In the Shadow of Obesity: The Female Triad

Deliberate efforts to control body weight (e.g., purposeful dieting, prolonged fasting, self-induced vomiting, the use of diet pills), or unintentional restriction of energy intake that does not cover the costs of energy expenditure, all have a role in creating low energy stores (Golden, 2002; Manore, 2002). However, when young females develop patterns of unhealthy eating in conjunction with strenuous exercise during this window of bone accrual, menstrual dysfunction and low estrogen levels that may result can undo the beneficial effects of exercise on bone density (Drinkwater et al., 1984; Gordon, 2003; Miller, 2003) and place amenorrheic females at risk for premature osteoporosis (Drinkwater, et al.).