When she got her first job as a sports dietitian at the University of Oregon in 2011, Rachel Manor was tasked with putting teams of student athletes through the Bod Pod. Basketball players and track and cross-country runners alike sat motionless inside the small, egg-shaped device. Afterward, she’d share results that included their weight, body fat percentage, and amount of lean mass.
Such testing wasn’t a part of Manor’s dietetics curriculum, so her supervisors trained her, saying it was part of providing “high-level nutrition service.” (Manor left the school in 2013, overlapping briefly with head coach Robert Johnson, who later faced allegations of a harmful focus on reducing athletes’ body fat.)
Manor said she felt uncomfortable with the process from the start. She next joined the University of North Carolina at Chapel Hill, which also used the Bod Pod, and her concerns grew. Some athletes skipped meals before the tests, lost confidence afterward, and compared their results to others’. This often led them to dwell on or restrict their food choices. And when they asked how the results helped their performance, she couldn’t come up with a good answer.
“I think body composition testing increases risk for disordered eating and eating disorders,” Manor said. She also thinks the testing contributes to symptoms of depression and anxiety. “In my clinical experience, I didn’t think any perceived benefit was worth it.”
So around 2016, Manor—who was promoted to director of Olympic Sports Nutrition at UNC in 2018—made a bold choice: She phased out body composition testing on all the teams in her purview, including track and cross country. (For a while, as part of university research, cross-country runners underwent DEXA scans, which use X-rays to measure both bone mineral density and body composition. But athletes received information only about bone health, she said.)
Instead, she met with new athletes individually, providing nutrition education and support and screening them for disordered eating or eating disorders. “It was a much better use of my time,” she said.
More than numbers
To some, the step likely seemed radical, and Manor recalls getting some raised eyebrows around the athletic department when she rolled out her new policy. Collegiate athletic programs generally, and running programs specifically, have long tracked athletes’ weight, body fat, and muscle mass using tools as advanced as the Bod Pod and DEXA or as low-tech as scales and skin-pinching calipers. Coaches and dietitians have said these metrics help them plan and track the results of their training, fine-tune nutrition guidance, and prevent injury.
But in a culture that places a moral value on body size and in a sport with a high rate of eating disorders, these measurements aren’t neutral. “It’s one data point,” said Jill Miller, head cross-country coach at Northwestern University. “But I think we all know, especially working with young women, it’s more than that—there is an emotional hit. It can be something that takes away from someone’s mental resilience and starts steering [them] to focus on the wrong things.”
In recent years, high-profile allegations about overuse or abuse of such measurements have arisen in running programs, including those at Oregon, Wesleyan University, and the University of Colorado, where results of an internal investigation into this and other team culture issues are expected later this month. Reports from student athletes, health professionals, and researchers suggest monitoring body composition has risks, and limited benefits.
As a result, many schools and programs are reviewing their policies surrounding body composition testing, said Riley Nickols, Ph.D., CEDS-S, a counseling and sport psychologist who has consulted with universities about their protocols. Some are implementing changes to reduce risks, such as ensuring such tests are voluntary and keeping results between athletes and sports medicine staff, rather than sharing them with coaches.
And others are forgoing them entirely. “I’ve not utilized any of those tools, nor will I ever,” said Diljeet Taylor, head women’s cross-country coach and associate director of track and field at Brigham Young University, where she’s led the women to a national cross-country championship and two runner-up finishes. “I don’t think any modern-day programs should be utilizing these practices. We have seen what it is doing. If it’s detrimental to one female student athlete, it’s going to be detrimental to a lot more.”
High risk, low reward
Body composition and weight do influence running performance, Nickols said—but so do at least 38 other physiological and psychological factors, from genetics to training to motivation and mental health. Testing can place an outsized emphasis on body shape and size, often to the detriment of other elements. “I think there’s sometimes some old-school mentality; I don’t know a better word for it,” he said, where coaches cling to a “rigid bandwidth” of body composition for specific sports or events.
