A closer look at fat.

as track and field season reaches its peak in the coming months, it's important to raise awareness of a condition that affects many--though by no means only--high school and collegiate women runners. It represents the opposite extreme from our national youth obesity problem, which we examine on page four.

What is FAT? FAT stands for Female Athlete Triad, a condition referring to a combination of amenorrhea (absence of a menstrual period for three or more months), disordered eating and decreased bone mineral density in athletes; some clinicians define it more broadly as involving general menstrual abnormalities. The result of FAT is often stress fracture. Female athletes must meet certain nutritional requirements or a number of hormonal responses can occur, most notably decreased estrogen production, which compromises bone mineral density and other aspects of the athlete's overall health.

Amenorrhea is the major warning sign you're failing your body nutritionally. In short, if you stop menstruating you've got an imbalance of energy intake and energy expenditure. The first thing to try is running a little less and eating a little more.

Is less fat optimal fat? The health and fitness media widely reported as-yet unpublished research conducted at the University of Buffalo last year showing that female runners who restricted their fat intake to 27% of caloric intake were more injury-prone than female runners who allowed fat to make up 30% of their diet. The researchers followed 87 female runners (averaging 30 miles per week) for a year. It's far from certain that this study will survive the rigors of peer review. Further exploration of this phenomenon is called for in academic circles, as a causal link between inadequate fat intake and running injury is for now tenuous at best.

Nevertheless, the study contributes to our evolving grasp of the role of nutrition in female athletes, and how that role differs for men. While a "light chassis" for faster race times has long been a major impetus behind restrictive fat intake, it also has been thought to reduce injury risk by alleviating excess pounding on the bones and joints. An infinitely lighter, leaner body as superior running machine appears to at least be under scrutiny.

Are schools doing enough? A study of Division-1 universities published last July concluded that screening, prevention and treatment programs are by and large inadequate for eating disorders and menstrual dysfunction among NCAA female athletes. Though 79% of the 138 schools reported screening for menstrual dysfunction, the researchers found that only 24% used a comprehensive menstrual history questionnaire. Furthermore, of the 60% that reported screening for eating disorders, less than 6% used a structured interview or validated questionnaire. Better standardized screening and mandatory education for Division-1 college athletes, both female and male, as well as for athletic department personnel, are long overdue.

(J. Orthop. Sports Phys. Ther., 2003, Vol. 33, No. 10, pp. 594-614; Phys. & Sportsmed., 2003, Vol. 31, No. 7, pp. 33-38; The Complete Book of Running for Women by Claire Kowalchik, Pocket Books, New York, NY, 1999, 432 pp. $16)