NATA Safe Weight Loss PDF

Journal of Athletic Training 2011:46(3):322-336 © by the National Athletic Trainers' Association, Inc position statement. www.nata.org/jat National Athletic Trainers' Association Position Statement: Safe Weight Loss and Maintenance Practice...

Journal of Athletic Training 2011:46(3):322-336 © by the National Athletic Trainers' Association, Inc position statement. www.nata.org/jat National Athletic Trainers' Association Position Statement: Safe Weight Loss and Maintenance Practices in Sport and Exercise Paula Sammarone Turocy, EdD, ATC (Chair)*; Bernard F. DePalma, MEd, PT, ATCt; Craig A. Horswill, PhD:t:;Kathleen M. Laquale, PhD, ATC, LDN§; Thomas J. Martin, MDII; Arlette C. Perry, PhD~; Marla J. Downloaded from http://meridian.allenpress.com/jat/article-pdf/46/3/322/1456284/1062-6050-46_3_322.pdf by guest on 26 January 2025 Somova, PhD#; Alan C. Utter, PhD, MPH, FACSM** *Duquesne University, Pittsburgh, PA; tCornell University, Ithaca, NY; tUniversity of Illinois at Chicago and Trinity International University, Deerfield, IL; §Bridgewater State University, MA; IIHershey Medical Center, PA; ~University of Miami, FL; #Carlow University, Pittsburgh, PA; **Appalachian State University, Boone, NC Objective: To present athletic trainers with recommenda- practices, and methods to change body composition. Body tions for safe weight loss and weight maintenance practices composition assessments should be done in the most scientifi- for athletes and active clients and to provide athletes, clients, cally appropriate manner possible. Reasonable and individual- coaches, and parents with safe guidelines that will allow ath- ized weight and body composition goals should be identified by letes and clients to achieve and maintain weight and body appropriately trained health care personnel (eg, athletic trainers, composition goals. registered dietitians, physicians). In keeping with the American Background: Unsafe weight management practices can Dietetics Association (ADA) preferred nomenclature, this docu- compromise athletic performance and negatively affect health. ment uses the terms registered dietitian or dietician when refer- Athletes and clients often attempt to lose weight by not eat- ring to a food and nutrition expert who has met the academic ing, limiting caloric or specific nutrients from the diet, engaging and professional requirements specified by the ADA's Commis- in pathogenic weight control behaviors, and restricting fluids. sion on Accreditation for Dietetics Education. In some cases, a These people often respond to pressures of the sport or ac- registered nutritionist may have equivalent credentials and be tivity, coaches, peers, or parents by adopting negative body the commonly used term. All weight management and exer- images and unsafe practices to maintain an ideal body com- cise protocols used to achieve these goals should be safe and position for the activity. We provide athletic trainers with rec- based on the most current evidence. Athletes, clients, parents, ommendations for safe weight loss and weight maintenance in and coaches should be educated on how to determine safe sport and exercise. Although safe weight gain is also a concern weight and body composition so that athletes and clients more for athletic trainers and their athletes and clients, that topic is safely achieve competitive weights that will meet sport and ac- outside the scope of this position statement. tivity requirements while also allowing them to meet their energy Recommendations: Athletic trainers are often the source and nutritional needs for optimal health and performance. of nutrition information for athletes and clients; therefore, they Key Words: body composition, body fat, diet, hydration, must have knowledge of proper nutrition, weight management metabolism, sport performance eight classifications in sport (eg, youth football, high-density lipoprotein cholesterol concentration, increased W wrestling, rowing, boxing) were designed to ensure healthy, safe, and equitable participationl; however, not all sports or activities in which weight might playa role fibrinolysis, reduced resting blood pressure, reduced resting glucose and insulin, and increased insulin sensitivity? In fe- males, lower body fat may also protect against breast and other in performance use a weight classification system. In activi- reproductive cancers.4 Although lean body mass has been as- ties such as dance, distance running, gymnastics, and cycling, sociated with positive health benefits, negative health outcomes weight and body composition are believed to influence physical are associated with excessive loss or gain of body mass.s performance and the aesthetics of performance. Yet