In reality, each athlete has an individual sweet spot, where body and brain perform best. “Genetically, we are different in terms of what body composition is going to result from our recommended nutritional and training plan,” said Michelle Barrack, Ph.D., R.D., an associate professor of nutrition and dietetics at California State University, Long Beach, who studies nutrition among collegiate runners. “Some athletes naturally are going to have a little bit higher body fat percentages, and then some athletes can actually be very fueled and healthy and have lower body fat percentages.”
Coaches like Taylor and Houston Franks—who coached NCAA champions and Olympians at Mississippi State University and is now head cross-country coach and assistant coach for mid-distance and distance at Louisiana State University—say their experiences bear this out. “I’ve seen [athletes] run really fast with numbers all over the place,” Franks said.
That nuance is missed when coaches, dietitians, or any other person on the athlete’s team suggests an individual athlete conform to a predetermined range of body fat percentages. “That’s really where the danger is,” Nickols said. “Any good athlete will think, ‘Well, sport means everything to me, and I want to do all I can to maximize and leverage my opportunities and my talents. So if Coach or this provider feels my body fat needs to decrease, I’ll do whatever I can to make that happen.’”
Athletes given an explicit or implicit directive to lose weight or fat may restrict their eating and develop relative energy deficiency in sport (RED-S) or the female or male athlete triad, syndromes that occur when athletes don’t eat enough to cover the energy they use in training, Barrack said. These may impair performance and increase athletes’ risks of injuries and other health problems.
In some cases—like many of those that make headlines—coaches or others working with athletes can “weaponize” the data, either by knowingly criticizing athletes or failing to deliver results in a sensitive matter. “Sometimes, unintentionally or intentionally, it can be communicated that you’re not as dedicated or committed as an athlete, because your weight and body comp are higher,” Nickols said. “And that goes for the jugular, in my opinion.”
Athletes’ firsthand accounts demonstrate this type of distress. During her graduate program in dietetics, Linda Steinhardt, R.D., now a sports and eating disorders dietitian at EDCare, an eating disorder treatment center in Denver, surveyed 183 Division I athletes about their experiences with body composition testing, many of which were negative.
Athletes’ comments highlighted the risks: “I don’t like how the information is given to our coaches and then used against us if things like body fat go up,” one athlete wrote. Another said: “It can bring to light numbers that may seem like an issue and cause mental distress for a person that was perfectly fine with their body before, and the discoveries made in testing don’t mean as much as someone thinks.” Several said they’d watched teammates develop eating disorders linked to testing.
Another reported: “After my first body composition test in college, I obsessed over my body fat and muscle percentages, and went right home to my computer and researched them to make sure I wasn’t ‘fat.’ I was told right after my test by my dietitian that I was perfectly healthy and strong, but even hearing that didn’t stop me from worrying about the numbers.”
Steinhardt’s results also raise doubts about whether the testing improves nutrition advice. Of the two-thirds who had undergone such testing, 40 percent said they received no follow-up based on the results.
For those who did, the most common recommendations were to increase protein intake, improve hydration, focus on timing of meals and snacks, or to keep doing what they’re currently doing. “Things that were recommended based on your body composition weren’t any different than I’d probably recommend if I just had a conversation with the athlete,” Steinhardt said.
Testing invites comparison, lacks accuracy
Taylor also finds direct communication with athletes more effective than monitoring. Before arriving at BYU, she coached at Cal State Stanislaus, a Division II institution without access to tools such as the Bod Pod or DEXA. “I found ways to focus on body image and the importance of making good choices for your body and fueling it properly without those modalities,” she said.
She talks openly and frequently with her athletes about the importance of having regular periods, the changes their bodies may experience as they enter and move through their collegiate years, and how to manage negative thoughts about their appearance. (Talk to yourself the way you would your teammate, sister, or best friend, she advises those who raise concerns about the size or shape of their bodies.)
