INTRODUCTION:

The female athlete TRIAD (FAT) consist of Disorders Eating (DE), Menstrual Dysfunction (MD), and Reduced bone mineral density (BMD). In sports where female athletes have to maintain a particular weight, they are involved in various ways to fit into that weight category. It can involve eating patterns which may cause low energy intake with vigorous DE. Low energy intake affect hormone secretion and specially oestrogens and leads to menstrual disease which can lead to weakens bones and increases the risk of stress fractures and other musculoskeletal injuries. These interconnected issues pose a significant threat to female athletes' health, performance, and long-term well-being. Importantly, the TRIAD doesn't necessarily require the presence of all three components simultaneously. It can an area to be explained and invented to increase participation and optimal performance of female athlete and to reduce dropouts from competitive sports.

The concept of the female athlete TRIAD has undergone a fascinating evolution since 1992 by the American College of Sports Medicine (ACSM). Initially recognizing the interconnectedness of DE, MD and Reduced BMD, the terminology has broadened to encompass a more comprehensive spectrum. The 2007 reformulation as "Relative Energy Deficiency in Sports" (RED-S), reflecting the important role of energy availability in menstrual function and bone health. This concept was further refined in 2014 by the International Olympic Committee with the introduction of the Female and Male Athlete TRIAD Coalition, acknowledging the condition's broader applicability beyond just female athletes.

METHODS:

Participants: The sample of the present study consisted of 100 National level female players of India (Chhattisgarh, Delhi, Gujarat, Jharkhand, Madhya Pradesh and West Bengal) 16-30 years of age.

Table: 1 Details of participants of various games:

S.No.	Games	Participants
01.	Martial Art	36
02.	Indigenous Games	33
03.	Team Games	21

Procedure: This study is survey based and a self-structured questionnaire was used to diagnose the DE, MD, BMD and Osteoporosis % dimensions of awareness, occurrence and impact information and SPSS version 25 was used to calculate the data

RESULT: Diet and body weight play crucial roles in athletic performance; this study investigated the weight management practices and concerns of 100 National-level female athletes from various sports.

Table: 2 shows the awareness of the TRIAD among National Female Athlete of India.

TRIAD
Aware	Not aware
40%	60%

Figure: 1

Figure: 2

Figure: 3

Figure: 4

Figure: 5

Awareness: Present study reveals that 76% of athletes reported awareness of disordered eating, whereas 24% remained unaware. Among those aware, understanding varied; 51% demonstrated general awareness, 8% defined DE as binge eating, 16% equated DE with overeating, 1% recognized self-induced vomiting as a component. 64% athletes expressed concerns about body weight and engaged in self-directed weight management.

Only 17% took professional guidance, harmful weight management practices were prevalent, 19% reported fasting, 28% engaged in excessive training, 8% reported vomiting, 4% reported usage of laxatives, 5% reported usage of diuretics, 30% of athletes reported experiencing low energy and fainting. 59% of athletes were aware of menstrual dysfunction, 35% had general knowledge, 5% associated MD with the absence of periods, 17% identified pain with menstruation as a symptom, 2% recognized irregular menstruation and 41% lacked any knowledge of MD. Only 37% of athletes were aware of bone mineral density and 63% were unaware. Awareness of osteoporosis was only 33%. 40% of athletes were aware of the TRIAD, 31% believed all three components were necessary and 9% understood that not all components were required. 60% of athletes were unaware of the Female Athlete Triad. 28% of athletes in aerobic sports demonstrated the highest awareness of Triad risk and 17% of athletes in anaerobic sports demonstrated awareness, concerning 55% of athletes were unaware of any sport-specific risks.

Table: 4 shows the occurrence of the Female Athlete TRIAD and its individual components among National-level female athletes.

Components	DE	MD	BMD	TRIAD
Occurred	76%	71%	17%	12 %
Not occurred	24%	29%	83%	88%

Figure: 6

Figure: 7

Figure: 8

Figure: 9

Occurrence: 76% of athletes reported experiencing disordered eating, among these 24% reported Anorexia Nervosa symptoms, 23% experienced Bulimia Nervosa symptoms and 29% struggled with Binge Eating Disorder. 71% of athletes’ experienced menstrual dysfunction in which 42% experienced dysmenorrhea, 1% experienced insufficient bleeding, 4% experienced heavy bleeding and 24% reported bleeding with clots. In 71% athletes, only 12% took medical evaluations for MD. 11% consulted a doctor for advice and 8% used medication to manage their symptoms. 15% of athletes reported family history of low BMD or osteoporosis, increasing their fracture risk. 17% of athletes reported abnormal BMD. 3% reported with osteopenia and 12% had osteoporosis and 2% had severe osteoporosis. 30% of athletes experienced fractures during training, highlighting a significant prevalence of bone injuries, 4% had stress fractures, 3% had traumatic fractures, 2% had fractures from being hit with an object and 21% fractures from falls during training in which 14% of athletes experienced a second fracture and 28% experienced delayed healing of fractures or injuries. 34% reported ongoing joint pain. 82% reported adequate sun exposure, contributing to vitamin D synthesis. 87% regularly consumed milk, a significant source of calcium, 27% used calcium supplements and 45% used sunscreen products. 12% of national-level female athletes confirmed the occurrence of all three components of the Triad (DE, MD, and low BMD), only 7% took professional advice for medication management related to the TRIAD.

