Eating Disorders and Their Appearances Among Athletes

MASARYK UNIVERSITY

Faculty of Sport Studies

Department of Health Promotion

Eating disorders and their appearances among athletes

Master’s diploma thesis

Supervisor: Ing. Iva Hrnčiříková, Ph.D. Author: Bc. Ondřej Chudoba

Conditioning Coaching

Brno 2019

I declare that I have worked on this thesis independently, using only the primary and secondary sources listed in the bibliography.

…………………………………………………………………………………… Author’s signature, place, date

I express my deep gratitude and hereby thank Mrs. Hrnčiříková for sharing a much-needed knowledge, patience and expert leadership throughout this thesis.

Bibliografická identifikace

Jméno a příjmení autora: Bc. Ondřej Chudoba Název bakalářské práce: Poruchy příjmu potravy a jejich výskyt u sportovců Pracoviště: Katedra podpory zdraví – Fakulta sportovních studií Vedoucí magisterské práce: Ing. Iva Hrnčiříková, Ph.D. Rok odevzdání závěrečné práce: 2019

Anotace: Tato práce se zabývá zpracováním a analýzou poruch příjmu potravy a jejich výskytu ve sportu. Práce je zaměřena na analýzu poruch příjmu potravy od již zkoumaných, známých forem až po nově se vyskytující fenomény související s nástupem trendů pohybových aktivit zaměřených na estetickou stránku rozvoje. Práce se také spekuluje s vlivem sociálních sítí, ježto multiplikátorů rozvoje tendencí poruch příjmu potravy u neprofesionálních sportovců. Hlavní část práce je zaměřena na energetickou dostupnost a dvě případové studie výskytu dlouhodobé nedostatečné energetické dostupnosti a jejími následky z prostředí amatérského olympijského boxu.

Klíčová slova: poruchy příjmu potravy, sport, diety, alternativní stravovací návyky, atletická triáda, energetická dostupnost, box, ženský box, redukce váhy, váhové kategorie

Bibliographical identification

Author’s first name and surname: Bc. Ondřej Chudoba Title of the master’s thesis: Eating disorders and their appearances among athletes Department: Department of Health Promotion – Faculty of Sport Studies Supervisor: Ing. Iva Hrnčiříková, Ph.D. The year of submission of the final thesis: 2019

Anotace: This thesis deals with compiling and analyzing eating disorders and their appearance in sports. Thesis is targeted to the analysis of eating disorders from known and already described forms to newly appearing phenomenon associated with beginning of physical activities focused on esthetic aspects of development. Thesis also speculates on the influence of social media as the multiplicator of the inclination to eating disorders among non-professional athletes. Main part of the thesis is directed to energy availability and two case studies of long-term insufficient energy availability and its consequences from the environment of Amateur Olympic boxing.

Key words: eating disorders, sports, diets, alternative eating approaches, athletic triad, energy availability, boxing, women boxing, weight reduction, weight categories

Table of contents Bibliografická identifikace ...... 4 Anotace: ...... 4 Klíčová slova:...... 4 Bibliographical identification...... 5 Anotace: ...... 5 Key words: ...... 5 1 Introduction ...... 9 2 List of abbreviations ...... 11 3 Systhesis of information ...... 12 Classification of Eating disorders, Related Conditions and Potential tendencies ...... 12 3.1.1 Alternative eating approaches ...... 12 3.1.1.1 Vegetarianism ...... 12 3.1.1.2 Veganism ...... 14 3.1.1.3 Pescetarianism ...... 15 3.1.1.4 Fruitarianism ...... 16 3.1.1.5 Raw foodism (Rawism) ...... 17 3.1.2 Diets ...... 19 3.1.2.1 Atkins diet ...... 20 3.1.2.2 Zone diet...... 21 3.1.2.3 South Beach diet ...... 22 3.1.2.4 Weight Watches diet ...... 23 3.1.2.5 Mediterranean diet ...... 24 3.1.2.6 Carb cycling ...... 25 3.1.2.7 Ketogenic diet ...... 26 Eating disorders ...... 27 3.2.1.1 Anorexia nervosa ...... 29 3.2.1.2 Bulimia nervosa ...... 30 3.2.1.3 Binge eating disorders ...... 32 3.2.1.4 Night eating syndrome ...... 33 3.2.1.5 Orthorexia ...... 33 3.2.1.6 Drunkorexia...... 33 3.2.1.7 Disordered eating ...... 34 Energy availability ...... 34

Athletic Triad ...... 35 Sport of Boxing ...... 36 3.5.1 Definition of Boxing ...... 36 3.5.2 History of Boxing ...... 37 3.5.3 Physiology of Boxing ...... 39 3.5.4 Amateur boxing ...... 42 3.5.5 Professional boxing...... 43 3.5.6 Weight classes and weight cutting in boxing...... 44 Eating disorders in the sport boxing ...... 46 4 Methodology ...... 49 Description of subjects ...... 49 Used methods ...... 50 4.2.1 Training plans ...... 50 4.2.2 Dietary regimen ...... 50 4.2.3 Target talks ...... 51 Time table of data collection and data analysis ...... 52 5 Objectives ...... 54 Cease studies ...... 54 5.1.1 Subject L ...... 54 General description ...... 54 Boxing career ...... 56 Symptoms ...... 58 Diagnostics ...... 59 Subjective complaints ...... 60 Conclusion and proposition of a solution ...... 61 5.1.2 Subject K...... 63 General description ...... 63 Boxing career ...... 64 Symptoms ...... 68 Diagnostics ...... 69 Subjective complaints ...... 69 Conclusion and proposition of a solution ...... 70 Hypothesis ...... 71 5.2.1 Subjects comparison ...... 71 5.2.2 Negative consequences of nutritional manipulation in boxing ...... 72 5.2.3 Weight reduction as a form of mental preparation ...... 73

6 Conclusions ...... 75 7 Discussion ...... 77 8 Summary ...... 83 LIST OF REFERENCES ...... 84 Résumé ...... 88 Resumé ...... 88

1 INTRODUCTION

I chose this very topic for my master’s degree thesis since I am a conditioning and boxing trainer and coach therefore, I work in a field where weight reduction is a common problem every coach needs to deal with. In my conditioning coaching practice, I also specialize on helping my clients getting rid of unfit motional stereotypes and unhealthy habits including nutritional ones and resetting their minds and bodies to the state in which they are capable of creating better and healthier ones.

Yet another motivation is my personal and professional animosity towards nowadays trends in amateur or recreational sports where the good will and insufficient competence and knowledge of clients is abused only in order to increase sales of nutritional supplements, training equipment and otherwise dispossess the motivated people of their hard-earned money but most importantly their health. Trends such as fitness or crossfit may advertise that by practicing them clients will get fit, healthy, stronger, faster, bigger and happier yet the opposite is true. The only people that are getting any of those things are those selling these misguided merchandises. I sincerely and wholeheartedly despise of these people and trends since argue with me all you like, in my opinion as a practicing professional, there are not many things in this life as valuable as health. As a trainer and a coach I deem myself obligated doing my best to lead my clients and all those who are willing to listen towards maintaining good health and teaching them how to prevent from something unhealthy happening to it. A small part of this thesis is also directed on those potential trends.

While laying the literary and informatory backgrounds in the first part of this thesis the second one is a case study of two subjects who might or already did go through a sort of eating disorder or a disordered eating condition. Those two subjects are two female competitors in amateur Olympic boxing who are competing under my training and coaching leadership for five years. They both

9 exhibited idiosyncrasies in their eating habits and symptoms of abnormal eating habits. As will be revealed in the second part of this thesis they both went through and definitely go through a manipulation with their energy intake due to the fact that boxing is one of the typical examples of weight division sports where cutting weight and descending to lower weight division may mean increasing the chance of emerging victorious in competition.

2 LIST OF ABBREVIATIONS

EA – energy availability FFM – fat-free mass RED-S – relative energy deficiency in sports BMD – bone mineral density VO2 max - maximal oxygen uptake/maximal aerobic capacity

3 SYSTHESIS OF INFORMATION

Classification of Eating disorders, Related Conditions and Potential tendencies

3.1.1 Alternative eating approaches

The path of an adjusted or alternative nutritional approach is nowadays sought by yet many who are motivated to adjust their attitude towards life and express it in this matter. Not rarely is it associated with taking an interest in healthy lifestyle, ethics, ecology or certain philosophical approaches.

Most common types of alternative eating approaches are vegetarianism, veganism, frutarianism, pescetarianism or rawism. Often these decisions to deviate to such an approach lie in taking an inspiration in Ayurveda or traditional Chinese medicine. Common characteristics of all types of alternative eating approaches is a fact that this adjustment does not concern only a dietary regimen but also an attitude to life itself. Conduction such an approach is mostly the expression of a lifestyle since the human being is perceived as a reconnection of body and mind and achieving the harmony with the nature itself.

3.1.1.1 Vegetarianism

Vegetarianism is a form of alternative dietary regimen consisting in excluding a meat out of it. The reasons leading to choosing such a diet may vary greatly from ethical reasons such as compassion with animals to health issues reasons such as prevention or rectification of flawed previous dietary regimen or ecological ones since the production of vegetal foodstuff is less demanding ecologically than animal production, also economical reason – the use of home produced foodstuff, religious reasons, because some religions prohibit meat consumption, philosophical ones – for instance a principle of ahinsá i.e. non- violence, cultural ones – a person can grow up in the environment of vegetarianism or a combination of some of these factors together. Rarely ever is

12 vegetarianism related only to nutritional habits, often it is rather one’s lifestyle which can also impinge on living, fashion and cosmetics attitude such as non- usage of fur clothing, animal tested cosmetic products and ecological household. Resentment of meat-eating has been appearing throughout the history in various forms. Oldest reference of vegetarianism is form antient India and Greece. (Spencer, 1993) In both cases the vegetarianism was associated with religious and philosophical motives, mainly with non-violent attitude towards animals which were precepted as live being who are supposed to be treated as people. In India this principle is called ahinsá. (Gandhi, 2003) Both Hinduists and Buddhists resent meat consumption. Even in Christianity, Judaism or Islam mention the non- meat sustenance. During the age of Rome Empire and late Antique the vegetarianism almost disappeared from the entire Europe. In the medieval age monks would conduct non-meat-eating regiment due to the ascetic attitude. During the Renaissance vegetarianism reappeared again in Europe but in only gained its prominence again in 19. and 20. century. (Spencer, 1993) Among the most famous representatives are Pythagoras, Socrates, Plato, Ovidius, Cicero, Seneca, Hippocrates, Leonardo da Vinci, J. J. Rosseau, Victor Hugo, Lev Nikolayevich Tolstoy, Albert Einstein, Gandhi and others.

The word vegetarianism is derived from word “vegetus” which means fresh, lively. This term has been used since 1847 and the first mention of the usage is by Vegetarianism society of England which started advertising the benefits of this approach.

Main component of vegetarianism diet is vegetal produce such as cereal, legume, fruits, vegetable, nuts, seeds and high-quality vegetable oils. Vegetarian diet is low in fats and rich in fiber and polysaccharides. Vegetarian diet is low in sodium and nitrogen which is the main reason why the vegetarians are less prone to suffer from lifestyle diseases and cardiovascular diseases. However, the controversy about the benefits and perils of strictly vegetarian diet is a topic of discussions and research as well. Unfortunately the results of studies vary greatly and often bring rather antagonistic information.

As mentioned, vegetarians are less susceptible to lifestyle and cardiovascular diseases such as cancer, diabetes, circulatory system, loss of appetite and allergies. Vegetarians have also healthier levels of cholesterol since they eat less saturated fatty acids and more fiber. According to some views, vegetarian diet also decreases the speed of aging process and the body is less polluted with toxins.

On the other hand, non-meat diet can be imbalanced thus unbeneficial. In order to balance the diet properly vegetarians need to combine the intake of such types of food which has the potential to do so. For instance the closer concentration needs to be on protein intake since the vegetal protein has lower biological value then the animal protein. Vegetal protein may miss some essential amino acids that should be supplemented additionally. The same is the situation with the vitamin B12 which is mainly obtained from meat so the vegetarian need to supplement it, too in order to avoid chronical shortage of it and all that its negative consequences. Inaptly constructed vegetarian diet may cause anemia, malfunction of menstrual cycle and other issues. (Hartinger, 2004)

Vegetarianism is highly inappropriate for pregnant and nurturing women. It also should be avoided by professional and performance athletes since the lack of certain vitamins and the proteins deficient in biological value may cause more complications rather than benefits.

3.1.1.2 Veganism

Veganism may be perceived as a more radical form of vegetarianism. The main principal is the basically synonymous but except for non-meat diet, vegans abide strict no animal produce diet. Anything related to animals cannot be consumed. The term veganism was first introduced in 1944 by Vegan Society in Great Britain. (Macurková, 2014)

Veganism may seem monotonous due to the absence of animal produce such as meat, dairy products, eggs and so on. The dietary regimen of vegans

14 consists of cereal, legume, fruits, vegetable, nuts, seeds, spices, herbs, mushrooms and high-quality vegetable oils.

Just as well as the vegetarianism the research about the benefits and perils of veganism vary significantly. Presumably greatest limit of veganism is the notorious lack of vitamin B12 with all its negative consequences as mentioned in previous chapter. Not only vitamin B12 is lacking in vegan diet, other vitamins and minerals are calcium, selenium, iron, iodine and vitamin D. Nowadays all these vitamins and minerals including the B12 may be supplemented additionally but it certainly begs the question of meaningfulness of this diet when on hand we exclude something only to create a must to supplement it somehow else. However, when supplemented all these missing elements vegan diet has its benefits too, generally it is a light form of diet with lower calorie intake which leads to lean and low body fat body constitution thus lower BMI. With these factors taken into an account, vegans are less susceptible to lifestyle diseases as the vegetarians are.

3.1.1.3 Pescetarianism

Pescetarians sometimes also referred to as lacto-ovo-vegetarians or ovo- lacto-vegetarians are people who exclude from their diet a meat and fat produce except for sea-food. They consume fish, milk, dairy produce, eggs and all the vegetable produce. The name of this alternative dietary regimen is derived from Italian word “pesce” which means fishes. Pescetarians include into their diet all types of fishes both freshwater and saltwater, shellfish, vegetables, fruits, cereal, legume, eggs and dairy produce. This type of diet is simply a type in which everything is eaten except for meat and smoked meat and “fat” meat. Pescetarian diet is similar to Mediterranean diet in which the main source of animal protein are fishes. (Jibrin, 2014)

Main asset of pescetarianism is as with Mediterranean diet, veganism and vegetarianism in lowering the risks of lifestyle diseases, lower levels of blood cholesterol and healthy blood pressure. Unfortunately not even this type of diet is without its limitations. Objectors of this diet state, that high consumption of fishes

15 may cause the increase intake of mercury and other toxins which may be cause by sea and ocean water pollution. Some studies show, that the benefits of eating higher amount of fish outweigh the risks of potential excessive intake of mercury and other toxins.

