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Abstract A literature review was employed to evaluate the current epidemiology of injury related to the safety and efficacy of youth resistance training. Statistics from Altmetric.

Footnotes Funding GDM received funding support from the National Institutes of Health grants RAR and RAR Competing interests None. Linked Articles Warm up Are kids having a rough time of it in sports?

Dennis J Caine. British Journal of Sports Medicine ; 44 Published Online First: 21 Dec doi: Read the full text or download the PDF:. Overuse and overtraining can also leave young athletes feeling exhausted, physically and mentally. See " Burnout in Young Athletes: How to Keep the Fun in Sports.

Young athletes and performers tend to make the same moves over and over again during practices, games and meets. They may also engage in focused training that puts even more strain on their bodies. The result is often strains, sprains, fatigue, pain—and sometimes, life-changing injuries.

All bodies need time to heal after a serious workout. You're probably familiar with this yourself if you've ever overdone it on the playing field or at the gym.

But young, growing bodies are even more vulnerable to the stress that tough workouts place on bones, muscles, tendons, ligaments and other tissues.

Tough training schedules can push young athletes past reasonable limits, opening the door for injuries that may require surgery and even end athletic careers.

Overuse injuries are different from acute sports injuries that involve a sudden fall or collision. They develop over time when a child's training load is out of balance. Training load means the total duration, intensity and type of activity a young athlete's body must handle.

For example, the training load for a cross-country runner might mean a certain number of miles each week at a particular pace. Young athletes in sports with a lot of running or jumping, for example, might feel pain in their knee because of too much stress on the area where the kneecap tendon connects to the shinbone.

This is known as Osgood-Schlatter disease. Or, a gymnast who does lots of moves that involve bending their wrist might get an injury where the wrist bone grows, called " gymnast's wrist.

Sometimes, the injuries might not seem like a big deal at first. A young baseball player might notice they're not throwing as fast or as accurately as before because of an injury called " little league shoulder.

These injuries might not always show obvious signs like swelling or bruising, so athletes and their families might not realize they need medical care. Stage 2: Pain while playing or practicing that doesn't hamper performance. Young athletes who work especially hard at sports, dance and other physical activities may suffer overuse injuries.

Kids can easily reach the point where healthy exercise becomes harmful—a pattern exercise experts call overtraining syndrome. Their body-mass index BMI is relatively high, placing extra stress on muscles and joints. Preventing overuse injuries depends on our shared willingness to help kids balance activity with rest and healthy eating.

As adults, we need to allow or even require student athletes to take good care of themselves. Coaches, trainers, school administrators and even sports fans can join with parents and caregivers to support healthy participation in physical activities.

Here are specific tips for safe and healthy sports participation to keep in mind for your child — and the whole family. Start with a sports physical before the season. Take your child to the doctor for a preparation physical exam PPE at least 6 weeks before the season or class session begins.

This helps your pediatrician make sure your child is ready for the sport or activity they've chosen. It also gives you the chance to ask questions about overuse, overtraining and other concerns you have about sports and health. Encourage kids to vary their activities.

There's plenty of time to specialize in one sport later on, but younger kids can avoid injuries by trying different activities that work different muscle groups and parts of the body. Know your child's training requirements.

Coaches, trainers and instructors can explain what's expected when your child signs up. These adults can be your best allies in making sure your child observes proper training limits.

So if your budding basketball star is practicing 1 hour daily, the following week's training time should not increase by more than 12 minutes. Gradual increases as the season moves forward can reduce the chances for overuse injuries.

Build in breaks. Kids should not be required to play or train more than days a week. They should also have at least 2 to 3 months off from any given sport during the year.

These breaks can be divided into one-month breaks when they can focus on other activities or free play. Ask for coaching or team support when you're worried things are falling out of balance. Aim for one team at a time. Encourage your athlete to participate on only 1 team during a season.

If they do play on more than 1 team, they should not have games or practices on the same day. Also make sure your child takes extra precautions if they participate in multigame tournaments in short periods of time.

Learn from experience. If your child has had pain or injuries in the past, make sure coaches or instructors take this into account. Talk with your child about the mistaken idea that "playing through the pain" is safe.

