Is Low Body Fat Dangerous For Women?
Fat Loss Q & A With Tom Venuto,
Author of Burn the Fat, Feed the Muscle
Q: I was just reading a blog about a woman's fitness journey from overweight all the way down to 12% body fat. It was inspiring and motivating, except for one thing - she started experiencing negative health effects, which she attributes to being so lean. Her BMI was in the normal range. I'm curious to know your thoughts about this whole subject of "dangerously" low bodyfat levels, especially in women, but also in general.
Have you experienced clients getting to this point, and needing to advise them to increase their bodyfat to a healthier range? The ACSM position statement says that a body fat level of below 12-14% in women is considered a health risk. Fitness models and competitors regularly drop well below that, but in theory, it's only temporary for that contest or photo shoot.
I think the photos and publicity may create unrealistic expectations for the rest of us "average" women looking to get shredded. To be honest, this information discourages me, because my ultimate goal has been to get down to around that level. I know every woman is different, and maybe I won't have those unwanted side effects, but the idea that I might unsettles me.
A: I know both men and women who get contest lean and they have absolutely perfect health - far healthier than most people with "average" body fat levels.
However, yes it's true there ARE some possible health risks of extreme low body fat levels - especially for women - and especially maintaining extreme low body fat levels. Many physique athletes will even tell you that being totally "shredded" is not all that pleasant - more like a "necessary evil" for competition. There are some psychological issues here as well, which could be a whole separate discussion.
I think, especially in the context of sports, it's best to look at this in terms of risks, rather than certain danger or something you should never do.
There are risks in all extreme sports. In boxing or MMA, just participating is a guarantee that you're going to get hurt. In football you could get anything from broken bones to brain injuries. In almost every sport, there's risk. In physique sports, there's arguably a lot less risk than violent or even popular contact sports. However, you have to reach very low body fat levels to compete, and that could be considered extreme in its own way.
If you choose to be a competitor, you choose to accept the risks, or you just don't compete. Your goal is to manage the risks and be smart about it. There are some really dumb things done for the sake of the hallowed low body fat percentage, and they're just not worth it.
It's not just being super lean that might be unhealthy, it's what you do to yourself in the process of getting there.
Athough some concerns or dangers exist, I believe the risks of low body fat can be a lot less serious than many people think, due to the intelligent nature of how low body fat is achieved by smart and sensible physique athletes. Without a doubt, the risks are much greater when a low body weight and body fat are produced as a result of eating disordered weight loss than athletic weight loss.
So what are the risks of extremely low body fat?
When body fat levels drop to extremes, questions about general health, endocrine health, immune system health and even mental health often come up. But probably the biggest issue is amenorrhea, defined as the loss of the menstrual period for three months or more, which is associated with extreme leanness. That in turn brings up concerns about bone density, which raises concerns for osteoporosis and increased risk of fractures especially as you age. Combined with low calorie dieting, this is known as the female triad.
Bone density is a legitimate and serious concern for women. The good news is, women who do strength training usually have excellent bone density. That is different from someone who starved herself and didn't exercise (as in anorexia or extreme weight loss diets). Also, bone density can easily be measured, so instead of worrying about it, you can get a test and know for sure.
Women over age 40 are often advised to get their bone density tested. A piece of wise advice for female athletes who drop to extremely low body fat levels: Get your bone density measured, regardless of your age. If the results come out favorably, that's one concern you can lay to rest.
Studies confirm that strength-trained athletes who have lower body fat are likely to have far fewer problems than women whose low body fat came as a result of starvation dieting or disordered eating behavior, without the training. A study at Concordia University in Quebec found that female boxers have a high bone mineral density despite low body mass, high energy expenditure and amenorrhea. The researchers said that the type of training that boxers do has a positive effect on bone mineral density.
The same results have been found in gymnasts. Female gymnasts have much higher prevalence of amenorrhea than non athletes. A study from Oregon State was published in the Journal of Bone Mineral Research. It compared gymnasts and runners who had similar body fat (around 14%), where the control group was 22%. The gymnasts had a higher lean body mass and higher lower body muscle strength than the runners, even as the body fat percentages were similar. Amenorrhea was present in 47% in the gymnasts and 30% in the runners.