3.1.1.4 Fruitarianism

Fruitarianism is a type of dietary regimen in which a fruits, nuts and seeds can only be consumed. Frutarianism is highly alternative dietary approach since it excludes significant portion of ordinary types of food a human being consumes. Fruitarianism is rare form of alternative nutritional approach and it is a strict form of veganism where the food consists mainly of fruits, nuts, seeds and other types of plant-based foodstuff. Moreover while harvesting the fruits, the plan itself must not be harmed, therefore some fruitarians only consume the fruits which has already fallen off the plant. (Wodzak, 2016)

As far as the benefits of this approach go, it is far from optimal since it is missing the basic elements of human diet thus in the long-term this diet may conclude to be even unhealthy since the human body is not adjusted to intake such a high dosages of sugar thus the pancreas is overloaded constantly. Also it is not optimal to have insulin and glucagon spike so much so often. The spiking is caused by constant need to balance the blood sugar levels due to aforementioned high intake of simple sugars. Fruitarianinas also suffer from the lack of zinc, vitamin B12 and proteins with high biological value. It is highly unsuitable for adolescents, pregnant or nurturing woman and in general for anyone who needs to or has to gain a muscle mass or grow physically otherwise.

Followers of fruitarianism argue, that this type of diet is the most natural one for human being since the diet of our predecessors mostly consisted of gathering goods such as seeds and fruits and also that the raw food without any heat adjustments is in general better than any heat-adjusted.

The benefits of this approach are definitely the high fiber intake due to the increased fruit and seeds intake. Fiber is beneficial to peristalsis thus the intestines are prone to be healthier just as the levels of cholesterol may decrease, too, due to the ability of fiber to tie the cholesterol on itself and rid the body off of it. The fruitarian diet is high in vitamins C, E, K and some of the vitamins of B category.

Most significant negative of fruitarianism is the absence of animal components such as quality proteins or fats which may eventually lead to worsening of their skin condition, tissue resistance in general and even the thermoregulation processes. Low fats intake must then be supplemented by higher intake of nuts and cereals. Raised intake of sugars may lead to proliferation of yeast and mold in gastrointestinal tract. These aspects may lead to immune complications.

Fruitarianism is definitely an extreme and highly alternative dietary regimen. It may be suitable for some but in the long-term, it may eventually lead to significant health complications. This approach should rather be understood as a type of short-term cleansing procedure for healthy individuals rather than a life- long permanent approach.

3.1.1.5 Raw foodism (Rawism)

Raw foodism or rawism is a type of nutritional approach which is based on raw, “live” food. It is also perceived as a more extreme sprout of vegetarianism. People who abide by rawism resent anything that was heat adjusted on the degree higher than 42 °C. Food that has been heat adjusted over 42°C is consider a dead one. According to the interpretation of “dead food,” when adjusted over 42°C the food loses its value due to the fact that the heat over this particular level causes the proteins to disintegrate as does the original enzymes, vitamins and minerals. Thus the food “dies.” Along with the heat adjustments not only does the food increases its value, the process also causes the creation of toxic or unusable elements, which in the very least body has to get rid of this may be for instance

17 unsaturated fatty acids that change with the heat adjustments into saturated fatty acids that are carcinogenic, sugars change into inertial sugars and the food loses its natural water content. The ultimate argument is, that only the humans eat heat adjusted food and it is the only species to suffer from lifestyle diseases.

Rawism is no new approach, it originally has been defined in 1897 by doctor Maximillian Bircher-Benner and later redefined by Leslie and Susannah Kenton in a book „Raw energy: Eat your way to radiant health” (Kenton, Kenton, 1984) and was presented as a way to avoid degenerative diseases. Rawism has also two additional principles: never starve – always have a fruit or vegetable with you and never eat fruits after vegetables and make the vegetable outbalance the fruit in the diet. Raw diet is not based solely on fruits and vegetables. It also consists of nuts, seeds, legume, cereal, sprouts, herbs, raw-cocoa, coconut milk, all oils which are produced via cold-pressing, unpasteurized dairy produce, raw meat, eggs and mainly fishes.

Benefits of rawism are mainly associated with high consumption of fruits and vegetables which supplies the body with high amounts of vitamins, minerals and fiber. Due to these aspects, taking up a rawism is often associated with slight weigh loss but it is not a standard. Some studies show that it also leads to the betterment of mental state, vital energy increase and decreased need for sleep, since the body does not require so much energy for digestion.

Negatives of rawism may be the imbalance of this diet caused by lacking the B12 and D vitamins, some types of proteins, omega-3 fatty acids and especially the minerals such as calcium, zinc, iron, iodine and selenium. Even though the raw food contains these types of substances, the body is only capable of using certain portions of it which may result into a need to supplement it additionally. This, on the other hand, is unacceptable for raw-practitioners, since the supplements rarely comply with the demands of rawism itself.

Highest risk is probably the fact, that since the food is not heat-adjusted, certain microbes and parasites can be found in it and thus consumed. Also the increased intake of fiber may lead to flatulence, diarrhea or other related gastrointestinal issues. Sometimes, since the practitioners are relied on certain types of allowed food, some sort of eating disorder may be developed in the process. In the long-term the rawism may turn out to be defective and may also endanger the health. Thus the rawism should also be perceived as a type of cleansing procedure to help the body and mind getting rid of unsuitable or unhealthy lifestyle and dietary regimen.

3.1.2 Diets

Food intake is one of the most basal needs of a human being. With the development of human society food is not a simple fuel for a human body as much as a lifestyle expression that reflect some sort of personal philosophy and the point of view at the life and world around.

There is a significant number of reasons that lead people to change their nutrition habits and their lifestyle habits. Some of those reasons may be the need to change their habits as a result of proceeding health issues, desire to try a new nutritional lifestyle and need to live more in harmony with the nature or even changing the nutritional habits do their religious beliefs.

But when the decision is made to change the nutritional habits certain aspects definitely need to be considered. Such as potential positives and negatives since some of nutritional approaches are a rather extreme and may lead to significant health issues and those are executed for a longer period of time.

The change in nutritional habit are often associated with word diet. A word diet comes originally from Greek word diaita that in literal translation means a food. In general a word diet is explained as a guided intake of food and liquid's a type of nutritional habit that is aimed on specific goal. It is crucial to realize and appreciate the difference between diet as it is understood in English speaking

19 countries and the way this concept is explained in the rest of the world and in our country. In our country it is rather explained as a specific approach of eating of ill people. (Segal & Elina, 2019)

Definition of word diet differ significantly. Almost every time in the differs according to the angle the diet is concentrated on. As aforementioned diet may be explained and executed as a manifestation of a lifestyle as well as a reduction diet designed to help in weight-loss. for someone else diet also may mean eating clean or healthy in order to get the body rate of the toxins. For someone else died means implementing a nutritional supplement into their nutritional habits.

3.1.2.1 Atkins diet

Atkins diet was designed in early 70s last century and the author is American doctor Robert Atkins. This diet is a low carb type of diet and it operate on lowering carbohydrates intake only to 20 grams a day but on the other hand there are absolutely no limitations on the intake of foodstuff rich in protein for instance eggs meat dairy products and such. According to Atkins as long as the body is robbed of carbohydrates it has an inborn tendency to gain the energy from the fat cells which gradually leads to a weight-loss.

While Atkins diet executing you are literally forbidden from feeling hungry it is also recommended to intake the food in the smaller doses but do not overeat. It is also vital to maintain the drinking regime so that the dehydration of organism is prevented. The drinking regime must consist only of a liquid with no sugar which means set all the juices eliminates and others like this are forbidden. The dietary regimen must not include gluten or other side dishes as aforementioned permitted food stuff are especially nutrients such as meat dairy products eggs whole corn bakery products, Playing chocolate with high content of cocoa, sugar free drinks even a wine but certainly in a lower dosage and some vegetables. This diet does not concern itself with the fat and intake. On the other hand side dishes in general all the food that is high in carbohydrates is strictly forbidden. Those include for instance potatoes, rice, corn, pasta made from

20 semolina flower, bakery products made from white flour, bananas, sultanas, melons, pineapples, carrots, sugar, melasa, honey or beer.

As it is the same with the other one-sided diets, Atkins diet has a big limitation in imbalance that sprouts from the lack of certain nutrient which Carries certain health issues. As long as the high fat and high protein diet regimen is conducted, we are creating a bigger risk caused by the overuse kidneys, pancreas or gall bladder. For diabetic’s special threat lies in the constant lack of carbohydrates which influences the insulin production.

Atkins diet is I'm suitable for diabetics, cardiacs and people who are suffering from any kind of kidney condition. Among others it is not recommended to be conducted by athletes or people with high physical and thus energy demands. This diet does not provide the body with needed nutrients and the high number of protein intake burdens the body while digesting. (Atkins, 2000)

3.1.2.2 Zone diet

Zone diet is inspired by Atkins diet and the designer of this diet is American biochemist Bary Sears. He adjusted Atkins method of lowering the carbohydrates intake even more. Zone diet is based on exact division of three main micronutrients each food must consist exactly of 30% fat, 30% of protein and 40% of carbohydrates. Thanks to this distribution body does not suffer from hunger – since normally our nourishment consists of 60% of carbohydrates. If the share of carbohydrates is lowered to this number a fat consumption is started which ultimately leads to weight reduction. but zone died also watch is the remaining macro nutrients thanks to regular intake of carbohydrates and fat body is not suffering from hunger but even when it's losing weight it is not losing a muscle mass. By conducting this procedure body automatically reaches a balance between insulin and glucagon therefore it is a potential too remedy itself this state of body is called Sears zone thus the zone diet.

The zone diet is also based on smaller portions of food usually taken in three-hour intervals. Each daily food must consist of exact ratio of fats carbohydrates and protein. Zone diet enables you to consume all kinds of nutrients and food stuff, but it is vital to be aware of the fact that the exact ratio between each macronutrient must be kept at all times. Biggest negative zone diet is its difficulty since it requires calculation of calories and its ratio in each foodstuff. Zone diet was originally designed for athletes since it does not negatively restrict physical load as much as Atkins diet. (Gilman, 2008)

3.1.2.3 South Beach diet

The author of South Beach Diet is a cardiologist Arthur Agatston Who was trying to find the ideal diet or his patients. This diet is based on low glycemic index nutrients and the division of fats on the good and the bad. From the dietary regimen the bad carbohydrates are removed those are responsible for fat storing around the area of lower abdomen and general obesity. It is of high importance to maintain a high intake of fiber and also replacement of none quality so called bad fat with the good one. So called good fat is considered here a vegetal fat with Out of unsaturated fatty acid. South Beach Diet consists of three phases. Phase one takes two weeks during which the diet promises to lose proximately 3 to 6 kilograms boarding to the weight the subject. In these 2 weeks all carbohydrates are strictly forbidden it is also vital to maintain regular eating for instance breakfast snack lunch snack dinner. Diet should consist only of protein and of the unsaturated fatty acids. In this phase body is significantly Deprived of its main source of energy - the carbohydrates. in this phase it reaches state called ketosis and as a result it has the potential to start burning out the stored fats and protein. During the second phase Some of the carbohydrates are included for instance whole-wheat rye bakery products, whole-wheal pasta and rice.

It is important to observe the glycemic index nutrients and ideally big those with low glycemic index. Third phase is designed to put a man to the course of normal life. Third phase is considered the most difficult one since it is a Considered as the one that should be maintained for the rest of the life. All the

22 sweet stuff on healthy sugars, fats and also the nutrients with high glycemic index are forbidden. It is permitted do sin once in a while, but it should not become a rule.

South Beach Diet is considered one of the healthier ones since it is based on healthy nutritional habits and food intake. The biggest disadvantage is the need to keep the phase three for the rest of the life. Among others there's diet is regularly criticized for its first phase since the weight loss is quite significant due to the restrictions in carbohydrates intake. (Agatston, 2004)

3.1.2.4 Weight Watches diet

Weight Watchers diet is one of the most successful and favorite dietary programs designed to cut weight especially abroad. Diet is based on so called “smart points” which is a point system in which the food is assessed based on protein, carbohydrate, fat, calorie and fiber content. It is basically a simple counting of calories and there are absolutely no restrictions concerning fruit and vegetables that can be eaten. Whole system is fairly simple, and it is based solely on counting points that each and every food has been apportioned to with according to their nutrition value. For instance higher number of unsaturated fats and shooters elevates the value of the nutrient whereas the higher number of proteins decreases the number of points. For instance potato chips has a value of 10 points yogurt with fruits and nuts has only 2 points. Apart from these also nutrients with 0 value can be found in the program but they should definitely not outbalance other nutrients. Among these nutrients are for instance fish, eggs, been, tofu, non-fat white yogurt and so on. These Tables help people choose nutrients and food which have a potential to Fill them up for a bigger period of time and are just as well healthy. another positive of this diet is also a support from people who have already benefited from going through this diet already lost their weight thanks to this approach.

At the beginning of the program each member is Apportioned with certain number of daily points based on their personal measurements such as height, age,

23 gender and weight he or she wants to reach. Even though there are no forbidden nutrients diet needs to remain under the point limit.

Applicants who decides to join the group of Weight Watchers are known as members. One of the basic stones of this program are meeting of the members and their support to one another. Members can choose from a couple of programs the different level of support.

Positive of Weight Watchers diet is irrational baseline build on the control of the portions, food and the system of gradual rational weight reduction. The program emphasizes the necessity of the general change in lifestyle. It is also Suitable for people with different dietary restrictions or food allergies since it enables them choosing the nutrients according to their specific point system.

Certain negative maybe a financial demandingness which for some people maybe too much to afford. Also there is a constant predisposition that the members are going to watch the nutrients and the point system that should be included in there point system assessment. (Gilman, 2008)

3.1.2.5 Mediterranean diet

Mediterranean diet is one of the diets that should not be perceived as an energy intake restriction one as a nutritional habit expressing a certain lifestyle of those who choose to adopt it. The general thought here is to stay healthy by maintaining these principles. It is based on the food that is typical for countries around Mediterranean Sea such as Greece, Spain or Italy. Main goal of this diet is to establish a healthy lifestyle due to which a weight reduction of redundant kilograms may appear.

