Rapid weight loss
involves risk

by Sheri Albert, MPH, RD

   Rapid weight loss can hurt performance and endanger the health of athletes. Although most health professionals discourage "weight cutting" or "making weight," it is common among athletes competing in sports that have weight classifications.1 Health providers can play a major role in curtailing the damage of weight cutting practices by emphasizing the "minimal competition weight" that is safe for individual athletes and by encouraging prudent steps to maximize recovery in the period between weigh-in and competition.
   Much of the research on rapid weight loss is with male athletes, particularly wrestlers. However, weight cutting practices have been observed in female rowers, body builders, and martial artists.^2-4 By competing in the lowest possible weight class, the athletes aim for a strength and leverage advantage over their smaller opponents. However, because their desired competition weight is often far below their natural off-season weight, many resort to drastic measures to temporarily drop weight quickly before each competition. This is generally accomplished by restricting food and fluid intake, sweating in a sauna, exercising vigorously in plastic or rubber suits, and/or using diuretics, laxatives, self-induced vomiting, or even spitting.⁵ Most of the weight loss occurs in less than 10 days prior to competition, with some research indicating as late as 2 to 3 days before an event.⁶ Rapid weight loss in high school and collegiate wrestlers has been shown to average 4.4 pounds per week,⁷ with some athletes losing as much as 11 to 20 pounds a week during the competitive season.⁸ An athlete may drop 5 to 6 pounds just hours before a weigh-in.⁹ The up and down weight cycle is typically repeated before each competition and may recur more than 10 times in a season.⁷
   Rapid weight loss in athletes is largely due to reductions in body water (dehydration), glycogen reserves, and lean body mass, NOT fat loss. Thus, weight cutting can potentially have many negative effects on an athlete's health and performance.

Dehydration
   Moderate dehydration (up to 3-4 percent of body weight lost) can generally be tolerated without serious health effects. But in severe dehydration (over 5 percent of body weight lost), physiologic systems are progressively compromised, and the risks for cardiovascular, renal, and thermoregulatory problems, and even death, increase.⁹
   Without sufficient fluid in the body, athletes will experience reduced blood volumes and cardiac function (e.g., higher heart rate, smaller stroke volume, and reduced cardiac output), decreased renal blood flow and renal filtration, and reduced sweating and blood flow to the skin to cool the body. Three cases of dehydration- and hyperthermia-related deaths have recently been reported involving collegiate wrestlers who had lost approximately 15 percent of their total body weight and were competing at 25 to 37 pounds below their preseason weight.¹⁰
   As for performance, dehydration of as little as 1 to 2 percent of body weight has been shown to impair muscle endurance, likely due to the adverse changes in cardiac output.¹¹ However, these adverse effects do not seem to impair muscle strength during high-power exertions lasting less than 30 seconds. In fact, for athletes participating in brief-duration, high-power sports, rapid weight loss may give them an advantage by increasing power on a pound for pound basis. But, as strenuous exercise is prolonged, environmental temperatures rise, and degree of dehydration increases, performance will ultimately suffer.¹¹ In addition, electrolyte losses may occur with large fluid losses or diuretic use, which could further affect muscle function, resulting in impaired coordination on increased muscle cramping.⁹

Depleted energy reserves and lean body mass
   Food restriction reduces muscle and liver glycogen stores, which can affect all aspects of physical performance. For example, it reduces muscle endurance capacity and high-intensity power, impairs the body's ability to maintain blood glucose levels (thus leading to fatigue, lightheadedness, and difficulty concentrating), and accelerates the breakdown of the body's protein.⁹ Some studies have shown retarded growth of lean tissues in wrestlers during their season and, as a result, reductions in muscle strength and endurance after following a weight loss diet for as few as 3 days.⁹ Maintaining a high-carbohydrate diet (65-70 percent of total calories) during periods of negative energy balance may help prevent declines in high intensity power, possibly by minimizing the loss of muscle glycogen.¹²

Other effects
   Although the scientific data are not conclusive, rapid weight loss may also alter hormonal status, impede normal growth and development, slow resting metabolic rate (thus making rapid regain of weight more likely), affect psychological state and cognitive function, impair academic performance, and have more severe consequences such as pulmonary emboli, pancreatis, and reduced immune function.^7,9,13
   In women, overtraining coupled with undereating to "make weight" often results in menstrual irregularities and may increase the vulnerability to developing disordered eating. However, it is unclear whether the disordered eating behaviors, so commonly seen in female athletes attempting to cut weight, persist and develop into full-blown eating disorders after the competition is over. Many male wrestlers, for example, have a disordered eating pattern, but very few have an eating disorder.¹⁴

