Task Force on USA Gymnastics Response to the Female Athlete Triad

Preliminary Report
September, 1995

With over 50,000 registered female athletes, most of them adolescents, USA Gymnastics recognizes its responsibility to understand the Female Athlete Triad (disordered eating, amenorrhea, and osteoporosis) and to actively pursue policies that will provide a healthy environment in which gymnasts can pursue their goals. Therefore, in the fall of 1994, USA Gymnastics created a Task Force to examine its response to the Female Athlete Triad.

The Task Force is chaired by Nancy Thies Marshall, 1972 Olympian and four time National Team member. The Task Force represents the broad spectrum of opinion on the Triad. It includes sport psychology consultants, nutritionists, and medical experts, all leaders in research and practice in dealing with the Triad. The Task Force also includes Olympic athletes, coaches, officials, and parents; each member chosen because of their unique perspective.

The purpose of the Task Force is to recommend improved programs for administrators, athletes, coaches, judges, and parents after reviewing products and services currently offered by USA Gymnastics. To our knowledge this is the first time a governing body of a sport has so aggressively pursued an understanding of this challenge and asked so openly for guidelines and recommendations from an independent body.

The Task Force has had two full meetings and numerous subcommittee tele-conferences. The final report of the Task Force will be presented to the USA Gymnastics Board of Directors at their November meeting. This preliminary report is intended to provide an outline of their findings and anticipated recommendations.

Task Force Findings

What is the Female Athlete Triad and to what extent does it affect gymnasts?

The Female Athlete Triad is defined by the American College of Sports Medicine (ACSM) as the inter-relatedness of disordered eating, amenorrhea, and osteoporosis, disorders that may lead to significant health problems. The young female athlete is at risk for the development of disordered patterns of eating, which may lead to menstrual dysfunction (amenorrhea) and subsequent premature osteoporosis or bone loss. Disordered eating refers to the spectrum of abnormal patterns of eating, including behaviors such as: bingeing and purging or both; food restriction; prolonged fasting; use of diet pills, diuretics, or laxatives; and/or thought patterns such as preoccupation with food, dissatisfaction with one's body, fear of becoming fat, and a distorted body image. Anorexia nervosa and bulimia nervosa are at the extreme end of the spectrum of disordered eating.

The number of gymnasts affected by disordered eating or Triad related problems is unclear.

Dr. Bill Sands' unpublished survey of elite gymnasts and their mothers indicated that 28 percent of the gymnasts surveyed had eating disorder problems. A survey of 42 NCAA gymnastics programs showed that 62 percent of collegiate gymnasts have engaged in disordered eating practices. No statistics are available on the numbers or percentages of gymnasts who have anorexia nervosa or bulimia nervosa.

Preliminary research on osteoporosis indicates that this element of the Triad is not a problem for gymnasts, apparently because the muscle development of gymnasts actually creates positive bone mass and bone density. However, further research will be done.

The study of elite gymnasts by Sands shows that on average they begin menstruation at 15.5 years, prior to the 16 year age at which the failure to menstruate becomes a medical concern. (It should also be noted that the onset of regular menstrual periods is important not just the age of onset of menstruation which is not always the case for the gymnasts is this study.) That same study indicated mothers and daughters in the study achieved the same final height.

What factors in the gymnastics experience might exacerbate disordered eating problems?

Disordered eating, particularly the extremes associated with anorexia nervosa and bulimia nervosa, is at its root, a psychological problem. In making that recognition, the Task Force concluded that all efforts must be made to ensure that gymnasts, including recreational, competitive, and elite program participants, have an environment that leads to positive self-esteem as the best prevention for eating disorders and potential subsequent health problems.

Sands' survey of elite level gymnasts indicated that 92 percent of those surveyed felt they had a positive experience with gymnastics. However, there are factors in gymnastics which, combined with society's emphasis on thinness, can affect an athlete's tendency to develop disordered eating patterns. These include:

• The fact that most gymnasts are young. Studies by the American Association of University Women and others indicate that self-esteem in all pre-adolescent (middle school) and adolescent girls plummets as much as 30 percent from the self-esteem of girls in elementary school. The majority of recreational, competitive, and elite athletes are in middle-school and high school.
• Gymnasts, especially elite level gymnasts, tend to have personality traits including striving for perfection, obsessive behavior and attention to detail that correlate with the personality traits of adolescents who tend to have disordered eating problems.
• Gymnastics is a subjectively judged sport, where the athlete's anxiety about her performance can be misplaced on her body size and image. While nothing in the Code of Points or other judging regulations relate to body size, gymnasts perceive that having a body type similar to the existing champions will increase her chances of success. In many cases it simply is not possible for the gymnasts to have the body size that she believes to be necessary for success.
• Coaches, parents, or officials providing information about appearance or weight control issues can inadvertently and unintentionally trigger obsessive pre-occupation with weight and body image and a tendency to gain control by developing disordered eating patterns.
• Lack of knowledge by parents on the Triad and occasional over emphasis on the athletes performance by parents can contribute to the problem.
• For some athletes a breakdown in communication between the coach and parents (or between the athlete and coach or coach and athlete) makes it difficult for her concerns to be properly addressed.
• In elite athletics, including elite gymnastics, environments can be created that are highly evaluative and characterized by negative feedback in the event of poor performance. Research has shown that such environments can put athletes at risk.
• Former gymnasts report experiencing marked declines in self-esteem or an identity crisis and consequent disordered eating patterns at the completion of their competitive careers when the structure, goal setting and hours devoted to gymnastics, and the recognition stemming from the sport, are taken away from them.