Mediterranean diet is based on eating light, easily digested food. Substantive is also abstemiousness in food intake. Diet also consists of bigger consummation of fruits, vegetables, olive oil, whole-wheat foodstuffs, fish, seeds

24 and red wine. Other types of food that is included in this diet are olives, almonds, artichoke, asparagus or tomatoes. This diet should not include types of meals that have a potential to burden the digestive system due to their excessive complexity such as sweets, smoked meats, fatty meals, fried meals, sweet drinks, alcoholic beverages fatty dairy products and excessive intake of salt.

It is typical for Mediterranean diet that there are no strict restriction and forbidden types of food and no strict rules. Main goal is to achieve balanced nutritional regimen rich in vitamins, minerals and unsaturated fatty acids owing to this the diet has a potential to help reducing the weight and it also has a beneficial influence on cholesterol levels thus a productive asset for whole cardio vascular system. Thanks to these it is considered as a prevention of a stroke, heart failure and also may lower the risks of certain types of cancer. (Abenavoli, 2016)

3.1.2.6 Carb cycling

Carb cycling diet is some of the most effective ones that is used mainly by a professional sportsman and dietologists. basic principle of the style is the intake of exact number of grams of carbohydrates due to which the body is a potential of burning out the fat reserves. Due to exact amounts of carbohydrates which are repeated every week the tendency to so called yo-yo is suppressed. since you managed to baffle the body and you force it to start burning out the fat reserves. It does not start falling into economic mode and storing the energy into fat reserves for the worst time.

The amount of carbohydrates can be increased, decreased or interrupted and in certain cycles carbohydrates maybe even left out entirely. All the approaches have three common phases these are high carbohydrates days, low carbohydrates days and no carbohydrates days. Cycling can be divided into decreasing or increasing one.

High carbohydrates days are designed to refill the glycogenic reserves. In these days the intake off proteins should be decreased in order to the name of the body too re synthesize carbohydrates into the reserves. I'm like the low carbohydrates days no complex carbohydrates are allowed only in the form of vegetables as a side dish for any kind of protein. Among others it is vital to for the types of vegetables, types of vegetables in which the high portion of carbohydrates is contained must be excluded, these are for instance peas corn or beet.

This diet has no universal Dietary regimen there is no exact amount of carbohydrates that has to be eaten each day. The amount of carbohydrates must be designed individually, and it is dependent on persons weight, age, gender and percentage of body fat.

This dietary regimen is usually practiced by professional athletes and body builders since this a necessity during the preparations for competition. It is not recommended an ideal maintain this diet long term since it is highly demanding especially physically end psychically. Also the long-term confirmation of types of food with high levels off protein and low portions of carbohydrates Burdens kidneys and may gradual elite to health issues. (Dustin, 2016)

3.1.2.7 Ketogenic diet

Ketogenic diet is a nutrition procedure with high intake fats average intake of proteins and low intake of carbohydrates. Much like the zone diet this procedure also leads Jude their low intake of carbohydrates to the state called ketosis. the blood sugar drops significantly and also the produce of insulin is repressed. Energy generation is shifted from carbohydrates metabolism to fat metabolism.

While ketogenic diet all sorts of food with high levels of carbohydrates are excluded such as sweets drinks with high the levels of sugar also wheat, starches, fruits, legumes, root-vegetables and corms, low-fat and dietetic produces and alcohol. Ketogenic diet Is a diet rich in fats and proteins. Among recommended types of food are for instance meet including the smoked ones, bacon, fatty fish, eggs, butter, cream, jeez, nuts, seeds, healthy oils, avocado and vegetables.

Early stages and the beginnings of ketogenic diet maybe followed by uncomfortable complications such as lack of energy heightened sense of hunger sleeping issues and peristaltic issues. These complications and issues should only last for a couple of days since the body need some time to adjust itself with the new style of food intake.

Ketogenic diet is usually recommended to patience with significant obesity, with diabetes type 2, or with metabolic syndrome which requires a necessary weight reduction. This diet is not recommended and suitable for professional athletes or people who aim to build a muscle mass. It is vital to take into considering that this diet can only be used temporarily since in the longer time span it may result in irreversible damage of body due to the an unnatural carbohydrates restrictions Since carbohydrates are vital and one of the three macro nutrients that cannot be dissected from any sort of nutritional habit in a long term. (Ramos, 2018)

Eating disorders

Eating disorders are a symptomatic problem of the nowadays world. In the vast majority of cases, these diseases are associated with a response to personal satisfaction, social success and health. Food is no longer a simple mean to soothe a hunger, nowadays it has also become a mean of socializing and meeting friends and family. Maloney and Kranz (1997) report that eating disorder can be discussed when a food becomes a person’s center of life instead being merely a

27 part of it or if the food becomes a tool to deal with emotionally challenging situations.

People suffering from eating disorders have a common effort to achieve a slim figure by reducing energy intake and increasing energy expenditure. The fear of obesity and the high level of self-observation and the diet often leads to continuous observation of how they look, how much they lost, how much they weigh, how much they ate and how much they gained.

We are talking about eating disorders when one uses food to deal with emotional problems. In a difficult situation food or diet becomes a mean to relieve their feelings with. Regarding eating disorders the food dependency is similar to alcohol or drug addiction. For people with eating disorders, food is no longer a part of life, but it becomes its main focus. You always have to think about food, weight and diet.

According to Maloney and Kranz (1997), all eating disorders have something in common and often an overlap. Being rigorous in keeping a dietary regimen often turns into binge eating or bulimic seizures, but these can be followed up by an anorexic period of starvation. "Patients often exhibit an attitude: I'm not an anorexic, I never wanted to lose weight, I just want to eat healthy, … Some patients have valid good reasons (obesity, jaundice, mononucleosis, etc.) to limit their food intake namely quantity and frequency. But excessive self-control in food and dietary restrictions then gradually become a habit, especially when accompanied by satisfaction of a weight loss.” (Krch, 2010) There are cases where patients do not have to meet all the criteria for eating disorders, yet they may have severe psychological and health problems. Other health problems may be the cause of eating disorders, so a doctor's visit is the best first step.

The group of people affected by eating disorders is various and sundry. (Marádová, 2007) Despite the fact that treatment success is relatively high in adolescence, these disorders are very dangerous. There are several reasons why women suffer from eating disorders more frequently than men. For example, society has never been too oriented on how much men weigh. In magazines and social networks one can encounter more often the diets and advice on how to lose weight for women rather than men.

3.2.1.1 Anorexia nervosa

Anorexia nervosa is characterized primarily by deliberate weight loss. (Krch, 2010) These people do not reject food because they do not want to eat, but because they choose not to eat. As a result the starvation and loss of appetite eventually occur.

Mostly the patient is merely trying to lose weight in a certain area of the body (hips, abdomen, thighs, arms) and even when they are hospitalized with low weight, they still claim to be fat and that they need to lose weight. Maloney and Kranz (1997) add, that some experts believe that despite the fact, that they are already institutionalized anorectics, thy truly believe, that they are still fat. On the other hand some cured anorectics claim to be aware of their thinness, they knew they were not fat, but they simply could not admit it. The fear to concede was mainly caused by an argument, that they would be forced to eat. "Regardless of how they perceived their body, it was crucial for them to continue in the regime of self-control and maintaining a low body weight." (Maloney, Kranz, 1997)

Some of the afflicted would hide their skinny bodies, so that the people around them would not notice, because they would be afraid, that others would try to stop them and force them to eat. Others would expose their bodies and think they are almost as slim as they wished for. Maloney and Kranz (1997) state, that anorectics do not trust anyone who tries to force them to eat. They consider such a person dangerous, someone who tries to control them and wants to deprive them of their leanness and self-control.

People with anorexia nervosa never feel lean enough, on the contrary. In the overwhelming majority, they reach only 75% of the optimal body weight, often fainting from lack of energy.

Almost half of the anorectics are unable to maintain a strict diet constantly. There are occasional appearances of overeating phases. In the short term, they consume a large amount of food, due to which they later suffer from bad conscience and try to remedy their misconduct. Some try to throw up the food they ate, others resort to a stricter diet or harder exercise.

Krch (2010) in a book Mental Anorexia lists the parameters by which anorexia nervosa is defined: a) maintaining extremely low body weight (regarding adults and girls, body weight that corresponds to a BMI of less than 17.5 or less than 85% of normal body weight with the height and age taken into consideration) b) amenorrhea c) exaggerated interest in their appearance, fear of gaining weight and obesity, which persists despite a very low body weight

3.2.1.2 Bulimia nervosa

Bulimia nervosa is characterized by significant hunger and subsequent repetitive episodes of overeating and vomiting associated with excessive weight control. The impression of overeating is a relative term. (Marádová, 2007) It is clear from the records of indisposed people, that despite the loss of control over the food and overeating, these people ate just a little more than they wanted or was possible.

It is not a problem for bulimic people to eat up to 10 times more than the usual portion. Despite the great number of precautions to prevent overeating (keeping the empty refrigerator, depriving food, throwing-out food, hiding food), there is always a need to eat and they always find a way to procure the food.

Afterwards then the sense of guilt and despair appears and in order not to get fat, it forces them to vomit the eaten food. Some people are capable of enduring without overeating for several days, but then the urge comes again, and they overeat eventually again.

Krch (2010) in a book Mental Anorexia lists the parameters by which bulimia nervosa is defined: a) repeated bouts of binge eating - a impression of uncontrollable loss of food intake control is a more important indicator of overeating than the absolute amount of eaten food b) excessive body weight control accompanied by vomiting, exercise, starvation and the use of laxatives c) Exaggerated interest in bodily appearance, fear of gaining and obesity that lasts despite low body weight.

To compensate for overeating, these people are able to go really far down. Just the thought of the need to compensate for a large amount of food is a defining feature of bulimia nervosa. Bulimia is often associated with vomiting, but it is not the only way to compensate. Another way is laxatives, diuretic means and means that reduce appetite and others. Most people who suffer from bulimia, that is binge eating and subsequent compensation of food consumed, are on a diet. And it is just diet, that is a frequent trigger of binge eating.

The vast majority of people who suffer from bulimia tend to compensate their overeating by vomiting. It gives them the persuasion, that they can eat whatever they want, when they want, but as long as they throw up it all up, they cannot gain any weight. In the beginnings, the vomiting is usually initiated by sticking the fingers down the throat. "About a quarter of the people with bulimia who vomit can control their gag reflex willingly: it means they can initiate vomiting by mere bending or squeezing the abdomen." (Cooper, 2014) Some have troubles inducing vomiting, so they use chemical means - they drink salt water or various syrups. It is impossible to determine how often people with bulimia vomit.

Some vomit after each meal, even 7x, 10x a day, others vomit after eating, or after eating bad (unhealthy) food, that can make them fat. Others vomit only once a day after overeating. (Cooper, 2014)

The so-called rinsing method is also associated with vomiting. "He vomits, drinks water, vomits again, drinks water again, and so on; the process is then repeated until the emitted water is clean and the person can be sure that he has got rid of all the food he was able to get rid of.” (Cooper, 2014)

At first, some really lose weight, and so they conceive the impression, that this procedure works. They get involved in a vicious circle. "Vomiting is not nearly as effective in calorie removal as those who practice it would like to believe. Even though most of the calories consumed during an episode of binge eating will be eliminated, sizeable amount is absorbed.” (Cooper, 2014)

Another way to compensate is to use laxatives and diuretics. Bulimics believe that this method will help them get rid of the received calories, but that is not the case. Cooper (2014) adds that laxatives act in the lower area of a colon while calories from ingested food are absorbed in the higher areas of digestive system.

3.2.1.3 Binge eating disorders

Maloney and Kranz (1997) present, that it is difficult to determine the boundaries between binge eating and others. Food is not no longer used only to soothe hunger, but also for many other reasons (decreasing of blood sugar, nutrients replenishment, and more).

The disease is characterized by repeated binge attacks, but compared to bulimia, it does not use any compensatory behavior such as vomiting, laxative use, exercise, etc. Compared to anorexia and bulimia, binge eating is associated with noxious self-control and unhealthy eating habits. The sick person continues to eat despite being no longer hungry. According to Maloney and Kranz (1997),

32 some people are affected that once they start eating, they can't stop. This type of eating disorder is particularly typical for obese or overweight people. Krch (1999) states that among the obese who sought help, one-fourth of them had binge attacks. The heavier the degree of obesity, the more often binge eating behavior can be encountered.

This disease affects more often men than women and it affects more often the older age group. These aspects are a fundamental difference between anorexia and bulimia and binge eating.

3.2.1.4 Night eating syndrome

Evening anorexia, insomnia and night-time binge eating are typical for this eating disorder. Stress, an attempt to lose weight or an inability to lose weight have a major impact on this disease. Krch (1999) adds that afflicted people are unable to stop eating. There is a complete lack of hunger during the binge-eating episode.

3.2.1.5 Orthorexia

Orthorexia is a disorder for which the obsession with extremely healthy diet is typical. These people are obsessed with careful choosing of what the food they are about to eat contain. It may not contain any preservatives, sugars, salts, dyes and white flour, without exception. Fear of these foods can lead to a narrow choice of food, often causing a significant underweight.

3.2.1.6 Drunkorexia

A reduction diet is typical for an eating disorder called drunkorexia. Drunkorectics are prone to reduce calories intake so that they can afford to consume more alcoholic beverages. The typical group is high school and university students. Especially the girls who are longing for a slim figure and endless parties are at risk. People with this disorder reduce food intake to a minimum. Subsequent consumption of alcohol soothes hunger and suppresses fear

33 of weight gain. Alcohol is absorbed more quickly in an empty stomach, which can culminate in acute alcohol poisoning. Alcohol dependence is more common with people who suffer from eating disorders.

3.2.1.7 Disordered eating

Given the increasing number of cases of eating disorders, there are more patients who miss some of the main symptoms – i.e. they do not meet all diagnostic criteria.

When meeting with such a case in which an eating regimen is obviously inflicted sometimes the symptoms may overlap interdisciplinary. Sometimes we may encounter cases in which the condition disappears and reappears due to the difficult life situation or any other stress related aspect. In cases like these, the hospitalization may not be necessary but certain tending to it is a must anyway. Disordered eating may be perceived as any type of eating regimen that may cause in the long-term any kind of physical or mental issues.

Energy availability

Energy balance is the standard concept used to assess the energy intake and energy outtake. Nowadays the energy requirements of athletes are assessed in so called energy availability (EA). Energy availability is the overall amount of energy that is left for the athlete when the energy outtake induced by training or competing is subducted. The result is quantified in kilocalories or kilojoules and is related to one kilogram of fat free mass per day. Energy availability is perceived as an energy which the organism has at the disposal to cover basal physiological needs such as thermoregulation, growth, reproduction, cell synthesis or immune processes etcetera and all other habitual processes except from training or competing processes.