Some weight loss methods can lead to serious physical and psychological harm. Additionally, certain weight loss practices impair athletic performance and increase injury risk.

Weight loss may initially improve athletic performance because of an increase in the strength-to-weight ratio. However, continued use of inappropriate weight loss methods can result in reduced muscle strength, reduced performance in aerobic activities, decreased mental and cognitive performance, mood changes, depression, compromised immune response, and changes in the cardiovascular, endocrine, gastrointestinal, renal, and thermoregulatory systems.

The term hypohydration refers to the state of suboptimal hydration, and dehydration describes the transition from a well-hydrated to a hypohydrated state. Using these tactics over the course of several days can lead to progressive dehydration because many athletes fail to fully rehydrate each day.

Dehydrated athletes often experience mental status and cognitive changes Table 5. Poor hydration status is also associated with impaired performance on the Sports Concussion Assessment Tool, an instrument used to assess mental status and symptoms after concussion.

Adapted from Weber AF, Mihalik JP, Register-Mihalik JK, Mays S, Prentice WE, Guskiewicz KM. Dehydration and performance on clinical concussion measures in collegiate wrestlers. J Athl Train. Effects of voluntary fluid intake deprivation on mental and psychomotor performance. Croat Med J. The influence of exercise and dehydration on postural stability.

In , over the course of 33 days, 3 college wrestlers died as a result of attempting drastic weight loss before competition. Additionally, the NCAA established a system of setting a minimum weight for competition during the wrestling season by using a calculation that incorporates hydration status based on urine specific gravity , weight, and body composition.

Before the competition season, athletes submit a urine sample from a witnessed collection for testing. If the urine specific gravity is 1. Body fat is measured by using 1 of 3 methods: skin fold caliper measurement by a trained evaluator, hydrostatic underwater weighing, or air displacement plethysmography commonly performed by using a Bod Pod device.

Body fat and weight are entered into an online optimal performance calculator and are used to calculate the lowest allowable weight LAW by using 2 different methods.

The LAW2 accounts for the 1. The highest of these calculated weights is the lowest weight allowed for competition during the wrestling season. In the high school wrestling arena, the Wisconsin Interscholastic Athletic Association was the first state high school athletic association to implement a plan to curtail weight cutting among high school wrestlers.

High school wrestlers must have a urine specific gravity of 1. As with NCAA athletes, high school wrestlers may lose no more than 1. Additionally, there is a 2-lb growth allowance for each weight class per season.

High schools are permitted to use bioelectrical impedance analysis as an alternative to skin fold caliper and air displacement options to determine body fat percentage. The establishment of minimum competition weight rules has led to a decrease in the practice of rapid weight loss before competition.

Additionally, consuming a large quantity of plain water over a short period of time leads to lower serum osmolality and increased urine output and dilution. There is no agreed-on gold standard for the assessment of body composition.

Skinfold measurement is an inexpensive, well-validated method that is commonly used in the high school and collegiate setting to determine body composition. However, skinfold measurement requires trained personnel and may not be as accurate for individuals with obesity.

High schools are allowed to use bioelectrical impedance analysis to measure body fat percentage; this technique is less accurate than others, and hydration status can affect the results.

Body composition is most accurately calculated with serial measurements that use the same assessment technique performed by an experienced health care provider, such as an exercise physiologist, athletic trainer, registered dietitian nutritionist RDN , or sports medicine physician.

Changing the timing of precompetition weigh-ins to immediately before matches has been proposed as a means of decreasing the incentive to cut weight. Many athletes attempt to lose weight by restricting energy caloric intake. Athletes typically need a greater caloric intake than nonathletes.

Unhealthy weight loss behaviors occur along a continuum. At the other end of the spectrum are athletes engaging in dangerous weight loss practices that carry a high risk of associated morbidity and mortality; this extreme includes children and adolescents with frank eating disorders, such as anorexia nervosa and bulimia nervosa.

Persistent weight loss via unhealthy behaviors may result in delayed physical maturation, growth impairment, and the development of eating disorders. When first described, the 3 facets of the triad included disordered eating, amenorrhea, and osteoporosis. A small body of research supports the concept that male athletes also appear to be susceptible to inadequate energy availability and may experience adverse health consequences as a result.

