Aiming for healthy weight in wrestlers and other athletes By Vito A. Perriello, Jr., MD Wrestlers and athletes in other “weight-sensitive” sports are at high risk of engaging in unhealthy weight-loss practices. Learning how to intervene effectively will help you deal better with weight issues in all your patients.

nhealthy weight loss and sports, unhealthy weight loss Pediatricians are more likely to suboptimal nutrition, along practices are prominent in both encounter patients experiencing Uwith disordered eating habits sexes, with reported prevalences weight loss problems in wrestling and eating disorders, are significant of 10% to 15% in boys and 25% to than in most other sports. problems among adolescents. Seventy- 30% in girls.3,4 Other health issues associated five percent of patients with dis- Weight-sensitive sports involve with wrestling, such as injury and ordered eating develop the problem either a requirement to reach a spread of infection, put wrestling during adolescence.1 specific weight or a perception in the fish bowl of public scrutiny. Because 90% of eating disorders that an advantage exists if the This year, the National Fed- occur in girls and women, most athlete performs at a lower eration of State High School Asso- discussion in the literature focuses weight. Sports often cited for ciations, the governing body for on this as a female problem. A having a high incidence of ath- high school athletics, recom- 1995 study of middle schools in letes engaging in unhealthy nu- mended to the wrestling rules North Carolina, however, found trition and weight loss prac- committee that all states have that, in addition to the 10% of tices include rowing, gymnastics, weight management programs in girls in the sixth to eighth grades cross country, cheerleading, place for wrestling no later than who reported using vomiting and dancing, and wrestling. Although 2004. Physicians across the coun- laxatives to lose weight, 4% of many of the same concerns apply try may therefore be called upon boys reported similar practices.2 to all of these sports, this review to certify the minimum appropri- Among athletes, especially those focuses on unhealthy weight loss ate weight for participation in participating in “weight-sensitive” practices in wrestling for several wrestling, especially if a youngster’s reasons: natural weight is below the recom- THE AUTHOR is a general pediatrician in private The magnitude of the weight loss mended minimum. Physicians practice in Charlottesville, Va. He serves on the problem in wrestling is great and making these decisions for patients Medical Advisory Committees of the Virginia High has been well-documented, with involved in wrestling and other School League and the National Federation of studies reporting as many as 45% weight-sensitive sports need to be State High School Associations. He is clinical assistant professor of pediatrics, University of wrestlers at risk for a major familiar with techniques for deter- 5,6 of Virginia School of Medicine. eating disorder. mining body fat and appropriate Wrestlers photographer: Jill Sabella/FPG International

September 2001 CONTEMPORARY PEDIATRICS 55 WEIGHT AND WRESTLING

TABLE 1 weight management pro- Medical concerns more likely to try diuretics, grams. This information also chromium, pyruvate, or can provide a valuable tool associated with wrestling ephedrine (ma huang) to lose for educating youngsters weight. [Editor’s note: For Injuries about nutrition, fitness, and more on supplements, see healthy weight loss or gain, Wrestling ranks fourth in nonfatal catastrophic sports injury “Nutritional supplements whether or not the youngster Wrestling ranks first or second in overall sports injury rate and the young athlete: What participates in sports. you need to know” in the Three wrestlers died from wrestling-related causes in 1998 July issue, also accessible Health concerns Use of supplements at www.contpeds.com.] in wrestling Alleged fat-burning supplements (more common These substances have not Wrestling has a long and in wrestling than in other sports) been shown to be effective, storied history. Drawings of Ephedrine (ma huang) and their use presents sig- wrestling holds have been nificant risks to young found in Egyptian tombs Chromium athletes. from 2,500 BC, and wrestling Pyruvate The greatest medical was one of the five sports in Androgenic supplements (less common in wrestling concern associated with the first Quadern Olympiad than in other sports) wrestling is the dangerous in 776 BC. Participation in weight loss methods used by Creatine wrestling has been shown to many wrestlers. In 1998, contribute positively to self- Androstenedione these behaviors led to the esteem, mental and physical Spread of contagious disease deaths of three collegiate toughness, self-discipline, wrestlers that were directly Viral illnesses (rhinovirus, influenza) and character. Despite these attributed to excessive weight positive attributes, wrestling HIV infection/hepatitis (theoretical but not reported) loss.10 has suffered from the general Skin disease (herpes gladiatorum, impetigo, perception that it is an un- tinea gladiatorum) What is fighting weight? healthy sport. The medical Inappropriate weight loss literature substantiates this For most young athletes in all perception to some extent. Excessive weight loss sports, the best weight at Table 1 lists some of the Too rapid weight loss which to compete is the ath- medical concerns associated Cycling of weight (repeated rapid loss and gain) lete’s natural weight, which is with wrestling.7 In addition defined as out-of-season to a high injury rate, the weight when eating and exer- spread of infectious diseases, hepatitis B is not zero, it is extremely cising in a healthy manner. Studies highlighted by documented epi- low, and no documented trans- suggest that a body fat percentage demics of herpes gladiatorum, mission in the course of sports of 7% to 9% is efficient meta- has long concerned the wrestling participation has been reported. bolically for most males. For most community, and much work has The use of supplements in all females the most efficient and been done on developing guide- sports is of concern to the sports healthy percentage is 12% to lines for wrestlers’ return to medicine community. In contrast 15% body fat.4,11 Attempts to participation after developing skin to athletes in many other sports, achieve body fat compositions be- diseases.8,9 Although the risk for who take supplements such as cre- low these percentages usually re- spread of systemic contagious dis- atine or androstenedione to gain quire unhealthy eating practices. eases such as HIV infection and weight and strength, wrestlers are No evidence exists to suggest any