According to the current research the insufficient energy availability is under 30kcal/kg/FFM/day. The insufficient energy availability leads to both short- term and long-term performance unproductivity, it suppresses the regenerative processes, immunity, growth in general especially regarding the adolescent athletes. The ideal and recommended energy availability is 45kcal/kg/FFM/day (Loucks et al., 2011)

The concept of energy availability was formulated while studying the female athletic triad. The syndrome of female athletic triad is a concurrency of certain conditions which are eating disorder, amenorrhea, osteoporosis, low bone density and low energy availability. (Barrack, Ackerman, & Gibbs, 2013)

Athletic Triad

The concept of athletic triad is comprehended as a condition induced by long term energy insufficiency which is defined as a relative energy deficiency in sport i.e. RED-S. Even though the condition was defined while studying the female athletic triad it is not avoided by men athletes either.

Female athletic triad was comprehended as a concurrency of three factors: eating disorder, amenorrhea, osteoporosis (Nattiv et al., 2007). Nowadays the syndrome is perceived as a concurrency of amenorrhea, low bone density and low energy availability. (Barrack, Ackerman, & Gibbs, 2013) This updated concept takes into an account weighty the negative impact of RED-S and it also emphasizes, that even male athletes are not resistant to suffer from it either.

Consequences of athletic triad lead to skipping or total interruption of menstrual cycle, lowering of bone density and also into developing an eating disorder which is induced by constant undervalued energy intake. Due to these issues the consequences are the negative impact on basal physiological processes such as menstrual, endocrinal, metabolic, hematological, psychological, cardiovascular, gastrointestinal and immune dysfunction. These are then the ultimate factors in lowering the sports performance, regenerative processes,

35 training adaptation, lowering of endurance capacity, impaired coordination skills, lowered training adherence, increased injury risks, reduction of glycogenic stores, suppresses proteosynthesis and the decrease of muscle strenght capacity. Mountjoy et al., 2014)

To recapitulate the energy availability, athletic triad and a relative energy deficiency in sport when composing the dietary and training regimen for professional or performance athletes the simple procedures that may be used with amateur athletes cannot be applied. Due to high volume, intensity and the high number of training units the adequate procedures need to be employed. In order to avoid RED-S and all its negative consequences the EA must be taken into an account and the dietary regimen must be adjusted to the specific type of sport and even the specific training unit. We need to take into consideration the frequency of training units, time-distance between each unit, intensity of training unit, volume of all training units, also volume of activity and its specific intensity in each training unit in order to assemble the ideal nutritional regimen so the RED-S can be avoided. When stressing enough the importance of optimal dietary regimen we can both guarantee better results in the long-range just as well as protecting the health of an athlete.

Sport of Boxing

3.5.1 Definition of Boxing

Boxing is a combative or fighting sport with one-on-one combat in which the two opponents try to hit each other with hands clenched into a fist wearing protective gloves into allowed places on the upper body and head for a predetermined set of time inside the predefined place called ring. Boxing match is of an intervallic character divided into rounds of the length from 1 to 3 minutes each. It is highly demanding strenght-speed activity. Boxers are divided into weight and age divisions and compete only with an opponent from the same weight and age division.

Boxing match takes place in boxing ring, which is four-square space on a 0,9m high raised platform. The pedestal is at least 0,46m wider that the area amongst the ropes where a match takes place. The area which is demarked by four ropes that run around the entire square is from 4,9m to 6,1m wide. Ropes are in four given heights: 0,46m 0,76m 1,07m and 1,37m. Ropes are made of steel cords wrapped in foam padding. Out of four corners the two of them are white – the neutral ones. Third one is red, fourth one is blue. Each boxer is placed in one corner from where he or she starts a match and to which he or she returns while the one-minute breaks between the rounds.

3.5.2 History of Boxing

First depiction of a human activity resembling a boxing comes from Sumerian relief in Iraq dated over three hundred years BC, later depictions are found in second century BC in Mesopotamian nations such as Assyria, Babylonia and in Hittite art from Asia Minor. Then later approximately around 1500 BC first mentions of fighting with any kind of gloves can be found in Minoan Crete. From the same period of time also come statues depicting a combative activity that resembles boxing.

Later on in ancient Greece in Homers Iliad is mentioned a match that also resembles boxing between two men fighting each other with bare hands. This match was described as extremely bloody one. Boxers in this story wear only ox- hide thongs on their hands thus far the bloody contest. Earliest evidence of boxing rules comes also from ancient Greece as was the combative activity called pygme which was a part Olympic program since 776 BC which later became an official part of 23rd Olympic Games in 668 BC. These Olympic Games also produced the very first official Olympic Champion one Onomastus of Smyrna.

Romans later on developed a piece of equipment that resembled gloves called caestus as was later mentioned in Virgil’s Aeneid and also a match between Dares and Entellus is described. (Virgil, 2003) Later on this specific kind of combative activity was also executed while Gladiator games. Roman soldiers also

37 liked to box one another as training for hand-to-hand combat. Slaves were also trained to fist fight and were taught so in order to fight one another for the entertainment on their masters. Slaves used to fight in a circle marked on the ground – thus the ring later on.

With the rise of Christianity and the imminent decline of Roman Empire boxing in its form ceased to exist for many centuries. Another mention of boxing- like activity then later on comes only as a part of medieval seven knight’s virtues. Throughout the upcoming centuries boxing was surviving as a fist-fighting activity executed in various provinces and cities in Italy between 12th and 17th century. In Russia for instance we are talking of an activity called Kulachnyi boy of pugilism or fist-fighting.

As a milestone in history of modern-day boxing is a year 1719 in which Englishman James Figg found a School of Arms Art of Self-Defense Academy and laid basic ground rules for modern day boxing. From that moment on boxing resembled more the combative sport as it is perceived nowadays rather than a criminal activity where two people are trying to hurt one another. Another ground breaking yet tragical event occurred in 1866 where John „Jack“ Broughton and Georg Stevensonem fought for the title of world champion which led unfortunately to Stevenson’s death which then caused even bigger adjustment of rules of boxing, for instance the specific lengths of rounds and pauses were employed as well as strict usage of gloves and these changes made the boxing into a sport as it is known nowadays. Behind these specific changes was John Sholto Douglas, the 9th marquess of Queensberry.

The very first official heavyweight champion of the world became in 1882 John L. Sullivan. Then the course of events took up a speed and in 1904 men amateur boxing became a part of official Olympic program. Women’s boxing only became a part of Olympic program in London, 2004. In 1926 FIBA organization was found which was the first official association for amateur

38 boxing. FIBA was replaced by AIBA in 1940 and all amateur boxing activities come under this association.

3.5.3 Physiology of Boxing

Each sport is being affected by a number of factors. These factors are for instance somatic, physical, technical, tactical, and mental. Boxing is no exception. Boxing is a sport where the domination of acyclic movement is present. To execute such a movement a strenght and a speed is required. Boxing requires perfect full body coordination. Hands are but a mean to convey the energy and a direction of a punch, but the movement potential is created via rotation movement and weight shifting of the entire body. Thus the perfect intramuscular coordination is necessary just as well. Aerobic-anaerobic stamina is important requirement, too. Boxer’s vision requires high level of adaptation in order to assess the dynamic changes in distance to be capable of throwing and optimally landing a punch just as well as being capable of not being hit by the opponent’s punches. All these components lead to high improvements in boxer’s neuromuscular coordination. (Sobolová & Zelenka, 1973)

Boxers require not only agility, speed and strength in short, explosive bursts, but also a high level of anaerobic strength endurance in order to perform these bursts over and over from three to twelve rounds or more. (Hatfield, 1997) Boxing is a sport characterized by short duration, high intensity bursts of activity, requiring significant anaerobic fitness, within a well-developed aerobic system. Boxing is estimated to be 70-80% anaerobic and 20-30% aerobic, with a work to rest ratio of 2. The characteristics of boxing requires athletes to sustain power at high percentages of maximal oxygen uptake or VO2 Max, which is often above lactate threshold, which produces high levels of blood lactate which may lead to fatigue. The primary objective of strength and conditioning program for boxing is to delay the onset of fatigue by increasing lactic acid tolerance and ATP/CP regeneration and increase the efficiency of oxygen use which leads to an improvement in recovery between rounds . The successful boxer aims to hit his opponent without being hit in return.

It has been well documented that amateur boxers require a well-developed aerobic capacity. Senior English amateur boxers have been shown to have a relative VO2 max of 63,8 (+/- 4,8 ml/kg/min), which was similar to that of national senior German amateur boxers prior to altitude training, showing relative VO2 max values of 62,1 ml/kg/min (+/- 3,6 ml/kg/min). The importance of having a high aerobic capacity is supported by the data from a recent British Olympic medalist who had a relative VO2 max value of 69,1 ml/kg/min. A group of Italian middleweight (75kg) amateur boxers, had a relative VO2 max of 57,5 ml/kg/min (+/- 6,9 ml/kg/min). Junior Indian amateur boxers demonstrate the lowest relative VO2 max values 49,8 ml/kg/min (+/- 3.29 ml/kg/min). Comparative VO2 max values for elite boxers across Europe have been identified. Greek National boxers – 55,8 ml/kg/min. Hungarian Boxers – 56,6 ml/kg/min, French boxers – 64,7 ml/kg/min. The differences in VO2 max values between groups mentioned above might be related to the type of training undertaken, level of maturation or length of time engaged in aerobic training. Therefore in order to compete at the required intensity for all four two-minute rounds of amateur boxing it is necessary for an amateur boxer to have a well-developed aerobic capacity.

Physical activity is of an interval character with constant changing of intensity. This intensity is submaximal. Boxers must have big amount of explosive energy potential available. Boxing also requires high level of agility and swiftness. Thus hardly ever do we see a boxer taller than 1,9m even in super heavy weight division.

The short rest periods (1-minute) between rounds of amateur boxing, highlights the intense nature of competition and identifies the critical role played by anaerobic glycolysis in sustaining ATP resynthesizes during an amateur contest. When the intensity of activity increases, production of lactic acid in the muscle becomes high, resulting in high lactic acid accumulation in the blood. The heart rate is linearly related to the oxygen consumption, so measurements of heart rate during training indicate the aerobic or anaerobic demand and as blood lactate rises so does heart rate. Blood lactate values of 13,5 +/- 2 mmol/L post contest

40 were recorded in senior English amateur boxers, whilst junior amateur boxers recorded blood lactate values of 14,1 +/- 2 mmol/L. The average heart rate and blood lactate of Indian amateur boxers recorded after 4 x 2-minute rounds of boxing was 192 bpm and 13,6 Mmol/L. Heart rates and blood lactate responses were also studied in senior Indian national level boxers in competitive bouts to further explore the aerobic – anaerobic metabolism nature of boxing. The mean heart rate and blood lactate levels were 178 bpm and 8,24 mmol/L over the 4 x 2- minute rounds. Heart rate values have been studied during “Open Sparring Sessions” which is the specific conditioning the boxer undergoes during the final days prior to competition This type of training closely replicates the physiological demands associated with competitive boxing. Typical heart responses of a senior English international boxer showed that a high heart rate response is achieved during each 2-minute round (200 - 203bpm). During the 1-minute recovery heart rates drop by 20-30bpm (160-180bpm). These values further highlight the intense nature of competition and highlight the need to integrate into an amateur boxers training program specific sessions aimed at increasing a boxer’s lactic acid tolerance. Interval work such as 8 x 1-minute rounds on the focus pads with 1- minute recovery between rounds has been shown to be the most effective method of stressing the anaerobic glycolytic energy system, with lactate values in excess of 10 Mmol/L being demonstrated. The training requirements of boxing demand the tolerance of high lactate levels and heart rates. Lactate levels of approximately 9.0 Mmol/L and Heart Rates of 180 bpm over the duration of 2-minute rounds have been recorded. It is therefore recommended that strength and conditioning specialist replicate these physiological responses during training regimes.

Somatotype of boxers is dependent of weight class. Lighter boxers up to 60 kg are mostly ectomorphic-mesomorph. Boxers in middle weight categories from 64 kg up to 81kg have balanced somatotype. Boxers under 81kg are mostly endo-mesomorphic. Also in general boxers are optimally longer-handed and shorter-legged. Longer hands are an asset considering the reach towards the opponent. Shorter legs provide boxer with better stability and agility (Grasgruber & Cacek, 2008).

3.5.4 Amateur boxing

Amateur boxing is an Olympic sport (men since 1904, women since 2004). On the national level individual boxers compete for their club in which they are registered. They are evaluated by points for the matches they fight which are then assigned to their club. Clubs compete amongst each other in various levels of competition. In Czech Republic we only have two levels of boxing competition. Extra – league – the highest national league, sometimes even a team from Slovak Republic is included. The lower level is regional competition. In current season Czech Republic is divided into four regions. The principal of total win is that the team who gains the most points through the course of whole competition becomes a winner. In amateur boxing boxers wear either red or blue outfit which corresponds with the color of either red or blue corner of the ring. The outfit contains of top and trunks. The equipment the boxer must have while entering the ring in order to take part in a boxing match contains of gloves, mouthpiece, bandages, suspensor, boxing shoes and except for men in Elite category also a head-piece. Gloves weigh either 10 ounces or 12 ounces. Also the manufacturer of official boxing equipment must be AIBA certified. All categories both weight and age wear 10 ounces gloves except for Elite men category from 69 kilograms up, they wear 12 ounces gloves. Bandages must be from 2,5 meter up to 4,5 meters long. Mouthpiece must be neither red nor in any other shade of red. Men must wear only groin suspensor, women must wear groin and chest suspensor. Amateur boxers both women and men compete in only three rounds whiles the length of the rounds is determined by the age category. Rounds are from 1 till 3 minutes long.

In general, amateur boxing is stricter concerning the rules. Quality and the correct execution of punches is also assessed as well and as a foul is also considered un-clean punch landed for instance not with the correct part of fist just as well as a low blow or a blow on the back of the head. Technique itself is of high importance in amateur boxing. Boxer in amateur boxing is protected more by

42 the rules then in professional boxing and it is safe to say that amateur boxing is more sports-like activity rather that a brutal combative confrontation of two. Boxing match has one referee and three judges. Referee enforces rules inside the ring and does not influence the outcome of the match via scoring points. His primary assignment is enforcing the clean fight via overseeing the rules. Referee can stop the fight also for instance when the dominance of one boxer is so great that it could very well endanger the health of the other boxer. Referee can also consult with the ring doctor when being in the suspicion that one of the boxers is injured or that some minor facial injury such as skin cut is turning into the jeopardy of boxer’s vision or overall health. Three judges on scorecards are supposed to assess rounds and at each round chose a winner of that round who is than evaluated with 10 points. Loosing boxer of that very round is evaluated with maximally 9 points or less. Number of points depends on dominance of round winning boxer. For instance 10-9 result is a slight dominance during the round, 10-8 is stronger dominance or a point deduction for knock-down or foul. 10-7 is overwhelming dominance or two knock downs. 10-6 is absolute dominance and this score should not happen during the match since the dominance is so great that it can endanger the loosing boxer and in this case the referee inside the ring should stop the fight via RSC decision which means that the referee stops the contest.

