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?
A. 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 muchwhen 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.
A. 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?
A. 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.
A. 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?
A. 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.
Q. One of the difficult issues that face coaches, particularly male coaches, is talking to players about “female issues”, like menstruation. What recommendations do you give to a coach to broach the subject, of say menstruation, to find out if the player is having her period and discuss female issues? What should a coach do? (Having a regular menstrual cycle is important for female tennis players. Irregular menstruation, or lack of a menstrual cycle, is commonly associated with the female athlete triad – disordered eating, abnormal menstrual cycle, and osteoporosis).
A. I think the main thing is not to not be afraid of bringing up the issue. Treat both your female and male players with respect. You are going to give them privacy, if you are bringing up something that might be sensitive, and you are going to handle everything with confidentiality. Use the same principles you are already use when approaching males when it comes to talking with female players about issues like their menstrual cycle. I think you can have a way of indicating you are aware women have a menstrual cycle and at a certain time of the month they may be having a more difficult time, and that you understand that. If there is a conversation taking place that goes into more detail, always have the conversation in privacy – you do not want to embarrass the young woman. They can become very easily embarrassed about this, so if you can do his in a private setting or a private office, that is probably the best way. Also, you may have to take any issues about the menstrual cycle on to the next level – which is to a health care provider. Have those referrals ready and available to provide the player or know who in your community that player has access to and say “I am not the expert when it comes to this, but I do want you to see and expert to get it managed. Because my understanding is that we can help you with this if it is interfering with you performance and/or your life.”
Q. Do you notice a higher incidence of lower body injuries (in the leg, hip, foot, knee) in females compared to what other people are reporting for males, and if so why do you think that is the case.
A. I think what we notice are a higher number of low back sacro-iliac joint (SI joint) injuries. Some of that is related to the kinetic chain, so it can go down to the feet, like stress fractures in the feet, being the weight bearing joint. What we are really seeing is a lot of rotational injuries in the lower back and I think that is due to poor core stability and the need for strengthening of the core. On the men’s side they are seeing a higher number of hip injuries which is more prevalent with the loading in an open stance.
Q. What are some guidelines with regards to training and competition that coaches can use to protect the health of the young female player and also promote great tennis development?
A. Unfortunately, we do not have solid information on this topic for young players, but we are looking into it. The information I have comes from some studies done on the WTA tour. We started to look at injuries and when they occur. I think it is important to adhere to periodization principles and incorporate all four phases of the periodization cycle into training and competition - which are critical - and really apply that approach. It is also important to monitor the players as to what training they are doing. I spoke with some coaches earlier today about injuries they were seeing and we related them back to what the players are doing off the court and in the gym. Not just how much they are playing, and working out, but what are they doing. Players really net to be ggetting into the core stability types of exercises - emphasizing strengthening the core, and the trunk, and the shoulder - rather than doing something more aggressive, like plyometrics – even modified plyometrics - at the younger ages. What we really need to be looking at what they are doing and asking is their technique proper, whether they are in the gym or on the court, in addition to looking at the frequency of what they are doing.
Q. I think #1, as a coach you want to pay attention to each player individually and specifically what they are doing. If you have a player who loses in the first round every week, she may be able to compete in more tournaments on the road because she in only playing 3 matches in three weeks, versus 7, 8, or 9 matches in three weeks. Things like that need to be taken into account. I think also, as Kathleen indicated, you are looking at what the players are doing off the court. When they have a schedule, each individual does respond differently to travel. If the player is a “home body,” maybe 3-4 weeks is too much for them to be on the road. It may not be so much physical as it is emotional. You need to take into account all of the elements of the individual as you put the schedule together. I think you have to continue to monitor it. For example, if a player is not doing well at the beginning of the year when they are playing 1-2 matches each week and they start progressing and doing better, you may need to reassess things when they are playing 4-5 matches each week. You may not be able to go 3-4 week back-to-back.