Nutritional Considerations for Female Athletes in Weight Category Sports

Body Mass Management Practices of Olympic Weightlifting Athletes

This study explored the body mass (BM) management practices among competitive male and female Olympic weightlifting athletes, hypothesizing that athletes compete in lighter weight categories than their habitual training weight (i.e., making weight). Utilizing a validated, anonymous survey, data were collected from 149 Olympic weightlifting athletes (>18 years; female = 94). The survey comprised five sections: demographics, training/competition history, weight history, source of influence, and BM management practices. The prevalence, magnitude, and methods employed for BM management were analyzed with subgroup analysis using one-way analysis of variance. Post hoc testing including Spearman's rho and chi-square analysis was completed when a significant effect was found. Three quarters (76%) of athletes acknowledged using chronic weight loss and/or acute weight loss strategies to make weight. Usual BM loss (2%-3%) in the week before competition was within recommended guidelines. Gradual dieting, fluid restriction, and low food weight, high-calorie options were the most commonly used BM management strategies. Female athletes were more likely to use gradual dieting (p = .043; r = .104) and were less likely to increase their exercise (p = .046; r = -.105) and utilize fasting (p = .038; r = .05) compared with their male counterparts. Women further identified dietitians/nutritionists (p = .006; r = .022) as a highly influential source of information. This research offers new insights into the BM management practices of Olympic weightlifting athletes, identifying that the majority of athletes compete at a BM lighter than their habitual training weight, achieved using a range of chronic weight loss and acute weight loss strategies.

Does Relative Energy Deficiency in Sport (REDs) Syndrome Exist?

Relative energy deficiency in sport (REDs) is a widely adopted model, originally proposed by an International Olympic Committee (IOC) expert panel in 2014 and recently updated in an IOC 2023 consensus statement. The model describes how low energy availability (LEA) causes a wide range of deleterious health and performance outcomes in athletes. With increasing frequency, sports practitioners are diagnosing athletes with "REDs," or "REDs syndrome," based largely upon symptom presentation. The purpose of this review is not to "debunk" REDs but to challenge dogmas and encourage rigorous scientific processes. We critically discuss the REDs concept and existing empirical evidence available to support the model. The consensus (IOC 2023) is that energy availability, which is at the core of REDs syndrome, is impossible to measure accurately enough in the field, and therefore, the only way to diagnose an athlete with REDs appears to be by studying symptom presentation and risk factors. However, the symptoms are rather generic, and the causes likely multifactorial. Here we discuss that (1) it is very difficult to isolate the effects of LEA from other potential causes of the same symptoms (in the laboratory but even more so in the field); (2) the model is grounded in the idea that one factor causes symptoms rather than a combination of factors adding up to the etiology. For example, the model does not allow for high allostatic load (psychophysiological "wear and tear") to explain the symptoms; (3) the REDs diagnosis is by definition biased because one is trying to prove that the correct diagnosis is REDs, by excluding other potential causes (referred to as differential diagnosis, although a differential diagnosis is supposed to find the cause, not demonstrate that it is a pre-determined cause); (4) observational/cross-sectional studies have typically been short duration (< 7 days) and do not address the long term "problematic LEA," as described in the IOC 2023 consensus statement; and (5) the evidence is not as convincing as it is sometimes believed to be (i.e., many practitioners believe REDs is well established). Very few studies can demonstrate causality between LEA and symptoms, most studies demonstrate associations and there is a worrying number of (narrative) reviews on the topic, relative to original research. Here we suggest that the athlete is best served by an unbiased approach that places health at the center, leaving open all possible explanations for the presented symptoms. Practitioners could use a checklist that addresses eight categories of potential causes and involve the relevant experts if and when needed. The Athlete Health and Readiness Checklist (AHaRC) we introduce here simply consists of tools that have already been developed by various expert/consensus statements to monitor and troubleshoot aspects of athlete health and performance issues. Isolating the purported effects of LEA from the myriad of other potential causes of REDs symptoms is experimentally challenging. This renders the REDs model somewhat immune to falsification and we may never definitively answer the question, "does REDs syndrome exist?" From a practical point of view, it is not necessary to isolate LEA as a cause because all potential areas of health and performance improvement should be identified and tackled.