3.5.5 Professional boxing

Professional boxing is basically the same sport as amateur boxing with only certain variations which are supposed to make professional boxing into a more attractive but also a more dangerous spectacle. Boxer is not protected by rules to such an extent as in amateur boxing. Cleanness of punch is not assessed here to such an extend as in amateur boxing. As long as the hand is clenched into a fist and the punch resembles what a punch is supposed to look like the rules do not pay any further attention to it.

The main difference between amateur and professional boxing is in the length of a match. In amateur boxing the match never exceeds three rounds, in professional boxing the match can last from four up to twelve rounds.

Another difference is also visible in appearance of boxers. Amateur boxers also wear the upper part of their outfit - the top - whereas professional boxers do not. Professional boxers are allowed to tape their hands with additional padding whereas amateur boxers as was mentioned are only allowed bandages of given length. Professional boxers do not fight for their team. They fight for their own individual rating within the respective association and the matches are promoted for them by their promoting agencies.

Professional boxing match is also judged by three scorecards judges and one ringside referee. Score of individual rounds can be wider in span due to the fact that in professional boxing is not a three knockdown rule kept so hypothetically a fighter can be knocked down nine times and the score card can that be 10-0 but as long as a referee does not stop the fight or the towel is not thrown into a ring by the loosing boxer’s corner the fight can go on. Professional boxing has more than one association. Most prestigious associations are WBC, WBA, IBO, The Ring magazine, IBF.

3.5.6 Weight classes and weight cutting in boxing

Sport of boxing is a type of a sport in which the competitors are divided into classes according to their weight which is the reason why the general tendency is to move down at least one weight division or two in order to compete with opponents who are not stronger or bigger due to their natural weight. This may and also is nonsensical since it if neither of athlete cut the weight, they would weigh the same and the weight division would be an irrelevant formality. In my practice my competitors are basically forbidden from cutting the weight prior to the match since weight reduction is certainly not healthy especially for kids and juvenile athletes who need ideal energy intake in order not to interfere with their growth process. My competitors are allowed to cut weight up to 3% of their body

44 weight since according to literature the dehydration between 3-5% does not have a negative influence on the performance. I also have my competitors watch weight before and after a boxing training unit in order to determine how much weight they lose to the dehydration in average so I can then determine individually the approximate safe percentage of their possible weight cutting prior to the boxing match in order for them to move down one weight division.

There is a relevant difference between amateur and professional boxing since amateur are officially weighted couple of hours before their match whereas professionals have the official weigh-in at least 24 hours up front. Thus the significant difference in time span in which the athlete can rehydrate and restore the originally weight and energy supply.

In later years with the onset of better medical treatment, performance enhancing drugs especially in this case the diuretics, professional boxers even female professional boxers cut their weight up to 10% of their body weight. This certainly raises a polemics of health endangerment but the main difference between amateur and professional sport is indeed in undeniable fact that professional sport does have nothing to do with maintaining good health rather the other way around. Therefore the explanation of my coaching philosophy of forbidding weight reduction of all my athletes.

Weight cutting is usually carried out by every intake restriction and when the match approaches with massive dehydration executed by long training units in lower intensity while wearing sauna suits and additional layers of clothes with the intention to activate thermoregulation via sweating thus the dehydration and successive weight drop. It is not unusual for the athlete to feint, pass out or collapse even. Number of boxing matches is postponed or canceled due to failing the weight limit or by the athlete ending up in hospital being incapable of competing at all.

Eating disorders in the sport boxing

As mentioned in the previous chapters, the sport of boxing is a sport of weight divisions thus the necessity to at least concern oneself about how much he or she weights, what weight division would one be, then and also who from professionals is competing in that particular division and whether one could even picture him or herself stepping inside of the ring with that particular boxer. And so the gradual concern with the number on the scale begins.

At first when someone starts boxing the biggest concern is the physical condition since each boxing training is demanding in stamina, endurance, speed, strenght, power and relentlessness. Those who overcome these first months of total exhaustion after each training unit reach the point of becoming somewhat addicted to the pain and torture of boxing training and step on the road of infinite search how to be capable of taking even more significant volume of training load. That’s where the interest in nutrition peaks. One gets to realize the fact that unless fed properly the road does not go any further. So the interested in specific needs of boxer nutritional regimen begins and after some time, you necessarily come across the dieting prior to the boxing bout and the need to adjust the energy intake while maintaining the intensity of boxing training regimen.

Along with the need to manipulate the energy intake arises the need to find an ideal way to do that. Unfortunately still the high percentage of boxing trainers and coaches know literally nothing about dieting and basic nutrition principles thus making boxers lose weight irrationally in general and when losing weight making the boxers accomplishing it by simple no eating and no drinking procedures. Logically the combination of sever undernourishment, dehydration and continuous high volume of training load the foundation for a problem is developed. In the search for ideal way to lose enough to get into desired weight class various nutrition manipulation is carried out by certain type of dietary regimen. The type of dietary regimen described in the previous part of this thesis may be implemented. Unfortunately the energy intake is rarely ever decreased in

46 the long-term type of a rationally adjusted regimen by way of implementing certain type of diet. Mostly it is carried out in the last week prior to the match by decreasing the intake significantly along with the general decrease of fluids intake which leads to inadequate energy availability.

After a couple of times of going through such a procedure of weight manipulation mostly the athlete develops an urge to go even one weight class lower. This way the need to implement even more drastic and longer-term every intake decrease is developed. Unfortunately hardly ever does an athlete consult or tries to find a way with a professional and self-educate him or herself via unreliable sources and procedures mostly conducted by self-appointed internet expert who simply use the procedures of lowering energy intake, eating “empty” calories or supplementing various types of “fat-burners” in order to be ripped and be rid of the fat. This way the continuous insufficient energy availability is developed which in long term may cause complications described in previous chapters.

Yet another fact plays significant role in boxers’ dietary regimen. When putting oneself through the torture of hard training and dieting when the match or a tournament is over, they naturally feel the need to reward themselves with food and especially the junk one. Often you get to see the boxers both amateur and professionals posting photos on social media of them overeating in fast food type of establishment. Sometimes when the stress before the match sets, boxers sometimes state that they want it all to be over with no matter the outcome and that they are looking forward to finally eating the junk food. This type of attitude is not unusual, and this is also a foundation for developing an eating disorder, too. After overeating couple of days after the boxing match the body has a natural need to super compensate and in couple of days the weight sometimes jumps even couple of kilograms higher than the natural weight before used to be, leading into frustration and guilt conscience and increases the motivation for even harder regimen of diet and the need to get the weight in order as soon as possible. This

47 sort of attitude does certainly meet the definition of disordered eating since the need to evaluate the quality of life in the food intake is established.

4 METHODOLOGY

Description of subjects As a main method used in order to accomplish the case study was a description of situation. The knowledge required to compose the case study was obtained via target talks that I maintain with my pupils and all the people I train.

I set up a routine that after each training unit I ask all the attendees whether there are some questions regarding the training unit, some feedback or if there is anything thy would like to share or talk with me. I am happy to state that my pupils now let me know couple of days ahead in order to “book” a time after the training with me. Always there is something we talk about. This way I work closely with all my pupils having relevant feedback regarding their feelings, training influence and the state of their mind that allows me to adjust the planning process ideally in order to keep improving myself as a coach and a human being while improving the training regimen in the process. I try to ask the questions and lead my pupils to find the answers within themselves instead of telling them what to do. They are taught that there is no such thing as anyone knowing everything and that the only person capable of helping themselves are themselves only. I teach them to search within I merely provide them with the means to do it better with each situation dealt with.

The same way I work with both subject in these case studies. More time is probably spent with them than with others and it is due to their need and requirements to talk to me more often since their training and preparations is opening up more unclearness that need to be addressed. Thanks to these target talks I have a feedback on daily basis which allows me to do required optimizations and adjustments due to the changes that may occur during the training process. This gathered detailed information was then used to formulate both case studies. Description of subjects was based on target talks that were

49 designed to provide a feedback. The main procedure to design the training process is discussed in following subheads.

Used methods

4.2.1 Training plans

In a designing of training process I use standards and procedures I was taught while studying at the Faculty of Sport studies. I designed the year training cycle using types of periodization described in Periodization Training for Sports (Bompa, 2015). The boxing season varies significantly thus the adjustments. Basically the season is divided in two halves: autumn and spring. Throughout each part there is a type of league that is held six times per each half. Plus the various tournaments are also held from official ones such as nationals, European, world just as well as unofficial ones like championships and fight nights some clubs organize. Naturally I try to design the training regimen accordingly to the season halves counting on the fact that the tournaments and the matches will be participated in. In order to accomplish these requirements I use block periodization during the winter and summer off-season preparatory cycles and wave periodization during the in-season time.

4.2.2 Dietary regimen

As mentioned in preceding parts of this thesis I try to educate my pupils gradually for them to be able to evaluate what their body needs on themselves. I organize workshops and seminars in order to provide them with necessary knowledge about nutritional methods and dietary regimens. Most of the season they are capable of evaluating themselves on daily basis how to approach their dietary regimen and we consult the outputs when needed. Only when the match or tournament approach I design particular diet corresponding with the specific needs either to maintain the weight or to manipulate with it both ways.

I teach them how to count their basal metabolism using Harris-Benedict equation and how to count approximately the optimal energy intake using the PAL coefficient. Then I have them take notes of their individual dietary procedure at least for 3 to 4 weeks (the length of the average mesocycle in my planning). After that we assess the weeks individually in order to have valid outputs and we make the average with which we can work then. Even though as described in chapter 2.4 the ideal EA is supposed to be between 40 – 45kcal/kg FFM hardly ever does anyone go above 40 kcal/kg FFM. The EA of my athletes is between 35 – 40 kcal/kg FFM with them claiming that they feel well regarding the regeneration and mental state, also despite the high volume of training load they maintain their weight steadily.

I want my boxers to compete in weight divisions having their natural weight without the need to lose more than 2 – 3% of their body weight which is the level of dehydration they usually experience during every training unit. This being a state they experience on regular basis I do not expose them to any additional stress prior to boxing match conjoined with the boxing match itself.

4.2.3 Target talks

In order to be provided with up-to-date outputs not only do I have my pupils and trainees have a training diary or any other kind of training analysis, I prefer face to face interaction with all of them in order to create a bond with them strong enough for them to trust me with their health. I do not exaggerate here while using a word health. Me, as a coach I have a power to affect their health not only due to the employing the training plans I create but also since boxing is a combative sport and a martial art in which a serious injury can be afflicted. They must have the unyielding trust in themselves and their abilities in order to prevent them getting injured or hurt while practicing the sweet science of boxing.

As mentioned, I do my best to spend at least some time with each of my pupil talking about their feelings or moods and especially how they feel regarding the training process. The talks are targeted to address the impact of each training

51 unit on them. Not only the physical aspects but also the psychical ones. When conducting the target talk, I firstly start up with easy topics such as how are they doing in general and how did they like the training. When I have them started talking and set up a baseline of a conversation, I steer towards more specialized things such as the level of their exhaustion, potential sore spots on their body caused by going through the training unit. I ask them how they felt before the training unit, whether they felt exhausted, sore or ready and activated. I ask them about their energy intake and dietary regimen in general and before the training.

Slowly when the baseline is set, I steer towards the topic of their mental state. I ask them about the family situation and the relationships in general. I am happy to state that they feel comfortable enough to tell me even very personal feelings and notions. Only this way am I capable of helping them nurture their mental health just as well as their physical one. It is strange that a mental coaching or any kind of psychic preparation is only employed when the problems sets usually.

I try to address these forms of preparation with the same importance as any other aspect of training for instance a condition one. Mind and body need to be tent to in balance for the athlete to grow meaningfully and be capable of gaining the peak of the potential.

Time table of data collection and data analysis

The data to compose this thesis are gained systematically and the span overlaps the years. With the subject L the data is gather for six year with subject K the data are gathered for almost five years. Since I am the one who oversees and composes the year training cycle of both subject just as well as the whole boxing club, I have a complete concept of how much, how often, the intensity, the volume just as well as the outputs of the application of training cycles.

As stated, the training plans are composed accordingly to the phase of the year cycle just as well as the dietary regimen of athletes.

The feedback from athletes is either registered in their individual training diaries or dealt with during the aforementioned target talks. The results are the analyzed using the procedures formulated by literature concerning the sports training and all its aspects just as well as an individual and subjective feedback given by athletes themselves.

5 OBJECTIVES

Cease studies

As the objectives for this thesis and the case studies I chose two female boxers from our boxing club which I train and coach in competitions. I chose these two since they are already performance athletes and thus they compete in tournaments and their training regimens consist of high volume of training units which require the careful planning, meticulous programming and surely enough optimally adjusted dietary regimen. Since they have already experienced dietary manipulation, weight-loss protocols and high volume of training units associated with competition tensions and worries they both exhibited certain type of disordered eating or at least their attention of what they eat is permanently heightened due to the constant need of a performance athlete to keep and optimal weight just as well as increase his or hers performance.

Yet another reason why I chose specifically these two is the fact that since they are females, the complexity of their complications associated with a disordered eating and challenging training regimen bears more variables then it may with a male athlete. It is demanding for them two just as well as for me to work with all the variables in these equations in order to tune up their performance to the heights of their potential while maintaining their health. Since I did not manage to prevent some negative impacts from happening I feel the need to share my findings in this thesis to help potential disciples avoiding the mistakes I made due to my incompetence caused by either not-knowing or not appreciating the risk involved.

5.1.1 Subject L

General description

First subject of this case study is a female elite boxer. She is 20 years old. She is 169 cm high and her training weight oscillates between 70 to 71 kgs. Her

54 offseason weight sometimes increases even 3 kilograms, but it drops down when the in-season cycles start again. For the purpose of maintaining anonymity she is going to be referred to as subject “L”.

L comes from somewhat non-traditional family since her father is originally from Mid African state of Benin. Her mother comes from Czech Republic and along with her two younger siblings live together whereas the father does not live with them in the same household. Reasons why he does not live with them may be a little controversial to some since he teaches at the university. The controversiality of those reasons are those that he sees his children once a month in the average. The relevance of this information for this case study may lie in the fact that even though the family does not live in some sort of conflict or disharmony per se it certainly is not a traditional environment to bring up kids since not only are they not residing together, they are not married at all, too. This may have played the role in the early pubescent years where L chose to engage in martial arts. Her father is strongly obstinate and selfish which are the character features that L did take after him. Thus her choice of martial arts of all sports and activities.

