Factors That Affect the Young Female Athlete

The past 35 years have seen a tremendous increase in the number of female athletes at all ages and abilities. Recent research has shown a myriad of benefits for girls and women who participate in sports. Physical activity positively influences almost every aspect of a young woman’s health, from her physiology to her social interactions and mental health. As the level of girls’ participation in sports increases, it is important to examine their risk factors for sports-related injuries.

History of women in sports

The past 35 years have seen a tremendous increase in the number of female athletes at all ages and abilities. The civil rights federal law Title IX of 1972 prohibits sex discrimination at any educational institutions that receive federal funds, including school-sponsored sports. The number of high school girls playing competitive sports increased from fewer than 300,000 before Title IX to almost 3 million in 2005–2006, an increase of 1004% ( Fig. 1 ) .

Historically, women were excluded from most sports. In 1896, the first modern Olympics did not let women compete because of a concern that they could injure their reproductive organs. Women were introduced gradually into the Olympic arena; in 1904 archery was added, in 1908 lawn tennis and figure skating were included, and then women’s diving and swimming were added to the 1912 Stockholm Olympics. The 1920s saw a trend toward the elimination of interscholastic competition for girls because of its “undue stress” and “morbid social influences.” During these times, Babe Didrikson Zaharias, who is considered the female athletic phenomenon of the 20th century, found very limited opportunities to compete in sports . Throughout her athletic career, she endlessly challenged the public’s stereotype while excelling in multiple sports, including those dominated by men. The Associated Press ultimately named Zaharias the Woman Athlete of the Half Century in 1950 .

Sport has been one of the most important sociocultural learning experiences for boys and men, and those same benefits were becoming available to girls and women especially in the last 35 years. ABC televised the 1968 Winter Games live and in color for the first time, and the enduring image is of Peggy Fleming’s free-skating program. She won the Gold Medal, the only Gold Medal the United States brought home from Grenoble . During the 1968 Summer Olympics, Georgia’s Wyomia Tyus set a world record running the 100 meter in 11.08 seconds . By the end of her career, Tyus held world records at both 100 yards and 100 meters, won eight National AAU titles, five of them outdoors, and was elected to the U.S. Olympic Hall of Fame in 1985. At those same Summer Games, Debbie Meyer won a gold medal in the 200, 400, and 800-meter freestyles, making her the first woman swimmer to win three individual gold medals at one Olympic Games. Over the course of her career, Meyer broke 20 world and 24 American records. She was named Swimming World magazine’s Swimmer of the Year from 1967 to 1969. She won the 1968 Sullivan Award as the top amateur athlete in the country. She was inducted into the International Swimming Hall of Fame in 1977 and into the U.S. Olympic Hall of Fame in 1987 .

In 1973, just 1 year after Title IX was passed and during the infancy of the Equal Rights Movement, Billie Jean King brought women’s tennis and women’s sports into prime time as she defeated Bobby Riggs in the internationally televised “Battle of the Sexes.” In 1974, she helped establish a player’s union and professional women’s tour and fought for equal pay . She then founded the Women’s Sports Foundation, a charitable educational organization dedicated to advancing the lives of girls and women through sports and physical activity . By 1996, Women’s Team Events dominated the Atlanta Olympics in soccer, basketball, softball, and gymnastics, witnessing a 27% increase in participation compared with the previous 1992 Olympic Games in Los Angeles . Mia Hamm and the United States women’s national soccer team won the gold medal in front of 80,000 spectators, an all-time record for any women’s sporting event . In 1999, Women’s Soccer USA became the World Cup Champions, and by 2001, the Women’s United Soccer Association held its first game . The Women’s National Basketball Association (WNBA) began play in June 1997. In 2001, WNBA games were broadcast to nearly 60 million fans in 23 different languages and 167 countries .

Obvious financial differences exist between compensation for the professional male and female athlete. So far the WNBA’s monetary success has not mirrored that of the NBA’s. The maximum salary for a WNBA player in 2007 was $100,000. Many WNBA players choose to supplement their salaries by playing in Australian women’s basketball leagues during the WNBA off-season . 2006 WNBA hard salary cap was $700,000 and the minimum for a four-year veteran was about $47,000 . In comparison, the 2006-07 NBA salary cap was $53.135 million and the average salary was $5.215 million . At the top of Forbes list of highest-paid athletes, Tiger Woods is recognized as the world’s best-paid athlete. According to David Carter, professor of sports business at the University of Southern California, Woods has what it takes to be marketable. He is not only articulate but also attractive, clean-cut, and scandal-free. “Ultimately, it boils down to whether an athlete has charisma, believability and the ability to communicate. Tiger Woods has all of these things.” Another solid Nike investment like Woods, tennis player Maria Sharapova is the world’s best-compensated female athlete . She is safe and likable, and beautiful. In comparison to Woods who earned $87 million in 2005, Sharapova earned $18+ million in the same year. Annika Sorenstam, the world’s top-ranked female golfer, made $7.3 million that year . The number of women on the Forbes list is less than a handful.

