The Female Athlete Triad FAT Mary Lloyd Ireland

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The Female Athlete Triad (FAT) Mary Lloyd Ireland, M. D. University of Kentucky Dept.

The Female Athlete Triad (FAT) Mary Lloyd Ireland, M. D. University of Kentucky Dept. of Orthopaedic Surgery & Sports Medicine Lexington, Kentucky USA (859) 218 -3061 www. ukhealthcare. uky. edu/sportsmedi cine

The Female Athlete Triad

The Female Athlete Triad

The Female Athlete Triad Three related factors: Disordered eating Amenorrhea Osteoporosis Prevalence: 15 -62%

The Female Athlete Triad Three related factors: Disordered eating Amenorrhea Osteoporosis Prevalence: 15 -62% 3. 4 -66% Unknown High recurrence rate in anorexia: 30% relapse • 10 -18% mortality rate Most likely you have seen a female athlete with this triad.

Body image is important to all ages Thin is still in Young females are

Body image is important to all ages Thin is still in Young females are doing anabolic steroids to look “cut”

Did you know that Marilyn Monroe was. . . 5’ 4”, 140 lbs. and.

Did you know that Marilyn Monroe was. . . 5’ 4”, 140 lbs. and. . .

. . . that she pumped iron!

. . . that she pumped iron!

The Following Slide Contains an Excerpt Courtesy of American College of Sports Medicine “The

The Following Slide Contains an Excerpt Courtesy of American College of Sports Medicine “The Female Athlete Triad”

American College of Sports Medicine “The Female Athlete Triad”

American College of Sports Medicine “The Female Athlete Triad”

The Next Slide Contains a Short Preview of the New Video: “Eating Disorders: More

The Next Slide Contains a Short Preview of the New Video: “Eating Disorders: More Common Than You Think” Sponsored by the James E. Ireland Foundation Supported by the Women’s Sports Foundation

“Eating Disorders: More Common Than You Think” Sponsored by the James E. Ireland Foundation

“Eating Disorders: More Common Than You Think” Sponsored by the James E. Ireland Foundation Supported by the Women’s Sports Foundation

“Eating Disorders: More Common Than You Think” Funded by the James E. Ireland Foundation

“Eating Disorders: More Common Than You Think” Funded by the James E. Ireland Foundation http: //james-e-irelandfoundation. com/ Scenes in the video were played by students from the School for Creative and Performing Arts (SCAPA)

1992 US Olympic Gymnastics Team eating hamburgers at the White House

1992 US Olympic Gymnastics Team eating hamburgers at the White House

Epidemiology of FAT (Female Athlete Triad) • 15% – 62% of college female athletes

Epidemiology of FAT (Female Athlete Triad) • 15% – 62% of college female athletes with disordered eating • 3. 4% – 66% female athletes with amenorrhea compared to 2% – 5% in the general female population • Amongst female athletes with menstrual disturbance, prevalence of osteopenia or osteoporosis ranges from 1. 4% – 50%

Epidemiology of FAT (Female Athlete Triad) • 425 female college athletes, 7 Universities •

Epidemiology of FAT (Female Athlete Triad) • 425 female college athletes, 7 Universities • 3. 3% reported a diagnosis of anorexia nervosa • 2. 3% reported a diagnosis of bulimia nervosa • 15. 2% – 32. 4% scored “at-risk” for EDO • 31% reported menstrual irregularity • 65. 9% reported muscle injuries during collegiate career • 34. 3% reported bone injuries during collegiate career (Beals, Manore. Int. J Sp. Nutr, 2002)

Disordered Eating • At risk: • Sports that focus on weight (distance running, gymnastics,

Disordered Eating • At risk: • Sports that focus on weight (distance running, gymnastics, dancers, wrestlers) • Chronic diseases related to caloric utilization (diabetes) • Food- or weight-focused professions (models, culinary professionals) • Disordered eating is fueled by the misconceptions: “Thinner is better”! “If I’m thinner I’ll run faster, jump higher, be more popular, be happier. ”

Description of Eating Disorders • Abnormal eating patterns & cognitive distortions related to food

Description of Eating Disorders • Abnormal eating patterns & cognitive distortions related to food and weight • Emotional/psychiatric ▪ Disturbed body image ▪ Preoccupation with becoming thinner ▪ Fear of becoming fat • Disease affects: ▪ nutritional status ▪ medical health ▪ mental health