Effect on Performance due to TRIAD: 12% of Athletes with TRIAD continued their sport after diagnosis, but they also reported decreased performance and experienced low energy. After that, they dropped out of sports due to TRIAD.

DISCUSSION:

Present study found that most athletes said they were aware of disordered eating. However, they didn't seem to have a very clear understanding of what it really means. This is worrying because if athletes don't understand DE, they might not recognize it in themselves or others, and they might not get help early enough to prevent serious health problems (Borgen and Torstveit, 2003; Nattiv et al., 2007). Many athletes were worried about their weight and were trying to manage it on their own. This makes them more likely to develop unhealthy eating habits, especially since only a few of them talked to a professional for advice. This fits with Green et al. (2009) found – that many people have unhealthy ways of managing their weight even if they haven't been diagnosed with an eating disorder.

Similarly, a good number of athletes said they aware about menstrual dysfunction, but their understanding wasn't very deep or accurate. This could mean they don't realize how serious the health effects of MD can be, or they might be hesitant to seek medical help and also saw a similar pattern in other studies about painful periods and people might not seek help (Thirza et al., 1999; Okusanya, 2009).

Athletes aware even less about bone health. Most of them didn't understand bone mineral density or the risks of osteoporosis. They also didn't seem to realize that DE, MD, and low BMD are connected as part of the FAT. This shows that really need to educate athletes more about these issues and also notice that athletes in sports like running or swimming (aerobic sports) seemed to know more about the risks of the TRIAD compared to those in sports like weightlifting (anaerobic sports). This suggests that it might be helpful to create educational programs that are specific to different sports. However, it's concerning that over half of the athletes didn't aware about any health risks that are specific to their sport also found that disordered eating is quite common in this group of athletes. Many reported symptoms that could point to anorexia nervosa, bulimia nervosa, or binge eating disorder. This high number matches what other research has shown – that athletes, especially those in sports where being thin or a certain weight is important for performance, are more likely to have problems with eating (Ezechi, 2016; Pentyala et al., 2013).

Present study also report that many athletes had problems with their periods. This is consistent with other studies that show how intense training and not eating enough can affect the hormones that control periods in female athletes (Borgen and Torstveit, 2003; Nissenbaum et al., 2012). The athletes in present study reported different kinds of period problems, like painful periods, very light or very heavy bleeding, or bleeding with clots. This shows that MD can show up in different ways. It's a concern that so few of the athletes with period problems went to consult with doctor, as untreated MD can lead to long-term health issues, including weak bones (Yoshino et al., 2019).

Present study also found that a number of athletes had lower than normal bone mineral density, including some with osteopenia and osteoporosis. Many athletes also reported getting fractures during training. This suggests that their bones might be weak. This could be due to not eating enough, hormone problems from MD, or not getting enough calcium and vitamin D, even though most athletes said they got enough sun and drank milk. It's also worrying that many athletes had more than one fracture or that their fractures took a long time to heal. We also confirmed that a significant number of female athletes in present study had all three parts of the FAT. It's concerning that even fewer of these athletes were getting professional medical help for the TRIAD. This highlights a big gap between being aware of these issues and actually taking steps to get treatment.

Finally, present study found that athletes who had all three parts of the TRIAD and kept playing their sport reported that their performance got worse, they felt low energy, and eventually, some of them had to dropout sports a. This shows how much the FAT can negatively affect an athlete's career. It supports the idea that not eating enough, hormone problems, and weak bones can all make it harder for athletes to perform well, make them feel tired, and increase their risk of getting injured, which can ultimately force them to dropout from competitive sports (Souza et al., 2014; Matzkin et al., 2015).

CONCLUSION:

It is concluded that the Athlete TRIAD is found among the female athletes, there was lack of awareness regarding different components of the TRIAD. Intervention awareness program regarding the Athlete TRIAD is needed so that female athletes’ dropout can be checked and performance can be enhanced. These findings highlighted the potential impact of unhealthy practices weight management and eating, on menstrual health in female athletes. The lack of comprehensive knowledge about MD further emphasizes the need for educational programs, nutritional guidance and medical support. More research is needed to understand the specific risk factors and prevalence of the FAT across different sports disciplines.

ETHICAL APPROVAL:

The study received approval from the Pt. Ravishankar Shukla University Raipur Chhattisgarh Institutional Ethical Committee (IEC).

CONFLICS OF INTEREST:

In the present study there is no conflict of Interest.

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Received on 15.03.2025 Revised on 05.07.2025

Accepted on 16.09.2025 Published on 07.11.2025

Available online from November 20, 2025

Res. J. of Humanities and Social Sciences. 2025;16(4):256-260.

DOI: 10.52711/2321-5828.2025.00042

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Creative Commons License.

Components	DE		MD		BMD		OSTEOPOROSIS
Awareness	Aware	Unaware	Aware	Unaware	Aware	Unaware	Aware	Unaware
Percentage	76%	24%	59%	41%	37%	63%	33%	67%