A survey of female high school athletes revealed that one third had disordered eating; disordered eating was correlated with an increased risk of musculoskeletal injury.

Although female athletes have the highest rates of eating disorders, male athletes are also at risk. The AAP Preparticipation Physical Examination monograph contains a history form for use during preparticipation evaluation.

aspx and includes questions designed to screen for disordered eating and menstrual irregularities. BMI less than the fifth percentile, BMI less than Education of athletes, parents, and coaches about unhealthy weight loss behaviors and their negative impact on health and athletic performance is important to prevent adverse health effects.

For non—weight-class sports, coaches should promote healthy eating habits and be alert to unhealthy eating habits in their athletes. Coaches of weight-class sports should discourage unhealthy weight-control methods and encourage athletes to compete at a weight that is appropriate for their age, height, physique, and stage of growth and development.

Many coaches inappropriately focus on weight instead of performance. In addition, coaches generally do not have an adequate nutritional background to counsel an athlete about weight loss. Athletes should focus on optimizing energy availability for maximizing performance and good health.

Female athletes with menstrual dysfunction require an evaluation to determine the underlying etiology. If low energy availability is the cause, increasing energy intake will generally lead to resumption of normal menses. Referral to an RDN may be of benefit to assist athletes with a well-designed, healthy weight loss program or to provide guidance on increasing caloric intake, when appropriate.

The AAP has published clinical reports that outline guidance for the prevention and treatment of obesity for all children and adolescents.

For most children and adolescents, the goal of weight management should be to keep BMI below the 85th percentile. Recommendations for weight maintenance and weight loss are based on the degree of obesity. Excessive body fat may interfere with acclimation to heat and negatively affect speed, endurance, and work efficiency.

Because weight is not an accurate indicator of body fat, lean muscle mass, or performance, athletes should focus on maintaining lean muscle mass.

An imbalance between energy intake and energy expenditure can result in the loss of lean muscle mass, which can negatively affect performance. Athletes should avoid cyclic weight fluctuations. Once desired body composition and weight are achieved, dietary, exercise and lifestyle behaviors should focus on maintenance, with allowances for growth.

Gradual weight loss appears to confer greater performance benefits than rapid weight loss. A study of athletes engaged in strength training demonstrated that weight reduction of 0. Adult athletes generally require a minimum of kcal per day, but this can vary widely depending on sex and level of activity.

Type and intensity of physical activity will also influence caloric needs. Young athletes attempting to lose weight may benefit from the guidance of a RDN with sports nutrition experience. Athletes involved in sports such as football, rugby, power lifting, and bodybuilding may desire to gain weight and lean muscle mass to improve power and strength or to achieve a muscular physique.

Preadolescent and adolescent athletes who want to gain weight may require guidance about appropriate, healthy strategies for achieving their goals. Table 7 lists healthy and unhealthy methods of weight gain.

Increasing caloric intake in the form of food consumption or use of dietary supplements may lead to excessive fat accumulation rather than the desired increase in lean muscle mass. Supplement manufacturers are not required to prove safety before bringing their products to the market.

Many supplements, even those sold by national retailers, contain unlisted, potentially harmful ingredients. Adolescent males who perceive themselves as under- or overweight are nearly 4 times more likely to use anabolic steroids to attempt to change body composition as compared with those who perceive themselves as being at an appropriate weight.

Summary of Performance-Enhancing Substances Commonly Used by Athletes With Effects on Performance and Possible Adverse Effects. Modified from LaBotz M, Griesemer BA; Council on Sports Medicine and Fitness. AAP Clinical Report: Use of Performance Enhancing Substances.

AAS, anabolic-androgenic steroid; DHEA, dehydroepiandrosterone; hGH, human growth hormone; HMB, hydroxymethyl butyrate; IGF-1, insulin-like grow factor 1; —, not applicable. Young athletes in sports in which a muscular physique is valued for aesthetic or performance reasons may seek to gain weight and increase lean body mass through a combination of increased caloric intake and strength training.

Female athletes and prepubertal male athletes typically increase strength with a weight-training program but generally do not have sufficient circulating androgens to increase muscle bulk considerably. To increase muscle mass, athletes must consume sufficient calories and include adequate proteins, carbohydrates, and fats.