She’s now at a Division I university with access to more resources, but Taylor believes using them in this area would be a competitive disadvantage, as they could undermine an athlete’s confidence. “If my women felt insecure about their body and they were comparing it to other people’s, they would not reach the pinnacle of their potential,” she said.
Laurie Henes, head coach of women’s track and field and cross country at North Carolina State University, came to similar conclusions several years ago. Around 2015, the athletic department began using the Bod Pod, and Henes at first agreed to test her cross-country and track athletes. The school’s strength and conditioning coaches at the time hoped the readings could provide feedback on athletes’ progress in the weight room, she said.
But before long, Henes noticed the results were more distracting than informative. “No matter how much you say that the data is private and individual, the athletes have the choice to talk to each other, and no one can stop that,” she said. “If athletes are looking at who’s running really fast, and if this number is a certain number, then people feel like … maybe I should be the same. And it’s just not the same for everybody.”
Again, Steinhardt’s research validates this concern. More than half of student athletes—56.5 percent—who underwent body composition testing said they compared their results to those of their teammates.
Henes soon noticed another problem: the accuracy of the data. One runner called Henes from her testing appointment, incredulous, because her results said she had a body fat of 5 percent—an obvious error (essential fat, for women, is about 10 to 13 percent). The technicians had her put her hair up in a ponytail, and her percentage immediately increased to 9 percent, which was still unbelievable.
“That was the breaking point for me,” Henes said. “I just vividly remember walking over there and saying, ‘We are not doing this anymore.’”
Indeed, error rates are another reason many medical and eating disorder experts recommend caution. DEXA scans are considered highly accurate, but even with those tests, technicians’ training, athletes’ hydration status, and other variables come into play.
Other methods, including Bod Pods (which measure the amount of air displaced by the athlete’s body), bioelectrical impedance analysis (where a weak electric current is passed through the body), and calipers (where trained practitioners pinch skin and the underlying fat on several sites on the body, then plug the results into a formula), tend to have more variable results.
Calipers also involve being “pinched and poked” in sensitive areas, said Christina Weidman, M.S., R.D.N., a sports dietitian at Northwestern. Though she’s trained in the technique, she’d hesitate to use it on cross-country runners, who have a high rate of disordered eating. “That’s already a sport where they’re in the tightest of shorts and spandex,” she said. “Their bodies are already exposed. It’s so invasive for those athletes.”
A health screening model
Many experts say DEXA scans have value as medical tests. The collegiate years are critical for building bone mass, and athletes who don’t eat enough risk bone injuries, as well as bone-thinning diseases like osteopenia or osteoporosis. DEXA scans can flag bone density that’s low for an athlete’s age or decreasing over time. And if athletes already have conditions such as RED-S, knowing body composition can detail the extent of the issue, and guide them back to good health.
If healthcare professionals in a collegiate program conduct scans sparingly and share results in a sensitive manner, athletes can gain valuable information about their health, said Kathryn Ackerman, M.D., M.P.H., sports endocrinologist and director of the Female Athlete Program at Boston Children’s Hospital.
At Northwestern, cross-country runners undergo DEXA scans when they enter the program, as well as at the beginning and end of every season. The tests are voluntary, and runners can choose not to see the results. In that case, the sports medicine team will provide feedback only if they spot a problem, such as low bone density or a concerning drop in muscle mass that indicates an athlete is underfueling.
Those who do want the results will schedule an appointment with Weidman or the team physician. There, results will be discussed as part of a more comprehensive review of their health and performance.
“I think where you can get in trouble is when you are getting body composition data, and you’re just acting on that alone,” Weidman said. “It sends the message that this is a really important piece of information that we need, and it’s enough to act on. We try to send the message of, ‘Yes, we’re collecting this data, it’s important—but it’s not the only important piece.’”
