By: Rebecca L. Carl, MD, MS, FAAP
Has your child talked about losing or gaining weight for his or her sport? Such practices start young, and the pressure can be intense.
For example, instead of competing at their natural weight, many wrestlers attempt to lose weight rapidly and believe a lower weight class will give them an edge during competition—which can be as soon as the very next day. Dancers and gymnasts often feel that they will be judged more favorably if they have a thinner physique. With other sports, like football and weight-lifting, some young athletes seek to gain weight and add muscle mass. As a result, many of these young athletes put their bodies through extremes to change their weight—using methods that have the potential to cause serious health problems.
The American Academy of Pediatrics (AAP) clinical report, Promotion of Healthy Weight-Control Practices in Young Athletes, describes some of these unhealthy methods of weight loss and gain as well as policies and approaches used to curb these practices. The AAP report also reviews healthy strategies for safe weight loss and weight gain for young athletes.
Regulations—What's in the Rule Book?
Weight classifications in sports (e.g., football, wrestling, rowing, boxing) were designed to ensure healthy, safe, and fair play. While that is the concept, it is far from the reality due to the number of young athletes who try to manipulate the system.
How national sports governing bodies have tried to address the issue:
The National Collegiate Athletic Association (NCAA) instituted updated rules to curb dangerous weight-loss practices in wrestling. They banned the use of diuretics, impermeable suits, and saunas for weight loss and decreased the amount of time between "weigh-ins" and competition. Additionally, the NCAA established a system of setting a minimum weight for competition during the wrestling season—using a calculation that incorporates hydration status, weight, and body composition.
In 2006, the National Federation of State High School Associations adopted similar guidelines (i.e., body composition, weigh-in procedures, and hydration status) for determining minimum body weights in high school wrestlers. However, the body fat minimums were higher (≥7% in males, ≥12% in females) than the levels for collegiate athletes determined by the NCAA. These differences were implemented to address growth needs of teens during puberty and sex differences.
The establishment of minimum competition weight rules has led to a decrease in the practice of rapid weight loss before competition. However, not all sports or activities in which weight might play a role in performance use a weight classification system. For example, in dance, distance running, gymnastics, and cycling, weight and body composition are believed to influence physical performance and the aesthetics of performance. Yet the governing organizations of these activities have no mandated weight-control practices.
Why Athletes Shouldn't Focus on BMI
Body fat percentage varies by age, and weight is not an accurate indicator of body fat or lean muscle mass.
Use of body mass index (BMI) in athletes is not recommended, because it falsely classifies some teens who are of normal weight as being overweight.
BMI can also be falsely elevated in an athlete or nonathlete with a muscular build, as well as in someone who has a high torso-to-leg ratio.
Body composition measurements (body fat and lean muscle mass) in addition to height-for-weight for age measurements can be much more useful in determining an athlete's physical status.
Lean muscle mass should be greater than 25th percentile in most well-nourished athletes.
The Continuum of Unhealthy Weight Loss
At one end of the spectrum are those with mild energy imbalance. At the other end of the spectrum are athletes who try to lose weight (and subsequently maintain that lower weight) with dangerous techniques that may actually hurt athletic performance, increase injury, and cause medical complications.
If your child plays a sport that emphasizes thinness, leanness, and/or competing at the lowest possible weight, be on the lookout for any of the following:
Fasting/calorie restriction
Restricting intake of liquids
Use of laxatives, diuretics, or stimulant medications
Excessive exercise to promote sweating
Use of saunas to promote sweating
Vomiting after eating
Tips for parents:
Emphasize to the athlete that gradual weight loss is best: No more than 1.5% of total body weight or 1 to 2 pounds each week is recommended.
Calorie requirements depend mainly on the size of the athlete and the caloric expenditure during exercise. The appropriate diet for most young athletes is 2,000-3,500 calories per day divided as follows:
Except in sports requiring mandatory weigh-ins, your child's coach should not be discussing weight or weight loss.
Talk with your pediatrician to determine if weight loss is appropriate for your child, and if so, how to develop a safe and effective diet and exercise program to achieve a healthy weight. Your pediatrician may refer you to a registered dietitian or nutritionist for advice on an appropriate diet.
Children and teens should avoid cycling between high and low weights but should attempt to maintain an appropriate weight.
Unhealthy Weight Gain
Some sports—such as football, rugby, and weightlifting—value a muscular physique for improved power and strength. This may cause some children and teens to try to gain weight. However, simply increasing the amount of food one eats may lead to increasing body fat without an increase in muscle mass and strength. Increased or unhealthy body weight may put certain athletes at higher risk of injury and heat illness. Supplements used to increase muscle mass have the potential to be associated with unfavorable side effects. Contrary to popular belief, eating more protein by itself will not lead to increased production of muscle.
Tips for parents:
Talk with your pediatrician to determine if weight gain is appropriate for your child. Discuss how to develop a safe and effective diet and exercise program to increase lean body mass. Your pediatrician may refer you to a registered dietitian or nutritionist for advice on an appropriate diet.
Children and adolescent athletes can participate in strength training. They should begin by learning proper technique under the supervision of a knowledgeable adult. Weight loads should be increased gradually; programs should incorporate 2 to 3 sets of 8 to 15 repetitions with the athlete maintaining proper technique. Young athletes who have not finished puberty yet should be aware that, while weight training will improve strength, they might not see an increase in muscle bulk.
Kids First. Athletes Second.
As a parent, the most important thing you can do is surround your child with a community of coaches and teammates who care more about his or her long-term health than short-term accomplishments. While an Olympian may say great achievements take great sacrifice, your teen is a teen first and an athlete second. When it comes to your child's long-term health, how much sacrifice is just too much?
Additional Information & Resources:
About Dr. Carl:
Rebecca L. Carl, MD, MS, FAAP, is an attending physician in sports medicine and non-operative orthopaedics at The Ann & Robert H. Lurie Children's Hospital of Chicago and an assistant professor of pediatrics at Northwestern University Feinberg School of Medicine. She received a BA at Cornell University, an MD at the University of Illinois, Chicago College of Medicine, and an MS in clinical investigation at Northwestern University. Dr. Carl completed a pediatric residency at University of Wisconsin and fellowships in primary care sports medicine (Rush University) and non-operative orthopaedics (University of Wisconsin). Within the American Academy of Pediatrics, she is a member of both the Section on Orthopaedics and the Council on Sports Medicine & Fitness.