PLEASE NOTE: The medical opinions in USTA.com's Ask the High Performance Lab are responses intended for the average player. Please consult with your primary physician before beginning any new exercise program.
At the 2005 Competition Training Center Workshop (CTC) held in January 2005, USTA Sport Science Committee members Kathleen Stroia, Carol Otis, and Page Love gave brief presentations on medical, developmental, and nutritional issues facing young female players.
Following the presentations they were joined by Jean Nachand, Director of Women’s Coaching for the USTA, in a panel discussion, fielding questions posed by the audience. While many of the questions came directly from information given in the presentation, the answers are applicable to all coaches who work with female players.
Additional information on the panelists is included below.
• Kathleen Stroia, MS, PT, ATC – Vice President of Sport Sciences and Medicine and Professional Development of the WTA.
• Carol Otis, MD – Physician and expert on women’s issues in sport. Dr. Otis has also served as a medical consultant to the WTA.
• Page Love, MS, RD, LD, CSCS – Nutritionist who has worked with many tennis players in the USTA, WTA as well as other professional sports organizations.
• Jean Nachand – Director of Women’s Tennis for the USTA in the High Performance Division.
These questions represent Part I of a two-part series: The Developing Female Tennis Player.
Q: Is there a difference between “disordered eating” and an “eating disorder”? I am a coach who has a player and I suspect he/she has an eating disorder, what should I do?
Page Love: Disordered eating can include a whole realm of issues, as basic as a female athlete just under-eating, eating infrequently, skipping meals, or starting to partake in some eating disorder behavior – maybe binge behavior starts occasionally, or occasional purging – but it does not quite meet the diagnostic level. I have to honestly say, in doing this work with tennis, I do not see a high number of full blown eating disorders because the sport requires such a powerful female athlete. They are just not going to be able to compete at the highest level without encountering some medical problems that would prevent them from continuing to play at that elite level.
If you do identify that a player has started to show some of these patterns, noticing they are not eating much when you are traveling with them, maybe they are bowing out of participating in meals, or maybe they are disappearing after meals for 15-20 minutes at a time, it could be a sign that they are disappearing to purge their meal, you may just want to suggest the player gets a physical – just as a first step. That will allow you to quickly identify if the behavior is affecting the body medically. When talking with that player, some of the communication things you should follow include:
• Express your concerns about their physical well-being.
• Be sure not to accuse them of anything, but say you are concerned about little things you have noticed – maybe they are more fatigues on the court as a result of the behavior they are engaging in. Say you would like them to get a physical. It could be the door that opens that gets them more help.
Carol Otis: To complement what Page has said, the disordered eating occurs on a wide spectrum of practices that often comes about when individuals are uninformed that these things do not work for weight loss. That can include starving themselves for one day, going into the sauna, or just not meeting their nutritional needs. That can be the start of an eating disorders that can then develop into a full blown clinical disorder, like anorexia which is severe weight loss, or bulimia, which is purging. Both of these have strong psychological roots that need to be treated. A treatment team that will address the underlying psychological causes will likely be needed.
There is a wide variety of disordered eating practices. Individuals can move from one practice of disordered eating to another – they can move from having bulimia to becoming anorexic. It is important for coaches to be aware that this is a very common, a very chronic, and a very complex problem among female athletes. Have a high index of suspicion if you think that “things” look strange.
Get involved early, refer early, and get evaluations early. That brings our best results – to recognize the disorder soon and identify the factors that are causing it, whether it is inadequate education about how to eat properly or if there are serious underlying problems.
Q: What is an appropriate body fat percentage for a female athlete? Someone who is 12, 14, or 16? Does it change as a player gets older?
Page Love: Many young women, aged 14-16, feel that 12% is an ideal level of body fat; however, a young female usually will not have a period with a body fat under 16-17%. There are rare cases where females will menstruate with body fat lower than this level, but that is definitely not the average.
When I measured several girls at the pro camp, their average body fat levels were at 22-24%. That is really very normal for elite level women on the tour. Again, tennis being more of a power sport, they’re going to need a little more strength and power, and some of that comes from having a normalized body fat level.
My concern is for girls who may get their information at a fitness center, or even in a fitness classes in school setting, that they may be comparing themselves to males, who carry approximately 10% less body fat. The young women may think they need to have these really low body fat levels. And yes it is normal as a female develops for body fat to slightly go up – it’s normal.
Carol Otis: We know an average woman has a body fat percentage is 20-30%. That is really scary to many females, but that is what’s normal. The majority of this body fat is sex-specific fat. It is mediated by the hormones of puberty and is there for a purpose. Trained women have a slightly lower body fat percentage, but nowhere near what women are trying to achieve today.
Something coaches should be aware of is that the message often goes out to the player “If you could only lose some weight you would be better at your sport.” The myth for tennis is that thinner is necessarily faster. Besides the media driven images to try to be unrealistically thin, there are also some of the performance issues.
We do not have scientific evidence in a sport like tennis, which is not an endurance, long-distance sport, that being any thinner will help you make those first couple of steps to the ball faster. It is better to train individual’s anticipation, footwork, and reaction time skills rather than to get them to believe that thinner is better, especially since they are already getting this message from everyone else in society.
Q: Regarding nutrition – are there any particular or specific supplements (particularly calcium, iron, or multivitamins) that you would recommend a female player take, or do you even recommend a player take any supplements/vitamins/ minerals at all?
Page Love: Many times it is appropriate to take calcium carbonate or calcium citrate, combined with Vitamin C. Generally, if someone is taking calcium (e.g. 1000mg per day), the amount should be divided and taken as two smaller doses during the day. It is harder for the body to absorb 1000mg taken at one time, so it should be split apart. I
would usually not recommend a separate iron supplement unless the player has gotten a blood test and their iron levels come back low. It is not healthy to take excess iron. A women’s multivitamin will provide a safe level of iron, and other vitamins and minerals, to the player. One-A-Day or Centrum are two brand names I recommend to players.
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