Body composition, weight, bodyweight, racing weight. Do any of these words sound like alarm bells to you?

What about bone density, bone mineral density, T-score or Z-score? Slightly less alarming or do you still feel the cortisol surge?

What if I said osteoporosis, inflammation, visceral fat and metabolic syndrome? Now what do you feel?

Racing Weight

In 2009, Matt Fitzgerald, an award-winning sports journalist, coach and certified sports nutritionist, published a book called Racing Weight: How to Get Lean for Peak Performance. Editorial reviews reveal praise. Here’s one from DailyPeloton.com:

The mysteries of weight and its relationship to performance are unlocked in Matt Fitzgerald’s “Racing Weight.” If you’ve got a basic handle on both training and nutrition, this book offers the means to improve your diet and athletic performance.

Several years later, I heard Fitzgerald make an offhand comment on a podcast about how Racing Weight as a book title would not be accepted by the public today. He wasn’t being mean or malicious, just plain matter-of-fact.

More recently, my sister reported that at my niece’s last wellness visit, the doctor drew blood to “check her cholesterol.” I say “check her cholesterol” in quotes because this was expressly communicated to both my sister and niece. My niece nine. NINE! Tall, lean and athletic-looking. On the surface, and based on family history, which I am privy to, no apparent reason for concern.

Did you know what cholesterol was when you were age nine?

As one last point of interest, my Pilates teacher recently shared that she was taking her mom for a DEXA scan. My teacher has been training her mom who, now in her golden years, is recovering from a hip replacement surgery after a fall. This is a storyline that is commonplace.

DEXA, for those unfamiliar, stands for dual-energy X-ray absorptiometry and can determine bone mineral density (BMD) (among other things) and help diagnosis osteoporosis. In the case of my teacher’s mom, who again had already suffered a fracture and fall, the scan would be her first, in line with the first time her doctor recommended a test for BMD.

Athletes and Weight

Let’s return to Fitzgerald’s comment about his book title and riff on the current conversation around body composition, bodyweight and sports. Or is there a conversation even up for debate? My experience says, “no,” and that the topic, particularly among student-athletes, is completely taboo.

As one case in point, during my sophomore year in college, my rowing coach decided to have weekly team weigh-ins. Rowing is a power-endurance sport where a rower’s power-to-weight ratio can directly impact how they perform. Weigh-ins seemed relevant and reasonable, yet the practice lasted all of one week.

Post-collegiately and at the international level, I raced for 10 years as part of the lightweight rowing classification. Weigh-ins before racing were literally required standard protocol. Yet support, education and resources around nutrition, body composition, and training and racing weight were rare.

We accept having conversations about cholesterol with healthy nine-year-old children and subject them to lipid screenings. The testing, by the way, is based on guidelines set by the American Academy of Pediatrics (AAP) in 2011. The updated standards followed the release of the “Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents,” by the National Heart, Lung, and Blood Institute (NHLBI) (Iannelli, 2022). I looked this up because, frankly, I balked when my sister told me about my niece and the test.

And we accept bone density loss, hip replacements, fractures and falls as part of “normal aging.”

Yet, we can’t have conversations as capable, autonomous young adults, in a sports-specific context or not, about body composition, weight, performance and health.

Where is the logic in that?

Body Positivity, Mental Health and Collegiate Athlete Concerns

The voices of body positivity might contend that any type of metric related to weight, be it the total body composition analysis included with a DEXA or simple weight in pounds offered by the standard at-home scale, would undermine the development of a healthy body image.

Body image is a person’s subjective picture or mental image of their shape and aesthetic. Its formation starts early (i.e., in childhood) and poor body image is linked to problems including depression, low self-esteem and eating disorders, particularly among adolescent girls (Cherry, 2024).

When we look at the big picture, current statistics around mental health are upsetting.

Athlete Stats

A 2022 survey conducted by the NCAA revealed that “rates of mental exhaustion, anxiety and depression have seen little change since fall 2020 and remain 1.5 to two times higher than identified before the COVID-19 pandemic” (Johnson, 2022, para. 2).

Among other results, the survey also revealed that:
• Sixty-five percent of women’s sports participants and 58% of men’s sports participants agreed or strongly agreed that mental health concerns are taken seriously by fellow teammates.
• Fifty-six percent of both men’s and women’s sports participants reported knowing how to help a teammate facing a mental health issue.
• Fifty-five percent of men’s sports participants and 47% of women’s sports participants agreed or strongly agreed that their mental health was a priority within their athletic departments (Johnson, 2022).

When we branch out to disordered eating (DE) and clinically diagnosed eating disorders (ED), we learn that prevalence among athlete populations is high. A 2020 position statement issued by the Australian Institute of Sport (AIS) and National Eating Disorders Collaboration (NEDC) found that “DE can occur in any athlete, in any sport, at any time, crossing boundaries of gender, age, body size, culture, socioeconomic background, athletic caliber and ability” (Wells et al. 2020).

Likewise, a 2023 study highlighted in BMC Sports Science, Medicine and Rehabilitation found that ED risk related to sport type and body satisfaction was prevalent among 14.6% of the adolescent and 6.9% of the adult athletes (Borowiec et al., 2023).