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additional benefit in metabolic effi- myth that wrestling at a lower Losing weight too rapidly, losing ciency or performance at lower weight for the same height improves an excessive amount of weight, and levels. These percentages are con- leverage and provides an advantage frequent “cycling” of weight (rapid, sidered the minimum for most per- over one’s opponent. Because it is repeated loss and gain), on the sons and therefore are not neces- difficult to demonstrate how an ath- other hand, can undermine health sarily the natural or ideal for a lete would have performed at differ- and well-being. Such unhealthy given youngster. ent weights, no convincing data are patterns generally occur only if Because of ethnicity or genetics, available to show whether perfor- water is lost—which can lead to some youngsters’ natural weight mance is better or worse at lower dehydration—or “fat-free” tissue may place them below the 7% weight classes. Wrestling at a lower (such as muscle) is lost because of minimum body fat for males and weight class may also be motivated inadequate caloric intake. Neither 12% minimum for females. A by the desire to avoid competing type of weight loss benefits athletic physician familiar with the youth against a wrestler in the athlete’s performance and, when carried may be asked to verify that he or more natural weight class who is to extremes, can impair growth, she is healthy and fit and can safely significantly better or to help the strength, and endurance. participate at his or her present team fill an empty weight class slot. In female athletes, the triad of weight even though body fat is be- Last, many in the wrestling commu- osteoporosis, amenorrhea, and low the established minimum. The nity have developed a mentality of eating disorders, along with de- physician should feel comfortable commitment, sacrifice, and self- layed physical maturation, have certifying such a youngster for discipline that traditionally sees been linked to excessive weight participation if medical records weight loss as a critical component loss and sports participation at document a consistent pattern of of the “no pain, no gain” philosophy. weights below minimum natural weight and no evidence of mal- weight. nutrition or pathologic eating or When is losing weight Weight loss in prepubertal chil- exercise behaviors. harmful? dren is an even greater concern if Obviously, not all weight loss is not undertaken cautiously. Ex- Why do wrestlers harmful. Anyone, including an cessive restriction of caloric in- want to lose weight? athlete, can benefit from losing take and inadequate nutrition Most athletes who want to lose body fat in certain circumstances. during growth can have an ad- weight are motivated by a desire Excessive fat does not enhance an verse effect on adult height and for improved appearance, better athlete’s performance, even in foot- health. performance, or perceived compet- ball where coaches often seek out Two kinds of weight-loss prac- itive advantage. Sports such as heavy players. It can hamper heat tices in wrestlers are cause for con- wrestling, crew, and youth football acclimatization, speed, endurance, cern. One is loss of weight to a require that teams or individuals and work efficiency. Weight loss level below what is considered meet specific weight targets to par- can be beneficial if it involves losing healthy and appropriate (less than ticipate. The drive to compete can excessive body fat without reducing 7% to 9% body fat for boys and 12% encourage athletes to lose weight, lean muscle mass or causing signif- to 15% body fat for girls; weight loss whether or not they have excessive icant dehydration. Healthy weight at a rate faster than 1.5% of body body fat. loss requires eating a balanced diet weight or 2 lb per week is also con- The major motivation for that supplies adequate calories to sidered unhealthy). The other is re- wrestlers to lose weight is the hope support growth and daily activity peated cycling of weight throughout of achieving greater success by com- and drinking enough fluid to the wrestling season. Cycling in- peting in a lower weight class. This maintain an appropriate state of volves losing weight rapidly to perception may be based on the hydration. “make weight” at a weigh-in for a

