Underfueling: are we taking weight loss too far?

Featured article in the Fall 2015 Issue of Nutrition Close-Up; written by Pamela Hernandez, CPT

The Female Athlete Triad is most often associated with high school or collegiate athletes, but its symptoms can affect women of any age who engage in high levels of physical activity and eat a very low-calorie diet in an attempt to lose weight. 

The triad is defined by the combination of three conditions, according to the American College of Sports Medicine:1

  • A pattern of disordered eating
  • Amenorrhea or oligomenorrhea
  • Decreased bone mineral density

Women who are not competitive athletes may not even be aware that they are at risk for these conditions when pursuing weight loss with popular dieting methods and extreme exercise programs. Undereating with or without high levels of intense physical activity can potentially lead to Female Athlete Triad as well as nutritional deficiencies, muscle loss, and other health risks. They can also undermine the intended long-term goals of weight maintenance and good health.


For example, one popular dieting technique is to eliminate certain food groups, like grains, dairy or fruit. However, these foods provide necessary vitamins, calcium, fiber and phytonutrients to the diet. Juicing is also another popular weight-loss trend that can leave the female fitness enthusiast without the necessary protein and fat to repair muscles, support hormone production, and utilize fat-soluble vitamins like vitamin D. All diets that limit caloric intake under the resting metabolic rate risk sacrificing lean muscle tissue.


Personal trainers, group fitness instructors, and other fitness professionals need to be on alert for these conditions and behaviors in their clients. While nutrition may not be within the scope of practice for all fitness professionals, health professionals can comfortably encourage several behaviors to help prevent the undesirable effects of overtraining and underfeeding in female athletes.


  • Highlight all the benefits of exercise, not just the calories burned. For overall wellness, activity should be seen not as a means to an end but the goal itself. By turning the focus away from earning food or reaching a certain number of calories burned, we can start to redefine the relationship many women have with food and exercise. Fitness professionals should emphasize the benefits of gaining strength or stamina, increasing energy, and mood improvements that come from regular physical activity. They should also explain the benefits of rest and recovery as part of a balanced fitness program.
  • Focus on the types of foods clients should eat instead of those to avoid. Creating a list of “off limits” foods creates a good/bad food dichotomy and encourages a reward or punishment relationship with exercise. Clients may also start to skip meals entirely when faced with a “bad choice.” Instead, help her develop strategies to make choices that align with her health goals.
  • Promote a balance of macronutrients at each meal with an emphasis on colorful and natural foods. Fruits and vegetables are a very important part of a healthy diet but so are protein and fat. The Dietary Guidelines for Americans 2010 2 recommends 35 to 55% of daily caloric intake from a combination of protein and fat. Asking clients to create a plate that is roughly two- thirds fiber-rich carbohydrates (like vegetables, fruits and beans) and one third lean protein (like eggs, Greek yogurt and tuna) coupled with healthy fats (like avocado, almonds and olive oil) can help them reach energy needs while providing essential nutrients.


Whether she is training for a sport or not, every female who engages in physical activity is an athlete. In helping her train for life and create a healthy balance between food and exercise, fitness professionals must listen for the signs of undereating and overtraining. We should make it clear that short-term results at any cost are not part of the path to a healthy and fit life.


Pamela Hernandez is an ACSM Certified Personal Trainer and ACE Health Coach. She runs Thrive Personal Fitness in Springfield, MO and is the author of the book “The 4 Keys to Real Fitness.” Her goal is to empower women with fitness and help them take control of their lives by taking control of their health.





  1. American College of Sports Medicine. ACSM Information On The Female Athlete Triad. Version Current 8 May 2015. Internet: http://www.acsm.org/docs/brochures/the-female-athlete-triad.pdf (accessed 8 May 2015).
  2. S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2010. 7th Edition, Washington, DC: U.S. Government Printing Office, December 2010.



Key Messages

  • Undereating with or without high levels of intense physical activity can lead to Female Athlete Triad, as well as muscle loss and other health risks, which undermine the intended goals of good health.
  • Physical activity should be seen not as a means to an end but the goal itself. Fitness professionals should emphasize the benefits of gaining strength, stamina, and increasing energy.