Promotion of healthy weight-control practices in young athletes

Many athletes engage in unhealthy weight-control practices. This new policy statement urges pediatricians to attempt to identify and help these athletes and provides information about how to support sound nutritional behavior. Athletes may engage in unhealthy weight-control practices, particularly in sports in which thinness or "making weight" is judged important to success, such as body building, cheerleading, dancing (especially ballet), distance running, diving, figure skating, gymnastics, horse racing, rowing, swimming, weight-class football, and wrestling.1-3 Some athletes may use extreme weight-loss practices that include overexercising; prolonged fasting; vomiting; using laxatives, diuretics, diet pills, other licit or illicit drugs, and/or nicotine; and use of rubber suits, steam baths, and/or saunas. The majority of these disordered eating behaviors do not meet Diagnostic and Statistical Manual of Mental Disorders, 4th ed, criteria4 for anorexia nervosa or bulimia nervosa. In two surveys of 208 female collegiate athletes, 32% and 62% practiced at least one of the following unhealthy weight-control behaviors: self-induced vomiting, binge eating more than twice weekly, and using laxatives, diet pills, and/or diuretics.5,6 Of 713 high school wrestlers in Wisconsin, 257 (36%) demonstrated two or more behaviors related to bulimia nervosa.7 In a survey of 171 collegiate Indiana wrestlers concerning their behaviors in high school, 82% had fasted for more than 24 hours, 16% had used diuretics, and 9.4% had induced vomiting at least once a week.8 Many athletes are secretive about these potentially harmful practices. Disordered eating may have a negative short-term impact on athletic performance. Athletes who lose weight rapidly by dehydration are probably impairing their athletic performance, especially if it involves strength or endurance,9 and these strength deficits may persist even after rehydration.10