58 CONTEMPORARY PEDIATRICS Vol. 18, No. 9 WEIGHT AND WRESTLING

FIGURE 1 The ups and downs of weight cycling among wrestlers

160 159 155 155 154 150 152

145 Weight (lb) 145 145 145 140

135 Day 1 Day 8* Day 9 Day 15* Day 16 Day 22* Day 23

* Day of a match

“Cycles” of weight gain and loss during the wrestling season average 5 to 10 lb a week in many wrestlers, who lose weight rapidly to “make weight” for a match, then gain back the lost pounds within a day afterward. Data on the graph have been compiled from multiple studies. match, then eating and drinking af- weight is loss of body water by a renal blood flow, decreased glomer- ter the match to compensate for nu- combination of fluid restriction and ular filtration rate, electrolyte im- trition and fluid losses. Many excessive fluid loss. This method balance, and acidosis, which alters wrestlers repeat this process for usually results in varying degrees cellular function throughout the every match. Research has consis- of dehydration accompanied by body. tently reported an average of 5 to the familiar physiologic changes: In addition to the familiar physi- 10 pounds of weight loss and gain hypovolemia leading to decreased ologic problems associated with de- every week in such athletes. hydration, athletes demon- The graph above summarizes strate two other worrisome TABLE 2 the findings of a number of abnormalities resulting from studies of average weekly Weight loss methods excessive weight loss and weight loss among wrestlers.12 repeated cycling of weight: As many as 80% to 93% used by wrestlers abnormal thermoregulatory of wrestlers use one or more Percent capabilities and decreased of the measures to lose of wrestlers cardiac output. Thermoregula- weight that are outlined in Method using tory abnormalities markedly 2,5,6,8,10,13,14 Table 2. Many of Running, jogging 73% increase the threat of heat in- these practices also occur to jury and severe dehydration Exercise using a device (bicycle, jump rope, etc.) 59% some degree in other to poorly hydrated athletes weight-sensitive sports. Rubber suit, nylon top 34% who are performing strenu- Sauna 14% ous workouts because they Dehydration and interfere with sweating and Vomiting 8% other dangers cooling of the body. The The major method of rapid Spitting (to get rid of the weight of the saliva) 5% danger is actually greater weight loss for athletes at- “Fat burner” devices (belts, etc.) 2% during a long practice work- tempting to make a target out, which often occurs in a Diuretics 2%