Here's the interesting part: Among either athletic group, bone density did not differ significantly whether they were oligomenorrheic, amenorrheic or eumenorrheic. However, runners had lower bone density in the spine than gymnasts OR controls. This suggests that strength training or training that protects lean body mass helps maintain bone density (and that runners whose only training is endurance work would benefit from adding strength training).
Other studies in both men and women have made similar findings: a low amount of lean body mass is associated with increased bone loss. So this rule holds up in general: lift weights and gain or maintain lean body mass to protect your bone density.
Weight bearing exercise is also associated with maintaining bone mineral density. A study published in Medicine and Science in Sports and Exercise compared body composition and bone density in groups whose exercise program was only swimming versus groups participating in weight bearing sports such as running, field hockey and basketball. They found that females who participated regularly in the premenopausal years in high-impact physical activity had higher bone density than nonathletic women who did not.
Let's get back to the physique sports for a moment
Bodybuilding, physique, fitness, fitness model, figure - these are sports where the outcome is not performance, or where the low body fat is a side effect of training for performance. Physique sports are cosmetic, where the low body fat levels are an end to themselves. It's important to recognize however, that peaking at a low body fat for a figure/ fitness contest and maintaining a low body fat are two different things.
I know women who have cracked the single digits - the lowest I've ever measured on a female was 8.9%. You could look at that and say, "If amenorrhea shows up in gymnasts almost half the time at 14% body fat, then clearly single digit body fat is far too low, isn't it? Yes, but a point that many people outside the physique world don't acknowledge is that not only do fitness or physique athletes NOT maintain at 9 or 10% body fat, they can't (practically speaking). That same girl I spoke of was, in fact, around 14% body fat in the off season, a swing of about 5% between off season and contest season. To the best of my knowledge, she had perfect health, all year round. Many women look spectacular and are as lean as they ever want to be at 15-19% body fat.
Frankly, the leanest most average women will ever get is the off season level of a figure or physique athlete - 14 to 15% or so. Even if the average female could reach 9 to 10% body fat (it's extremely difficult and hard work), most wouldn't take it that far because it's not the look they want (think shredded abs, bicep/shoulder veins, drawn-in facial features, loss of breasts, etc). So whether contest level body fat is healthy is probably a moot point for any women except fitness, figure or physique athletes - a very small percentage of the athletic population and they only get that lean for a few weeks out of the year.
Very low body fat is par for the course for many athletes - in physique competition and in some endurance sports. I think the key for these women to be aware of the risks and possible markers of risk (the "female triad"), monitor them and open up a dialogue with their physicians. The best one would probably be a sports medicine doctor who "gets" the needs and goals of athletes (this article is opinion and information only - it doesn't replace a qualified medical opinion).
Let me leave you with a couple final points to think about:
One, you will see this discussion about low body fat come up in the context of two completely different areas: women with eating disorders and extremely lean athletes. It pays to recognize there is quite a difference in how each of these two different groups of people pursue their goals, and how that affects their health.
The former are starving themselves skinny and struggling with body image issues. The latter are training for strength and feeding the muscle and don't necessarily have body image problems (though they do exist in physique sports - including in the opposite direction - "muscle dysmorphia").
You're going about your quest for super-leanness in the healthiest of ways if you avoid starvation diets, avoid rapid/crash weight loss, monitor bone density, eat nutrient-dense natural food, maintain your lean body mass, train with weights, do weight bearing activity or cardio, set realistic goals and consciously work on a healthy self-image.
Two, let's be completely honest. Even if you experienced no real health problems, and you could maintain a contest-lean body fat level, most athletes will tell you it's no walk in the park. It might look glamorous in the fitness magazine photo shoots, with the models all smiles. But it's very hard work and the truth is, you're usually hungry, tired, grumpy and weaker than you are at a more normal "off-season" body fat level.
Fortunately, you don't have to be "shredded" to look fantastic. But... If you want to compete in physique sports, or just look like you could, you certainly CAN get very very lean - even competition lean - and there IS a way to do it that's most physically kind to your body and psychologically healthy as well.
That's what Burn the Fat, Feed the Muscle (BFFM) is all about - healthy, natural fat loss - whether your goal is a "lean, but normal" body fat percentage or all the way to ripped and ready for competition.
Train hard and expect success,Tom Venuto,
author of Burn the Fat, Feed the Muscle,
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