Increased energy intake should always be combined with strength training to induce muscle growth. Children and adolescents who wish to engage in strength training should begin by learning proper technique without resistance. Weight loads should be increased gradually; programs should incorporate 2 to 3 sets of 8 to 15 repetitions with the athlete maintaining proper technique.

Although weight-training programs for children and adolescents have health and athletic performance benefits, the AAP recommends that skeletally immature children and adolescents avoid power lifting, bodybuilding, and maximal lifts. BMI, defined as weight in kilograms divided by height in meters squared, 2 is a commonly applied screening tool used as a measure to assess general health.

BMI values between the 5th and 85th percentile for age are considered normal. The Centers for Disease Control and Prevention has published BMI charts that categorize BMIs on the basis of sex and age.

Approximately one-third of adults classified as having obesity on the basis of BMI measurement have good cardiac and metabolic health on the basis of other variables, such as blood pressure, cholesterol concentrations, and insulin resistance.

An increased torso-to-leg ratio also results in increased BMI. In adolescents, increased weight gain and increased height velocity during puberty may not coincide, resulting in temporary elevation or depression of BMI.

Although there are normative data for body fat percentage, there are no established recommendations regarding body composition in children and adolescents.

These minimums are well under the fifth percentile for body fat observed in the general adolescent population. Rather than suggesting a specific percentage of body fat for an individual athlete, a range of values that is realistic and appropriate should be recommended.

Physicians who care for young athletes are encouraged to have an understanding of healthy and unhealthy weight-control methods;. Health supervision visits for young athletes generally include history-taking to ascertain diet and physical activity patterns.

When discussing diet and exercise, physicians can encourage parents of young athletes to place nutritional needs for growth and development above athletic considerations. Acute weight loss through dehydration and the use of potentially harmful medications and supplements for weight control should be strongly discouraged;.

Physicians should counsel young athletes who express a desire to gain or lose weight to avoid weight-control methods that may have adverse health effects, such as acute weight loss through dehydration and the use of potentially harmful medications and supplements.

Many of these methods may have a negative effect on performance as well;. Some states require a specific form for sports preparticipation examinations. For physicians in states without a specific requirement, the AAP Preparticipation Physical Examination monograph contains a standardized history-taking form that may be helpful for screening athletes.

This form is also available on the AAP Web site and includes questions designed to screen for disordered eating and menstrual irregularities. Physicians are encouraged to engage the services of RDNs familiar with athletes to help with complex weight-control issues, if these providers are available in their communities.

Monitoring athletes with weight-control issues every 1 to 3 months can aid the physician in detecting excessive weight loss;. There are no established recommendations for body fat percentages in adolescent athletes.

Rather than suggesting a specific percentage of body fat for an individual athlete, a range of values that is realistic and appropriate should be recommended;. Physicians should counsel young athletes that weight gain or weight loss regimens should be initiated early enough to permit gradual weight change before a sport season.

Slow weight gain, in combination with strength training, will decrease gain of body fat. Slow weight loss in the athlete with excess body fat will decrease loss of muscle mass.

A well-balanced diet is recommended for all athletes. Once the desired weight is obtained, the athlete should attempt to maintain a constant weight; and.

When opportunities for community education arise, pediatricians should collaborate with coaches and certified athletic trainers to encourage healthy eating and exercise habits. Dr Martin drafted the report update proposal, conceptualized the initial manuscript, contributed to editing on the basis of comments from American Academy of Pediatrics AAP reviewers; Dr Johnson conceptualized and wrote the initial manuscript, contributed to editing on the basis of comments from AAP reviewers; Dr Carl revised the initial manuscript, contributed to editing on the basis of comments from AAP reviewers; and all authors approved the final manuscript.

This document is copyrighted and is property of the American Academy of Pediatrics and its Board of Directors.

All authors have filed conflict of interest statements with the American Academy of Pediatrics. Any conflicts have been resolved through a process approved by the Board of Directors. The American Academy of Pediatrics has neither solicited nor accepted any commercial involvement in the development of the content of this publication.

Clinical reports from the American Academy of Pediatrics benefit from expertise and resources of liaisons and internal AAP and external reviewers. However, clinical reports from the American Academy of Pediatrics may not reflect the views of the liaisons or the organizations or government agencies that they represent.