September 2001 CONTEMPORARY PEDIATRICS 61 WEIGHT AND WRESTLING

TABLE 3 increased heart rate and lethargy, resulting in lower decreased stroke volume. grades during wrestling season. Reported harm to wrestlers A high percentage of Some of these symptoms appear from excessive weight loss unhealthy weight loss to be caused by hypoglycemia occurs in smaller ath- from prolonged fasting as well Academic performance letes and the lowest weight as dehydration. 6 Lethargy, sleepiness, mood swings classes of wrestlers. A lowered testosterone level, Weight loss in the aver- decreased growth, and an in- Lower grades during wrestling season (compared to age range of 5 to 10 lb creased incidence of disordered out of season) per week could repre- eating and eating disorders all Diminished short-term memory and cognition sent a 5% to 10% level have been reported to result from Athletic performance of dehydration in many the weight-loss practices of of these athletes. Low wrestlers and other youngsters. Lower testosterone level cardiac output and ther- Horswell and colleagues have Lower endurance moregulatory abnormal- shown that a 3% to 6% level of Decreased strength on ergometric testing ities also pose a greater dehydration decreases strength threat to younger and and endurance on ergometric Altered body function smaller athletes, who muscle measurement.7,9,17 Thus, Decreased growth have greater body sur- besides being harmful to health, se- Increased susceptibility to infection face area for every vere weight loss is detrimental to kilogram of weight. performance. Decreased serum protein level Although many re- Lowered glycogen stores ports about health is- Effective weight management Decreased cardiac output and glomerular filtration rate sues related to severe weight loss in athletes Most effective and safe weight Poor temperature control with increased risk of heat injury are anecdotal, recent management programs, whether for Disordered eating data increasingly docu- wrestlers and other athletes in Binge eating (6% of wrestlers meet criteria)1 ment the adverse effects weight-sensitive sports or individu- of excessive and fre- als attempting to lose weight for Eating disorders (11% meet profile for eating disorders on eating attitudes test [EAT])2 quent weight loss, espe- personal reasons, aim to minimize cially among wrestlers unhealthy weight loss. Such pro- REFERENCES (Table 3). Similar prob- grams generally include a com- 1. Oppliger RA, Landry GL, Foster SA, et al: Bulemic behaviors among interscholastic wrestlers: A statewide survey. Pediatrics 1993;91:826 lems have been reported prehensive nutrition and fitness 2. Garner DM, Olmsted MP, Bohr Y, et al: The eating attitudes test: Psycho- in nonathletes who ex- component that attempts to edu- metric features and clinical correlates. Psychol Med 1982;12(4):871 perience frequent swings cate athletes, parents, and coach- in body weight.16 es about the dietary requirements warm wrestling room, than in a An increase in academic diffi- needed to support growth, activ- match, which lasts six minutes or culties has been noted among ities of daily living, and the in- less.15 young athletes whose food and creased nutritional requirements Another significant threat is de- fluid consumption is inadequate. of sports. Another important com- creased cardiac output, which can Unlike most athletes, who tend to produce strain on the heart even earn better grades during sports The patient guide on the next pages about ▲ with minimal exertion. Cardiac participation, wrestlers are likely healthy weight loss can be photocopied output drops when reduced blood to experience poor focus and con- and distributed to families in your practice volume from dehydration leads to centration, mood swings, and without permission of the publisher.

62 CONTEMPORARY PEDIATRICS Vol. 18, No. 9 GUIDE FOR PATIENTS

Steps to healthy weight loss

here are no short cuts to losing weight effectively of calories burned can vary to some degree depending Tand safely. Weight gain and loss are directly on your weight and how long and intensely you related to the balance between the calories you take exercise. The minimum calorie requirements in and the calories you burn through daily activity suggested here support only usual daily activities. and specific exercise, such as sports. You must consume additional calories if you participate A government-sponsored task force recently in aerobic activities such as athletics, dancing, or reviewed the multimillion-dollar industry of fad diets strenuous work. that guarantee quick weight loss using everything Teenagers need to eat a balanced diet that consists of from vibrators to pills. The task force concluded that carbohydrates (55%), fat (20% to 25%), and protein although some of the diets may contribute to weight (15% to 20%). Teens who are healthy and eating a good loss, none maintains weight loss (keeps weight off diet do not need nutritional supplements. Eating a high- once you lose it). Eating less fat (meat, cheese, and whole milk, for example) and more complex Minimum daily calorie needs at desired weight carbohydrates (bread, cereal, 3,500 pasta), along with regular • aerobic activity, appears to offer 3,000 • • the best hope for losing weight • • and keeping it off. 2,500 • Losing excess body fat • 2,000 • • should be your only goal in • losing weight. Losing water or Calories 1,500 fat-free tissue, such as muscle, is not desirable or healthy and 1,000 does not improve performance 500 or appearance. 0 Eat right 100 110 120 130 140 150 160 170 180 190 Most adolescents need 1,700 to Weight (lb) 3,000 calories a day just to meet physiologic needs and support growth and normal daily activities. The minimum carbohydrate meal four to six hours before a sports number of calories varies somewhat based on size, competition can improve performance and well-being. as shown on the graph at right. Don’t forget to drink enough water, which is An average 30-minute period of aerobic exercise, the most important nutrient, making up 60% of the 1 such as jogging, burns about 350 calories; an intense body. During exercise, you should drink ⁄2 cup two-hour sports practice can burn more than 1,000 to 1 cup of water every 15 to 30 minutes calories. The table on the next page shows about how depending on the heat index and the intensity many calories various activities consume. The number of the exercise.