DSM IV: Anorexia Nervosa • Restricting type No regular binge eating or purging •

DSM IV: Anorexia Nervosa • Restricting type No regular binge eating or purging • Binge-eating/purging type Regular binge-eating or purging behavior • self-induced vomiting, laxatives, diuretics, enemas • Refusal to maintain body weight • (< 85% expected); no weight gain during periods of growth • Intense fear of gaining weight and becoming fat, even though underweight • Disturbance of body image, or denial of seriousness of low body weight • Amenorrhea (3 consecutive menses)

Food Behaviors – Anorexia Nervosa • Counts calories/fat grams Anorexia Nervosa • Restricts fat,

Food Behaviors – Anorexia Nervosa • Counts calories/fat grams Anorexia Nervosa • Restricts fat, protein and • Co-morbidity other foods ▪ 25% lifetime prevalence of • Avoids red meat, other meats obsessive compulsive • Eats mostly vegetables disorder and fruit ▪ 50 -75% prevalence of • Eats slowly dysrhythmia • Cuts food into small pieces • Prognosis • Denies hunger • Throws food away ▪ 40 – 50% recover completely ▪ 30% improve ▪ 25% chronic course ▪ 10 – 15% mortality rate

DSM IV: Bulimia Nervosa • Recurrent episodes of binge eating • Amount of food

DSM IV: Bulimia Nervosa • Recurrent episodes of binge eating • Amount of food larger than normal • Sense of lack of control • Inappropriate compensatory behaviors • Self-induced vomiting, misuse of laxatives, • • • diuretics, enemas • Fasting or excessive exercise Behaviors occur 2 x per week for 3 months Self-worth based on body size, shape, & weight Not occur exclusively during episodes of AN Purging type • Regular self-induced vomiting or misuse of laxatives, diuretics or enemas Non-purging type • Inappropriate compensatory behaviors, such as fasting or excessive exercise • No self-induced vomiting, misuse of laxatives, diuretics or enemas

Food Behaviors – Bulimia Nervosa • • • Somewhat aware of calories Binges on

Food Behaviors – Bulimia Nervosa • • • Somewhat aware of calories Binges on calorie-dense, sweet foods Eats fast, gulping food in large bites Frequently hungry Cannot waste food • Co-morbidity • Depression • Substance abuse • Many have history of sexual trauma • Prognosis • > 50% recover completely • 25% retain some abnormal eating habits • Few become anorectic • 30% maintain a nonspecified eating disorder

DSM IV: Eating Disorder NOS • AN, but regular menses • AN, but normal

DSM IV: Eating Disorder NOS • AN, but regular menses • AN, but normal weight; despite weight loss • BN, but frequency < 2 x/week or <3 months • Inappropriate compensatory behavior after normal food intake • Chewing & spitting, not swallowing, large amounts of food • Binge eating disorder (BED): binges w/o purging

Menstrual Dysfunction • Delayed menarche • No secondary sexual characteristics by age 14 •

Menstrual Dysfunction • Delayed menarche • No secondary sexual characteristics by age 14 • No menses by the end of the 16 th year • Oligomenorrhea • Cycle length > 35 days, < 90 days • Secondary amenorrhea • Cessation of menses for 90 days once normal menses have been established

Orthopaedic Conditions More Common in Females Stress Fractures

Orthopaedic Conditions More Common in Females Stress Fractures

High Risk Tensile Side

High Risk Tensile Side

Low Risk Compression Side

Low Risk Compression Side

Injury Patterns • Cheerleading Injuries • Who gets hurt? • How bad? • No

Injury Patterns • Cheerleading Injuries • Who gets hurt? • How bad? • No NCAA tracking of injuries in cheerleading • Studies on cheerleading injuries are needed

Fatalities and Catastrophic Injuries – from Cantu RC, Mueller FO, “Fatalities and catastrophic injuries

Fatalities and Catastrophic Injuries – from Cantu RC, Mueller FO, “Fatalities and catastrophic injuries in high school and college sports, 1982 -1997, ” in The Physician and Sportsmedicine 1999; 27(8): 35 -48.

