Study Shows Triad Starts Early

By Staff

Coaching Management, 15.1, January 2007,

The symptoms of female athlete triad syndrome—disordered eating, menstrual irregularities, and low bone mass—have been a concern among college athletes for many years. But recent research suggests high school girls, too, should be wary of the risks.

In a study published last year by researchers at San Diego State University, the authors found that among 170 female high school athletes from eight different sports, 20 percent exhibited at least one symptom of the triad. In the sample, 24 percent experienced menstrual irregularities, 22 percent had low bone mass, and 18 percent showed signs of disordered eating.

“The results are a wake-up call for physicians, physical therapists, athletic trainers, and coaches who work with female athletes,” study co-author Mitchell Rauh, Professor of Exercise and Nutritional Sciences at SDSU, told the San Diego State Universe. “These conditions may happen earlier than realized and these professionals should start to encourage positive behaviors now.”

To help female athletes avoid the triad, which can lead to stress fractures, osteopenia (a precursor to osteoporosis), and full-blown eating disorders like anorexia and bulimia, experts say coaches should keep an eye out for early warning signs. “Anytime there’s a significant, unexplained drop in a female athlete’s performance, that’s cause for concern,” says Caroline Hodges, Nutrition Counselor at the Elmira (N.Y.) Nutrition Clinic, who works with both high school and college athletes. “Other red flags include slow healing and recovery times, stress fractures, and any significant preoccupation or obsession with food.”

Hodges says coaches are often in the best position to observe triad symptoms—they can recognize performance changes during training and competition, and even notice abnormal eating habits, since most teams share meals when they travel. She also notes that track and field athletes are a high-risk group because the sport’s culture fosters a “thinner is better” mentality.

“Many track athletes subscribe to the idea that lighter is faster, and that’s a problem,” Hodges explains. “There’s no question that when female athletes go through puberty, their times usually get worse. It’s not because they’re getting fatter, they’re just going through physical changes, and their performance will often come back up over time. But athletes don’t always understand that, so it can lead to unhealthy behaviors.

“Younger athletes, in particular, don’t always know how to fuel their bodies adequately,” Hodges continues. “Girls today start dieting at a very young age, and that results in guilt when they do eat, which in turn leads to food restriction.”

If you’re concerned that an athlete in your program is showing signs of disordered eating, broaching the subject can be difficult. For coaches, a smart approach is framing the discussion around performance. “Saying, ‘I don’t think you’re eating adequately, and I know you could do better if we got your food on track,’ is a very non-threatening way to start a conversation,” Hodges advises. “Then, you can recommend they see a nutritionist or tap into any other resources that are available.”

Ron Helmer, Head Men’s and Women’s Coach at Georgetown University, says the key for coaches is not to go it alone. “Coaches have a unique relationship with athletes in that we’re often in a position of trust, but we need to remember that we’re not doctors,” he says. “If you think an athlete may be suffering from an eating disorder, that’s a medical issue, and it’s not up to you to solve the problem yourself. Coaches can play an important supporting role, but it’s critical that we refer the athlete to the proper professionals so they can get the help they need.”