The guidance in this report does not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.

All clinical reports from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time. Advertising Disclaimer ». Sign In or Create an Account. Search Close.

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Weight Loss. Unhealthy Weight Loss. Healthy Weight Loss in the Athlete Classified as Having Overweight or Obesity. Weight Gain. Unhealthy Weight Gain. Healthy Weight Gain.

Weight, BMI, and Body Composition Measurements. Guidance for the Clinician. Lead Authors. Council on Sports Medicine and Fitness Executive Committee, — Past Executive Committee Members.

Article Navigation. From the American Academy of Pediatrics Clinical Report September 01 Promotion of Healthy Weight-Control Practices in Young Athletes Rebecca L.

Carl, MD ; Rebecca L. Carl, MD. Address correspondence to Rebecca Carl, MD, MS, FAAP. E-mail: rcarl luriechildrens. This Site. Google Scholar. Miriam D. Johnson, MD ; Miriam D. Johnson, MD. b Department of Pediatrics, University of Washington, Seattle, Washington;. Thomas J.

Martin, MD ; Thomas J. Martin, MD. c Department of Pediatrics, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania;. d Department of Pediatrics, Milton S. Hershey College of Medicine, Pennsylvania State University, Hershey, Pennsylvania; and. e Central Pennsylvania Clinic for Special Children and Adults, Belleville, Pennsylvania.

COUNCIL ON SPORTS MEDICINE AND FITNESS ; COUNCIL ON SPORTS MEDICINE AND FITNESS. Cynthia R. LaBella, MD ; Cynthia R. LaBella, MD. Margaret A. Brooks, MD ; Margaret A. Brooks, MD. Alex Diamond, DO ; Alex Diamond, DO. William Hennrikus, MD ; William Hennrikus, MD. Michele LaBotz, MD ; Michele LaBotz, MD.

Kelsey Logan, MD ; Kelsey Logan, MD. Keith J. Loud, MDCM ; Keith J. Loud, MDCM. Kody A. Moffatt, MD ; Kody A. Moffatt, MD. Blaise Nemeth, MD ; Blaise Nemeth, MD. Brooke Pengel, MD ; Brooke Pengel, MD. Andrew Peterson, MD Andrew Peterson, MD.

Pediatrics 3 : e Connected Content. This article has been reaffirmed: AAP Publications Reaffirmed or Retired. Cite Icon Cite.

toolbar search toolbar search search input Search input auto suggest. View Large. Boxing Crew Horse racing—jockeys Martial arts Weight-class football Wrestling. TABLE 3 Sports That Emphasize a Muscular Physique.

Baseball Basketball Bodybuilding Football especially linemen Powerlifting Rugby Track eg, shot-put, discus. TABLE 4 Unhealthy and Healthy Weight Loss Methods. Healthy Weight Loss. However, due to the overall limited number of studies, with simultaneously dozens of different sport types to be examined there is not enough data in total.

Additionally, several methodological problems across the different studies make a clear final conclusion impossible.

Three studies suggest that restrict weight-control is particularly prevalent in leanness-sports defined as sports emphasising leanness or low body weight such as aesthetic or endurance sports [ 33 , 34 , 42 ].

Reinking and Alexander [ 33 ] could show that within their NCAA Division I athletes, those competing in leanness sports scored significantly higher on the sub score for Body Dissatisfaction than those competing in non-leanness sports. Equally, athletes from leanness sports had a lower mean desired body weight than athletes from non-leanness sports.

Parks et al. They could show a significant difference between these two groups, with runners expressing more weight concerns and aiming for less weight than footballers who wanted to if anything gain weight. Rosendahl at al [ 34 ] could show in addition to the comparisons with controls mentioned above that athletes competing in leanness sports scored higher for weight-control behaviour than those competing in non-leanness sports.

In contrast, four other studies did not find any differences between leanness- and non-leanness sports weight-control behaviour [ 13 , 18 , 19 , 32 ].