This Guide for Patients may be photocopied and distributed without permission to give to your patients and their parents. Reproduction for any other purpose requires express permission of the publisher. Copyright © 2001 Medical Economics Company.

September 2001 CONTEMPORARY PEDIATRICS 65 GUIDE FOR PATIENTS/STEPS TO HEALTHY WEIGHT LOSS

Calories burned by various activities Calories burned Activity in 60 min* Aerobic dancing 470 Backpacking (carrying a 40-lb pack) 670 Badminton 440 produce energy. This undermines strength and Basketball 630 endurance. Bicycling (10 mph) 450 Get enough exercise Circuit weight training 420 Adequate exercise, along with moderately reducing Cross-country skiing 650 the number of calories you consume, promotes the Racquetball 800 most efficient loss of fat while preserving fat-free Rope jumping 775 tissue. The minimum amount of aerobic activity necessary to benefit from this efficient fat loss is Running (7 mph) 880 30 minutes three times a week of an exercise that Swimming (slow crawl) 600 burns about 350 calories in one workout. Volleyball 228 Studies suggest that you must burn 3,500 calories to Walking lose one pound of fat. You can therefore lose 1 or 2 lbs 3.5 mph 350 of fat a week by burning 500 to 1,000 more calories a 4 mph (with 5-lb hand-held weights) 590 day than you take in. (Remember: Burning more than 4 mph (with 5-lb ankle weights) 540 500 to 1,000 calories beyond what you take in leads to loss of fat-free tissue and is undesirable.) Chores Digging ditches 660 Maintain your “natural weight” Mowing (push or power mower) 510 You should strive to maintain a “natural weight.” Sawing with a hand saw 550 Natural weight is your weight when you are eating Weeding 330 a healthy, balanced diet with enough calories to *Values vary based on intensity of activity and weight. Values shown here are for a 167-lb person. sustain growth and usual daily activities and getting 30 minutes of aerobic exercise at least three times a week. Your doctor can help you determine Avoid “semistarvation” diets—those in which your natural weight and body fat composition the number of calories you consume during a (what percentage of your weight consists of fat). 24-hour period is more than 500 to 1,000 below For most boys (with some variation), the normal the number of calories you burn. Deficits greater range of body fat composition is 7% to 20%. A body than 500 to 1,000 calories usually result in very fat composition of 10% to 15% is considered limited additional loss of fat and promote loss of excellent. For most girls (again, with variation), the water and some fat-free tissue (muscle). Most acceptable body fat range is 12% to 25%. A range of people on such diets tend to regain weight 15% to 20% is ideal. Abnormally high body fat quickly. composition can lead to health problems such as Severely reducing the number of calories you high blood pressure, a high cholesterol level, heart take in causes your body to lose large amounts of disease, diabetes, and gall bladder disease. water, electrolytes (substances such as sodium Too little body fat, like too much, can be bad for your and potassium), and minerals. In addition, the health. Body fat below 7% for boys can interfere with body looks for sources of energy other than fat growth, strength, and endurance. Body fat below 12% and finds it in muscle and glycogen (carbohydrate for girls can be associated with problems such as missed stored mostly in the liver), which it then uses to menstrual periods, weak bones, and eating disorders.