the govern- ing organizations of these activities have no mandated weight RECOMMENDATIONS control practices. In 2005, the American Academy of Pediat- rics2 published a general weight control practice guide for chil- Based on the current research and literature, the National dren and adolescents involved in all sports. Athletic Trainers' Association (NATA) suggests the following In addition to the potential performance benefits of lean safe weight loss and weight maintenance strategies for partici- body mass and lower levels of body fat, long-term health bene- pants in all sports and physical activities. These recommenda- fits include decreased cardiovascular risk factors, reduced trig- tions are built on the premise that scientific evidence supports lyceride concentration, possible increases in cardioprotective safe and effective weight loss and weight management practices and techniques, regardless of the activity or performance goals. Table 3. Determining Goal Weight from Body Composition The recommendations are categorized using the Strength of Rec- Current % body fat - Desired % body fat = Nonessential body fat, % ommendation Taxonomy criterion scale proposed by the Ameri- can Academy of Family Physicians6 on the basis of the level of Current body weight x Nonessential body fat, % = Nonessential fat, Ib scientific data found in the literature. Each recommendation is (in decimal format) followed by a letter describing the level of evidence found in x the literature supporting the recommendation: A means there are well-designed experimental, clinical, or epidemiologic studies to Current body weight - Nonessential fat, Ib = Ideal body weight, Ib support the recommendation; B means there are experimental, clinical, or epidemiologic studies that provide a strong theoreti- cal rationale for the recommendation; and C means the recom- mendation is based largely on anecdotal evidence at this time. 7. When hydration is a concern, regular or more frequent (or both) assessments of body weight are indicated. Evidence Category: C Assessing Body Composition and Weight 8. Active clients and athletes in weight classification sports 1. Body composition assessments should be used to determine should not gain or lose excessive amounts of body weight Downloaded from http://meridian.allenpress.com/jat/article-pdf/46/3/322/1456284/1062-6050-46_3_322.pdf by guest on 26 January 2025 safe body weight and body composition goals. Evidence at any point in their training cycles. Evidence Category: C Category: B 9. Management of body composition should include both diet 2. Body composition data should be collected, managed, and and exercise. Evidence Category: B used in the same manner as other personal and confidential 10. Total caloric intake should be determined by calculating medical information. Evidence Category: C the basal metabolic rate (BMR) and the energy needs for 3. The body composition assessor should be appropriately activity. Evidence Category: B trained and should use a valid and reliable body composi- 11. Caloric intake should be based on the body weight goal tion assessment technique (Table 1). Evidence Category: C (Table 4). Evidence Category: C 4. Body weight should be determined in a hydrated state. Evi- 12. A safe and healthy dietary plan that supplies sufficient en- dence Category: B ergy and nutrients should be maintained throughout the 5. When determining goal weight, body weight should be year (Table 5). Evidence Category: B assessed relative to body composition. This assessment 13. The U.S. Department of Agriculture's Food Pyramid Guide should occur twice annually for most people, with no less is one of the methods that can be used to ensure adequate than 2 to 3 months between measurements (Tables 2, 3). nutrient intake. Evidence Category: C Evidence Category: C 14. The metabolic qualities of the activity should be considered 6. To track a person's progress toward a weight or body com- when calculating the need for each energy-producing nutri- position goal, private weigh-ins and body composition ent in the diet (Tables 6-8). Evidence Category: B assessments should be scheduled at intervals that provide 15. Safe and appropriate aerobic exercise will facilitate weight information to guide and refine progress, as well as to es- and body fat loss. Evidence Category: C tablish reinforcement and reassessment periods. Evidence 16. Body composition adjustments should be gradual, with no Category: C excessive restrictions or use of unsafe behaviors or prod- ucts. Evidence Category: C 17. Combining weight management and body composition Table 1. Body Composition Assessment Techniques7 goals with physical conditioning periodization goals will Standard Error assist athletes