L does not get along bad with her mother, but she sees her as not competent enough to cope with everyday course of household. Her mother is also practicing some sort of alternative eating habit which consist of non-eating to veganism. Even though she is certainly not a good example of healthy eating habits she does not make much less force any of her children to eating her way. She provides them with complete scale of food and drinks which is a little surprising thing since normally parents tend to force their eating habits on their kids especially when they take up some alternative eating habit such as vegetarianism or veganism.

L family situation character predisposition and also the fact that she her race is mulatto led her down the road towards the martial arts since she felt ever since she was little that she would have to fight much harder than the rest of her

55 peers to deserve respect, love and some sort of social status she can be content about. Her appearance does not indicate her being of mixed race since she mostly took after her mother. Yet she would always be very sensitive about other people joking about this very fact even though hardly ever in a bad way. This fact would always also drive her towards the need to achieve more than others.

L’s road to martial arts begun in another field entirely although not unrelated. At the age of 6 she begun with dancing and she did so for another 7 years. She gradually became not satisfied with her time being spent on dancing and with the onset of her puberty also her competitiveness developed. Despite the disapproval from both of her parents she started kickboxing at the age of 12. At the age of 14 she started boxing with the ambition of becoming a professional boxer someday. That is when she became my pupil in boxing and somewhat of a mentee in life. As will be later described my method of training and coaching people include regular target talks with the high emphases on the development of both mind and body in a sort of kalokagathia way. Since only in equilibrium can true potential be revealed.

Boxing career

Ever since L started training her regimen was always composed of hard work and to some extend extreme conditions and high amount of training units in the course of whole year. She would train twice a day five days a week and in the remaining two days once a day which is twelve training units per week, no rest day. Morning training units would consist mental preparation, running, shadow boxing, technique training. The evening unit would always consist of extremely hard metabolic training on the top of at least hour of boxing drills and bags work out. It was at that time while still at school where she would fall in love with the professional training regimen which would leave her focused solely on training towards winning the upcoming boxing match. Training regimen and the one-sided mind set became some of an addiction which would later in life cause her troubles for instance at school and in more or less any other activity then boxing itself. After one years of training her first amateur match came which she would win via

56 technical knock-out outclassing her more experienced opponent entirely. She was picked for national women team immediately and her another two matches took place in international tournament in Germany which she would also win via early stoppages. The career was started ideally considering she was only 14 at that time. Little after the first match a little shoulder injury occurred that she would unfortunately cause herself while adding yet third training unit into her day without my permission. Little rupture at the front delta muscle was cause during her individual dead-lifting session while lifting 100kg (at that time she was 14 years old and she weighed 62 kilograms). Despite the injury she would win all aforementioned matches. Right after her arrival from tournament we started looking for recovery which led to laparoscopy of the incriminated shoulder. Unfortunately the general surgeon did the operation stating that only a slight inflammation caused the permanent pain. After weeks of rehabilitation and additional weeks of progressive loading of training load she would come back only to discover that the problems were not terminated. So we would have to start looking for another solution which costed a lot of money and substantial amount of time. In the end the problematic ligament that would originally be ruptured would gain its original strength but the pain in the area remains to these days. Only the intensity of the pain differs depending on exhaustion and training load.

L would while dealing with injury box another seven boxing matches which she would win all but only via points decision. Her first loss came in the semifinal of state championship 2018 where she would lose closely on points with seven-time state champion who would later win the final to become the eight-time state champion. Later that year they would meet again in the ring with the very same result. After these two losses L would decide to leave her job and amateur boxing switching to professional boxing. Her professional debut took place in April 2019 and she won it decisively via point decision.

Since the sport of boxing is a one of weight divisions, she would have to watch her weight practically all the time. This would create a habit of constant

57 control over what she would or could eat just as well as a mean to maintain the warrior mindset that will be discussed later in this thesis.

I was the one controlling her training and eating regimen which would often lead to sort of disagreements since she would develop a need to train even more and eat even a little less. We would come across a phenomenon of her not being in good mental shape before the matches since she was forced by me into not reducing her weight more than two maximally three kilograms. Even tough well fed and ideally regenerated and also physically prepared she would exhibit worse match performances blaming the regimen not being hard enough for her to become mentally ready in her own eyes.

Symptoms

First symptoms of problems appeared after the re-entry of training regimen after the shoulder injury. She would the exhibit the symptoms of overtraining. Subjectively, during our target talks she would state that she does not feel good or strong and that her sparring and match performance are poor. Ultimate situation of this poor state of her mind was when she would cry hysterically after a won match (which she would only win on points) that she is no good anymore and that she never will be again. Objectively her strength would decrease after her injury. Before the injury she would be capable of performing a series of at least 10 push- ups and she would do 2-3 pull ups. After the comeback she would be capable of doing any pulls ups and one or two strict push-ups. Her bodyweight would increase too but it was only because she was still in the process of growth. She would weight 69 kilograms. The training plan would also change. I designed the training regimen to be only six training units a week with the Sunday as a rest day. Even though the number of training units decreased I designed each unit to be more demanding and more complex so in general the same amount of work would be done as if she trained previously with significantly higher number of training units per week.

Diagnostics

During the annual sport medical testing she would exhibit highly above average outstanding results measured in spiroergometric bicycle ergometer, yet her strength would not increase to the previous levels. Her physical constitution was highly above average, too. For instance her body fat is approximately 13%. It was at that time she would start exhibiting additional symptoms of overtraining and potential female athletic triad. She would also provide me during our target talks with the feedback in which she would state that even though she knows and is aware that her energy intake is closely sufficient she would rather decrease the intake even more. I did practically forbid her from doing so and I am fairly certain that at the beginning she would listen to me and that she did obey. But as the time moved on, she would pressure me even more to let her eat less in which point I gave up. I provided her with books and additional materials concerning nutritional habits in sports and let her deal with it on her own. In this point I felt like it was more productive to give her an opportunity to gain knowledge on her own and experience it all on her own since I did not find productive to be constantly in the opposition in the fear of her losing the trust towards myself and my methods.

Objectively she exhibited some symptoms that are common for disordered eating and female athletic triad. First her energy intake let alone energy availability were not by far sufficient. When composing her own diet she would have the EA approximately 16-18kcal/kg (FFM) which is way below the minimum, yet she would subjectively state that when she is eating in this matter, she finally feels good. Surprisingly enough her weight would not differ, and the weight would vary between 68 – 69 kg. She stated that she would ideally have the weight around 64kg, but she got stuck around this weight and it would not decrease anymore. On the other hand when she would increase the intake short term for instance for a weekend or couple of days her weight would spike up 1- 2kg. That would automatically initiate the reaction of her need to decrease the intake even more. She was capable of taking the weekly training load, but I felt could not see the progress nor physically neither in her boxing performance. Yet

59 another factor should be mentioned here. She was finishing the high school and was graduating at that time. Even when she stated that she was not nervous about it she was definitely bothered and annoyed by it since she would state that she does not want to end up in the conventional type of job and she would increase her speculation with the thought of becoming a professional boxer since she could not picture herself going to work on daily bases much like to school.

Subjective complaints

For the professional debut she would have to lose even bigger amount of weight she would need to descend with her weight below 66,6kg. This time we would change the approach in the weight reduction to concentrate less on the lowering the energy intake and we would achieve the required weight via water reduction. Six days prior to the weight-in she would gradually increase the water intake to almost 8 liters a day and three days before the weight-in she would decrease the fluids intake to three then two and then to half a liter a day along with hot baths in order to gain the weight. It was a first time we would go through this procedure and at it did work since her official weight was 64,4 kgs. This is only 0,9kg to the next lower weight class so the consensus for the next match is that she is going to be moving down one weight class to 63,5 kg weight class. After her professional debut her weight would gradually rise to 74 kgs in four days and while another target talk, she would state that she feels that even when she is already overeaten and full, she still has the urge to eat more regardless the type of food from healthy alternatives to junk food. We both would agree on the fact that she does have an eating disorder and that it will probably never going to be fully cured at least not while her professional career. I would propose the approach of us agreeing on the fact that it is a disorder and but that it is not going to be precepted as one. That we would rather call it a state of affairs and that it is there and that it needs to be worked with via these target talks and dietary regimen that is going to control this setting so as it does not spin out of control with the ultimate argument being, that it would negatively influence her promising career. This is the point of view I deem productive since the only stimulus stronger than her eating habits is her need to be successful boxer. As a coach and as a human

60 being I am strongly torn about this very situation which is the reason why I do not train most of my pupils to be competitors rather to become professionals’ users of their body and mind via movement activity.

Another symptom of female athletic triad is the measuring of bone density. We have not managed for her to be tested yet. It was not a priority to have these results since she did display others conclusively. From time to time she would experience joints pain. Since there is a significant rheumatism occurrence on her father side she was also physically examined for rheumatism. The results were inconclusive, yet she was prescribed some sort of medication which is normally prescribed to people who factually have the rheumatism. Potential side effects of this medication were serious in very bad way, so we decided not to go through with it. At the leaflet of this medication were listed side effects such as temporary blindness, kidney or liver damage, nauseas. I made the tough call to instruct her not to take this medication since we also were in accord in this matter.

As aforementioned she did display the symptoms of disordered eating with constant insufficient energy availability. She would also exhibit significant irregularities in her menstrual cycle. There would be absolutely no regularity at all. The cycle would be between 6-8 weeks in length and the span would be from 3-8 days in which she would experience excruciating pain and cramps in lower abdomen around the uterus a week ahead of the beginning of the cycle just as well as feeling nauseated sometimes being at the brink of fainting due to the pain or/and due to the high blood pressure. This being the fact it highly influences the training cycle since she would be out of the training regimen for almost two weeks in average due to these complications. Having experiencing this irregularities she would incline to lowering her energy intake even some more since with the lower intake it is possible to disrupt the menstruation completely – a fact that she would be willing to accept due to the huge complications caused by this not only in her sports life but in her personal life just as well.

Conclusion and proposition of a solution

With L’s training eating and match regimen it is highly unlikely that she would be capable of switching back to healthy normal as should be. Also with the fact that is a professional boxer now and the weight reduction is a must in this line of work it is certain that there is a risk of health problems due to this regimen. She is planned to compete 5 to 7 times a year. The training and eating regimen are going to be adjusted to reflect the needs of more demanding professional boxing competing.

Two aspects are going to change that are going influence the whole training and eating regimen. She is going to be completing in even lower weight class in which the weight limit is 63,5kg so the weight reduction prior to the matches is going to need to be even more dramatic and challenging.

In professional boxing the structure of the match is slightly different, too. In amateur boxing there are three rounds, three minutes long. In professional boxing there are from four to ten rounds but only two minutes long. The pause is the same in both professional and amateur boxing which is one minute between each round.

In conclusion there is absolutely no way that she is going to take up normal eating habits anytime soon. In the years to come she is going to be training heavily and manipulation with her energy intake significantly. The ultimate task here and it is a task for me as a head coach to do as much damage control as possible without endangering the results in the ring. I am going to need to work with her on the number of aspects in order to forge her into a world champion, but it is impossible to do so when the athlete is injured or sick or otherwise incapable of training. As aforementioned the answer lies in equilibrium and balance. It is going to be a very challenging process with hard decisions and measurements. It is absolutely bipolar for a head coach to see the need of results and progress on one hand and the slow decrease of general health on the other.

Solutions of general damage control is going to be in meticulous training periodization and planning along with close eating habits analysis basically on daily basis. It is also vital to analyze the training process closely and also have her tested medically and ideally implement other methods to evaluate training load and its impact on the athlete such as measuring of creatine kinase or other.

I wish not to sound too pessimistic or that I am giving up on the L’s health but unfortunately I need to come to terms with the fact that she is a professional now and that the health is going to be damaged irreversibly weather I like it or not so instead of confronting myself with it I will try and do my best to be a capable head coach and compose training plans and eating measurements as good as the situation allows in order for the damage from the professional sportsmanship would be as low as possible.

5.1.2 Subject K

General description

K is a 19 years old female elite boxer and she is the second subject for this case study. Also for the purpose of anonymity she is going to be referred to as K. K is 179 cm high and her normal training weight oscillates between 72kg to 73 kg. During the off-season time when she doesn’t train for couple of weeks her weight increases 1 to 2 kilograms temporarily but in drops down when the in- season cycles start. K comes from stable and traditional family. Her parents live together in a household in a small village near the city where are boxing club is situated. She gets along well with both her parents maybe a little better with her father. Their personalities are similar that is why they hardly ever have a conflict or misunderstanding. She just gets along with her mother well too yet whenever she has a conflict at home with either of the parents it is usually with the mother. We are not talking about some significant conflicts per say we are talking here only about the type of the conflict that a teenager has with the parent. It may be caused by the fact that their personalities are a little different. There are irregularities in

63 the platform of their communication. Her mother has a special and unique way of voicing her concerns about K’s safety regarding the boxing matches. It is not that she is not supportive of her boxing career, but she would certainly be happier if K would not compete in boxing. As a coach I can certainly appreciate these concerns of either parent since I used to compete in boxing too and my own parents would only become supporting of my boxing career when I stopped competing actively and when I became a coach. Whereas my parents would not speak with me about my boxing career or matches K‘s parents engage more in her boxing career. Unfortunately the engagement of her mother is rather negative to say the least. There is this strange phenomenon but the entire of her mother side. They have a special way of communicating with K and her boxing career especially regarding her boxing matches her results and all. Whenever the boxing match would approach K’s mother would gradually engage in voicing her own concern about K’s health by saying and stating things such as “aren't you afraid that you are going to lose ” “you are going to lose anyway ” “you are going to lose like you did the last time ” “I don't know why you still do it when you are losing ” and so on. The entire mother’s side of K’s family what communicate in this manner. we can only speculate on the reasons why they would behave in such way, yet it certainly is an aspect that needs to be taken into consideration.

K’s indirect route to her boxing career begun when she was approximately 9 years old and she would take ballet lessons twice a week, couple years later she switched to folklore dances since in the region of south-east Moravia especially when living at the countryside it is very typical for people to have their kids go to folklore dance lessons. She did this as a hobby for four years and at the age of 14 she started boxing.

Boxing career

When someone starts boxing in our boxing club, I always have a sort of interview with this person. I ask them how they come up with the idea of starting with such a sport, why they want to conduct such a sport, what they expect from it and what they want to achieve and what their dreams are just as well. These

64 cursory diagnostics help me in select optimal and adequate approach towards them from the day one so their expectations can be met with reality and achieved if possible. It is also vital to help them shape their goals more rationally so that they do not get frustrated from not achieving some irrational goals them or their parents may have in store for them prior to starting a boxing career.

