The female triad

Disordered Eating

Society has done a great disservice to adolescent females by perpetuating the "ideal" body image. For young women, this can intensify the pursuit of a thin physique at a time when nutrition plays a key role in proper growth and development. According to a 1997 Youth Risk Behavior Surveillance Survey, 34 percent of adolescent females were likely to consider themselves "too fat" and, therefore, limited their dietary intake (Kann et al. 1998). Hobart and Smucker (2000) add that many factors may create poor self-image and pathogenic weight-control behaviors in female athletes. Likewise, frequent weigh-ins, punitive consequences for weight gain, pressure to "win at all costs," an overly controlling parent or coach and social isolation caused by intensive sports involvement may increase a female athlete's risk of disordered eating behavior.

Disordered eating occurs in 5 percent of the general population (Donaldson 2003), but affects as many as two thirds of young female athletes (Nativ et al. 1994). According to Gidwani and Rome (1997), 32 percent of female athletes, at all levels of competition, practice pathogenic behavior for weight control. Rosen and Hough (1988) reported disordered eating behavior in 15 to 62 percent of female college athletes. Even before the triad was officially recognized as a distinct syndrome, Calabrese (1985) performed a study with collegiate gymnasts and discovered 62 percent displayed stone type of disordered eating--26 percent vomited on a daily basis, 24 percent used diet pills, 12 percent fasted and 75 percent had been told by their coaches that they weighed too much. Disordered eating behavior is believed to contribute to a disruption in the hypothalamic-gonadal axis, resulting in amenorrhea (Donaldson 2003).

The Interrelationship of the Triad

The three components of the female triad--disordered eating, amenorrhea and osteoporosis--pose serious health concerns for young athletic women. Shafer and Irwin (1991) state that the adolescent growth spurt accounts for approximately 25 percent of adult height and 50 percent of adult weight. Additionally, girls develop reproductive capacity during this time and dieting behaviors and nutrition can have an enormous impact on their gynecologic health (Seidenfeld and Rickert 2001).

While they can all occur independently, the interrelationship between the three parts of the triad is such that one component will affect another. In order to understand the physiological beginning of this syndrome, one must first realize that, in addition to the calories required for basal metabolic rate and physical activity, calories are required for menstruation, building and repairing muscle, healing and, in younger athletes, growth (Papanek 2003). The pathophysiology of the triad can be explained by a caloric deficit which disrupts the release of gonadotropin-releasing hormone, resulting in low levels of gonadotropins and secondarily reduced levels of estrogen and progesterone, leading to amenorrhea and osteopenia (Elford and Spence 2002).