or clients in reaching weight goals. Evidence Model Assessment Technique of Estimate, % Category: C 18. Education on safe dietary and weight management prac- 2 Compartment Hydrodensitometry ±2.5 tices should be communicated on a regular and planned Air displacement plethysmography ±2.2-3.7a basis. Evidence Category: C Skinfold measurements ±3.5b 19. Individual body composition or dietary needs should be Near-infrared interactance ±5b discussed privately with appropriately trained nutrition and 3 Compartment Bioelectric impedance ±3.5-5b weight management experts. Evidence Category: C Dual-energy x-ray 20. Ergogenic and dietary aids should be ingested cautiously absorptiometry ±1.8a and under the advisement of those knowledgeable of the Multiple Computed tomography or Not fully developeda requirements of sports and other governing organizations. compartment magnetic resonance Evidence Category: C imaging a More research is needed. Background and Literature Review b Differs with each equation. Weight management and nutrition is a multibillion-dollar industry that has become pervasive in almost every aspect of Table 2. Body Fat Standards (%) by Sex and Age modern life. Diet and exercise have always affected sports and Body Fat Standard Males Females physical activity, but with the intensity of competition increas- ing at all levels has come a renewed interest in controlling the Lowest reference body fat (adults)5,8-11 5 12 factors that influence performance and health. Diet, exercise, Lowest reference body fat (adolescents)",12 7 14 body composition, and weight management now play larger Healthy body fat ranges13 10-22 20-32 roles in an active person's life and performance. Because ath- Journal of Athletic Training 323 Table 4. Determining Total Caloric Needs Harris-Benedict 14 Female basal metabolic rate = 655.1 + (9.6xweight [kg]) + (1.9xheight [cm])-(4.7xage [y]) + Activity needs Male basal metabolic rate = 66.5 + (13.8xwt [kg]) + (5xht [cm])-(6.8x age [y]) + Activity needs Activity needs Sedentary (mostly sitting): add 20%-40% of basal metabolic rate Light activity (sitting, standing, some walking): add 55%--65% of basal metabolic rate Moderate activity (standing and some exercise): add 70%-75% of basal metabolic rate Heavy activity: add 80%-100% of basal metabolic rate Mifflin-St. Jeor'5 Female basal metabolic rate=(10xwt [kg]) + (6.25xht [cm])-(5xage [y])-161 Male basal metabolic rate=(10xwt [kg])+(6.25xht [cm])-(5xage [y])+5 Table 5. Determining Energy-Producing Nutrient Intake letic trainers (ATs) and other members of the health care team Protein intake have regular contact and ongoing relationships with athletes and clients engaged in active lifestyles, they are frequently Downloaded from http://meridian.allenpress.com/jat/article-pdf/46/3/322/1456284/1062-6050-46_3_322.pdf by guest on 26 January 2025 a. Calculation of protein needs based on activity levels: BW, kg x g/kg BW = 9 of protein/kg BW asked for assistance in achieving personal and performance _____ x _ goals. These goals often include diet, exercise, and weight management. Some AT-client relationships and their shared b. Convert the 9 of protein into kcal needed: __ 9 protein x 4 = kcal from protein body composition goals are formalized, as with weight-class sport athletes; others are not. c. % Protein needed of total caloric intake: __ kcal from protein + __ total kcal = __ % Weight Management in Weight-Class Sports Carbohydrate intake a. Calculation of CHO needs based on activity levels: Many safe and effective methods are available to achieve BW in kg x grams/kg BW = 9 of CHO/kg BW and maintain goal weight and body composition. However, al- _____ x _ though published and widely accepted weight and body com- position standards exist,9 there are few published or mandated b. Convert the 9 of CHO into kcal needed: __ 9 CHOx4 = kcal from CHO weight or body composition management requirements. Even within sports with weight-class systems (eg, boxing, light- c. Convert % kcal into actual number of calories: weight crew, sprint football, wrestling), only wrestling and __ kcal from CHO divided by __ total kcal = __ % sprint football consider the components of an athlete's weight Fat intake and body composition, as well as the safety considerations for a. Based on the remaining number of calories needed, calculate achieving and maintaining that body size.19,2o the fat intake needed: Since 1997, specific rules and guidelines have been imple- CHO, kcal + protein, kcal = kcal from CHO and protein mented to ensure that weight control practices in wrestling are ___ + = (A) __ safe, applied early in the competitive season, and conducted on b. Total caloric need - value A = fat needed, kcal a regular and planned