Women athletes have been successful at increasing their earnings. When the Ladies Professional Golf Association (LPGA) first began in 1950, the top purse was $15,000 and grew to $30.3 million by 1997 (43 events). Michelle Wei won the U.S. Women’s Amateur Public Links Championship at age 13. At age 14, Wie narrowly missed becoming the first woman to make a cut on the men’s United States tour since 1945. Now at 17 years old, according to Golf World magazine, Wie will be the most recognized female athlete in the world, because not only is she capable of rewriting female golf’s record books but she also has an almost perfect profile for advertisers. With a Korean background and born in Hawaii, Wie is the ideal sponsorship vehicle for both golf’s biggest current market, the United States, and its biggest new market, the Far East. “Once the apparel line gets rolling and you have a couple of other major endorsements her earnings could reach $30–40 million a year,” said Brandon Steiner of Steiner Sports Marketing . The women’s winner of the 2005 New York City Marathon took home $130,000. The women’s purse was the largest purse in marathon history and was $30,000 larger than the 2005 men’s purse . Although female athletes are making strides financially, they still have a large monetary gap to close.

Recent research has shown a myriad of benefits for girls and women who participate in sports. Physical activity positively influences almost every aspect of a young woman’s health, from her physiology to her social interactions and mental health. High school girls who are active in sports have higher graduation rates, fewer unwanted pregnancies, and greater self-esteem than those who are not active . Regular exercise has been shown to decrease the risk for multiple diseases, including obesity and type II diabetes, and has shown modest protection against breast cancer , coronary heart disease, hypertension, osteoporosis, depression , and some cancers of the reproductive system . The U.S. Preventive Services Task Force and the Office of Disease Prevention and Health Promotion have emphasized that physical activity and fitness must be viewed as a health priority among the older population (with women as the majority). Clearly, encouraging an active lifestyle among women is critical to the long-term health of the United States . With these benefits, health care providers should become aware of the unique issues these women face as athletes.

Body image

For at least the past 40 years, Western cultures have valued and idealized youthfulness and slimness in women. For the past 44 years, men have swooned over James Bond’s women. The Bond Girls have become an icon of film history and broken fashion boundaries with their sexy, mesmerizing style. The Bond films always show a strong appreciation for the silhouette of a woman’s body (such a silhouette is featured in the classic opening of the films). As Playboy founder Hugh Hefner states,

As much as I think of Sean Connery as the first and the best of the Bonds, I think Ursula Andress, the first of the Bond Girls, was the most memorable. The Bond Girl had that very contemporary good girl / bad girl quality that defined the nature of sexuality, particularly in the ’60s and ’70s, and it was timed to the arrival of the sexual revolution. These were independent women, always beautifully attired and coifed — and a lot of fun .

Perhaps not surprisingly, Hefner said the Bond Girl’s style is “exactly” the same as that of a Playboy girl. In fact, the magazine launched in 1953, the same year Ian Fleming published “Casino Royale.” Playboy also published advance excerpts of several Bond books, and the Playboy Club was featured in several of the films. With each film, the look, shape, and personality of the Bond Girls have changed. “They’re not as voluptuous as they used to be back in the ’60s,” said swimsuit designer Melissa Odabash. “Now they’re more athletic” .

Young girls in today’s American society deal with daily media that potentially changes the way they think about their own developing body. Numerous articles have been written about the children’s toys, books, and television shows, among other things, that teach children that only skinny is beautiful, including many Disney movies such as Beauty and the Beast, Cinderella, and Snow White. Barbie dolls also have this effect on children. A study by Davidson and colleagues examining the body-shape preferences of young children in the United States, Mainland China, and Turkey determined that all children did not necessarily prefer the slim body image, but preferred what the people from their area preferred. For example, the young girls from the Middle East favored larger-sized women, whereas the young children from China didn’t even believe that extremely overweight people existed . The children from the United States ranked being slim as their top choice . However, children of the Middle East do not necessarily have the same amount of freedom as to which foods they can eat, and in fact don’t always have enough food, which is perhaps why they prefer the bigger model compared with a slim one. Maybe they think that the more obese model has enough food and doesn’t have to worry about where their next meal comes from.

One study of Saturday morning toy commercials found that 50% of commercials aimed at girls spoke about physical attractiveness, whereas none of the commercials aimed at boys referred to appearance . Another study found 50% of advertisements in teen girl magazines and 56% of television commercials aimed at female viewers used beauty as a product appeal . Toys such as the famous Barbie Doll make girls and women feel as if they have to try to somehow attain her certain body type. Not only would she be 7-feet 2-inches tall, but also she’d have an impressive 40-inch bust line, a tiny 22-inch waist, and 36-inch hips. In addition to these absurd and physiologically impossible statistics, her neck would be twice the length of a normal human being . Barbie would not have enough room in her tiny waistline to have full-sized organs, nor would she be able to menstruate. Because of her proportions, she would have to walk on all fours because her body would not be able to adequately support her . Regardless, Barbie’s figure and other media-driven advertisements can make some girls feel unhappy with their bodies, even though Barbie’s body type is impossible to attain. However, when Mattell, the company that markets and produces the Barbie Doll, tried to change Barbie’s body because of pressure from today’s society, the doll they introduced with the regular body type failed in the market .