K did make it unequivocally clear that she strives towards competing and that she pictures herself as a successful competitor. Unlike with L I was fortunately more competent trainer and coach back then and I did not overload her with excessive training load and inadequate number of training units per week. During the first couple of months she would only train three times a week, after approximately half a year she would add one to two more training units per week. After another couple of months when her amateur debut approached, she would have six training units per week with Sunday as a rest day. This regimen with 5 to 6 training units per week is kept in the long haul. The number of training units would only increase with the approach of a competition tournament or a boxing match when she would have ten to eleven training units per week with additional four to five training units integrated into mornings before school during which she would either do the compensation conditioning work or some metabolic kind of a training in order for her weight to be adjusted according to the weight class she would need to reach.

Regarding her nutritional habits and diet I would gradually start talking about it only when the training load would increase to five to six units per week and she would give me a feedback of her being tired and feeling sore at the begging of upcoming training unit. I would progressively consult with her the nutritional preferences while slowly optimizing her regimen by teaching her how to maintain it herself without some written dietary regimen. It is always my goal as a coach not to give my trainees that metaphorical fish but to coach them to become a fisherman themselves. I did manage to achieve this level of knowledge with K. Unfortunately her mother would step into it from time to time with rather irrational comments like why she is eating like that and why would she not eat

65 something that she considers normal. When asked what she considers normal she would reply that normal is white wheat bakery or butter spread. This was definitely our most common topic via our target talks regarding her mental preparation prior to most of her boxing matches and competitions. This being a fact along with her type of personality I consider this to be one of the reasons for developing a type of eating disorder condition as will be dealt with in the subsequent part of this case study.

We would always as with every single competitor in our boxing club engage in metal preparation prior to their upcoming boxing matches. This mental preparation would include target talks in which we would address the feelings regarding and also not regarding the upcoming match, we would talk and sometimes try to analyze what is going on in their lives, in their heads, how they feel in general and what it means to them. With K we would deal with her excessive nervousness caused by her personality. She is a little introverted and enclosed, but you see that there is a lot going on inside her. I was grateful and happy that she would build a huge trust towards me and we have these little talks of ours on regular bases regardless the situation. Before the boxing match she would get nervous, tense and unstable. Her moods would switch from being overly eager to be nervous so much, she would almost sometimes tell me that she is not certain that she wants to go through with the match whatsoever. During the course of her first ten boxing matches she would even cry only a minutes before we would go to the ring. I would ask her in these situations if she wants to compete and whether I should cancel the match completely. She would resolutely refuse, and she would always ger herself to go there. The moment she would step inside the ring all the relentlessness would drop and she would be fine, ideal even. There was a match where she would get really agitated and she would eventually lose this match. She would even state between the rounds that she does not want to compete anymore. She even asked me to throw in the towel. Since her performance was not that bad, she would only be not doing well but her opponent did not surpass her quality I chose to be mean to her and very strict in that moment I would even use very harsh language and tell her that there is no

66 throwing the towel there that she has no choice but to go there, fight and loose with dignity but much like in life, sometimes you do not have a luxury to just throw in the towel and loose comfortably. Sometimes you need someone not to let you give up. I try to teach my pupils that they either win or learn but never lose. I teach them that they can live with the defeat, but you cannot live with giving up. I try to teach them that such thing is never an alternative and that this word is to be deleted from their dictionary. This was probably the most distinct symptom of her mental lability but even despite these mental states she would never give up on her resolution to keep on boxing. With her getting more experienced and us working on this particular limitation steadily she would get more composed and serene before the matches eventually.

She fought 14 matches and she won 10 of them before the national championship. The national was significant because of the fact that it was the very first time I wanted her to lose weight on purpose. Since her natural weight is 71 kilos and the weight limit is 69 kilos, we decided that she would got the weight for this purpose. It is rather strange and somewhat illogical but national championship lasts 3 days during which you fight 1 match a day with the last day being the finals. The strange thing about this is that not only do you have to make the wait the very first day at the first official weigh-in you need to be capable of maintaining the weight limit during the entire course of the tournament. The weight-in is always in the morning and the matches are always in the afternoon. For the purpose of her being capable of maintaining the wait for the entire tournament when you that we could not accomplish the weight limit via dehydration and water reduction we knew that we would have to lower the weight in general. That is why we initiated the 3-week program of gradual weight reduction with her losing approximately 1 kilo a week. The program consisted of 2 training units per day with the 1st morning one being the one designed to burn out the calories with continuous load in the middle zone heart rate frequency and the evening one being the boxing training unit. The weight we set to accomplish was 68 kilograms so that we had somewhere over reserve. Even though she was overall tired from all the training units, lower energy intake and the overall

67 pressure she stated that she felt the best in the long time, we did manage to meet the weight limit every day and eventually she won the entire tournament becoming the junior national champion. After the win of the national championship she was picked for the national team and she would then fight on the European championship tournament loosing on points in the first bout of the championship in the round of sixteen. Given the fact that it was her very first international tournament and only the winners of national tournaments would qualify for this event and she would also give a good performance, we were happy, satisfied and proud of her very much.

Symptoms

By the time the training load increased from 3 to 5 – 6 unites per week we would need to address her nutritional habits and create some sort of diet. As mentioned, I tried to teach her and, I think I succeeded in doing so, the general principles of nutrition and also how to adjust the nutrition to be in accord with sports training regimen.

It was around the time she started competing when she developed symptoms of nausea and stomach sickness. I would impute this to the nervousness caused by engaging in boxing matches since it would appear one to two weeks prior to the competition and it would decrease and cease to act up after the matches. Unfortunately the symptoms would increase in frequency and also in extend. She would claim that she is incapable of eating any sort of meal regardless of a form, type or quantity. At first, I tried to exclude all the potential issues that came were the easiest to try. I would make her try excluding the gluten and lactose from her diet but that would not prove to be effective and the symptoms would pretty much persevere. The strange thing was that she would exhibit the symptoms at the training days but during the rest days she would hardly notice anything. The symptoms would get worse when her heart rate would increase above the aerobic threshold. It would result in excruciating cramping around her stomach and lower abdomen also associated with blurring her vision forcing her to stop that particular activity and waiting for the symptoms to disappear.

Diagnostics

We decided that she would go to the gastroscopy to rule out the possibility of having an ulcer or any other kind of stomach issue. With the state of Czech medical care it would take almost four months and a lot of explaining to the doctors why she is supposed to go through this examination. It was also tiring since she was a minor at that time and she would need her parents, her mother, be part of all these processes having her nag constantly about K needing to stop boxing whatsoever since in her opinion she would not “eat normally” thus the stomach issues. One can only imagine my tranquility being put to the test here having my pupil trying to deal with her issues on one hand and her ever so competent mother with her opinions. I do appreciate her being worried about her daughter well-being and health in general, but it is really non-productive to say the least having to deal with such things. I guess this is what you sing up for the moment you decide to become a coach or a trainer.

Subjective complaints

After months of going through the ordeal of dealing with the incompetent doctors and her mother telling K, that when the training and boxing is causing this sort of trouble, it should then be terminated. When we finally got K have the gastroscopy surprisingly enough the testing was all negative ruling out all the suspicions of physical cause of her problems. After all this the only explanation remained: the troubles are psychosomatic – K could simply not stomach it. I am a holistic type of a person and whenever or whatever the problem I always try to approach it by gradual eliminating all the obvious and simple factors that may cause the problem. Such as oxidative stress caused by lack of sleep, bad nutritional habits, constant dehydration due to insufficient fluids intake or some sort of personal disharmony cause by various relationships in the family or with friends. All these events took place simultaneously with her preparation for the state championship. As the tournament approached, we knew that we would need to adjust the weight in order to meet the limit, so the diet was created for her to meet the limit. Her whole regiment changed a bit since in the last three weeks

69 prior to the tournament she would train twice a day with the final number of training units per week being 12 and with her energy intake and outtake being precisely counted. Her EA would be 17-18 kcal/kg FFM and her weight would decrease 1 kg a week reaching the weight of 67,8kg at the first day of the tournament at the official weight-in as targeted.

The strange thing about this whole regimen occurred regarding her stomach and lower abdomen issues. The moment we decided that she would compete at the tournament and we would initiate the training and dietary regimen the symptoms would vanish whatsoever. During the tournament she would have to watch the weight so she could not increase the intake as needed and also win the matches. She did manage to do both while maintaining the ideal mindset of being self-controlled and even happy despite the amount of stress she was supposed to be under. And as was mentioned beforehand she won the entire tournament via either technical knock-outs and decisive points decisions. Moreover her performance in the final was the very best she has ever fought.

Conclusion and proposition of a solution

Paradoxically when being exposed to the most powerful stress and energy deficiency even, K would display the tranquility and calmness of a Zen-warrior getting rid of her stomach issues in process. As will be dealt with the in chapter 3.2.3 the weight reduction and hard fighters regimen serves the best as a substratum to achieve an ideal mindset in which a competitions and tournaments can be won and also can be rid of own personal weaknesses. Unfortunately these results may lead to either productive and effective acquisition into everyday life or just as well as creating an issue of its own. The premise may be that the athlete can be inclined to maintain this “competition regimen” in the long term but to state the obvious there this regiment cannot be conducted in the long haul. The insufficient EA may lead to the development of female athletic triad or to an eating disorder or to and disorder eating at the least.

As a proposed solution here I try to communicate with her on regular bases during our target talks addressing the potential stress issues and mitigating the potential high risks issues by implanting preventive measures. I specifically try not to expose her by making her compete to an unnecessary stress that together with her everyday life may lead to the re-development of those stomach issues that would only then be multiplied by the attitude of some people around her.

We specifically decided for her not to compete this season since she is graduating at the high-school this year and she is also trying to pass successfully the entrance exams to the university. She only trains two to three times a week when she has a time as boxing is now a hobby for her. Since she is not exposed to the high volume of training load, stress from competing and stress and unease caused by her mother due to her concerns of K’s health and well-being she has not displayed the symptoms of stomach issues at all and she is fine to state it tersely. She does miss boxing and competing some, but she is rational enough to know, that if she tries to do both - boxing and school she will fail in either or both leaving her exposed to much greater stress than her actual missing of boxing in her life now.

After the graduations and university entrance exams we are planning on her coming back to the training process again with the climax of this year being the elite republic championship in October and a comeback to the national team. I am planning to gradually introduce her to the new training and dietary regimen consisting of optimal diet EA wise and rational training regimen consisting of six training units per week. I will also compose the dietary regimen and training load accordingly towards the block periodization that I plan to implement.

Hypothesis

5.2.1 Subjects comparison

K and L are less than a year apart from one another with L being the older one. They both weigh roughly the same and they are also the same somatotype.

Their hypodermic fat is also approximately the same with L having a 14% and K having a 12%. We have not done any other body composition testing such as in- body or fat-bod since the results differ so much but, in the end, they lack the relevance. At this point certain professional measures need to be implemented but sometimes it is at the expanse of the common sense and I am not that kind of a person. L is 169,5 cm in height and K is 179cm in height. The only quality they have against the ideal body for boxing is the proportion between the leg and body length. As stated in the chapter 2.5.3 it is more favorable for boxer to have shorter feet for stability and longer hands for reach advantage. The both do have their hands range above average, but they also have long legs. This may be considered a disadvantage, but this can certainly be worked with, so I do not consider this a disadvantage we only need to direct during the training process on coordination and stability work so as not to turn this potential problem into a given problem.

As stated in case study we did agree with L that she does already have a certain type of eating disorder and that it is a fact that needs to be taken into an account and that it needs to be addressed and worked with constantly. Unfortunately it is not uncommon for ex-boxer to get obese due to the constant weight reduction throughout the course of their entire career. With L specific type of diet will always need to be maintained at all times and it only will be adjusted due to the changes in training plan and before the matches and the weight-ins. With K the consensus is, that the dietary regimen will be written and counted only before the matches, too when the training load will have to increase along with the possible stress situation. These dietary regimens will be designed to adjust the weight a little, approximately one or two kilograms in the time span of two to three weeks with the intention there to create an undivided mindset that with a slight discomfort will help her to stay on the path and deal with the stress.

5.2.2 Negative consequences of nutritional manipulation in boxing

The moment the figurative Pandora’s box of dietary manipulation is opened one is a step closer to turn it into an obsession an ultimately a disorder. Whereas on one hand people who conduct a sport activity as a hobby or a mean to

72 be fit they may find themselves in a merry-go-round of social media and fitness industry pressuring them into looking good and feeling fit and decreasing their body fat so that their posts may make them look ripped and fit and sexy, professional athletes expose themselves to the need to meet certain weight limits or lowering their bodyfat in order to do well in competitions. Both those tendencies, hobby and professional may eventually lead to creating an eating disorder or overall frustration of not being happy about their state of body or their appearance. Common sense is certainly at the retreat there for both reasons. It my view it is critical for a coach or a trainer to be capable of keeping the clients or pupils in a rational state of mind in order for them not to develop a health issue of any kind.

Both subjects are proofs that the higher you aim at any kind of a professional or amateur sport your health will be endangered. In boxing it certainly is an increase in the potential development of an eating disorder or of and disordered eating. It is a vital role of a coach or a trainer to overlook the process and make sure that athletes health is impacted negatively as little as possible. In my view as an ex-boxer and a coach, the head-hitting is the smaller problem in boxing then the nutritional manipulation and the residuum of it left for the life afterwards the boxing career. It is the change in everyday life that is influenced so much by conducting a martial art that will always stay changed.

5.2.3 Weight reduction as a form of mental preparation

The moment you step into the regimen of high volume of training load and dietary manipulation you will find yourself in a slight discomfort. Nowadays, rarely ever do we experience any kind of fundamental discomfort such as hunger or cold or life-threatening danger. As described in both case studies, the moment you create a discomfort caused by lack of energy intake or high volume of training load you experience the state of mind in which you can only focus on certain amount of things and you are forced to prioritize what you can or cannot do with the limited potential you have. Since you want to win the upcoming event

73 you exclude everything else. You only have a mind capacity do only do one thing properly.

You experience the state of mind in which you see things clearly and you need to focus on the task at hand because the time is limited due to the high number of training units and the lack of energy intake takes away the potential opportunities to postpone the rest of the tasks that need to be accomplished. This state of mind enables you to gain a strong belief that since you sacrificed so much – the food, the comfort, the time you - have done everything you could and some more. This state of mind then is the only one that the grands the fighter the certainty that there is no loose end and that he is truly at his best to deserve the win and the success.