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TABLE 4 in weight, history of poor eating habits, or concerns about weight. Measuring body fat They can add credence and objectiv- ity to discussions with youngsters Method Comment and their parents about healthy Underwater weighing Expensive, limited access; gold standard weight management practices. Many methods of determining Skin-fold calipers (Lange/Harpenden) Closest to underwater weighing in accuracy; body fat are available; underwater validated; reasonable cost weighing is considered the gold Dual energy X-ray absorptiometry (DEXA) Expensive and not validated for youth standard. Table 4 lists a number of Bioimpedance (Tanita) Expensive and not validated for youth; easy to use other techniques used to determine body density, percent body fat, and Near-infrared photospectometry (Futrex) Expensive and not validated for youth; calculates other body composition measure- many other body nutritional parameters ments (body density is part of the Computerized calipers (Skydex) Contain the wrong formula for adolescents formula used to calculate percent Air displacement weighing (BOD-POD) Not validated for youth body fat). The only method that has been validated for high-school–age CT scans Expensive method of measuring fat youngsters, and the one that most closely reproduces the results of the ponent of proper weight manage- weight management programs.19,20 expensive and fairly inaccessible ment is determining body fat and The task force also encourages method of underwater weighing, is calculating the minimum recom- an increase in the number of measurement of skin-fold thickness mended participation weight, wrestling weight classes and/or with fat calipers.21 For information which is based on 7% body fat for participation by multiple wrestlers on how to use this method and how most boys and 12% body fat for in the more popular weight classes to calculate minimum weight, see most girls. A third component in- as a means of addressing this issue “How to measure body fat,” pages volves educating the athlete nationwide. 72 and 73. With a little experience about the maximum weight loss and the aid of precalculated charts each week that can be achieved in How can pediatricians kept on hand in your examining a healthy manner.18 (See the pa- help? room, you can measure body fat us- tient guide, “Steps to healthy weight One role of pediatricians and other ing the skin-fold method in less loss,” pages 65 and 66.) primary care physicians is to mon- than a minute. Discouraging wrestlers from itor the health and nutrition of all In Virginia, body-fat measure- bouncing from low weights for our patients, especially during ments are now part of the standard match weigh-ins to higher weights health maintenance or prepartici- preparticipation physical examina- between matches has been the pation sports physical examina- tion form, which has introduced most difficult aspect of weight tions. That makes it important to the idea of fitness to athletes, par- management. The 1996 American be familiar with body fat measure- ents, and physicians.22,23 While I College of Sports Medicine (ACSM) ments, minimum weight calcula- have been more reluctant to deter- position statement on weight loss tions, height-weight proportions, mine body fat routinely on female in wrestlers and a subsequent res- and normal growth curves. athletes than male athletes because olution by the ACSM wrestling Body fat measurements can be of the potential for precipitating task force emphasize the im- helpful in primary care practice for weight concerns and disordered portance of addressing this issue monitoring health and nutrition in eating, it can be a helpful and posi- and outline desirable features of patients with a significant change tive part of the physical evaluation

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How to measure body fat ody fat measurement is the best tool for establishing SUBSCAPULAR (boys and girls) Bsuitable weight targets. This is the case because fat • Locate the inferior angle, lowest point of the scapula. is the most desirable body component to decrease to If this is not palpable with the arms at the side, ask the achieve weight loss. Studies have shown that, with a patient to put the arm behind the back. little practice, skin-fold measurement can be a very • Mark a accurate technique for determining body fat and diagonal line calculating a healthy weight goal. Good quality skin below the scapula calipers, such as the Lange calipers, are inexpensive, that is an durable, and easy to use. Once you are familiar with the extension of the methodology and have created a chart or computer natural hollowing program to calculate body fat from skin-fold measurement, of the skin. This the entire procedure can be done in one or two should be on an minutes. axis from the left X Following are instructions for marking the three most shoulder to the commonly used sites for skin-fold measurement, some right hip, which general rules for measuring skin folds, and formulas for is approximately calculating body density, body fat, and minimum a 45° angle from weight at 7% and 12% body fat. The modified Lohman the vertical. Draw equation is the most accurate formula for high school a mark perpendicular to that line 1 cm below the boys. A modified Slaughter-Lohman-Boileau equation is inferior angle. used for girls. • When raising the skin fold for measurement have the patient stand with his arm hanging relaxed at his side. Marking skin folds TRICEPS (boys and girls) ABDOMINAL (boys only) • Have the patient stand with the right arm flexed • Have the patient to 90° at the elbow and relaxed. stand relaxed on • Determine the both feet and relax midpoint between the abdominal the acromial process of muscles. the shoulder and the •Mark a vertical line olecranon of the elbow 3 cm to the right of X and make a horizontal the midpoint of the mark there. umbilicus. • Make a vertical mark • Draw a horizontal to intersect this line line to intersect the over the triceps muscle vertical line 1 cm below the midpoint of the umbilicus. X in the midline of the posterior arm. General rules • For the actual caliper for measuring skin folds measurement, have the • Have the patient stand with weight evenly patient stand with the distributed on both feet and the arms relaxed and arm straightened and hanging down at his sides in the normal standing relaxed. position. For the abdominal measurement, have the patient relax the abdominal muscles. • For consistency, always take the measurement on the right side of the body.