Athletes can sign release forms if they agree to have results shared with coaches. But Miller at Northwestern said she asks not to see any specific values, only whether an athlete’s bone health is deteriorating. If it is, she adjusts their training—by decreasing mileage or adding in more cross-training.
Franks said the program at Louisiana State University operates in a similar way. Athletes receive voluntary DEXA scans two to three times per year. While Franks used to talk through the results with the team dietitian, he was recently told they’re no longer sharing specific numbers, only general information about trends and health.
“That’s fine with me,” he said. All that matters to him is that the dietitian and physician flag athletes whose results suggest they’re not fueling enough, so they can work with the dietitian to increase intake, or be referred to a sport psychologist or eating disorder expert to address any deeper issues. Then, if the medical team decides an athlete’s training needs to be adjusted or paused until their health is restored, he’ll enforce that. “We’re not using DEXA as a performance predictor. We’re using it as a health screening,” Franks said. “In my opinion, that’s how it should be used more.”
When Runner’s World asked about policies on body composition testing, a spokesperson referenced the NCAA Sport Science Institute website, which includes articles about eating disorders and energy availability. A section on body composition assessment in the organization’s sports medicine handbook—last updated in 2014–15—warns against the risk of comparison between students, suggests testing be conducted no more than twice per year, and emphasizes the need for health professionals to communicate results sensitively.
Nickols said a more comprehensive set of best practices would go further in protecting student athletes. He, Steinhardt, and Manor recommend colleges take additional steps, including:
- Minimizing coaches’ role. To avoid even the perception of pressure to manipulate body composition, they shouldn’t be present during testing or receive results.
- Ensuring body composition testing is truly optional, not only in policy, but in practice. Athletes shouldn’t feel they’ll face penalties if they don’t take part.
- Securing informed consent from athletes first. This means explaining all the risks—including experiencing more negative thoughts about their bodies or impulses to restrict their eating surrounding testing.
- Being clear on how the information is being used, and explaining that to athletes, too.
- Considering individual risk factors athletes may have for disordered eating both when taking measurements and considering results. Some athletes will have no problem with testing or even appreciate the results, while others will be significantly negatively affected, and those involved should screen for differences. “There shouldn’t really be a one-size-fits-all approach across all athletes,” Nickols said.
Nickols recognizes these types of guidelines take considerable resources, and that athletic departments are often stretched thin. If they don’t have the staffing to execute them, however, he recommends re-examining whether to do the testing at all.
Inappropriate use of body composition testing can not only harm athletes’ health and well-being in the short term, it can also negatively affect their relationship with food and their bodies once they move on from sports, said Manor. She left UNC in 2021 to relocate to Baltimore, where she is now a sports and eating disorder dietitian in private practice at Lutz, Alexander & Associates.
“There are so many more helpful things sports dietitians, sports nutrition professionals can do to support athletes,” Manor said, including screening for eating disorders and nutrient deficiencies and supporting them in learning how to cook and eat flexibly and socially, both in college and for the rest of their lives.
“We could do that independent of knowing what their relationship is to gravity or what their percent body fat is,” she said. “So I hope that’s what sports nutrition for athletics moves toward, providing that nutrition support and education that’s athlete-centered and unrelated to their body composition.”
If you are struggling with an eating disorder and are in need of support, please call the National Eating Disorders Association Helpline at 1–800–931–2237. For a 24-hour crisis line, text “NEDA” to 741741.
Cindy is a freelance health and fitness writer, author, and podcaster who’s contributed regularly to Runner’s World since 2013. She’s the coauthor of both Breakthrough Women’s Running: Dream Big and Train Smart and Rebound: Train Your Mind to Bounce Back Stronger from Sports Injuries, a book about the psychology of sports injury from Bloomsbury Sport. Cindy specializes in covering injury prevention and recovery, everyday athletes accomplishing extraordinary things, and the active community in her beloved Chicago, where winter forges deep bonds between those brave enough to train through it.
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