It is not the quality of the training or the quantity itself. It is the discomfort and the sense of sacrifice that allows the ever so obsessed fighter to indulge in the thought that the success is deserved. When the basics and fundamentals are restricted the very depth of our mind is reached and our perception of life is heavily transformed. It is not a diet or training itself that is the merit here, it is the discomfort and self-harm that athletes get addicted that later becomes the problem. Fundamentally there is no difference between self-harm by cutting yourself or starving yourself beyond the limit and the self-harm cause by the torture an athlete desires to put himself or herself through in order for him or her to reach a point in which the sacrifice and the torture was enough to deserve a success. Since everyone, once the success is tasted, wants to achieve more the next time, logically the need to put oneself through the bigger torture and sacrifice the next time is imminent. In my view this is where a coach or trainer needs to work and be at his best not to let these tendencies get the better of an athlete. It is difficult since on one hand you want to enable the athlete to get better with every training and every competition on the other hand this will certainly reach a point sooner rather than later in which the health of an athlete is endangered. This is the million-dollar controversy whether to let the athlete be successful at the expanse

74 of the health or to ensure that the health is preserved. This is the discrepancy that keeps me up at night sometimes because honestly, I am not sure.

6 CONCLUSIONS

The thesis was supposed to formulate a baseline for potential readers to learn about eating disorders, disordered eating about diets and various dietary regimen not only as a means to target a manipulation with energy intake but also as s potential prerequisite for creating an eating disorder. It is supposed to provide a mean to be capable of diagnosing the birth of potential disorder. In first part of this thesis there are also diets and alternative eating approaches described since a manipulating with a type of a food intake and adjusting the dietary regimen in any way may possibly lead to developing an eating disorder, too. First part also describes marginally nowadays training trends and the influence of social media on dietary regimen and training approaches.

Main part of this thesis brings two case studies of two of my female athletes competing in the sport of boxing and it describes the birth, development and course of their complications associated with dietary manipulation. These complications are cause by a necessity to reduce a weight in order to meet a weight limit in competitions.

The course of both case studies differs in development but have the same origin in the weight manipulation caused by regular weight reduction due to meeting the weight limits at the boxing competitions. This aspect alongside with the harsh training regimen, high volume and intensity of training units and high number of training units gradually led to developing complications regarding their eating habits. While with the subject L we can assess the condition as an eating disorder with the subject K we can speculate on seriousness of the condition so that the condition can be related to as a disorder eating rather than an eating disorder in the entire extent. These outcomes were formulated due to the detailed

75 description of both subjective and objective symptoms due to which an assessment of the state was possible to be formulated.

Yet both case studies result in establishing that the dietary regimen were influenced greatly and eventually led into a negative and rather complicated outcome. Case studies also describe the complications cause by developing the state of changed eating habits. It also deals with the measures that need to be employed while trying to manage the state both subjects find themselves in.

Thesis brings in a chapter weight reduction as a form of mental preparation a proposition, that dietary manipulation and weight reduction as a form of a self- induced discomfort also works and is employed as a form of mental and psychic preparation and training used by athletes to induce a focused and intent state of mind that is a must in a combat sport in order to ensure feeling that the potential win is deserved.

At the end of both case studies the proposition of a solution for each problem is designed. In both case studies the necessity to watch the dietary regimen systematically is suggested since the eventuality to develop a deeper and heavier condition is significant. The thesis brings about procedure of how a coach or a trainer is supposed approach the communication with athletes and how the planning of training cycles and weight manipulation is supposed to be dealt with. The thesis also warns coaches and trainers that the hunt for results and a wish to bring up a champion or a winner should not be accomplished by exposing athlete’s health at risk. The thesis also states that this dilemma is supposed to be approached by coaches and trainer with high appreciation, so the risks are minimized, and potential development of disorders or injuries is averted.

The thesis is based on a was created on the grounds of long-term training and dietary planning alongside with keeping records of the results and outputs of training procedures. The main method to gather and evaluate the outputs were target talks due to which results, and outcomes are formulated. To be capable of

76 creating this thesis and both case studies the years of keeping records and hours of target talks were spent so that the ultimate outcome may bear the relevance to the sport of boxing itself and to other various sports as well.

7 DISCUSSION

To encapsulate the inferences of this thesis we can argue, that professional sport in general brings challenges to the athletes health in general due to the high amount of training volume in capacity just as well as in intensity that the load itself is enough to influence the health in general since the need for specific adaptation is required in order to deliver much desired results. Thus the entire regimen of an athlete must be adjusted which certainly includes dietary regimen due to very specific and demanding needs. In some sports, boxing including, a dietary regimen needs to be adjusted due to the need to meet the weight limits in competition. In order to accomplish so, certain dietary regimen or specific nutritional approach is employed. First part of this thesis describes such approaches their pros and cons and also whether they are appropriate for athletes.

For that matter alternative nutritional approach is not to be perceived as a prerequisite or a spawn for eating disorder. The other way around, it is to be highly recommended to take an interest in individual eating habits since it may influence the health in a beneficial way as is stated by Freeland-Graves and Nitzke (2013). As stated in this thesis just as well as in aforementioned author it is beneficial to adjust the individual diet or overall eating pattern in order to recondition the functionality of the entire metabolism and human body in general.

Even when some alternative eating approaches may seem contradictory to the logic of healthy lifestyle or the needs of a professional athlete this thesis merely describes their specific characteristics, what nutrients are recommended or not recommended and does not wish to asses these approaches regarding their quality or healthfulness just as the cited authors such as Atkins (2000) or Dustin (2016) or Jibrin (2014)

The thesis also countenance with the results of work of Jeukendrup (2010) and Clark (2000) in the notion that sports nutritional requirements differ from the needs of common men not only by the absolute amount of energy that needs to be in-taken in order to meet demanding requirements of an athlete but also in the characteristics and the timing of food intake. Also the absolute amount of energy intake cannot be simply counted via basic equations but as the recommendation formulated by Mountjoy and col. (2014) states, the athlete’s energy intake requirements must be assessed via energy availability approach in order to avoid RED-S and the complications induced by an incompetent procedure of nutritional habits.

The thesis also describes the problematics of female athletic triad that is as stated in Loucks and col. (2011) work is mainly caused by insufficient energy availability. Inadequate energy availability along with deficient ergogenic carbohydrates aiding leads to the development of the series of medical issues such as pathological exhaustion and athletic triad that concerns not only female athletes but male athletes as well.

Unsuitable alternative eating approach or dietary regimen along with the demanding training regimen and the need to manipulate with the energy intake due to meeting the weight limits in sports an eating disorder may easily be developed throwing an athlete then into the merry-go-round of stress caused by the decrease in performance and results, reproaches concerning the ever so stagnating weight, constant need to increase the performance just as well as watching and adjusting the weight in order to meet the limits is the advancement of how an eating disorder or a disordered eating is developed as stated and agreed with the work of Thompson and Sherman (2010).

This thesis describes also the types of eating disorders in their variety and the way such a disorder may be developed. The outcomes of this thesis agree with the work of Thompson and Sherman (2010) in the clinical definition,

78 description of symptoms and the procedures and measurements that should be taken in order to diagnose, approach and start addressing it in the ambition to help the athlete fight it and overcome it eventually. Unlike the eating disorders developed among common population the main difference is in the initiating agent that later causes a development of such a disorder. With the common population the disorder is developed, as stated in the work of Marádová (2007), via general and deep embedded frustration or discontent with either the life in general or an aesthetic feature of a person afflicted with an eating disorder. The factor that leads to development of an eating disorder among athletes is acquired meaning that the person would not develop the disorder if the need was not artificially elicited via the creation of heightened attention to the food as an mean to increase the performance and the weight as an end to meet in order to perform better due to meeting the limits of lower division or via decreasing the weight performing better due to improving the ration of generated energy conversed on one kilo of weight. Eating disorders in sports is minutely defined in the work of Thompson and Sherman (2010). This book also provides us with the way of how to deal with an athlete developing an eating disorder. It is stated that it is crucial in order to prevent serious and irreversible negative changes in health to seek the competent help soon enough.

The topic of eating disorders in sport is also approached from the angle of a coach or a trainer and the notion is raised that the coach or a trainer should be competent enough to prevent it from happening. The way to prevent such thing from happening does not lie exclusively in timely disclosure of a disorder which might have already been developed but also and especially in the competent structuring of training and dietary regimen that does not throw the athlete in the spin of excessively high training volume with the inadequate dietary regimen. The coach must also be close enough with the athlete in order to be capable of seeing potential issues in advance as is described in the work of Sherman (2012).

The thesis brings and stresses out the need of competence of coaches not only in the aspect of composing the training regimen adequately as analyzed in

Bompa and Carrera (2014) in order to avoid over training or injuries or in composing the dietary regimen but also being a little bit of a friend a teacher and a psychologist to the athlete. The coach also must be competent enough to shelter the athletes from their own ambition just as well as from the ambition of athlete’s parents or the society in general which is very much results oriented. If failing to do so athletes may find themselves in an enchanted circle as described in Papežová (2013) of the need to have the ideal weight, perform on the high levels and satisfy the urges to be well-like by the people around him and possibly look successful on social media.

Specifics regarding this very thesis lie in the application of aforementioned knowledge on the sport of boxing. As described in the work of Hatfield (1997) and Delvecchio (2011) the sport of boxing is very demanding sport since it is a martial art and the boxers are not only subjected to the stress of horrendous training load but also to the stress of very real physical pain and injuries that happen basically on daily basis due to hitting and being hit. The biggest asset just as well as disadvantage of sport practicing basically any martial art is the getting used to the torture and pain and suffering that necessarily comes with the daily and “normal” regimen. As is described in the chapter “Weight reduction as a form of mental preparation” the getting used to the torture may function as a multiplicator of developing an eating disorder since for the boxers it may just be another pain and not that serious one since the pain they go through is much more intense than just being hungry. The way of warrior as described in many eastern books is the way of self-denial, discipline and overcoming oneself via not backing up when the issue generates pain and suffering. Thus, for some martial artist, being hungry or engaging in intermittent fasting may become the way to self-test the discipline and intransigence towards the small discomforts. Thus hand in hand a disorder may be developed just as easy in the sport of boxing since as is described in the book of Fung and Moore (2018) fasting has always been a way of those who need to overcome their own fears in order to surpass the limits of oneself.

After establishing the groundwork the thesis brings two case studies dealing with certain types of disordered eating or an eating disorder. Unfortunately there are no other published case studies on eating disorders concerning female elite boxers to compare to. Case studies bring the comprehensive view of the life of both boxers, regimens, diets, personal and family statuses and detailed description of the way the eating disorder was developed and was in motion with them. The outcomes of their disorders were different, yet the certain similarities are undeniable.

They both are elite female athletes and they both have the need to perform on the high level and also meet the weight limits, they both needed to manipulate with their energy intake in order to accomplish the needed results. Subject L developed serious case of female athletic triad as defined in Nattiv and col. (2007) whereas subject K only develop a case of disordered eating mainly cause by the stress and possible psychosomatic issues due to her family situation and the type of her personality.

This thesis definitely deals with the insufficiency of works written about the same topic. There are no other case studies dealing with the eating disorders in the sport of boxing and the problematics of insufficient energy availability in the sport of boxing. The thesis targets to apply primary sources and the knowledge gathered in general research and in other sports and has a ambition to serve as a source of information for other potential athletes or especially coaches in their sear for help when already dealing with the disorder or ideally preventing it from happening whatsoever.

On one hand I may be accused and reproached for insufficiency of sources and works to compare with but that should also be considered a greatest asset of this thesis since it lays down the ground work for other research that may lead into creating a prevention program as in Thompson and Sherman (2010) or providing an information that may help define ideal approach in order to create a adequate approach towards weight reduction and weight manipulation in sport of boxing.

We may start debating on the sense of reaching the weight limits in general or how to prevent the athletes from going through too much and then being more prone to fall for general dissatisfaction and eventually for eating disorder or disordered eating.

The thesis brings about a question of how a training process in combat sports and in sports in general should be approached just as well as the question of how and whether at all should an energy intake and weight manipulation should be conducted. Thesis states that it is a tremendous responsibility to be a coach and a trainer and therefore each individual who decides to practice such job should be highly competent and first and foremost must be aware of the fact that the athlete’s health should be placed before the results in competition. The thesis emphasizes the difference that needs to be held between the attitude in the professional and amateur sports and that in no way should these to be mixed together since in a professional sport the health of athlete is inferior to results being brought.

Potential work that may be continuator of this thesis may deal with the correlation between results in competitions and the health issues bought about during the training process. A topic of the competence of a coaches and trainers could also be taken into an account regarding the maintaining the health of amateur and professional athletes.

8 SUMMARY

In the conclusion the sport of boxing much as any other sport in which the weight needs to be reduced via energy intake manipulation and severe dehydration leads to inevitable health issues both physical and psychical. Some sort of mental condition is anticipated to be developed which eventually leads to physical consequences. Yet even though the body is burden with high volume of training doses and tormented by lower then needed energy intake the mind of a warrior and a professional sportsmen is developed in the process which is the aspect that athletes may become addicted to – experiencing the very best, very brightest and very sharpest form of themselves. Next time they need to go through tough training regimen and dietary restrictions they are capable of reaching even farther in both intensity and volume, since the need to overcome themselves and become even the better versions of themselves then they were the last time is stronger that the basal need to stay healthy and pain free.

I recommend highly for all the coaches in the amateur and professional sports to educate themselves in the matter of both training process and dietary requirements for them to be able to recognize in time whether they are pushing their pupils behind the limits or whether they are already causing them harm in both physical and psychical way. May this thesis be a mean to accomplish at least a general knowledge of risks and issues conjoined with food intake manipulation in sport where results play crucial role.

In my view a coach, trainer or teacher should be the protector of his or her pupils. They should shelter them from their parents inadequate and irrational expectations and shield them from their own ambitions that may lead them towards health detriments, general unhappiness and frustration from unfulfilled goals.

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RÉSUMÉ

The subject of this master’s diploma thesis is the appearance of eating disorders in sports. Synthesis of literature provides the reader with the description of types of eating disorders, alternative eating approaches, types of diets and a short specification of sport of boxing. Second part brings two case studies of how an eating disorder may be developed while practicing the sport of boxing and regular weight cutting necessary to meet the weight limits in competitions.

RESUMÉ

Tématem magisterské práce je výskyt poruch příjmu potravy ve sportu. Syntéza literatury poskytuje čtenářům popis typů poruch příjmu potravy, alternativních stravovacích návyků, typů diet a krátkou specifikaci boxu jako sportovního odvětví. Druhá část přináší dvě případové studie zabývající se způsobem, jakým mohou poruchy příjmu potravy vzniknou právě ve sportu, v němž je pravidelně upravována váha sportovce z důvodů splnění váhových limitů v soutěžích.