Psychometric Indicators of Eating Behavior and Risk Factors Associated with Physiological Adaptations to the Female Athlete Triad in Exercising Women

Open Access
Gibbs, Jenna Claire
Graduate Program:
Doctor of Philosophy
Document Type:
Date of Defense:
May 02, 2013
Committee Members:
  • Mary Jane De Souza, Dissertation Advisor
  • Nancy Williams, Committee Member
  • Jinger Gottschall, Committee Member
  • Leann L Birch, Special Member
  • Menstrual Disturbances
  • Exercising Women
  • Low Bone Mineral Density
  • Energy Deficiency
  • Disordered Eating
The Female Athlete Triad (Triad) is a syndrome of interrelated conditions (low energy availability (EA), menstrual disturbances (MD), and low bone mineral density (BMD)) that exist along a continuum from healthy to pathological clinical sequelae. The objectives of this dissertation were: (1) to examine the association between psychometric indicators of disordered eating behavior (high drive for thinness (DT) and dietary cognitive restraint (DR)) and physiological adaptations to chronic energy deficiency/low EA and MD in exercising women, (2) to examine the changes in psychometric indicators of disordered eating behavior (DR, DT, body dissatisfaction (BD), and bulimia scores) during a randomized controlled trial (RCT) of increased energy intake in women with exercise-associated menstrual disturbances (EAMD) and exercising controls with EAMD and ovulatory cycles, and (3) to determine the risk for low BMD in association with individual and combined Triad risk factors. In Study One, we demonstrated that exercising women with high DT exhibited signs of chronic energy deficiency (suppressed resting energy expenditure (REE) controlled for lean body mass and ratio of measured REE compared to predicted REE) and a greater frequency of severe MD (oligo/amenorrhea) compared to women with normal DT. In Study Two, we demonstrated that exercising women with high DR had a lower EA and a greater frequency of subclinical/clinical MD than women with normal DR. However, there was no difference in frequency of low EA between groups. In Study Three, we demonstrated that refeeding did not exacerbate DR or have adverse effects on DT, BD, and bulimia scores in women with EAMD during a 6 month RCT. In Study Four, we showed a cumulative effect of Triad risk factors on BMD in a large sample of exercising women. In conclusion, we demonstrated: (i) associations between high DT/DR and physiological adaptations to Triad disorders (MD and chronic energy deficiency/low EA) in exercising women, (ii) an RCT of increased energy intake combined with psychological and nutritional monitoring may have favorable outcomes for eating behavior, weight gain, and REE in exercising women with EAMD, and (iii) that exercising women with multiple Triad risk factors presented with a higher risk for low BMD.