We’ve long known some of the physical risks of underfueling for your sport, especially in women, but a new study finds a link between mental health and the Female Triad. 

A recent study published in the Clinical Journal of Sports Medicine reported that researchers have found a link between women screened for triad risk factors, and being at risk for depression and anxiety. This was especially found to be true in women with Low Energy Availability (LEA), and who experienced disordered eating – either currently, or in the past. These findings highlight the importance of addressing mental health concerns in women diagnosed with the female athlete triad, and researchers suggest that screening for depression and anxiety symptoms should be incorporated into the treatment and management of underfueling, alongside nutritional interventions. It is crucial to provide these athletes with appropriate mental health resources and support to prevent the progression of eating disorders and improve overall well-being.

The study involved a cross-sectional survey distributed online to male and female high school, collegiate and post-collegiate athletes. Participants completed the survey, assessing components of the triad, as well as questionnaires about depression and anxiety symptoms. We already know the results showed a higher risk or presence of moderate to severe depression and anxiety symptoms in women, however no significant associations were found between triad risk score and depression and anxiety symptoms among men.

What did researchers look at in their survey?

• Menarche (women only)
• Oligomenorrhea (women only)
• Body Mass Index
• Energy Availability
• Bone Stress Injuries

What did researchers consider underfueling?

Researchers evaluated energy availability through questions about eating behaviors, as well as dietary restraint, pathological behavior, shape concern and weight concern. A score of 2 suggested low energy availability [1,2], a score of 1 suggests moderate energy availability, and a score of 0 suggests high energy availability [3]. Researchers also asked the men and women about a history of eating disorders, giving a score of 1 or 2 to women who reported a past or current diagnosis of disordered eating or an eating disorder, based on responses to current eating behavior questions.

Low energy availability does not have to always come with eating disorders or a diagnosis of disordered eating, but they are frequently correlated, and researchers were not surprised to find that the depression and anxiety symptoms were reportedly correlated. They also found that ONLY the low energy availability risk score was independently linked with the mental health symptoms in women, and their measurement reflected the self-reporting of disordered eating behaviors. The researchers thought this observed link may “primarily reflect the mental health dimensions of disordered eating/eating disorders.”

More Research Is Needed

While further research will be needed to directly link LEA with depression and anxiety, the American Society for Sports Medicine’s current position is that all athletes should be routinely screened for eating disorders, as well as be provided with behavioral or family therapy [4]. But, not every low energy availability or disordered eating situation has become a full blown eating disorder, so researchers believe it might be beneficial for athletes to be also screened for anxiety or depression symptoms in order to avoid the progression.

Read the whole study here!

Want to know more about Low Energy Availability? Check out two resources below.

Nutritional Revolution dives into Low Energy Availability in a webinar available here: https://nutritional-revolution.com/product/low-energy-availability-lea-in-sport-webinar/

Watch the Nutritional Revolution podcast episode #21 with Dr. Kim Obrian about mental health tools for female athletes: https://nutritional-revolution.com/podcasts/episode-21-with-dr-kim-obrien-mental-health-tools-for-the-female-athlete/

References

1. Fairburn CG, Beglin SJ. Assessment of eating disorders: interview or self-report questionnaire? Int J Eat Disord. 1994; 16:363–370.

2. Barrack MT, Rauh MJ, Barkai HS, et al. Dietary restraint and low bone mass in female adolescent endurance runners. Am J Clin Nutr. 2008; 87:36–43.

3. Eating Disorder Examination Questionnaire (EDE-Q). Child Outcomes Research Consortium. Available at: https://www.corc.uk.net/outcome-experience-measures/eating-disorder-examination-questionnaire-ede-q/Accessed August 26, 2021.

4. Chang C, Putukian M, Aerni G, et al. Mental health issues and psychological factors in athletes: detection, management, effect on performance and prevention: American Medical Society for Sports Medicine Position Statement-Executive Summary. Br J Sports Med. 2020;54:216–220.