What has been done by USA Gymnasticsto ensure a positive environment for gymnasts and to decrease the incidence of disordered eating and Triad related problems?

• The number of gymnastics clubs that train elite level gymnastics has increased since the advent of the National Coaching staff in 1992. These elite clinicians provide specialized assistance to coaches who are training elite level gymnasts allowing increasing numbers of gymnasts to live and train in their home community and/or to live with at least one parent while training. The top 10 athletes at the 1995 National Championships came from eight different clubs. Of the top 10, only one athlete (who in fact has graduated from high school) is living away from her parents. The others live with at least one parent and the majority are living in the community where they originally lived. In the 1980s, there were only a few clubs that trained elite gymnasts and many of the athletes lived away from home without direct parental support.
• The artistic and rhythmic National Teams both have contracted team sports psychology consultants and nutritionists who work with the athletes, parents, and coaches.
• The International Gymnastics Federation (FIG) has increased the age limit for participation in artistic gymnastics in the 2000 Olympics to 16. The United States coaches have developed methods of training older athletes that have resulted in improved performance and an increased length of competitive careers. The top ten of the current National Team includes three members of the 1992 Olympic Team and four athletes who are 18 or older. These athletes are projecting a more mature image for gymnasts which can only aid in combating the pre-occupation with body image and weight since adolescent gymnasts strive to become like their idols.
• Information and training available to coaches through the Talent Opportunity Program (TOPs), national team meetings, and other coaching certification programs has assisted with training coaches about ways that they can contribute to the overall physical and mental health of their athletes.
• Initial efforts at parent education have included parent sessions at National Team meetings and at TOPs camps.
• Nutritional information is available to athlete members through USA Gymnastics magazine. Additionally, an Athlete's Cookbook is being printed, and numerous educational videos on nutrition and eating disorders are available through USA Gymnastics educational products sales.
• Recognition and awareness of the problems of the Triad is reflected in the emphasis on educational sessions at the state, regional, and national Congresses of USA Gymnastics.
• Educational programs for athletes are conducted at training camps, national team meetings and at the TOPs training camps by the team nutritionist and sports psychology consultants.

What additional steps can USA Gymnastics take to providing a positive environment for all athletes?

The Task Force has identified a number of action items for USA Gymnastics to take a leadership role in diminishing the incidence of disordered eating among gymnasts. The goal of these action items is to create a positive environment in which the athlete's self-esteem and her sense of self-determination is nurtured to enable her to perform to the best of her athletic ability and with the maximum opportunity for long lasting physical and psychological health.

Recommendations for Athletes

• Promote the Athlete's Bill of Rights, by circulation of a poster that identifies the following rights of athletes.
• Provide role models to further develop self-esteem, encourage communication about challenges and fears faced by athletes and decrease the sense of isolation that some gymnasts experience. Specific recommendations include:
  • Develop a mentoring system where former National Team members are paired with currently competing elite level athletes.
  • Create a video that includes athlete testimonies and helpful advice from those who have been there.
• Provide opportunities for athletes to discuss their concerns with nutritionists, sport psychology consultants and other outside resource people by developing a national network or referral list for athletes and by continuing the existing services for National Team members. This could include partnership with other organizations, including the USOC.
• Provide assistance in the transition from gymnastics competition to retirement by:
  • Providing continued services of the National Team sport psychology consultants and nutritionist after retirement from the National Team
  • Providing continued access to a national network of sport psychology consultants and nutritionists for athletes who are not on the National Team.
• Develop an alumni association for former athletes to stay connected and involved in the sport, including encouraging a transition to coaching and judging. Develop in consultation with sport scientists and the ACSM a more sport and female-specific pre-participation physical for all participants in the elite program and at the top levels of the Junior Olympic Program (i.e. Level 10 National Championships) to improve screening for potential Triad related problems.
• Provide information for athletes about ways they can address their coach and parents regarding their concerns and experiences.

Recommendations for Coaches

• Create an additional coaches education program that deals specifically with the need to create a positive environment for athletes. Suggested topics include nutrition, child development, sport and child psychology, emergency health care, the consequences of over training, and ways to determine the optimum training schedule and environment for a particular athlete. Emphasis should also be given to training coaches on the signs and symptoms of disordered eating, since early detection can arrest and reverse the downward spiral for athletes.
• Provide assistance to coaches in determining ways to utilize the services of sport psychology consultants and nutritionists in the training of their athletes.
• Provide guidelines to coaches, in association with the ACSM, about positive ways to discuss weight and strength issues with their athletes. Author Ken Fox in the British journal Coaching Focus, describes 10 tips for coaches to deal with weight related issues with their athletes. These include ensuring that coaches check the weight-related messages they convey and keep their performance related feedback entirely separate from comments about weight or leanness.
• Continue to utilize the member misconduct process, if and when necessary, to discipline coaches who are persistent in using abusive methods that undermine the self-esteem and health of their athletes.

