Female Athletic Triad
*Trigger warning, discussing body dysmorphia, the Female Athletic Triad, disordered eating*
I've been thinking a lot about body image this past week. There are many layers of body image, and body shaming from social expectations in many aspects of daily life. Since my profession focuses on fitness, wellness, movement therapy, and dance, body image is a common theme in all these spaces.
This goal of a perfected image is perpetuated within fitness and everywhere around us. People who look slightly more chiseled are suddenly fitness experts on social media even if they have no credentials, simply because they appear "fit". Fitness models are used as a measure of fitness "success" to strive for, instead of seen as the outliers that most people don't need to attain. Fitness professionals are often judged as less capable if the shapes of their bodies are not at the standard of typical beauty fitness.
As a dancer I grew up focusing intensely on my body, seeing my image reflected back in the studio mirrors while wearing only sheer tights and a leotard. Choreographers preferred us to have the ideal dancer body, giving us more attention and positive feedback. While social preferences of beauty change over time, the judgement of not meeting these ideals is constant. The dance world has come to acknowledge the severe aesthetic pushed on dancers, especially in Ballet, however, it's still an unspoken expectation that dancers will look a certain way.
As athletes, we need to fuel up in order to be strong and capable to perform at the high-intensity our art demands, yet we have an unspoken need to fit the sport-specific image. It's almost a secret competition to be skinnier than the other dancers. Many ballerinas have type-A personalities and are perfectionists. It's hard to know whether we grow into this personality from the rigor and training of Ballet, or if we're drawn to this art form, to this sport, because of our perfectionist drive. Either way, we are already primed to strive for perfection, pushing our bodies and minds farther for each rehearsal and class. And often it seems like it’s never enough.
In Ballet this body sensitivity can start with an unhealthy obsession with how pointed our feet are, how extreme our arches can bend, how high our leg can lift, and how extreme our turn out can get toward 180°. As years go on, this drive toward an idea of perfection can turn towards body fat and a restricted diet.
This caloric restriction can occur in anyone, in any sport, and at any age, but especially for participants in sports that focus heavily on body image. It is quite common in young women at an elite level of athletics. The combination of caloric restriction and extreme levels of training turns into an energy deficit in the body which can then cause significant weight loss. In women, this then can turn into amenorrhea, the loss of a menstrual cycle, which impacts bone mineral density (BMD), which paves the way for osteopenia or osteoporosis, significantly lowered BMD.
The trio of disordered eating habits, amenorrhea, and osteopenia is labeled The Female Athletic Triad.
This creates significant risk for the athlete as lower BMD can lead to stress fractures and other injuries, and the lack of calories can lead to dangerous weight loss and over time organ failure, gastric distress, and disordered metabolic function.
I remember learning about female athletic triad in freshman year of college in a Kinesiology course “Injury Prevention for Dancers”. When the professor began the lecture I quickly realized that I was a case example. That day after the lecture I decided I needed help, so I went to the student health center where we had easily access to therapists and physicians. My habits of disordered eating and body dysmorphia had started years before in High School, but with a professional dance schedule, anxiety, and full-time college class load it had easily gotten out of control. Disordered eating often stems from a desire to feel in control, which is an irony because the excessive control of food intake turns into obsession and anxiety surrounding food and weight, becoming out of control.
Luckily, I had access to great therapists who specialized in professional athletes' disordered eating, I had a support network, hobbies outside of my sport that helped to balance my focus, and I was willing to try to change my habits. However, some athletes won’t seek help, and will even hide the issue out of concern of losing control and “becoming fat” or because they don’t accept or understand that they have a problem.
To this day I still have triggers surrounding body image and food. Since I am a movement educator and wellness professional and have done my own personal work over the years, I know how to work through these triggers and reduce anxiety and eliminate disordered behavior for myself. However, I do still get anxious when I don't get to work out one day, whether it's because I'm busy, sick, injured, or tired. It's still challenging to give myself the break, even though I preach to my clients that they need to be kind to themselves and sometimes taking a rest day is more important than exercise.
Most recently I had an anxiety relapse surrounding body dysmorphia as I had been using a fitness app that tracks daily workouts and steps taken each day. I have never purchased a fitness watch specifically because I knew it would be a trigger for me. This app however is already on the phone, and I thought it would be fun to track the extra miles I had been training in jogging and biking. Within just a few weeks of use, I realized it was a major trigger, listing my daily workouts and assigning numbers to my workouts based on how many minutes it tracked me moving instead of simply focusing on how I felt.
These food tracking apps, workout tracking apps and fitness devices are great tools for people who need help getting started on a fitness path, or for people who lead sedentary lives to realize how much more movement they need to incorporate daily for general health. However, for fitness professionals and elite athletes, it can turn into another competition, another number to achieve, another goal. For myself, I deactivated the app after a month of use. Instead, I keep a fairly regular weekly exercise schedule because that's the level of control that feels good to myself to reduce anxiety without becoming obsessive. However, my next goal is to allow myself to be okay with taking rest days and to not become anxious about taking multiple days off when wanted or needed.
Just like I would tell a client, it's important to schedule rest days just as important as it is to get enough physical activity. Be kind to yourself. Fitness should be about health and wellness, not about changing ourselves to fit someone else's image of success or beauty.
Now my workout time is my space in the day that is important for me to feel both physically and mentally healthy, to center, to feel strong, to be present.
I was inspired to discuss this after hearing Shawn Johnson's recent youtube video describing her own journey through disordered eating, body dysmorphia, and the adverse health effects she experienced in gymnastics while professional and after she retired from her sport, and then years later as she went through pregnancy. This is too common of an issue, especially for women in sports, but luckily there is now more awareness of the Female Athletic Triad, and exposure for coaches and instructors on ways to help their athletes.
The hotline for the National Eating Disorder is: 1-800-931-2237.
Warning signs and symptoms may include, but are not limited to:
Amenorrhea: irregularity in menstrual cycle
Sudden or significant weight loss
Stress fractures
Constant weakness and fatigue
Significant and unhealthy changes in diet/eating behavior
Binging/purging, avoiding food, or creating rules/limiting what is "allowed" to be eaten (i.e. suddenly vegan or gluten free)
Orthorexia: Significant concern over “clean foods”
Body Dysmorphia
Burnout
Anxiety and depression
Hypergymnasia: overtraining or excessive and compulsive exercise
Longer recovery from injuries