schedule around competitions and do not __ =(B)_ include dehydration as a means of weight loss. 1 These weight management and dehydration prevention regulations are effec- c. Value B +9 = fat, 9 tive in reducing unhealthy "weight-cutting" behaviors and pro- ___ +9= _ moting equitable competition.21 Abbreviations: BW, body weight; CHO, carbohydrate In 2006, the National Federation of State High School As- sociations adopted similar standards (ie, body composition, weigh-in procedures, and hydration status) for determining Table 6. Energy-Producing Nutrients minimum body weights in high school wrestlers, but the body fat minimums were higher (-;::.7% in males, -;::.12% in females) Nutrient General Population Requirement than the levels for collegiate athletes determined by the National Carbohydrates 5-7 g/kg of body weight per d Collegiate Athletic Association (NCAA).21 These differences Proteins 0.8-1 g/kg of body weight per d were implemented to address growth needs in adolescents and Fats 15%-35% of total caloric intake per d sex differences. The National Federation of State High School Table 7. Carbohydrate Intake5,16 Activity Type Recommendation Optimal glycogen storage for single term or single event 7-10 g/kg of body weight per d Carbohydrate for moderate-intensity or intermittent exercise >1 h 0.5-1 g/kg of body weight per h (30-60 g/h) Daily recovery and fuel for aerobic athlete (1-3 h moderate-intensity to high-intensity exercise) 7-10 g/kg of body weight per d Daily recovery and fuel for extreme exercise program (>4-5 h moderate-intensity to high-intensity exercise) 10-12 + g/kg of body weig ht per d 324 Volume 46 Number 3 June 2011 Table 8. Protein Intake5,8,14,17,18 low the athlete to stay airborne as long as possible and to cover Athlete Type Recommendation a greater distance before landing.1O This performance standard also holds true for activities such as dance, figure skating, gym- Strength athletes 1.7-1.8 g/kg of body weight (maximum=2 g) nastics, and diving. The aesthetic aspect of performance is also Endurance athletes 1.2-1.4 g/kg of body weight a consideration for weight management practices in these ac- General population 0.8-1 g/kg of body weight Vegetarians 0.9-1 g/kg of body weight tivities. Leaner participants are viewed as more attractive and successfuF3,24 and perceived to demonstrate better body sym- metry, position, and fluidity of motion. Because no scientific or health principles support weight Associations standards have not been accepted or enforced uni- management for the purpose of aesthetics in performance, we versally in the United States. Therefore, universally safe or ef- will address this topic only in its association with body com- fective weight management practices in high school wrestling position and weight management. Many considerations for are not assured. aesthetic performance activities are related to the body com- Sprint football is a collegiate sport sponsored by 6 teams position of female participants, but research25,26also recognizes in the Collegiate Sprint Football League: Cornell University, the effect of similar social pressures on male body images. Mansfield University, Princeton University, University of Penn- Pressures on participants to control weight stem from various Downloaded from http://meridian.allenpress.com/jat/article-pdf/46/3/322/1456284/1062-6050-46_3_322.pdf by guest on 26 January 2025 sylvania, U.S. Military Academy at West Point (Army), and sources, including society, family,25,27-29 peers,3 and coaches,3°-33 U.S. Naval Academy (Navy). Sprint football has the same rules as well as the judging criteria used in some activities.34 These as NCAA football but also has a weight limit for players of pressures may place participants at higher risk for developing 172.0 Ib (78 kg), which is far lower than the weights typically unrealistic weight goals and problematic weight control be- seen in NCAA football players.2o To the previously required haviors. Most aesthetic performance activities require fit body minimum body composition of 5% body fat, sprint football in types for success, and these requirements may trigger an un- 2008 added compulsory assessment of body composition and healthy preoccupation with weight. 35Generally, participants in playing weight in a hydrated state with a urine specific gravity competitive activities that emphasize leanness for the sake of of rtNutr: 1993;3(1):29-40. G atJ::n:adeSports sci Jillt.1994;5( 4):2. Address m:rre::pondence to NationalAthJetic Tra:iners/ AffDdation, Canmun:ications DEpartment. 2952 StEmmons FJ:B2Way, D aJJas,TX 75247. Downloaded from http://meridian.allenpress.com/jat/article-pdf/46/3/322/1456284/1062-6050-46_3_322.pdf by guest on 26 January 2025