can be diagnosed as mild, moderate, or severe. The consequences of this devastating trio can be ruinous—an athlete ’s worst nightmare—leading to impaired performance; an increased risk of injury; impaired mental functioning; dehydration; malnourishment, which can cause electrolyte imbalances and loss of reproductive ability. The ultimate cost is starvation, organ failure, and even death. At various times, female athletes may be anywhere along this spectrum of health and disease. The ideal athlete is to the far right on the spectrum, which defines a healthy state. However, research studies tell us that many are not. A study by Byrne and McLean published in the Journal of Science and Medicine in Sport found eating disorders in 31 percent of elite female athletes in sports that emphasized a thin build, such as gymnastics, cross country, diving, ice skating, cheerleading, and light-weight rowing, compared to 5.5 percent of the control population. Another study in the Clinical Journal of Sports Medicine by Sundgot-Borgen and Torstveit found that 25 percent of female elite athletes in endurance sports, aesthetic sports, and weight-class sports had clinical eating disorders, compared to 9 percent of the general population.47 Menstrual disturbances vary widely by sport, age, training volume, and body weight. Small sample size studies have reported 69 percent of dancers, and 65 percent of distance runners experience amenorrhea. Researchers admit unreliability in gathering data and determining the prevalence of Female Athlete Triad components, as these issues are difficult for individuals to recognize in themselves and even more difficult, perhaps, to admit. Some conditions predispose a female athlete to the Triad. Athletes who participate in the aforementioned sports are at greatest risk for low energy when they restrict food intake, exercise more than necessary, and limit the types of food they will eat. Dieting at a young age is found to be the greatest contributor to disordered eating and eating disorders. Other factors include playing sports that require weigh-ins, punitive consequences for weight gain, low self-esteem, social isolation, family dysfunction, and a history of abuse...

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