Rapid Weight Changes and Competitive Outcomes in Muay Thai and Mixed Martial Arts: A 14-Month Study of 24 Combat Sports Events

This study investigates the rapid weight loss (RWL) and rapid weight gain (RWG) of contest winners and losers from Muay Thai (MT) and mixed martial arts (MMA) events. The relationship between rapid weight change variables of males and females, and competitive success is also examined. Data from a weight management questionnaire was collected one day post-competition from 185 participants across 24 fight events, resulting in 263 responses (MMA: n = 78, MT: n = 185). Official and secondary weigh-in data were provided by the Combat Sports Commission. The results show that in MT, contest winners compared to losers had significantly greater RWL-7 days (5.9 ± 2.6% vs. 4.6 ± 2.7%, p = 0.01), RWG (6.2 ± 2.9% vs. 4.7 ± 2.8%, p = 0.003), and RWG/RWL ratio (108% [86-132%] vs. 86% [60-119%], p = 0.038), while no significant differences were observed for MMA. Mixed logistic regression models that controlled for age showed that a 1% increase in female RWL-24 h ([OR = 1.57, R2 = 0.105, p = 0.001]) was associated with a 1.6 times higher likelihood of winning compared to female athletes without this increase. We emphasise that associations do not imply causation, and it is possible that other factors which align with rapid weight change practices may impact the observed relationship. Nonetheless, MT contest winners show greater RWL, RWG, and RWG/RWL ratio than losers, and female rapid weight changes appear to be associated with competitive success in this cohort.

Prevalence of physiological and perceptual markers of low energy availability in male academy football players: a study protocol for a cross-sectional study

Low energy availability (LEA) is a core feature of the female athlete triad and relative energy deficiency in sport (REDs). LEA underpins multiple adverse health and performance outcomes in various athletic populations, including weight category, endurance and aesthetic sports. Recent reports suggest LEA is highly prevalent in female football, volleyball and netball, with little known on male team-sport athletes. Therefore, the study aims to identify the prevalence of LEA among male academy football players (16-23 years), using surrogate markers that align with the International Olympic Committee REDs Clinical Assessment Tool-Version 2. A cross-sectional study design will be used with physiological and perceptual markers of LEA measured. The study will seek to recruit 355 players to complete several online questionnaires believed to be associated with LEA, measured using a 24-hour food and activity diary. Of the 355 players, a subsample (n=110) will complete an additional 3-day food and activity diary, provide a venous blood sample to measure levels of total testosterone and free triiodothyronine, and have resting metabolic rate (RMR) measured to determine RMRratio. The prevalence of LEA will be determined using the low (<30 kcal·kgFFM-1·day-1) domain of energy availability and divided by the total number of participants. Descriptive statistics will be used to summarise the whole group and difference status of energy availability (eg, low, reduced, optimal, high). A univariable and multivariable binary logistic regression analysis will be modelled to assess the association of various surrogate markers with the presence of LEA.

An appetite to win: Disordered eating behaviours amongst competitive cyclists

Competitive cyclists may be vulnerable to disordered eating (DE) and eating disorders (ED) due to perceived body composition optimisation and external influences within cycling culture and from stakeholders. Therefore, this study aimed to assess DE and ED risk in competitive cyclists using the Eating Attitudes Test (EAT-26), explore differences in responses based on sex, discipline and level of competition, and to gain insights into contributing factors towards DE via open-ended survey questions. In total, 203 participants completed a mixed-method questionnaire. Eating disorders were reported by 5.7% ( n = 11) of participants, with three being historic cases. The median (inter-quartile range) EAT-26 score was 8 (12) of a total possible score of 78. Disordered eating risk was observed in 16.7% of participants due to an EAT-26 score ≥20. Female participants had significantly higher scores than male participants (12.5 ± 17.5 vs. 6.5 ± 10.0; p = .004). There was no significant difference between road cyclists and off-road cyclists (7.0 ± 13.25 vs. 8.0 ± 10.5; p = .683). There was a significant difference in scores between novice/club/regional and national/elite/professional cyclists (6.0 ± 11.25 vs. 10.5 ± 12.0; p = .007). Thematic analysis of open-text responses found that the social environment of competitive cycling contributed towards DE behaviours and body image issues. These findings indicate competitive cyclists do appear to be an ‘at risk’ population for DE/ED. Therefore, there is need for stakeholders to enhance nutritional services, nutrition education and create supportive athlete environments.

