Competitive wrestlers traditionally wrestle at the lowest weight class possible in order to gain a competitive advantage. The pressure to be at a low weight before a match has led to the common practice of cutting a relatively large amount of weight in a short time period, primarily through dehydration. Concern about the health consequences of repeated rapid weight loss among wrestlers was expressed as early as 1930 (9). In 1967, the American Medical Association published a position stand against rapid weight loss in wrestlers (3), and in 1969 the Iowa Medical Society advised banning high school wrestling due to the unhealthy weight loss practices of wrestlers (16). The American College of Sports Medicine published a position stand entitled “Weight Loss in Wrestlers” in 1976 that called for preseason body composition analysis of wrestlers to prohibit wrestling at less than 5% body fat and outlined methods to discourage precompetition dehydration (1). A revised position stand in 1996 called for the enactment of rules that would limit weight loss among wrestlers (2). The American Academy of Pediatrics also published a policy statement in 1996 calling for the promotion of healthy weight-control practices in young athletes (7).
Several state high school athletic associations have proposed rules that establish a minimum wrestling weight based on measured percent body fat and limit the amount of weight that can be lost each week. However, at present, only four states have mandatory weight standards based on percent body fat. One of the arguments used against the implementation of such weight monitoring programs is that the cost is too great to address a problem that occurs in a small minority of wrestlers. The purpose of this study was to determine the overall prevalence of potentially harmful weight loss practices among Michigan high school wrestlers at all levels of success and competition.
Subjects and procedures.
In February of 1996, approximately 2.5 months into the wrestling season, a two-page survey was distributed by Michigan High School Athletic Association (MHSAA) to the athletic directors and coaches at each high school in Michigan with a wrestling program. The survey had been reviewed and approved by MHSAA and approved by the University of Michigan Human Research Board. Neither the school nor the wrestler’s names were included on the survey, and anonymity was assured to the coaches and the wrestlers. Participation in the study by the coaches and wrestlers was voluntary. Parents gave written informed consent to the MHSAA for their children to participate. Self-addressed envelopes were included for return mailing to the University of Michigan Department of Family Medicine.
The survey was designed to assess weight loss behaviors among high school wrestlers. Some questions were adopted from a survey developed by Oppliger et al. (12). The instrument began by asking wrestlers their weight on the first day of practice. Then wrestlers were asked to estimate how their weight would change by the end of the wrestling season on a five-point scale with 1 = “I will gain weight,” 3 = “I will stay the same,” and 5 = “I will lose weight.” Next, a series of questions asked for a report of their greatest weight in the past 12 months, the most weight lost in the 5 d before a match, the longest time without food before a match, and the age they began cutting weight for wrestling. The age that the athlete started competitive wrestling was also asked.
The influence of significant others was measured by asking the wrestlers to rate the amount of influence the following people have had on their weight loss practices: fellow wrestlers, coaches, former wrestlers, father, mother, doctor, school nurse, other school faculty members, nutrition educator, and body composition assessor. Ratings were made for each source on a five-point scale with 1 = “Not at all influential, ” 3 = “Unsure,” and 5 = “Very influential.”
Next, wrestlers were asked to indicate the frequency of weight loss methods used during the current season using the response categories of daily, 3–4 times per week, once per week, 2–4 times a week, and never. The weight loss methods listed were: gradual dieting (eating less food and losing 2–3 pounds per week), restricting food (skipping 1–2 meals per day), fasting (not eating all day), restricting fluids, increasing exercise, using heated wrestling room, saunas, rubber/plastic suits, spitting, laxatives, diet pills, diuretics (water pills), enemas, and vomiting to lose weight. A separate question asked whether or not they ever binge eat, defined as “eating uncontrolled, excessive (large) amounts of food within a short period of time.”
The next question asked whether or not they had ever been given information about nutrition and weight loss, and if so, by whom (coach, parent, doctor, nurse, or other). Grade in school, current weight, and height were then asked. Finally, they were asked whether they had their body composition determined by a MHSAA registered skin-fold assessor before the season.
Data were managed and statistically analyzed using the Statistical Package for Social Sciences (SPSS). Frequencies and summary statistics were calculated on all variables. Total weight change was created by taking the difference between the weight on the first day of practice and the current weight. Paired t-test was used to test the significance of the change. A percentage weight change was also calculated.
