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. Shopping Cart. Create Account. Explore AAP Close AAP Home shopAAP PediaLink HealthyChildren. header search search input Search input auto suggest. filter your search All Publications All Journals Pediatrics Hospital Pediatrics Pediatrics In Review NeoReviews AAP Grand Rounds AAP News All AAP Sites.

Advanced Search. Skip Nav Destination Close navigation menu Article navigation. Volume , Issue 3. Previous Article Next Article. 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. Decreased psychomotor function Decreased reaction time Decreased accuracy Decreased mental endurance Decreased alertness Increased problem-solving time Increased fatigue Increased levels of perceived exertion Temporary learning deficits Mood swings Changes in cognitive state.

TABLE 6 LAW1 and LAW2 Calculations. weeks in season wk. TABLE 7 Unhealthy and Healthy Methods of Weight Gain. Rapid weight gain Gradual weight gain Weight gain resulting in excess body fat Weight gain as muscle mass Use of anabolic compounds Boys gain up to 0.

Get adequate sleep. TABLE 8 Summary of Performance-Enhancing Substances Commonly Used by Athletes With Effects on Performance and Possible Adverse Effects. Usual Form of Intake.

Purported Mechanism of Performance Effect. Data on Performance Effects. Potential Adverse Effects. Creatine Creatine is found in meat and fish. Cooking can degrade some creatine in food. Most concern with impact on kidneys because of nephrotic metabolites methylamine and formaldehyde , and specific recommendation against use for athletes at risk for kidney dysfunction.

Causes water retention. Orally ingested creatine monohydrate supplement Anabolic agents Variety of testosterone derivatives.

Schedule III drugs. Oral, injectable, buccal, and transdermal forms. Premature physeal closure with decreased final adult height. Gynecomastia irreversible. Behavior change hypomania, irritability, aggression. Cholestatic jaundice, liver tumors.

Cardiac arrhythmias premature ventricular contractions increased blood pressure. Headaches, irritability, sleep disruption, tremor. Gastric irritation. Increased core temperature with exertion, particularly in hot environments.

Significant toxicity has been associated with ingestion of multiple energy drinks, leading to almost emergency department visits in in the to y age group.

Increased risk of liver disease. Individual amino acids or in combination Arginine and citrulline produce increases in nitric oxide see below for further discussion.

HMB is believed to enhance repair of damaged muscle tissue HMB: meta-analysis of studies on young adults show untrained athletes with 6. Synthesized from arginine via reduction to nitrate.

Citrulline is an arginine precursor Any potential benefit of arginine appears minimal in healthy young athletes who ingest sufficient protein. Inorganic forms of nitrate are associated with carcinogenesis, however, current data does not support restriction of vegetable source of nitrates.

Carnosine and β-alanine Buffers the metabolic acidosis resulting from high-intensity physical activity. β-alanine is a precursor of carnosine Data are variable regarding endurance exercise.

β-alanine with paresthesias at higher doses. 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.

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. 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.

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. AAP American Academy of Pediatrics.

DXA dual-energy radiograph absorptiometry. LAW lowest allowable weight. NCAA National Collegiate Athletic Association. RDN registered dietitian nutritionist.

FUNDING: No external funding. Prevalence of individual and combined components of the female athlete triad. Disordered eating and menstrual irregularity in high school athletes in lean-build and nonlean-build sports.

American College of Sports Medicine position stand. Weight loss in wrestlers. Promotion of healthy weight-control practices in young athletes [published correction appears in Pediatrics.

Effects of self-selected mass loss on performance and mood in collegiate wrestlers. Onset of adolescent eating disorders: population based cohort study over 3 years. Identification and management of eating disorders in children and adolescents.

Physiological consequences of hypohydration: exercise performance and thermoregulation. Policy statement—climatic heat stress and exercising children and adolescents.

Hypohydration during exercise in children: effect on thirst, drink preferences, and rehydration. Drink composition, voluntary drinking, and fluid balance in exercising, trained, heat-acclimatized boys. Effect of drink flavor and NaCL on voluntary drinking and hydration in boys exercising in the heat.

Exercise and fluid replacement. The effects of progressive dehydration on strength and power: is there a dose response? Skeletal muscle strength and endurance are maintained during moderate dehydration.

Active dehydration impairs upper and lower body anaerobic muscular power. Hydration and muscular performance: does fluid balance affect strength, power and high-intensity endurance? Effect of body hypohydration on aerobic performance of boys who exercise in the heat. Two percent dehydration impairs and six percent carbohydrate drink improves boys basketball skills.

Hyperthermia and dehydration-related deaths associated with intentional rapid weight loss in three collegiate wrestlers—North Carolina, Wisconsin, and Michigan, November-December The National Collegiate Athletic Association Wrestling and Rules and Interpretations.

The Wisconsin wrestling minimum weight project: a model for weight control among high school wrestlers. NCAA rule change improves weight loss among national championship wrestlers. Wisconsin minimum weight program reduces weight-cutting practices of high school wrestlers. Blood and urinary measures of hydration status during progressive acute dehydration.