Acute and Chronic Weight-Making Practice in Professional Mixed Martial Arts Athletes: An Analysis of 33 Athletes Across 80 Fights

Mixed martial arts' popularity has increased in recent years, alongside descriptive research and evidence-based performance recommendations. Guidelines for (both chronic and acute) weight making exist; however, how these translate in real-life scenarios and detailed investigations on practices in larger groups deserve attention. The present study examined the body mass (BM) and composition of 33 professional mixed martial arts athletes preparing for 80 fights. Athletes were supported by on-site dietitians, who encouraged evidence-based practices. Fasted BM was measured throughout the last ∼10 days before all bouts (acute weight management phase). A subset of athletes had body composition assessed before and after the chronic weight loss phase for 40 fights. Most athletes engaged in chronic BM loss, and all engaged in acute weight loss. Many lost fat-free mass (FFM) during the chronic phase, with rates of BM loss <0.5% best preserving FFM. Regardless of losses, the present athletes possessed greater FFM than other combat sport athletes and engaged in greater acute weight loss. Dehydration in the 24-48 hr before the weigh-in was not reflective of weight regain after the weigh-in, rather BM 7-10 days before the weigh-in was most reflective. These findings suggest that many mixed martial arts athletes could increase FFM at the time of competition by maintaining leaner physiques outside of competition and/or allowing increased time to reduce BM chronically. Acutely, athletes can utilize evidence-based protocols, eliminating carbohydrates, fiber, sodium, and finally fluid in a staged approach, before the weigh-in, reducing the amount of sweating required, thus theoretically better protecting health and preserving performance.

Contemporary Issue: Health and Safety of Female Wrestlers

ABSTRACT

Female wrestling has grown exponentially over the past decade. Within the United States, 46 states now recognize female high school wrestling, and 153 colleges have programs. It is on track to become an NCAA championship-level sport in 2026. A primary health and safety risk among this cohort pertains to rapid weight loss strategies. These can lead to intentional caloric restriction and decreased body fatness, with the perceived goal of attaining a competitive advantage. Low energy availability and low body fatness are associated with a number of health concerns including menstrual dysfunction and loss of bone mineral density in girls and women. The current recommendation of 12% as a minimum for percentage body fat is very likely too low, opening the door for health perturbations among this population. The minimum threshold might more appropriately fall within the range of 18% to 20%. Body fat assessment methods, primarily skinfold measures that are used to guide weight class selection, have not been adequately validated among this population and therefore should be an area of research focus, while also exploring alternative assessment techniques. Further, we recommend that weight cycling, restrictive energy intake, and intentional dehydration be avoided. Research should assess the effects of frequent weight cycling (to "make weight") and prolonged periods of low body fat on the reproductive and bone health of these athletes. Finally, research and clinical evaluations on female wrestlers are limited, and we offer a list of research priorities for future investigation into this contemporary issue.

Sex Differences in Hydration Biomarkers and Test-Retest Reliability Following Passive Dehydration

This study investigated (a) differences between males and females for changes in serum, tear, and urine osmolality, hematocrit, and urine specific gravity following acute passive dehydration and (b) assessed the reliability of these biomarkers separately for each sex. Fifteen males (age: 26.3 ± 3.5 years, body mass: 76 ± 7 kg) and 15 females (age: 28.8 ± 6.4 years, body mass: 63 ± 7 kg) completed a sauna protocol twice (5-28 days apart), aiming for 4% body mass loss (BML). Urine, blood, and tear markers were collected pre- and postdehydration, and change scores were calculated. Male BML was significantly greater than that of females in Trial 1 (3.53% ± 0.55% vs. 2.53% ± 0.43%, p < .001) and Trial 2 (3.36% ± 0.66% vs. 2.53% ± 0.44%, p = .01). Despite significant differences in BML, change in hematocrit was the only change marker that displayed a significant difference in Trial 1 (males: 3% ± 1%, females: 2% ± 1%, p = .004) and Trial 2 (males: 3% ± 1%, females: 1% ± 1%, p = .008). Regression analysis showed a significant effect for sex (male) predicting change in hematocrit (β = 0.8, p = .032) and change in serum osmolality (β = -3.3, p = .005) when controlling for BML but not for urinary or tear measures. The intraclass correlation coefficients for females (ICC 2, 1) were highest for change in urine specific gravity (ICC = .62, p = .006) and lowest for change in tear osmolarity (ICC = -.14, p = .689), whereas for males, it was posthematocrit (ICC = .65, p = .003) and post tear osmolarity (ICC = .18, p = .256). Generally, biomarkers showed lower test-retest reliability in males compared with females but, overall, were classified as poor-moderate in both sexes. These findings suggest that the response and reliability of hydration biomarkers are sex specific and highlight the importance of accounting for BML differences.

