Ever since Title IX opened the door to our participation, female athletes have been encouraged, or even required, to fight their body’s natural development and restrict their diet to keep up with the boys. But no matter how many news stories come out about the epidemic of disordered eating and subsequent injuries and trauma for women in high school and National Collegiate Athletic Association (NCAA) sports, we have continually failed to address the root issue: sports, as we know it, have never been designed around the developmental norms of the female body.
As a woman with nearly three decades in elite sport, first as a five-time NCAA and two-time USA champion athlete, and later, a coach of professional female distance runners, my direct experience and research shows how insidious and widespread this problem is for female athletes across a variety of sports, while our institutions are doing little more than shrug.
Why female athletes are experiencing harm in such large numbers isn’t a mystery. The sports institutions we fought to gain access to were designed by men for men and boys, and the system is built around physiology and performance norms for male bodies aged 14 to 22. But the male body develops in an entirely different way than the female body. A culture of leanness and expectations of linear progression may make sense for bodies that are responding to an influx of testosterone and androgens. Expecting the same of the female body during those same years is not only ignorant, it is also deeply harmful.
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Typical healthy female puberty invests in the development of tissues such as breasts and other body composition shifts that are not immediately beneficial to performance, making the female body softer than the male body, even in elite athletics. In natural development, females can expect a temporary performance dip or plateau while the body adjusts to puberty and the menstrual cycle before making a second rise toward its prime. The cause of the plateau is normal and essential, but a lack of basic education about the female body causes it to be viewed as a deviation from the ideal or a devastating setback. Coaches and athletes associate male-like body fat levels with fitness, leading to a culture of body shaming and endorsement of food restriction. So much of the embodied experience of females during adolescence is viewed as a problem to be fixed or minimized. The result is that women and girls are placed at war with their own bodies.
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To combat this, we must assemble and mobilize the research that clearly demonstrates how female athletes are experiencing harm, and how that harm shows up long-term. Two to three times as many females as males develop stress fractures in NCAA sports. They experience anxiety at roughly twice the rate of their male peers. In response to the inhospitable environment for female development where 60% of females report pressure from coaching concerning body shape, an alarming 54% of female athletes report being dissatisfied with their weight, and of these, almost 90% believe they are overweight by an average of 13.6 pounds. 35% of female collegiate athletes are at risk of anorexia, (vs 10% of males) and 58% are at risk of bulimia (vs 35% of males). These diseases are extremely serious, carrying the second highest mortality rate of all mental illnesses behind opioid addiction. They break bones, impair mental function, damage major organs, and strain social relationships—and are notoriously difficult to recover from. Early intervention is key to having a chance at a full recovery, but the NCAA has no formal policy for eating disorders, despite creating the ideal environment for them to propagate.
As football coaches long did with concussions, coaches often look the other way—exploiting the temporary performance benefit that comes with weight loss, and failing to make the connection when everything comes crashing down. In the absence of formal policy or best practices, the individual programs and coaches that are trying to solve the problem are winging it. Those who prioritize athlete health can suffer losses to teams that exploit athlete bodies for points. This problem is far too serious to take a laissez-faire approach.
The result of an unrealistic body ideal and unchecked energy deficiency is an epidemic of RED-S, (relative energy deficiency in sport), a syndrome of impaired physiological function that is the focus of a surge in research right now. A remarkable 80% of female athletes screened for RED-S had at least one symptom, with period abnormalities being among the easiest to identify. Female athletes have experienced menstrual dysfunction at such high rates in sports for so many years that a lost period has come to be mistakenly viewed by many coaches, athletes, and even medical professionals as a “normal” response to training despite an abundance of research demonstrating that a healthy hormonal cycle is absolutely essential for immune function, recovery, sexual function, reproduction, mental health, and more.
Bone health is a particular area of concern for female athletes facing RED-S. During the ages female athletes need to be building their lifetime bone bank, too many are doing the opposite. One study of high school female runners average age seventeen showed that nearly half had a history of period loss and 42% had low bone mineral density. Those who go on to compete in college will be subject to two to three times the rate of stress fractures as their male peers, and if they have RED-S, fracture risk is four to five times more likely, all this despite participating in a sport widely known to increase bone density in the general population. The legacy continues years later: Former elite runners in their 60s were found to be more likely to have osteoporosis and bone fractures than their non-athlete peers. Now that we are finally able to study athletes into older ages, we can see that generations of women are carrying the invisible wounds of their sport experiences.
Monitoring, protecting, and talking about menstruation—a basic human function that affects half the population—is key to identifying and preventing harm, but our overwhelmingly male coaches often can’t even say the word “period” without euphemisms. At a minimum, we need mandatory education on female puberty and physiology for all coaches. As with concussions, addressing who is responsible is an essential next step in the path forward. Concussions were previously viewed as the athlete’s problem, an occasional bad luck consequence of playing the sport. But when research showed how concussions actually stemmed from institutional neglect, everything changed. The harm is now attributed to poor prevention and treatment policies in the sporting institutions, making the institutions themselves liable. Once it potentially costs more to ignore a problem than fix it, concrete changes follow.
If women and girls were placed in sporting environments built around the norms of female puberty and female improvement trajectories, if their bodies were respected and encouraged to develop in their own time, outcomes for women would be entirely different. We can utilize the research on female athletes to drive change, and we must.
But this story goes far beyond statistics. I’ve lived it. Countless women who have gone through our sports systems carry a story about themselves that isn’t true. They were told something was wrong with their changing bodies, when they were actually right on time for a timeline nobody around them was educated about. This false story changed their sport experiences and their conceptions of themselves.
The war against one’s body extends years beyond one’s final competition, creating a kind of psychological static that colors so much of life. We cannot quantify this kind of pain or loss as easily as broken bones, but if we decide we care, if we are strategic, we can prevent it.