72 CONTEMPORARY PEDIATRICS Vol. 18, No. 9 • Make sure the skin is dry to facilitate accurate • If the first two measurements are not within 0.5 mm measurement. of each other, take a third measurement and average the • Do not take a measurement immediately after a two that are within 0.5 mm. If no two are within that workout or when the patient is overheated because range, average the three recorded measurements for elevated body temperature causes fluid shifts to the that site. skin, resulting in a falsely elevated reading. • Palpate the site to familiarize yourself and the Calculating body fat youngster with what is to happen. The formulas for calculating body density, body fat, • “Pinch” the skin and subcutaneous tissue only and minimum weight at 7% body fat (boys) or 12% (not muscle) between the finger and thumb firmly body fat (girls) are listed below. (Body density must (but not firmly enough to cause pain) about 1 cm be determined first because it is part of the formula above the intersecting lines you have drawn as for calculating body fat.) USA Wrestling is planning described above. The pinch should be parallel to the to post interactive spreadsheets on its Web site natural cleavage lines of the skin (the natural (www.usawrestling.org) that allow you to insert cleavage lines of the skin of the triceps, for example, weights and skin-fold measurements to calculate would be vertical rather than horizontal across the all the desired information. To obtain your own arm). Excel spreadsheet, contact Jon Almquist at • Apply the calipers at the intersecting marks [email protected]. perpendicular to the long axis of the skin folds and For counseling about healthy weight gain and loss midway between the body skin surface and the bulbous in general pediatric practice, using the patient’s crest of the skin fold. measured weight in the equations below provides • Allow the calipers to equilibrate for two to four acceptable accuracy. To determine minimum weight seconds before taking the readings. for wrestling, where athletes often “push the • When taking readings, be careful to look directly at envelope,” the NCAA and NFHS recommend the calipers to avoid parallax, resulting in an inaccurate documenting a urine specific gravity of 1.020 or less reading. before weighing the athlete to ensure that he is • Record measurements on data sheets to the nearest adequately hydrated. Otherwise, the weight shown 0.5 mm. on the scale will represent a dehydrated weight that • Rotate measurements from one site to the next is lower than the athlete’s actual weight and allow (triceps to subscapular to abdominal in boys) and then a lower minimum weight determination than is take a second round of measurements. considered appropriate and safe.

BOYS ONLY GIRLS ONLY Lohman equation for calculating body density (BD) Slaughter-Lohman-Boileau equation for calculating Sum SF* = Triceps SF + subscapular SF + abdominal SF % body fat (BF) BD = [1.0973 - (sum SF x .000815)] + Sum SF = Triceps SF + subscapular SF = [(sum SF)2 x .00000084] % BF = [(sum SF ) x 1.33] - [(sum SF)2 x .013] - 2.50 = % BF Brozek equation for calculating % body fat (BF) % BF = (4.57/BD - 4.142) x 100 Calculating minimum weight at 12% BF Weight at 12% BF = [1 - (% BF/100)] x currrent weight Calculating minimum weight at 7% BF 0.88 Weight at 7% BF = [1 - (% BF/100)] x current weight 0.93 * SF = Skin-fold measurement