To assess the overall frequency of potentially harmful weight methods, an index of unhealthy weight loss practices was created. This index (labeled risk) reflects the total number of weight loss methods engaged in by a wrestler at least once a week. It excluded gradual dieting and increased exercise, which were considered appropriate weight loss methods. A high-risk weight loss group was identified based on the frequency of their weight loss behaviors. Wrestlers who engaged in one or more potentially harmful weight loss methods per week were placed in the “high risk” group and compared with wrestlers who did not engage in any potentially harmful weight loss methods on a weekly basis. The new classifications were labeled Risksplit. Bivariate associations between Risksplit and the social influence, demographic, and weight loss variables were performed using chi-square and t-tests where appropriate.
Responses were received from 156 of the 441 high schools in Michigan which compete in wrestling, for a response rate of approximately 35%. A total of 2532 wrestlers completed the survey. Average age was 16 yr with 29%, 28%, 23%, and 20% in 9th through 12th grade, respectively. The wrestlers reported starting competitive wrestling at an average age of 12.7 yr.
One-third of the respondents stated that they never lost weight for wrestling. Those who had cut weight started at an average age of 14 yr. On the five-point scale of estimated weight change during the season, 48% estimated that they would lose weight; 23% estimated no weight change, and 29% estimated that they would gain weight. However, a comparison of the first day of practice weight to the weight at the time of the survey (a period of 2–3 months) revealed that wrestlers had lost an average of 6 pounds, or 3% of initial body weight. Over 50% of wrestlers had lost more than 5 pounds, 27% of wrestlers had lost at least 10 pounds, and 5% had lost at least 20 pounds at that point during the season.
The most weight wrestlers lost in the 5 d before a match averaged 6 pounds. Sixty-two percent had lost more than 5 pounds, and 16% lost more than 10 pounds in the 5 d preceding a match. The longest fast before a match averaged 12 h, with 11% of wrestlers reporting fasting longer than 24 h before match.
Nutrition and body composition information.
Thirty-five percent of the wrestlers had received body fat assessment by skin-fold measurements before the season. This measurement was part of a voluntary Michigan High School Athletic Association weight monitoring program. These wrestlers weight loss behaviors were no different than wrestlers who had not undergone body fat analysis (results not shown). Nearly 9 of 10 wrestlers reported that they had been given nutrition and weight loss information in the past. Of those who received information, 78% indicated it was from their coach, 42% from their parent, 37% from their doctor, 25% from a nurse, and 58% from a source not listed.
Frequency of weight loss methods.
Table 1 lists the frequency with which wrestlers engaged in different weight loss methods. Nearly 1 of 4 wrestlers restricted food at least 3–4 time per week. Of particular concern is that 2% of wrestlers indicated they took diet pills, diuretics, and/or laxatives at least weekly to lose weight. Fifty-eight wrestlers (2% of total) vomited at least weekly to lose weight.
The total number of potentially harmful weight loss methods used by wrestlers at least once a week during the wrestling season ranged from 0 to 12, with a mean of 2. Seventy-two percent of wrestlers engaged in at least one, 52% used at least 2, and 12% used at least 5 potentially harmful weight loss methods each week during the wrestling season (Fig. 1).
High “risk” vs low “risk”.
Shown in Table 2 are the differences between wrestlers as a function of Risksplit. Wrestlers who reported engaging in at least one potentially harmful weight loss method each week lost significantly more weight than wrestlers who did not report weekly potentially harmful weight loss methods. Within the “risk” group, 43% reported binge eating, which was significantly more than in the “low-risk” group. The “risk” group also began wrestling at an earlier age and had wrestled more JV and varsity matches than the “low-risk” group.
This study has the largest sample size of any similar study of high school wrestlers (10–12,14,16,17). In addition, it is the most inclusive, surveying all high school wrestlers, from varsity champions to the junior varsity reserves. Previous studies have included only wrestlers on successful teams, at tournaments, or at summer camps.
It was anticipated that inclusion of team members who did not need to “make weight” each week (i.e., heavyweights and nonstarters) would decrease the percentage of wrestlers using weight loss methods in our study compared with previous studies. In fact, one third of the wrestlers surveyed in our study indicated that they “never cut” weight for wrestling. Despite the inclusion of these wrestlers, the average weight loss of 3% of body weight and the use of various weight loss methods was only slightly less than that reported by previous studies of competitive high school varsity wrestlers (11,12,14,16,17).