Can DEXA Provide a Solution?

Integrative, by definition, is the combining and coordinating diverse elements into a whole. In medicine, it means using a science-backed approach to treat the whole person including mind, body and soul. It combines conventional, allopathic approaches with complementary interventions to achieve whole health and healing (Cleveland Clinic, n.d.).

In psychology, integrative therapy uses ideas and techniques from varying schools of thought and theory to best serve the client. It recognizes that each client has a unique makeup and needs and “can often offer a more flexible and inclusive approach to treatment” (Psychology Today, n.d.).

DEXA will not solve mental health, struggles with body image, DE or ED. However, it may offer a gateway to broadening the conversation and changing how we think about bodies and body composition as part of an integrative approach to performance and health.

Potential Positives

DEXA reveals body composition, which translates into what we can do functionally and has a “huge impact” on metabolic and mental health (Phillips, 2023). It shows differences in lean body mass across regions, and individual BMD along with measures called T- and Z-scores.

From an objective perspective, its output arms us with knowledge. It gives us insight into asymmetries in lean muscle, which can be targeted in training to help regain balance and mitigate injury risk. It can reveal problems with BMD, which, for the athlete population, is already a point of interest within the evolving and prevalent conversation about relative energy deficiency in sport (RED-S).

“If you see a client every year and they’re struggling with bone density concerns, then performing an annual DEXA might be a highly informative tool for monitoring progress,” says Dr. Marc Bubbs in Peak: The New Science of Athletic Performance That Is Revolutionizing Sports (2019, p. 118).

Subjectively, DEXA provides a fascinating window into the body and separates what is useful information for both health and performance from the emotion and cultural sensitivity to bodyweight and scales. A T-score, for example, is one of two numbers reported that indicate the strength of your bones. In most cases, “T-score” won’t elicit an emotional response or attachment in the way as a number on a scale.

Personal Thoughts

I have seen shame, panic and tear-filled eyes amidst conversations about weight in some of the highest performers in the country. On the flip side, I have memories of teammates finding added confidence and belongingness when moving into training environments where they see other athletes that “look just like me!”

I understand the goals of body positivity and appreciate the attention to unwarranted bias and deeply problematic cultural views. However, silencing the conversation is not working.

For the student-athlete population, statistics clearly indicate that mental health and its branches including ED exist at the forefront of college campuses, and athletic departments and training centers today. This population is vulnerable and also uniquely positioned with resources and in environment that will have a lasting impact on how they think and feel. Likewise, student-athletes have a specific drive to perform and curiosity about what they can do to be great.

DEXA does not come without challenges. It involves commitment and cost. However, it has the potential to be a powerful tool. When used in conjunction with sound coaching and training, healthy team culture, and school or athletic department resources like a nutritionist or health and performance coach, DEXA can be both a teaching tool and source of personal power.

In practice, if there is hesitation among athletes, give them autonomy and allow them to opt in. Emphasize that it can be a resource for getting stronger, not a point for comparison or shame.

References

Borowiec, J., Banio-Krajnik, A., Malchrowicz-Mośko, E., & Kantanista, A. (2023). Eating disorder risk in adolescent and adult female athletes: the role of body satisfaction, sport type, BMI, level of competition, and training background. BMC sports science, medicine & rehabilitation, 15(1), 91. https://doi-org.pacificcollege.idm.oclc.org/10.1186/s13102-023-00683-7

Bubbs, M. (2019). Peak: The New Science of Athletic Performance That Is Revolutionizing Sport. Chelsea Green Publishing.

Cherry, K. (2024, May 13). What Is Body Positivity? Verywell Family. https://www.verywellmind.com/what-is-body-positivity-4773402

Cleveland Clinic. (2022, August 7). Integrative Medicine. Retrieved June 18, 2024, from https://my.clevelandclinic.org/health/treatments/21683-integrative-medicine

Iannelli, V. (2022, November 14). American Academy of Pediatrics (AAP) Recommendations. Verywell Family. https://www.verywellfamily.com/latest-aap-recommendations-2634045

Johnson, G. (2022, May 24). NCAA Student-Athlete Well-Being Study. NCAA. https://www.ncaa.org/news/2022/5/24/media-center-mental-health-issues-remain-on-minds-of-student-athletes.aspx

Phillips, A. (Host). (2023, December 5). What does a Dexa scan tell us and should we get one? With Brendan Barry [Audio podcast episode]. In Healthy Her by Amelia Phillips. OmnyStudio. https://omny.fm/shows/healthy-her/what-does-a-dexa-scan-tells-us-and-should-we-get-o

Psychology Today. (n.d.). Integrative Therapy. Retrieved June 18, 2024, from https://www.psychologytoday.com/us/therapy-types/integrative-therapy

Wells, K. R., Jeacocke, N. A., Appaneal, R., Smith, H. D., Vlahovich, N., Burke, L. M., & Hughes, D. (2020). The Australian Institute of Sport (AIS) and National Eating Disorders Collaboration (NEDC) position statement on disordered eating in high performance sport. British journal of sports medicine, 54(21), 1247–1258. https://doi-org.pacificcollege.idm.oclc.org/10.1136/bjsports-2019-101813