Fatalities and Catastrophic Injuries Direct Fatalities & Catastrophic Injuries HIGH SCHOOL Cheerleading Gymnastics Track

Fatalities and Catastrophic Injuries Direct Fatalities & Catastrophic Injuries HIGH SCHOOL Cheerleading Gymnastics Track Swimming Basketball Softball Field Hockey Volleyball TOTAL Indirect Fatalities HIGH SCHOOL 18 9 3 2 2 1 39 Basketball Swimming Track Cheerleading Soccer Cross country Volleyball TOTAL 8 5 4 3 1 1 1 23

Fatalities and Catastrophic Injuries Direct Fatalities & Catastrophic Injuries COLLEGE Cheerleading 16 Gymnastics 2

Fatalities and Catastrophic Injuries Direct Fatalities & Catastrophic Injuries COLLEGE Cheerleading 16 Gymnastics 2 Field Hockey 1 Downhill skiing 1 Lacrosse 1 TOTAL 21 Indirect Fatalities COLLEGE Tennis Basketball 1 1 TOTAL 2

Prevention Strategies • Coaches should: • Supervise all practices • Be safety certified •

Prevention Strategies • Coaches should: • Supervise all practices • Be safety certified • Have an emergency plan • Cheerleaders should: • Have a preparticipation physical exam • Be trained in gymnastics, spotting, conditioning • Participate in stunts they have mastered

Extreme pressure placed on athletes by themselves and coaches Do we push our teenage

Extreme pressure placed on athletes by themselves and coaches Do we push our teenage athletes too hard?

STOP Elbow Injuries in Youth Baseball: Youth Sports Injury Prevention Sports Trauma and Overuse

STOP Elbow Injuries in Youth Baseball: Youth Sports Injury Prevention Sports Trauma and Overuse Prevention Powerpoint www. stopsportsinjuries. org/

STOP Cheerleading Injuries Tip Sheet

STOP Cheerleading Injuries Tip Sheet

Psychology of Coaching • Manhood: “Be the Man” • Boys/men humiliation tactics by their

Psychology of Coaching • Manhood: “Be the Man” • Boys/men humiliation tactics by their coaches if performing poorly • Do not work on female athletes – Kathy De. Boer, “Optimizing performance in team sports for female athletes. ” In Ireland & Nattiv, eds. The Female Athlete, 2002. • The female athlete is very competitive – must use methods to motivate and match world view

Joan Ryan, Little Girls in Pretty Boxes Warner Books (New York), © 1995

Joan Ryan, Little Girls in Pretty Boxes Warner Books (New York), © 1995

The Positive • High school girls who play sports are less likely to have

The Positive • High school girls who play sports are less likely to have an unplanned pregnancy, less likely to be involved with drugs, and more likely to graduate from high school. • A teenager’s risk of breast cancer drops with as little as 2 hours of exercise a week.

The Positive • It is possible to help prevent osteoporosis by engaging in weight

The Positive • It is possible to help prevent osteoporosis by engaging in weight bearing exercises that encourage an increase in bone mass. • Females involved in sports have been shown to have higher self-esteem and lower incidences of depression. • High school athletes have higher grades than their non-athlete counterparts.

The Positive • Females involved in sports have a more positive body image and

The Positive • Females involved in sports have a more positive body image and experience higher states of psychological well-being than those who do not play sports. • Sports teaches teamwork, goal-setting, the pursuit of excellence and other achievementbased behaviors. It has been shown these traits carry over to the workplace.

A WOMAN IS OFTEN MEASURED. . . by the things she cannot control. She

A WOMAN IS OFTEN MEASURED. . . by the things she cannot control. She is measured by the way her body curves or doesn’t curve. By where she is flat or straight or round. She is measured by 3624 -36 and inches and ages and numbers, by all the outside things that don’t ever add up to who she is on the inside. And so if a woman is to be measured, let her be measured by the things she can control. By who she is and who she is trying to become. Because as every woman knows, measurements are only statistics and STATISTICS LIE. ― Nike: “Helping Athletes with Eating Disorders”

The End. . . The Female Athlete Triad (FAT) Mary Lloyd Ireland, M. D.

The End. . . The Female Athlete Triad (FAT) Mary Lloyd Ireland, M. D. University of Kentucky Dept. of Orthopaedic Surgery & Sports Medicine Lexington, Kentucky USA (859) 218 -3061 www. ukhealthcare. uky. edu/sportsmedi cine Thank You!

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