Recommendations for Judges

• Provide additional education for judges as part of their certification that, similar to the course provided for coaches, would emphasize child development, sport and child psychology and emergency health care. Judges should also be trained on the signs and symptoms of disordered eating.
• Include articles in Technique magazine, the USA Gymnastics professional journal, and in the judges newsletters regarding the Triad and the impact of authority figures on the development of adolescent and athlete self-esteem.
• Encourage interaction of judges and gymnasts on a non-competitive basis.
• Continue to educate judges on performance judging versus appearance judging.
• Develop guidelines and appropriate phraseology to assist judges in discussing routines with gymnasts, coaches and parents.
• Continue to utilize the member misconduct process, if and when necessary, to discipline judges who are persistent in inappropriate discussions with athletes, parents and/or coaches regarding an athlete's appearance or weight related issues.

Recommendations for Parents

• Increase the Membership options for parents of gymnasts that would include a periodic newsletter for parent members. This newsletter would include updated information on gymnastics, the qualification process, nutrition, and sport psychology.
• Provide information to parents on what to look for in the process of selecting a coach or gymnastics club for their child and on ways to discuss problems with coaches. Parents must be encouraged to communicate fully with their child and coach to create the most positive environment for each individual athlete.
• Provide parent sessions at regional, state, and national USA Gymnastics Congresses and increase the parent sessions at TOPs camps.
• Publish a book for parents that includes general information about the sport, USA Gymnastics, athlete psychology, and parenting the competitive and elite athlete. The book would be available to all parents at a nominal cost and provided free of charge to parents of National Team members.

Recommendations for Club Administrators

• Institute a policy of periodic and frequent open practices at clubs.
• Work with parents to develop a parent's club that will act as a liaison between parents and coaching staff.
• Ensure that periodic sessions occur between coaches and parents to establish goal setting for the athlete in conjunction with parents.
• Provide for group education sessions (for parents in the club) to include athlete psychology and nutrition.

Recommendations for USA Gymnastics Administrators

• Develop a club certification program that will identify those clubs that provide an excellent program and positive environment for training gymnasts. These clubs would be allowed to identify themselves as "Five Star" clubs in their advertising and would be identified to parents calling for gymnastics program referrals. Identify and fund staff and other resources necessary to implement the recommendations of the Task Force.
• Seek support from sport scientists and others in researching issues related to the Triad to ensure that up to date information is available and widely disseminated in the gymnastics community.

Members of the Task Force

Members of the Task Force on USA Gymnastics Response to the Female Athlete Triad include:

Nancy Thies Marshall
Task Force Chair
1972 Olympian
USA Gymnastics Vice-Chair for Women

Dr. Gloria Balague
National Team Sports
Psychologist-Rhythmic
Assistant Professor, Dept. of Psychology
University of Illinois at Chicago Circle

Dr. Dan Benardot
National Team Nutritionist
Women's Artistic Program
Associate Professor, Nutrition and Dietetics
Director, Laboratory for Elite Athlete Performance
Georgia State University

Tanya Service Chaplin
Member of USA Gymnastics Athletes Advisory Council
Former National Team Member
Assistant Coach University of Washington

Marilyn Cross
Brevet judge in Women's Artistic
Chair Women's Technical Committee

Dr. Joan Duda
National Team Sports
Psychologist-Women's Artistic Program
Professor and Director, Sport and Health Psychology Laboratory Purdue University

Michelle Dusserre
1984 Olympian
Athlete Representative to the USOC AAC
Coach-Colorado Aerials
Registered Dietitian

Carol Kyanka
President-Women's Intersport Network-Kansas City

Kelli Hill
Coach-Hill's Angels
Coach-Dominique Dawes

Jennifer Mann
Former National Team Member-Rhythmic
Counselor-eating disorders

Cathy Rigby McCoy
1972 Olympian

Claudia Miller
Judge
Mother-World Champion Shannon Miller

Dr. Aurelia Nattiv
Assistant Clinical Professor UCLA
Co-Chair ACSM (American College of Sports Medicine) Task Force on the Female Athlete Triad

Sarah Patterson
Head Coach-University of Alabama

Dr. Polly Rost
Clinical Director Rost & Assoc.

Lynn Sievers
“House mother” Rhythmic National Group

Catharine Yakhimovich
Coach-Rhythmic National Team Member

Donna Strauss
Co-Director Parkettes

This report appears in the October/November 1995 issue of Technique, Volume 15, No. 9, pp.16-22.

---

[ Home ] [ Publications ] [ Technique Index ]

---

About USA Gymnastics Online.
Please report problems to our webmaster.
Copyright © 1996 USA Gymnastics. All rights reserved.

URL: http://www.usa-gymnastics.org/publications/technique/1995/9/triad.html