Under-Fueled and Under-Supported: Addressing a Policy Void to Prevent the Female Athlete Triad and Bolster the Promise of Title IX

Abstract

Since Title IX of the Education Amendments of 1972 banned sex-based discrimination in educational institutions, there has been a 614% increase in women’s sports participation at the collegiate level. Unfortunately, lurking behind the opportunities and public health benefits which Title IX has inspired for women and girls, lies the rise of a silent crisis in which one in three female collegiate student-athletes are impacted by disordered eating behaviors, menstrual irregularities, and/or impaired bone health – the three hallmarks of a potentially life-threatening condition entitled the Female Athlete Triad (Triad). The presence of one or all three components of the Triad threatens a woman’s health and her ability to participate in sport. If, as President Joseph Biden suggests, the promise of Title IX is empowering women to realize their full potential through unimpeded opportunity to participate in athletics, then the threat which the Triad poses to women and girls undermines the promise of Title IX.

The literature suggests that two environmental factors, which this thesis labels “external factors,” frequently lead to and perpetuate the Triad: (1) insufficient education among athletes and coaches regarding the Triad and the importance of sports nutrition and (2) training environments which prioritize winning over well-being. Since the Triad was first recognized in 1992, the nation’s most prominent sports medicine and collegiate athletic associations have published policy recommendations aimed at preventing the condition. However, comprehensive review of available literature suggests that the prevalence of Triad components among female collegiate student-athletes has not decreased over time and may even be increasing, raising questions about the sufficiency of current policies.

This thesis analyzes the compliance structure of Title IX and current Triad prevention guidelines and identifies that a policy void – defined as insufficient enforcement of policies aimed at promoting student-athlete well-being – may be contributing to consistently high rates of Triad components and undermining the promise of Title IX, an explanation which this thesis labels the Policy Void Hypothesis.

To build on the promise of Title IX and inform a set of policy recommendations which could prevent more young women from being impacted by the Triad, this thesis presents and analyzes the findings of two original research studies aimed at exploring this policy void from the perspective of student-athletes and college coaches. Descriptive statistical and logistic regression analyses support the Policy Void Hypothesis and indicate that many female student-athletes are under-fueled (not consuming enough calories to support their bodies’ basic functions) and under-supported (inadequately educated about the Triad and sports nutrition and training in environments which prioritize winning over well-being).

Given that the current administration of President Joseph Biden has signaled commitment to ensuring that women and girls can thrive in all aspects of society, this thesis seeks to learn from the past 49-years of Title IX-inspired women’s participation in sport and capitalize on an opportunity to bolster policy to empower young women to realize their full potential.