Body Mass Index

• Person’s weight in kg divided by the square of height in meters
• Can be used to screen for weight categories that may lead to health problems
• Is not diagnostic of the body fatness or health of an individual

To calculate your BMI go to: https://www.cdc.gov/healthyweight/assessing/bmi/index.html

Nancy’s Diagnosis

Based on clinical findings, Nancy was diagnosed with:

Female Athlete Triad

1. Low energy availability
2. Menstrual dysfunction
3. Poor bone health

Screening for Triad

Early detection of athletes at risk is critical.

It is recommended that screening for the Triad be part of the Pre-Participation Physical Evaluation.

Hormones

• Have you ever had a menstrual period?
• How old were you when you had your first menstrual period?
• When was your most recent menstrual period?
• How many periods have you had in the past 12 months?
• Are you presently taking any female hormones (oestrogen, progesterone, birth control pills)?

Diet

• Are you on a special diet or do you avoid certain types of foods or food groups?
• Have you ever had an eating disorder?

Weight

• Do you worry about your weight?
• Are you trying to or has anyone recommended that you gain or lose weight?

Bone Health

• Have you ever had a stress fracture?
• Have you ever been told you have low bone density (osteopenia or osteoporosis)?

Bone Mineral Density & Osteoporosis in Ages 5-19

The diagnosis of osteoporosis in children and adolescents requires the presence of both a clinically significant fracture history AND low bone mineral content or low bone mineral density

A clinically significant fracture history is one or more of the following:

• Long bone fracture of the lower extremities
• Vertebral compression fracture
• Two or more long-bone fractures of the upper extremities

What kind of fracture does Nancy have?

Lab Tests

To be added

A little bit about Female Athlete Triad

• Female Athlete Triad is common in physically demanding and competitive sports like Soccer, Basketball, Gymnastics, Dance, and Track and Field
• These activities expend a large amount of energy and if young girls are restricting their diet they are not meeting their metabolic demands to remain healthy

Q&A

Truth or False: Malnutrition only occurs if you are not eating enough calories daily?

FALSE, Malnutrition is a disorder characterized by insufficient nutrients of all types including (calories, fats, fiber, carbohydrates, protein, vitamins, minerals, and electrolytes etc) necessary to sustain the body

A person may have symptoms of malnutrition due to being overweight, underweight or at a healthy weight for their age group this disorder is largely affected by eating habits and daily intake

What are the long term effects of Malnutrition in competitive athletes?

Nancy has a history of binge eating and purging this has affected her energy levels as food is not being properly digested and absorbed throughout the body resulting in the body wanting to conserve energy available intrinsically as she is not getting fuel from food products.

The drawback of this condition will result in poor performance overtime, bone fractures as bone density is affected due to low levels of Calcium and Vitamin D, and may affect hormones and delay puberty

What makes Nancy at risk?

When Nancy reached her teenage years, she played basketball, hockey, and ran a number of events in track and field, and competed in gymnastics.

She loved to win, and had many trophies and ribbons in her bedroom.

Her father was very proud of her accomplishments.  With these sports taking up much of Nancy’s time, her school grades were average due to competing priorities.

Who is at risk?

• At greatest risk are those in sports that reward being thin for appearance (such as figure skating or gymnastics) or improved performance (such as distance running or rowing).
• Sports like gymnastics or figure skating that have subjective scoring, as well as sports with certain weight classes, such as wrestling or boxing. It can also include team sports, such as football or cross country running, where there are certain body types associated with specific positions or the ability to be successful.
• Body image issues in athletes can come from a wide variety of sources: certain sports value specific weights and body types more than others, athletes will deal with puberty in different ways, and some student athletes struggle with control in other areas of their lives, which can lead to body image issues and unhealthy behaviors around food and exercise.

Energy Expenditure  > Energy Intake = Decreased Energy Availability

Many female athletes without the diagnosis of an eating disorder may exhibit disordered eating habits. Most of the time, this will occur unknowingly, and the athlete will not take in enough energy. The extensive continuum of disordered eating ranges from healthy dieting to fasting, skipping meals, using diet pills or laxatives, and binging and purging A direct correlation exists between carbohydrate availability and reproductive and skeletal health. Low energy availability secondary to disordered eating results in menstrual dysfunction and low mineral density.

Treatment of Female Athlete Triad

The three components of the Triad recover at different rates with the appropriate treatment.

• Recovery of energy status is typically observed after days or weeks of increased energy intake and/or decreased energy expenditure.
• Recovery of menstrual status is typically observed after months of increased energy intake and/or decreased energy expenditure, which improves energy status.
• Recovery of bone mineral density may not be observed until years after recovery of energy status and menstrual status has been achieved. IGF-1, insulin-like growth factor-1.