Greenleaf et al. As a result, over half of the athletes The majority of them wanted to lose weight, on average around 5. However, only a small minority indicated purging behaviour: 2. For all weight concerns and weight-control behaviours, no difference could be found between the various types of sports.

basketball, volleyball, soccer , finding no difference [ 32 ]. Johnson at al [ 44 ] could show some differences between different types of sports. However, this was only true in two instances and with no particular connection to the categories of leanness and non-leanness sports: In female athletes gymnasts scored higher on the Drive for Thinness Scale than swimmers and basketball players.

Male football players showed greater body dissatisfaction than gymnasts and cross-country athletes. In their study about psychosocial correlates of bulimic symptoms, Anderson et al.

They could show that the level of body dissatisfaction as well as restrictive eating was related to the amount of experienced pressure from teammates and coaches.

There was no relation between the two components themselves. No difference with regard to type of sport could be shown. Looking at weight-dependent sports only, two studies described methods of rapid weight-control amongst judo athletes [ 4 , 35 ].

A large survey by Artioli et al. Most of them regained this lost weight at least partially within one week after competition. The fluctuation of weight was confirmed by a study from Rouveix et al. showing that rapid weight reduction is an inherent part of the lives of judo athletes [ 35 ]. Nearly two thirds limited their choice of food on a constant basis.

Other studies examined only selected sports types [ 31 , 45 ] describing the prevalence of weight concerns and weight-control behaviour in a particular field. Thiel et al. The majority of athletes did not score pathologically for weight concerns and weigh-control behaviour.

In particular, there was no difference between the male rowers and wrestlers. Only if they formed a subgroup of athletes with the diagnosis of a subclinical eating disorder based on the EDI-2 [ 39 ] Drive for Thinness subscale scores, did they find a difference on Body Dissatisfaction scale in comparison to the rest of the subjects.

Marshall at al examined female Canadian elite field hockey players [ 31 ]. In general, only a very low number of athletes 3. However, they did find a fivefold higher frequency of athletes scoring at risk for the Body Dissatisfaction BD scale, which made the authors conclude a higher prevalence of weight concerns.

Rouveix et al. included a comparably small sample size of only 24 athletes [ 35 ]. Reinking et al. on the other hand had a substantial difference in group sizes with only 16 athletes competing in leanness sports as opposed to 68 athletes competing in non-leanness sports [ 33 ].

also showed a significant difference in the group sizes of athletes with only 25 wrestlers but 59 rowers, which further reduce the generalizability of results found [ 45 ].

This study raises additional concern because they found differences only after creating a subgroup scoring pathologically for subclinical eating disorders, which makes their conclusions questionable [ 45 ]. In contrast, two studies used large, balanced samples [ 4 , 44 ].

A specific problem of the study by Johnson et al. was that large parts of their results were based on a self-created, unvalidated questionnaire that had its main focus on eating disorders [ 44 ]. Anderson et al. tried to make their results more generalizable by using a variety of universities to get their sample from which clearly reduces local biases [ 18 ].

Again, a lack of clear definitions made interpretation difficult: Two studies did not state clearly at which level their athletes competed [ 32 , 34 ]. In the study of Ferrand et al. Additionally, the sample of swimmers consisted of female and male athletes whereas the two other groups were female samples only.

Two studies did not state clearly how the sample of athletes was collected so it is hard to judge the quality of each study [ 35 , 42 , 45 ]. Summed up, the evidence seems to point towards no higher prevalence of pathogenic weight concerns or weight-control behaviour in athletes competing in leanness sports.

However, this behaviour does seem to be particularly present in weight-class sports where success is often dependent on the class an athlete is competing in. Although it is suggested that female athletes are more susceptible to developing eating disorders or at higher risk for pathogenic weight-control behaviour than male athletes, one study by Artioli et al.

did not find any gender differences [ 4 ]. They examined active judo competitors with the Rapid Weight Loss Questionnaire [ 46 ]. Increased exercises and restricted fluid intake were the favourite methods to lose weight.

They did not find any differences between gender — neither in prevalence nor manifestation of pathogenic weight-control. Looking at male athletes only, Galli and Reel [ 47 ] explored the body image and body enhancing behaviour of male athletes from various sports types in qualitative interviews.

The findings show that male athletes want to reduce fat and gain muscle mass, desiring a more muscular, stronger body.

