A focus on low body weight and body fat content, combined with regulations in some weight-sensitive sports, are considered risk factors for extreme dieting, eating disorders (EDs) and related health consequences among athletes. At present there are, from a health perspective, no generally accepted optimum values for body weight or percentage of fat mass in different sports and there is no 'gold standard' method for body composition assessment in athletes. On the basis of health considerations as well as performance, medical support teams should know how to approach elite athletes who seek to achieve an unrealistic body composition and how to prevent restrictive eating practices from developing into an ED. In addition, these teams must know when to raise the alarm and how to advice athletes who are affected by extreme dieting or clinical EDs. However, there is no consensus on when athletes struggling with extreme dieting or EDs should be referred for specialist medical treatment or removed from competition. Based on the present review, we conclude that there is a need for (1) sport-specific and gender-specific preventive programmes, (2) criteria for raising alarm and 'does not start' (DNS) for athletes with EDs and (3) modifications to the regulations in some sports. Further, the key areas for research identified include the development of standard methods for body composition assessment in elite athletes; screening measures for EDs among athletes; development and testing of prevention programmes; investigating the short and long-term effects of extreme dieting; and EDs on health and performance.
INTRODUCTIONIn various sports body weight and body composition are crucial performance variables.1 Some athletes are genetically suited to the specific anthropometric demands of the sport/weight class in which they compete, but many elite athletes struggle with extreme dieting and eating disorders (EDs) as they attempt to conform to competition regulations that are ill suited to their physique.2 As a consequence, athletes with very low body weight and/or body fat, frequent weight fluctuation, EDs and insufficient bone density are often found in weight-sensitive sports, with a high prevalence of menstrual dysfunction in women.3 Medical staff, including sports physicians, nutritionists and exercise scientists, experience challenges in handling the issues of optimum body composition, dieting and EDs in elite athletes.4 5 Furthermore, most sport nutritionists experience challenges related to application of minimum/maximum body composition or body mass values for health and performance, especially when confronted with a lack of knowledge among coaches and other support team members.5 Therefore, the aim of this article is to review the current knowledge related to minimising the risks associated with extreme weight control and EDs in elite athletes.
DefinitionsWeight-sensitive sports can be classified into three main groups: (1) gravitational sports, in which high body weight restricts performance because moving the b...