Our data indicate that potentially harmful weight loss practices are common at all levels of competition and not limited to a small number of “elite” wrestlers. As expected, we did find an association between the number of matches wrestled and the frequency of weight loss behaviors. However, this was true for both varsity and junior varsity matches and was not associated with win/loss percentage. Potentially harmful weight loss practices appear to be pervasive throughout the sport of wrestling at all levels of competition.
The wrestlers’ self-report of weight loss methods was not validated in the study. However, wrestlers who did complete the survey were probably more likely to underestimate, rather than overestimate, their weight loss and use of rapid weight loss techniques. In our study, only 48% of wrestlers estimated that they would lose weight during the season, but in a direct comparison of actual preseason weight and weight at the time of the survey, over 50% had actually lost at least 5 pounds. In addition, a higher survey return rate would have probably increased the reported percentage of wrestlers who lost weight or engaged in rapid weight loss methods, because wrestlers and teams that engaged in frequent rapid weight loss were probably less likely to return the survey. For these reasons, the survey results probably underestimate the amount of weight loss and use of rapid weight loss methods among Michigan high school wrestlers.
A program designed to decrease wrestlers’ use of potentially harmful weight loss practices must recognize that the wrestler’s desire to successfully compete outweighs most health concerns. Our study and several others (10,11,12, 16,18) have found that the coach and other wrestlers are primary determinants of a wrestler’s weight class and the methods by which he gets to that weight class. Parents, trainers, and physicians are relatively weak influences. Wrestlers and coaches believe that wrestling at the lowest possible weight class gives them a competitive advantage. Wrestlers typically cannot maintain this low weight, so rapid weight loss is needed before matches.
Consistent with this scenario are previous studies which reported that the majority of the weight lost by wrestlers during the season is actually lost and regained repetitively in frequent weight cycles. Varsity high school wrestlers average 6–8 cycles per season, losing 1.9 to 2.3 kg, or 3–4% of body weight, each cycle (10–14). Our survey did not ask specifically about weight cycling, but the frequent use of rapid weight loss methods, and the fact that 62% of wrestlers surveyed reported losing over 5 pounds in the 5 d before a match, indicates that weight-cycling was common among Michigan high school wrestlers.
The rapid weight loss techniques included in our survey have proven to be dangerous. Three collegiate wrestlers died in 1997 while attempting to rapidly lose weight before a match (5). These wrestlers were using a combination of the rapid weight-loss techniques listed in our survey. Rapid dehydration and fasting can adversely effect cardiovascular function and electrical activity, thermal regulation, renal function, and electrolyte balance. Frequent weight cycling during the wrestling season has also been associated with negative mood states and decreased concentration and short-term memory (6).
In our study, 94 wrestlers, or 4% of the total surveyed, reported vomiting to lose weight during the wrestling season, with 2.3% vomiting at least weekly. Studies focusing on more competitive wrestlers have reported that 5–8% of wrestlers vomited to lose weight at least monthly (12,14). Our rate of binge eating of 39% was also comparable to previous studies (10,12,14). Wrestlers in our study who more frequently used rapid weight loss methods also reported significantly more binge eating, a finding also reported among Wisconsin high school wrestlers (12). This suggests that frequent weight cycling may increase the risk of disordered eating. An increased risk of disordered eating among wrestlers has been noted in several studies. Criteria for bulimia nervosa was met by 1.7%(12) and 2.8%(10) of wrestlers, a rate substantially higher than the estimated baseline rate of 0.2% for adolescent males (4). Subclinical eating disorders were reported in 16%(15) and 18%(8) of collegiate-aged wrestlers. Whether or not these eating patterns persist beyond the wrestling season or into adulthood is unknown.
In conclusion, the majority of Michigan high school wrestlers at all levels of competition and ability use dehydration and fasting techniques to lose weight rapidly during the wrestling season. Almost 40% of wrestlers engage in binge eating during the wrestling season. Programs designed to decrease the use of these weight-cycling methods need to recognize the cultural norm in wrestling of frequent rapid weight loss. Altering these entrenched behaviors will require a unified effort by coaches, administrators, parents, and wrestlers throughout the sport.
The authors would like to thank Bill Bupp and the Michigan High School Athletic Association for their support in conducting this research. We also appreciate the cooperation of the Michigan high school athletic directors, wrestling coaches, and wrestlers.
Address for correspondence: Robert B. Kiningham, M.D., University of Michigan Department of Family Medicine, 1500 East Medical Center Drive, Room L2003, Ann Arbor, MI 48109-0239; E-mail: [email protected]
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