Patients who suffer from it perceive their body as too slim or not muscular enough, even if there is no objective evidence [ 48 ]. As a result of their perception, patients withdraw from social activities out of shame or stick to extensive workouts or usage of anabolic drugs [ 50 ].

Clear strength of the study by Galli et al. is clearly the insight gained through qualitative data. The majority of studies included in this review did find a higher frequency of pathogenic weight concerns and weight-control behaviour in female athletes than in male ones.

Martinsen at al [ 13 ] could show in their study that female athletes have more concerns about their weight and a higher urge to improve their appearance than male athletes.

Additionally, they used more pathogenic weight-control methods than their male counterparts. Johnson et al. This was true for vomiting and use of laxatives as well as diet pills over a lifetime. However, no statistically significant difference could be shown for use of diuretics or steroids.

In general, female athletes wanted to reduce their body fat down to a percentage where they would stop menstruating risking osteoporosis within one year. Rouveix [ 35 ] at al examined 24 judo athletes and came to mixed conclusions.

Nearly two thirds of the athletes lost more than 2. Most common methods were intensification of exercising and reduction of fluid intake. There was a gender difference in methods to reduce weight, though: female athletes fasted significantly more.

Interestingly, athletes reported their parents and society as equally important sources for the pressure to lose weight as their own drive to do so. Additionally, there was a clear gender difference for the ideal body with female athletes desiring a much lower body weight than male athletes.

A definite strength of this study is its clear definition of the athlete level and a good control of the comparison group, who did not engage in sports activities more than three times a week. This confirms different mindsets and intentions behind weight-control behaviour in female and male athletes.

Only two studies also draw conclusions about the role of age in pathological weight concerns and weight-control behaviour. One study by Artioli et al. suggests that the earlier in life athletes started reducing weight before competition, the more aggressive they were with respect to their methods [ 4 ].

Another study from Marshall et al. However, both studies have their limitations: Whereas Artioli only asked athletes retrospectively where memories could be distorted; Marshall compared two different age groups in a cross-sectional study.

Both did not examine athletes longitudinally to follow up the same cohort and their development. In summary, a number of studies provide evidence for pathogenic weight-control behaviour in both genders.

The form of pathogenic weight-control behaviour is different in male and female athletes. Whereas female athletes mostly want to reduce weight and focus on a slim appearance, male athletes mostly want to gain weight through muscle mass. Concerning weight-control behaviour in connection with age, no uniform conclusion can be drawn, as only two studies looked at it at all.

Results are heterogeneous, with one giving evidence that the age of an athlete starting with pathogenic weight-control behaviour might play a decisive role for the prognosis [ 4 ] whereas the other does not seem to see any connection with age [ 31 ].

To our best knowledge, this is the first systematic review on weight-concerns and weight-control behaviour in young elite athletes. It appears that young elite athletes are engaged in pathogenic weight-control behaviour despite long-term health being very important for the development of their sports career and achievement of peak performance.

Comparing athletes with non-athletes or controls, the majority of studies, several of which were large scale, found either no difference or an even lower risk of athletes for pathogenic weight concerns or weight-control behaviour [ 13 , 30 , 33 — 35 , 45 ].

Only one study could show a higher prevalence of pathogenic weight concerns but not weight-control behaviour in athletes [ 32 ]. Because of different demands associated with different sports types, we further analysed the studies found according to clusters.

We decided to use the classification into leanness and non-leanness sports for the sub-analysis of different sports types, as this is a very common distinction first introduced by Sundgot-Borgen [ 51 ] in connection with eating disorders in elite athletes.

Several of the studies included in our review used this particular classification. However, we are aware that there might be additional ways of clustering different types of sports that were not considered in this review.

Focusing on leanness-sports, three studies give evidence of a higher prevalence of weight-control problems in leanness-sports [ 33 , 34 , 42 ]. However, four other studies did not find any differences in the prevalence between these two categories [ 13 , 18 , 19 , 32 ], and there was no study in which a higher prevalence of pathogenic weight-control behaviour in non-leanness sports could be shown.

Whether leanness-sports are a risk factor for pathogenic weight-control or whether the higher prevalence is merely due to a selection bias has to be further investigated. It was suggested that gender plays an important role for the prevalence of pathogenic weight-control behaviour.