September 2001 CONTEMPORARY PEDIATRICS 73 WEIGHT AND WRESTLING

if handled in a sensitive manner the risks and benefits of various weight use potentially harmful methods to and presented in the proper con- loss methods practiced by young achieve an excessive amount or text (for example, as part of weight athletes and about how to achieve a rate of weight loss. In general, management counseling for girls safe rate and amount of weight loss. weight loss in adolescents and, es- who express concerns about weight Regrettably, many surveys have pecially, prepubertal youngsters is or girls with menstrual irregular- shown that wrestlers and other ath- not advisable unless excessive body ities that appear to be caused by letes hardly ever consult physicians fat is documented. inappropriately low weight). on these subjects. We need to take a Pediatricians have an important New growth curves are now avail- more active role in discussing nutri- role to play in educating parents and able from the Centers for Disease tion and fitness at check-ups and, youngsters about nutrition, body Control and Prevention (www.cdc. especially, at the preparticipation fat, and the role of exercise and diet gov/growthcharts) or Ross Products sports physical examination. in healthy weight loss and gain. Division of Abbott Laboratories Those who are familiar with quick, (Columbus, OH 43215-1724). The Toward sensible accurate methods of determining new charts reflect present growth weight control body fat and know how to prescribe standards for youngsters in this In our society, a significant number a healthy weight management pro- country and include 3rd and 97th of adolescents attempt to lose gram for patients can provide valu- percentile lines. They also include di- weight for a variety of reasons. able guidance at health mainte- rections for calculating body mass in- Many of these youths, whether nance check-ups and preparticipation dex, which makes them very useful they participate in sports or not, physical evaluations. □ for accurately determining whether a youngster is overweight or under- REFERENCES weight. [Editor’s note: For more on 1. Kreipe RE: Eating disorders among children and 12. Perriello VA: How Wrestlers can Achieve Victory and adolescents. Pediatr Rev 1995;16:370 Enjoyment While Maintaining a Healthy Diet. Virginia High this topic, see “Understanding 2. Krowchuk DP, Kreiter SR, Woods CR, et al: Problem School League Publication, October 1994 growth patterns in short stat- dieting behaviors among young adolescents. Arch Pediatr 13. Oppliger RA, Harns RD, Herrmann DE, et al: Grappling Adolesc Med 1998;152:884 with weight cutting. Physician and Sports Medicine 1995; ure” in the June issue, also 3. Perriello VA: Virginia High School League Training 23:69 accessible at www.contpeds.com.] Workshop on Wrestling Weight Management for Master 14. Parr RB: Exercise for overweight kids. Physician and Testers, Fall 1999 (available from Vito A. Perriello, Jr., MD, Sports Medicine 1998;26:109 When monitoring weight and nu- c/o Larry Johnson, Virginia High School League 1642 State 15. Montain S, Coyle E: Influence of the timing of fluid in- trition in young athletes, the pedia- Farm Boulevard, Charlottesville, VA 22901) gestion on temperature regulation during exercise. J Appl 4. Ashley CD, Smith JF, Robinson JB, et al: Disordered Physiol 1993;75:688 trician must know what sports the eating in female collegiate athletes and collegiate females in 16. National Task Force on Prevention and Treatment of patient plays, understand the role of an advanced program of study. Int J Sport Nutr 1996;6:391 Obesity: Weight cycling. JAMA 1994;272:1196 5. 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Physician College of Sports Medicine position stand: Weight loss in curs when, for example, a high and Sports Medicine 1999;27:35 wrestlers. Med Sci Sports Exerc 1996;28(6):ix 8. Anderson BJ: Effectiveness of valocyclovir in preventing 20. Case HS, Horswill CA, Landry G, et al: Weight Loss in school football coach sees a young- reactivation of herpes gladiatorum in wrestling. Clin J Sport Wrestlers. Current Comment from the American College of ster as a 185-lb linebacker and only a Med 1999;9:86 Sports Medicine. January 1998 9. Medical Advisory Committee to National Federation of 21. Kuta JM, Clark RR, Webber LM, et al: Inter- and intra- few days after football season ends, High School Associations: Physician release for wrestlers to tester reliability of skin fold measurements in high school the wrestling coach sees that same participate with skin lesions. Indianapolis, NFHS (PO Box wrestlers. Med Sci Sports Exerc 1990;22:S110 690, Indianapolis, IN 46206), 1999 22. Perriello VA: Virginia’s athletic exam form: Results and athlete as a 152-lb state wrestling 10. Three college wrestling deaths. MMWR 1998;47:105/ revisions. Virginia Medical Quarterly 1992 (summer); champion. JAMA 1998;279:824 119:159 11. Clark RR, Oppliger RA: Minimal weight standards in 23. Perriello VA, Almquist J, Pitrezzi M, et al: New medical Physicians must do a better job of high school wrestling, the Wisconsin model. Orthopedic standards for Virginia’s high school athletes. Virginia educating parents and patients about Physical Therapy Clinics of North America 1998;7:23 Medical Monthly 1989;116:359

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