Minimal weight
   To limit damaging weight cutting practices in wrestling, the American College of Sports Medicine recommends that each state implement rules requiring (1) body composition assessment prior to the competitive season to determine an athlete's minimal competition weight and (2) nutrition education programs for coaches and athletes about sound weight loss behaviors.⁷ Dietitians, team physicians, coaches, athletic administrators, trainers, and other health professionals can collaborate with high school and collegiate athletes to implement these recommendations in all weight class sports.
   An athlete's minimal body weight can be calculated from body composition. Female athletes should not drop below about 14 percent body fat.⁷ This is higher than the minimums for male athletes (5 percent for 16 years or older; 7 percent if younger). Female athletes may need to be reminded of the physiologic differences that require women's bodies to have more fat than men's. Skinfold measurement techniques are more useful than bioelectrical impedance analyzer systems, which tend to overestimate percent body fat in lean individuals and give a minimal weight that is below safe levels.¹⁰
   Minimal weight is not the same as optimal weight. Optimal weight is a weight that promotes both good health and performance and is reasonable to achieve and maintain. If an athlete insists on reducing body weight below the optimal level, weekly losses should not exceed 2 to 3 lb.⁴

Maximizing recovery
   Athletes who participate in rapid weight loss practices hope to replenish body fluids, electrolytes, and glycogen in the brief period (30 minutes to 20 hours) between the weigh-in and competition by immediately "bingeing" on food and beverages. However, re-establishing fluid homeostasis may take 24 to 48 hours, replenishing muscle glycogen may take as long as 72 hours, and replacing lean tissue might taken even longer.⁷ Further, the greater the amount of dehydration, the harder it is to refeed without gastrointestinal upset.⁵ Digestion requires a lot of water. The body normally produces 2 liters of gastric juice a day, which is almost all water. Refeeding without adequate water can lead to stomach upset, diarrhea, vomiting, and gas pains. This discomfort can impair athletic performance.⁵
   Despite these limitations, an athlete who has 5 hours or more between weigh-in and competition can experience significant recovery.⁵ Health providers working with these athletes should keep the following tips in mind:

1. Drink first, eat second. Eating delays the rehydration process and increases the athlete's risk for gastrointestinal upset. Encourage the athlete to drink a well-formulated sports beverage to provide calories and carbohydrate along with fluid. The beverage should be slightly cooler than room temperature (60-70⁰F) to enhance absorption and should be consumed in small amounts. Advise the athlete to start with 16 to 20 ounces, and then drink 4 ounces every 10 to 15 minutes to minimize nausea and vomiting.
2. Consume high-carbohydrate foods. Liquid meals are often the best choices. These are quickly digested and well tolerated, and most are low in fat and high in carbohydrate. Studies have shown that athletes recover better if they consume a high-carbohydrate (75 percent) formula diet after a period of rapid weight loss.¹⁵
3. Be aware and develop a routine. Encourage athletes to keep track of how many pounds they lose, over what period of time, and with which methods and also to note which foods or beverages they consume after weigh-ins, how well they tolerate them, and how strong they feel during competition. This will help determine the best refeeding regimen for the athlete.

Sheri Albert, MPH, RD, is a nutritionist at the UCLA Arthur Ashe Student Health and Wellness Center. She teaches courses in basic, human nutrition and sports nutrition for UCLA Extension's Fitness Certificate Program. She can be reached at [email protected].
 

References
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2.  Sykora C, Grilo CM, Wilfley DE, Brownell KD. Eating, weight, and dieting disturbance in male and female lightweight and heavyweight rowers. Int J Eat Disord 1993;14:203-211.. 
3.  Clark N. Nutritional concerns of female athletes: a case study. J Sports Nutr 1991;1:257-264.
4.  Rosenbloom CA. Sports nutrition: a guide for the professional working with active people. 3rd Ed. Chicago: Sports, Cardiovascular, and Wellness Dietetic Practice Group, The American Dietetic Association, 2000.
5.   Reimers KJ, Gradjean AC. Recovering from rapid weight loss. Strength and Conditioning 1997;19:14-17.
6.  Tipton CM. Making and maintaining weight for interscholastic wrestling. Sports Science Exchange 1990;3(2):22.
7.  American College of Sports Medicine. Position stand on weight loss in wrestlers. Med Sci Sports Exerc 1996;28:8x-xii.
8.  Steen SN. Nutritional concerns of athletes who must reduce body weight. Sports Science Exchange 1989;2(10):20.
9.  Clarkson P, Manore M, Oppliger B, et al. Methods and strategies for weight loss in athletes. Sports Science Exchange Roundtable 1998;9(1):31.
10.   Luttermoser G, Gochenour D, Shaughnessy AF. Determining a minimum wrestling weight for interscholastic wrestlers. J Fam Pract 1999;48:208-212.
11.  Lamb DR, Shehata AH. Benefits and limitations to prehydration. Sports Science Exchange 1999;12(2):73.
12.  McMurray RG, Proctor CR, Wilson W. Effect of caloric deficit and dietary manipulation on aerobic and anaerobic exercise. Int J Sports Med 1991;12:167-172. 
13.  Choma CW, Sforzo GA, Keller BA. Impact of rapid weight loss on cognitive function in collegiate wrestlers. Med Sci Sports Exerc 1998;30:746-749.
14.  Dale KS, Landers DM. Weight control in wrestling: eating disorders or disordered eating? Med Sci Sports Exerc 1999;31:1382-1389.
15.   Walberg-Rankin J, Ocel JV, Craft LL. Effect of weight loss and refeeding diet composition on anaerobic performance in wrestlers. Med Sci Sports Exerc 1996;28:1292-1299.