In total, only two studies made a clear statement about gender with contradictory results: whereas one study showed no difference between female and male athletes [ 4 ], the other one clearly supported the theory that female athletes are more engaged in pathogenic weight concerns and weight-control behaviour [ 13 ].

Two other studies showed mixed results within their different outcome variables [ 35 , 44 ]. Additional studies focus on female or male athletes alone, making gender comparison hard. However, they help to get a deeper understanding of gender specific ways to worry about body shape or weight-control.

Our review had to encounter several problems. In general, difficulties seem to arise when looking at the topic of pathogenic weight concerns and weight-control behaviour. Specifically, there does not seem to be a clear common definition of what weight concerns and weight-control behaviour are.

As a result, a variety of different measuring instruments are used. This heterogeneity makes consistent conclusions difficult. In our review, we included all studies that used these two terms. However, further research should clarify what these terms comprise exactly to get a better idea of what appropriate measures might be.

Another problem arises with choosing appropriate screening instruments. This is due to the fact that in some sports types the very same behaviours can be pathogenic or non-pathogenic depending on circumstances.

Normally, screening instruments used are not specifically designed for or even adapted to athletes and their specific demands which might incorrectly classify non-pathogenic, functional behaviour as part of a pathogenic one [ 25 ].

Furthermore, the next difficult distinction is the thin line between pathogenic weight-control behaviour and eating disorders in elite sports. This is especially supported by the fact that in leanness-sports a very thin look is considered normal, and more radical forms of weight-control are often accepted by coaches and athletes [ 2 , 6 , 8 , 52 ].

According to her, female athletes suffering from it show an intensive fear of gaining weight or even becoming obese, although the athlete is not overweight at all. To achieve their individually set ideal weight, these athletes use a variety of pathogenic weight-control techniques [ 8 ].

On the other hand, it is impossible to deny that for some sport disciplines a change of body weight is a necessary part of training and competition. Here, it is most crucial to support athletes in losing or gaining weight in a healthy way.

Several organizations and associations have acknowledged this fact and now provide specific guidelines for healthy weight management in elite athletes [ 9 , 53 ]. Therefore it seems crucial to combine the two sources by providing trainers with additional information about the topic of weight concerns and weight-control behaviour in young elite athletes.

Another challenge for this review was the broad heterogeneity of studies. Their sample sizes ranged from 10 to participants. Some examined groups only consisted of athletes from a special type of sport, and some had no control-groups to give evidence of the differences between athletes and non-athletes Furthermore, results are mostly based on self-rating questionnaires and no expert interviews.

This may have affected the validity, because many athletes might not answer truthfully or withhold their pathogenic concerns or weight-control behaviour. When some studies cooperated with the respective sports association or college, it cannot be excluded that athletes held back some information, as they might have been scared to lose privileges within their system.

In any case, this would have only lead to an underestimation of the results found. Additionally, the methods differ strongly between cross-sectional studies with big cohorts and qualitative interview studies with small samples.

Whereas, for example, Johnson et al. examined nearly athletes from 11 different universities [ 44 ], Galli and Reel examined 10 male athletes over ten in-depth semi-structured interviews regarding body image in male athletes [ 47 ]. Both methods are respectable forms of research but make a comparison difficult if not impossible.

Taken together, the examined papers show that there is some prevalence of pathogenic weight concerns and weight-control behaviour in elite athletes. However, there is no certainty that the prevalence is higher than in control groups.

Only in leanness-sports, where athletes are encouraged to be thin for either appearance or performance, the prevalence of pathogenic weight-control behaviour is higher in frequency than in non-athletes. The pressure of competitive sports seems therefore to be a risk factor for both genders.

Thus, special attention should be paid to athletes in leanness sports who have experiences with dieting and who show body- or weight-dissatisfaction. Further research is necessary to get a better understanding of the connection between elite sports and pathogenic weight-control behaviour.

First results show that this combined approach provides comprehensive data [ 55 — 58 ]. In addition, long-term studies are needed to see what happens if young athletes stop competing as adults. Hagmar M, Hirschberg AL, Berglund L, Berglund B: Special attention to the weight-control strategies employed by Olympic athletes striving for leanness is required.

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