Effects of Different Rapid Weight Loss Strategies and Percentages on Performance-Related Parameters in Combat Sports: An Updated Systematic Review

Most combat sports (CS) are structured in weight categories, and it is very common to carry out body weight adjustment strategies in order to compete in lower weight categories. For this reason, different rapid weight loss (RWL) strategies are usually performed to pass the pre-competition weigh-in test, and then a replenishment of fluids and carbohydrate-rich foods is conducted in an attempt to recover the weight and avoid a performance loss. In this context, no clear references have been found on whether these types of strategies have negative effects, impairing the athlete's combat and/or physical performance. For this reason, the aim of this study was to review the scientific literature on the effect of rapid weight reduction strategies on the performance of CS athletes. A literature search was performed through four different databases (PubMed, SPORTDiscus, Web of Science and ScienceDirect). Four inclusion criteria were established as follows: (1) the subjects had to be competitors in the CS and carry out RWL strategies; (2) at least two measurement points, that is, normal conditions and dehydration condition; (3) measurements in a real competition or simulating the same conditions; (4) original research articles written in English or Spanish and available in full text. Finally, a total of 16 articles were finally included in this research. All subjects (n = 184) were athletes from combat disciplines, with a minimum of 3-4 years of practice, as well as with certain experience in RWL. Six of the studies reported that an RWL strategy of around 5% of body weight loss did not affect performance parameters. However, the other ten studies with RWL between 3 and 6% or even higher reported negative effects or impairments on different parameters related to performance and/or athlete's psychophysiology, such as perceived fatigue, mood states, strength and power production, as well as changes in hormonal, blood and urine parameters, body composition, or the kinematics of the technical gesture. Although there is still no clear answer to the issue approached in this research, in general terms, it seems that in order to guarantee an acceptable athletic performance of the competitor, the weight loss should not exceed 3% to ≤5% of body weight together with ≥24 h for adequate (or at least partial) recovery and rehydration processes. In addition, it is highly recommended to lose weight progressively over several weeks, especially focusing on competitions lasting several days, as well as multiple rounds or qualifying stages.

Case Report: Effect of low energy availability and training load on sleep in a male combat sport athlete

Purpose

The aim of this case report was to describe the sleep responses in a male combat sport athlete, who was engaging in both chronic (CWL) and acute (AWL) weight loss practices in order to reduce body mass for a national competition.

Methods

During the first seven weeks of training (Phases 1 and 2), the athlete adhered to a daily energy intake (EI) equating to their resting metabolic rate (1700 kcal·day^-1) followed by a reduction in EI (915-300 kcal·day^-1) in the 5 days before weighing in (Phase 3). Nocturnal sleep was monitored throughout the 8-week training period using wristwatch actigraphy and frequent measurements of body mass/composition, daily exercise energy expenditure and training load (TL) were taken.

Results

The athlete was in a state of low energy availability (LEA) during the entire training period. There was a very large decrease in LEA status during phase 3 compared with phases 1 and 2 (3 vs. 20 kcal·kgFFM·day^-1) and there was a small decrease in TL during phase 3 compared with phase 2 (410 vs. 523 AU). The athlete's sleep efficiency increased throughout the training period, but total sleep time displayed a small to moderate decrease in phase 3 compared with phases 1 and 2 (386 vs. 429 and 430 min). However, correlational analysis demonstrated trivial to small, non-significant relationships between sleep characteristics and the athlete's LEA status and TL.

Conclusion

These findings suggest that CWL and AWL practices that cause fluctuations in LEA and TL may be implemented without compromising the sleep of combat sport athletes.

“Horrible—But Worth It”: Exploring Weight Cutting Practices, Eating Behaviors, and Experiences of Competitive Female Taekwon-Do Athletes. A Mixed Methods Study

This mixed methods study aimed to investigate weight cutting practices of female taekwon-do athletes internationally and explore their experiences of “making weight.” A survey of weight loss practices and eating behaviors was completed by 103 taekwon-do athletes from 12 countries, which illustrated that 72.5% of athletes engage in both acute and chronic weight loss practices prior to competition and that there were higher levels of disordered eating within this athletic population than nonweight cutting athletes. Semistructured interviews were conducted with five international-level competitors; thematic analysis of the interviews identified that the women in general felt weight cutting was “horrible—but worth it” and the women believed that (a) weight cutting is unpleasant, difficult, and challenging; and (b) weight cutting provides a competitive advantage. The implications of this study are that weight cutting is widespread among high-level competitive female taekwon-do athletes and this is unlikely to change given the perceived advantages. Efforts are needed to make sure that the women are knowledgeable of the risks and are provided with safe and effective means of making weight.