A Narrative Review on Female Physique Athletes: The Physiological and Psychological Implications of Weight Management Practices

Abstract

Physique competitions are events in which aesthetic appearance and posing ability are valued above physical performance. Female physique athletes are required to possess high lean body mass and extremely low fat mass in competition. As such, extended periods of reduced energy intake and intensive training regimens are used with acute weight loss practices at the end of the precompetition phase. This represents an increased risk for chronic low energy availability and associated symptoms of relative energy deficiency in sport, compromising both psychological and physiological health. Available literature suggests that a large proportion of female physique athletes report menstrual irregularities (e.g., amenorrhea and oligomenorrhea), which are unlikely to normalize immediately postcompetition. Furthermore, the tendency to reduce intakes of numerous essential micronutrients is prominent among those using restrictive eating patterns. Following competition, reduced resting metabolic rate, and hyperphagia, is also a concern for these female athletes, which can result in frequent weight cycling, distorted body image, and disordered eating/eating disorders. Overall, female physique athletes are an understudied population, and the need for more robust studies to detect low energy availability and associated health effects is warranted. This narrative review aims to define the natural female physique athlete, explore some of the physiological and psychological implications of weight management practices experienced by female physique athletes, and propose future research directions.

Physical health and symptoms of relative energy deficiency in female fitness athletes

“…Menstrual irregularities and GD have previously been reported in athletes with LEA, and may partly be due to hormonal perturbations, but also a direct consequence of the lack of energy to support cell metabolism and function. 1,6 Our findings imply increased health and functional impairment with the extreme dieting in FA, and some with persistent effects beyond the dieting period. The increased number with amenorrhea in FA at T3 underlines this finding.…”

“…Additionally, 8% (2,26) in FA had oligomenorrhea at T1. In FR, 4% (1,22) had oligomenorrhea at T1, none at T2, and 8% (2, 25) at T3 (P > .2). There were no between-group differences for menstrual irregularities at any time (P > .05).…”

“…4 By emphasizing regular exercise and eating well, the sport is also promoted as a healthy lifestyle, serving as an improved ideal to the former thinness inspiration. 2,4 In this sport, athletes are exclusively rated subjectively by judges on their aesthetic appearance, emphasizing a lean, toned figure, [1][2][3] which has been reported as a risk factor for extreme dieting and disordered eating. [3][4][5] The use of unhealthy and harmful methods for body weight (BW) regulation is common in organized sports characterized as weight-sensitive or organized according to weight classes.…”

“…[12][13][14][15] Additionally, they emphasize resistance exercise, [13][14][15][16][17] which specifically may be favorable in reducing the detrimental effect of dieting and low BW on lean body mass and BMD. 5,[13][14][15][16][17][18][19] However, FA are understudied with regard to physical and mental health variables, like the ones identified as symptoms of RED-s. 1,3,7 Previous studies of athletes in bodybuilding sports reveal issues with binge eating, and report on a high prevalence of previous eating disorders, specifically among females. 3 Recent findings in groups of fitness athletes are indications of a continued, strict dieting behavior beyond the competitive season, not to enhance performance, but to comply with the modern lean and fit body ideal.…”

“…There has been a tremendous increase in interest of fitness sports in which athletes exclusively are rated by their aesthetic appearance. 1,2 With the lack of knowledge on how this specific lifestyle might affect young athletes, we aimed to study the physical and mental health in female FA during a competitive season. A reference group of recreationally active and non-competing females (female references, FR) was included to provide information on whether findings are sport-specific, or general findings in a modern sample of young females, and to control for the effect of time.…”