December 6, 2005
A growing number of young athletes are trying to gain and lose weight in ways that could harm their health - and their performance on the playing field, according to an updated policy statement from the American Academy of Pediatrics (AAP).
"Disordered eating behavior is prevalent in male and female athletes," the AAP said in its statement. "These practices can impair athletic performance and increase injury risk." In addition, they can disrupt a child's growth and sexual maturation, foster eating disorders, and cause long-term problems with a child's heart and digestive system.
The AAP also urged pediatricians to help young athletes control their weight in healthy ways and to recognize when there's a problem.
"Fluid or food deprivation should never be allowed," the AAP said. "There is no substitute for a healthy diet consisting of a variety of foods from all food groups with enough energy to support growth, daily physical activities, and sports activities."
The AAP also drew some boundaries when it comes to weight loss and sports, saying that a weight loss program for sports should never be put in place before a child is in the 9th grade.
And with the exception of sports that require mandatory weigh-ins, coaches should not discuss weight or weight loss with an athlete because they don't have the medical background to do that kind of counseling, the AAP said.
The findings are part of AAP's updated policy statement on the promotion of healthy weight control practices in young athletes. AAP policy statements are designed to keep pediatricians up to date on new research that may be helpful in treating patients.
The policy focuses on weight-sensitive sports where leanness is emphasized, including wrestling, cheerleading, distance running, swimming, gymnastics, and martial arts.
Among high school boys who participate in sports, 10% to 15% try to lose weight in an unhealthy way, the AAP said. One study found that 11% of male wrestlers have eating disorders, while another found that 45% of male wrestlers are at risk for developing one.
One study showed that among young swimmers, 60% of average-weight girls and 18% of underweight girls were trying to lose weight. For those girls, weight loss can lead to irregular periods and loss of bone density.
Most commonly, young athletes attempt to lose weight by limiting food intake, vomiting, and using laxatives and diuretics to get rid of food, the AAP said.
Some athletes are voluntarily dehydrating themselves to lose weight or appear more lean, a process that can impair strength, reflexes, endurance level, and a child's ability to think clearly and concentrate.
Younger kids are particularly at risk for dehydration - they absorb more heat because they have a higher body surface to body mass ratio, tend to drink less fluids, and their capacity to cool down by sweating is less than that of teens or adults.
The policy also addressed sports that demand weight gain and muscle mass, such as rugby, football, and basketball. Kids are also using unhealthy methods like supplements and steroids to try to get to an ideal weight, the AAP said. These substances - which in many cases are illegal - can slow a child down, hurt endurance, and lead to long-term health problems like high cholesterol, high blood pressure, heart disease, and type 2 diabetes.
The AAP also urged doctors to be on the lookout for patients who are trying to lose weight for sports in an unhealthy way and to counsel them on healthy weight loss practices.
Young athletes should be involved in programs that focus on gaining skills and improving speed, flexibility, strength, and physical conditioning while maintaining good nutrition and normal hydration, the AAP said. "This should be done under the supervision of a coach who stresses a positive attitude, character building, teamwork, and safety."
What it Means to You
If your child participates in sports and is concerned about gaining or losing weight to perform well, it's important to talk with your child's doctor.
The doctor can tell you - and your child - whether it's a good idea for your child to lose or gain weight. If it's appropriate, the doctor can provide guidance on healthy methods of weight control and also may refer your child to a registered dietitian.
If you're concerned that your child's coach is pressuring him or her to lose or gain weight, talk to the coach about your concerns.
It can be a challenge to tell the difference between normal concerns about self-image and performing well in sports, and warning signs that your child may be developing a problem.
Kids and teens - girls, especially - are going to be self-conscious, compare themselves with others, and want to diet. But those concerns don't necessarily mean that they have eating disorders. If a child seems concerned with his or her weight in an obsessive or unhealthy way and is starting to refuse food, it may be a sign of a potential eating disorder. In kids with eating disorders, there are glaring abnormal behaviors and physical signs, including:
- significant weight loss (15% below the normal weight for height)
- brittle hair or nails
- depression with social withdrawal
- purging by strict dieting, fasting, vigorous exercise, and/or vomiting
- abuse of laxatives or diuretics ("water pills") to lose weight
- swollen cheeks or glands (from induced vomiting)
- depression or mood swings
- in girls, irregular menstrual periods
- dental problems, such as tooth decay
If you are concerned that your child is using steroids or supplements to gain weight for sports, watch for these warning signs:
- exaggerated mood swings
- confusion
- violent behavior
- unusually greasy skin with stretch marks
- acne
- a sudden increase in muscle size
- girls can suddenly become more masculine and have deeper voices
- boys can develop breasts, a condition called gynecomastia
If you have suspicions that your child is using these drugs, call your child's doctor, who may recommend that you have your child tested for them.
Talking to Your Child About Your Concerns
It's common for kids who are trying to control their weight in unhealthy ways to feel defensive and angry when confronted. They often have trouble admitting, even to themselves, that they have a problem.
Remember that it's not your job to diagnose your child - only a doctor can do that. Your job is to express your concerns and get your child to a medical professional for an objective and accurate assessment.
Approach your child in a loving, supportive, and non-threatening way. Try to use a setting where your child feels comfortable and relaxed, and there are no distractions.
Your child may be more receptive to a conversation if you focus on your own concerns, explain specifically the things that have made you worry, and say that you want your child to see a doctor just to put your own mind at ease.
If your child still resists help, the doctor may be able to give you some additional guidance on a better approach.
Reviewed by: Barbara P. Homeier, MD
Date reviewed: December 2005
