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A Triple Threat : Eating disorders, osteoporosis and more. The Female Athlete Triad affects thousands of active and competitive girls and women. And the physical damage can be lasting.

September 08, 1997|MICHAEL DOBIE | NEWSDAY

A star soccer player, wanting to run a little faster and play a little better, cuts down on her eating and throws up after every meal. Five months later she is hospitalized with medical complications from an eating disorder.

A national-class distance runner goes more than 10 years without having a regular menstrual cycle.

A college swimmer fractures two ribs while coughing during an asthma attack.

Three athletes, three different ailments, but one thing in common--the Female Athlete Triad.

The triad is a chain-link series of disorders that affects tens of thousands of women, according to experts. June marked the fifth anniversary of the identification of the triad, but there still is only limited information available for athletes, coaches and administrators.

The triad is a continuum that generally begins with disordered eating, a serious and widespread ailment that by itself can lead to a host of life-threatening health problems. Doctors have discovered that if left untreated, disordered eating also can cause amenorrhea (the absence of a regular menstrual cycle). Amenorrhea, considered a red flag for the triad, also is a sign of increased risk for osteoporosis, a condition researchers are finding is permanent. The presence of any one disorder puts an athlete in the triad and she should be screened promptly for the other two ailments.

Many female athletes suffering from these disorders face a fundamental paradox: Intense pressure to excel sometimes leads to behavior that causes health risks, making success more difficult and dangerous to achieve. This balancing act between health and athletic success can create conflicts for coaches as well.

"It's not necessarily true that being a world-class athlete or being an elite athlete is the best thing for your body," New York City nutritionist Ellie Krieger said. "It may actually be in conflict with your body. When an athlete is driven to be world-class, it may actually be in conflict with your physical well-being."

Or, as University of Connecticut team physician Jeffrey Anderson asked, "Are optimal performance and optimal health mutually exclusive?"


The triad ailments--particularly disordered eating--are not uncommon in the general female population, which already is under pressure from a society obsessed with weight and appearance. But experts say that athletes, faced with the physical demands of training and subjected by their sports to even more pressure to stay thin, are especially vulnerable. Often, some of the very traits that make a great athlete--competitiveness, stubbornness and perfectionism--also make a woman more susceptible to the triad.

For the past 18 months, Newsday has examined the many issues of the Female Athlete Triad. The investigation included interviews with more than 80 health care professionals, athletes and athletic officials, as well as more than 800 questionnaires answered by high school and college athletes and athletic directors.

Responses from all of the groups make one thing clear: As the number of serious female athletes grows, so does concern about the triad.

"We can't wait for data," said Carol Otis of the American College of Sports Medicine, the group that first defined the triad. "We have people dying. We have people being permanently harmed."

"There is a relative ignorance in the population about it being widespread," said Tina Huffman, an elite gymnast from Connecticut who quit the sport at 15. At that point, Huffman already was restricting what she ate, purging occasionally and exercising compulsively--all forms of disordered eating--to retain the small physique demanded by her coaches.

Eventually, she became anorexic. Huffman battled the disease for nearly 15 years, and was amenorrheic most of that time. She almost went into kidney failure, had an irregular heartbeat and was hospitalized many times, once after dropping to 65 pounds. Although she is in recovery, her bone density is 70% of normal and her risk of fracture is considered "moderate to marked."

For Huffman, the need to stay small overwhelmed any concern about medical consequences.

"The long-term effects don't matter," said Huffman, now 32 and doing her residency in medical physics at an Atlanta-area hospital. "You're told you can die from this, but that's not reality at this moment. The short-term benefits outweigh the long-term costs."

That was the case for Michelle, a 20-year-old woman from Long Island, N.Y., who just completed her junior year of college. Michelle requested anonymity for this story.

A standout soccer player, Michelle has battled eating disorders since her junior year of high school. Her problem peaked in college, when she decided to lose weight in an effort to increase her speed. After five months of cutting back on food, throwing up and abusing laxatives, she lost 45 pounds and had to be hospitalized.

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