Rehydration with drinks differing in sodium concentration and recovery from moderate exercise-induced hypohydration in man. Rehydration after exercise with fresh young coconut water, carbohydrate-electrolyte beverage and plain water.

Current status of body composition assessment in sport: review and position statement on behalf of the ad hoc research working group on body composition health and performance, under the auspices of the I. Medical Commission.

A quantitative critical review. Evaluation of the BOD POD and leg-to-leg bioelectrical impedance analysis for estimating percent body fat in National Collegiate Athletic Association Division III collegiate wrestlers.

Female athlete triad in elite swimmers of the city of Rio de Janeiro, Brazil. Vigorous-intensity activities burn more than 6 METs.

This method is not entirely reliable: Studies that measure physical activity more objectively, using special motion sensors called accelerometers , suggest that people tend to overestimate their own levels of activity.

Worldwide, people are less active today than they were decades ago. While studies find that sports and leisure activity levels have remained stable or increased slightly, 7 — 10 these leisure activities represent only a small part of daily physical activity.

Physical activity associated with work, home, and transportation has declined due to economic growth, technological advancements, and social changes. The flip side of this decrease in physical activity is an increase in sedentary activities-watching television, playing video games, and using the computer.

Weight gain during adulthood can increase the risk of heart disease, diabetes, and other chronic conditions. The latest evidence suggests that the recommended two and a half hours a week may not be enough.

Researchers found that women in the normal weight range at the start needed the equivalent of an hour a day of moderate-to-vigorous physical activity to maintain a steady weight.

Vigorous activities seem to be more effective for weight control than slow walking. Although women gained, on average, about 20 pounds over the course of the study, those who increased their physical activity by 30 minutes per day gained less weight than women whose activity levels stayed steady.

And the type of activity made a difference: Bicycling and brisk walking helped women avoid weight gain, but slow walking did not. Exercise can help promote weight loss, but it seems to work best when combined with a lower calorie eating plan.

All study volunteers were asked to stick to their usual diets. After six months, those assigned to the high-intensity regimen lost abdominal fat, whereas those assigned to the low- and medium-intensity exercise regimens had no change in abdominal fat.

More recently, researchers conducted a similar trial with post-menopausal women, randomly assigning them to either 45 minutes of moderate-to-vigorous aerobic activity, five days a week, or to a control group. Most of the women were overweight or obese at the start of the study.

After one year, the exercisers had significant decreases in body weight, body fat, and abdominal fat, compared to the non-exercisers. Researchers believe that physical activity prevents obesity in multiple ways: Being moderately active for at least 30 minutes a day on most days of the week can help lower the risk of chronic disease.

But to stay at a healthy weight, or to lose weight, most people will need more physical activity-at least an hour a day-to counteract the effects of increasingly sedentary lifestyles, as well as the strong societal influences that encourage overeating. People are less likely to be active if they live in sprawling suburbs designed for driving or in neighborhoods without recreation opportunities.

World Health Organization. Notes for the media: New physical activity guidance can help reduce risk of breast, colon cancers ; Accessed January 28, Global recommendations on physical activity for health ; Accessed January 30, of Health and Human Services.

Haskell WL, Lee IM, Pate RR, et al. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research.

Public Health Rep. Troiano RP, Berrigan D, Dodd KW, Masse LC, Tilert T, McDowell M. Physical activity in the United States measured by accelerometer. Med Sci Sports Exerc. Juneau CE, Potvin L. Trends in leisure-, transport-, and work-related physical activity in Canada Prev Med.

Brownson RC, Boehmer TK, Luke DA. Declining rates of physical activity in the United States: what are the contributors? Annu Rev Public Health. Petersen CB, Thygesen LC, Helge JW, Gronbaek M, Tolstrup JS.

Time trends in physical activity in leisure time in the Danish population from to Scand J Public Health. Ng SW, Norton EC, Popkin BM.

Why have physical activity levels declined among Chinese adults? Findings from the China Health and Nutrition Surveys. Soc Sci Med. Stamatakis E, Ekelund U, Wareham NJ. Temporal trends in physical activity in England: the Health Survey for England to McDonald NC. Active transportation to school: trends among U.

schoolchildren, Am J Prev Med. Wareham NJ, van Sluijs EM, Ekelund U. Physical activity and obesity prevention: a review of the current evidence. Proc Nutr Soc. Kjellstrom T, Hakansta C, Hogstedt C. Globalisation and public health-overview and a Swedish perspective.

Scand J Public Health Suppl. Mekary RA, Feskanich D, Malspeis S, Hu FB, Willett WC, Field AE. Physical activity patterns and prevention of weight gain in premenopausal women. Int J Obes Lond.

Seo DC, Li K. Leisure-time physical activity dose-response effects on obesity among US adults: results from the National Health and Nutrition Examination Survey.