By Elissa Rosen, MD, CEDS-S
To date, most of my blog posts have focused on health issues that female athletes may face in the setting of insufficient fueling whether unintentional or due to eating disorders. Inadequate fueling is not unique to females so we will talk about general aspects of this as it relates to male athletes.
Male Athletes Can Have Fueling Problems
Energy deficiency in male athletes has been much less discussed both in the scientific literature and in the athletic world in general. Since the term “female athlete triad” was coined in the 1990s, much of the focus has centered on the health consequences of insufficient energy intake in female athletes, namely as it relates to menstrual dysfunction and bone health. (1) Recognizing that male athletes can suffer health and performance consequences due to low energy availability, the International Olympic Committee (IOC) published a consensus statement in 2014 to broaden the term “female athlete triad” to “relative energy deficiency in sport” (RED-S). To date, there still remain a lot of questions to be answered regarding RED-S in male athletes. These include: does participation in certain sports influence the risk of RED-S in male athletes? What are the physiologic differences in the ways that males and females respond to RED-S? Is there a different threshold of low energy intake to induce RED-S in males? (2) This list goes on, but we will explore some of what is known about these questions below. But first….
Eating Disorders Occur in Male Athletes
RED-S can occur due to unintentional under fueling, but also can be due to an underlying eating disorder. While the prevalence of eating disorders is higher in female athletes, male athletes also suffer from eating disorders. One study estimated the prevalence of eating disorders in adolescent male athletes to be 15%. (3) In another study, a fourth of male athletes reported disordered eating and body dissatisfaction. (4) It is likely that the existing statistics are underestimates of the true number of male athletes with eating disorders. This is in part due to the general gender bias, which contributes to the underidentification and underdiagnosis of eating disorders in males in general.
RED-S and Eating Disorders Specific to Sport
The factors that contribute to low energy intake and the development to RED-S (and eating disorders) are likely unique to each sport. Weight class sports (e.g., wrestling, weight lifting, martial arts), endurance sports (e.g., cycling, running, triathlon), and aesthetic sports (e.g., gymnastics, diving, figure skating) are classically described as the sports in which RED-S, disordered eating, and eating disorders are more common in males. In weight class sports for example, athletes are commonly restricting energy intake and weight cycling to “make weight.” In endurance sports, like multistage cycling races, there are such high energy demands that energy intake may often be inadequate to meet an athlete’s needs. Even though there are many factors that impact the performance of an athlete, body composition and weight often tend to be the most emphasized even in male athletes which may contribute to body dissatisfaction and changes to food intake in order to manipulate appearance.
Next week we will talk more about the hormonal issues males with eating disorders may experience.
1. Mountjoy M, Sundgot-Borgen JK, Burke LM, Ackerman KE, Blauwet C, Constantini N, Lebrun C, Lundy B, Melin AK, Meyer NL, Sherman RT, Tenforde AS, Klungland Torstveit M, Budgett R. IOC consensus statement on relative energy deficiency in sport (RED-S): 2018 update. Br J Sports Med. 2018 Jun;52(11):687-697. doi: 10.1136/bjsports-2018-099193. PubMed PMID: 29773536.
2. Mountjoy M, Sundgot-Borgen J, Burke L, Carter S, Constantini N, Lebrun C, Meyer N, Sherman R, Steffen K, Budgett R, Ljungqvist A. The IOC consensus statement: beyond the Female Athlete Triad--Relative Energy Deficiency in Sport (RED-S). Br J Sports Med. 2014 Apr;48(7):491-7. doi: 10.1136/bjsports-2014-093502. PubMed PMID: 24620037.
3. Pustivšek S, Hadžić V, Dervišević E. Risk Factors for Eating Disorders among Male Adolescent Athletes. Zdr Varst. 2014 Dec 30;54(1):58-65. doi: 10.1515/sjph-2015-0008. eCollection 2015 Mar. PubMed PMID: 27646623; PubMed Central PMCID: PMC4820150.
4. Goltz F.R, Stenzel, L.M. Disordered eating behaviors and body image in male athletes. Revista Brasileira de Psiquiartria, 35, 237-242.