Studies have shown that both women and men, young women and girls in particular, are highly influenced by sociocultural factors concerning body image and eating habits, the latter of which is closely correlated with self-image . Researchers are concerned that, at such a young age, individuals have an unhealthy need to be skinny. Although the incidence of obesity is increasing among teenagers, adolescent girls of average weight are almost as likely to be dieting as their overweight peers . The desire to be thin not only affects girls who are considered medically overweight but also girls who are at a healthy weight. Reasons given by children for wanting to lose weight are rather varied and include “teasing by peers, pressure from family, feeling uncomfortable or embarrassed, wanting to feel better or look better, changing sports ability, not liking [current] weight, and wanting to be healthier” .

In a survey of 12-year-olds performed to determine which adults influence children the most about dieting and related eating behaviors, 77% responded that they first heard about the concept of dieting from a family member, usually a parent . Friends and peers also play an integral role in shaping attitudes concerning body image and weight loss behaviors. For younger girls aged 8 to 13 years, the strongest influences concerning the pressure to lose weight were found to be mothers and best female friends . Peers and close friends are often considered credible sources on the subject of dieting, particularly if they seem knowledgeable in controlling weight-related behaviors . In fact, adolescent girls reported their peers as one of the primary sources of information on weight control and dieting .

Girls’ attitudes and behaviors about weight stem from three main sociocultural influences: parents, peers, and the media. Experts have found that most young children discover the concept of dieting from their parents, either through parental attitudes or modeling. The role that peers have in terms of girls’ body image is very similar to that of parents. Peers are often a primary source of weight-control information and can influence other girls by pressuring them to lose weight through comments and teasing, and also by performing dieting behavior themselves.

These interactions between individuals, paired with the ever-present media, serve to perpetuate the thinness ideal. After examining each of these factors in turn, the overall process of socialization for young girls clearly contributes to the perpetuation of the thinness ideal, which for many girls increases body dissatisfaction and subsequent weight-control behaviors . The current American weight loss culture can include childhood preoccupation with a thin body and social pressure about weight. This obsession can be associated with the development of binge eating disorders in adolescence . In bulimia nervosa (BN), individuals may be slightly underweight, of normal weight, overweight, or obese. The primary diagnostic criteria for BN are behavioral; individuals binge and then engage in compensatory methods to prevent weight gain at least twice a week for an average 3-month period. Other criteria include excessive influence of body weight and shape on self-evaluation, and binging and purging that does not occur only during episodes of anorexia nervosa (AN). Two BN subtypes identified are purging type, in which laxative use, vomiting, diuretics, or enemas are used to prevent weight gain; and nonpurging type, which includes excessive exercise as the regular method of preventing weight gain . According to the 2003 Youth Risk Behavior Survey, 36% of adolescent girls believed that they were overweight and 59% were attempting to lose weight. In the 30 days before questioning, 8% of adolescent girls reported they had either attempted vomiting or had taken laxatives to help control their weight . The American Psychiatric Association identifies two subtypes of AN: restricting type and binge-eating/purging type. In the former, a low body mass index (BMI) is attained or maintained through dieting, fasting, or excessive exercise; in the latter, binge eating or purging is present . Eating disorder not otherwise specified (EDNOS) is used for diagnostic purposes when the disorder does not meet the all of the criteria for AN or BN .

An estimated 1 to 2 million American women meet the criteria for BN as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) . BN most often begins in late adolescence through young adulthood with a course that may be chronic or intermittent and lead to various physiologic problems . Half a million women meet the diagnostic criteria for AN . The onset of AN is often identified as occurring in mid- to late adolescence, ages 14 to 18 years. Although rare, onset can occur in the mid-adult years. The course of this disorder can be chronic, especially if untreated, and can result in numerous medical complications, including death .

EDNOS occurs in approximately 3% to 5% of women between ages 15 and 30 years in Western countries. Questions have been raised about the femininity and appearance of highly successful female athletes. Society has produced a stereotype of how a female should look. Today’s “healthy” look is thin, according to society’s current definition. Unfortunately, unhealthy behaviors are associated with this very slender appearance, and athletic performance diminishes as a result .

No consensus has been reached regarding the precise causes of eating disorders. An individual can experience a decreased sense of self-esteem or self-control because of predisposing factors (eg, biology, family history, traumatic events) and may then use dieting behavior or weight loss to provide a sense of stability or control . Our culture’s obsession with achieving lower weight conveys an almost unavoidable message to maturing adolescents. Several factors have been noted to be associated with the development of eating disorders. In a 3-year study of 44 secondary schools in Australia, students, initially aged 14 to 15 years, dieting was the most important predictor of a new eating disorder. High rates of earlier dieting and psychiatric morbidity in female subjects accounted for differences in eating disorder incidence between sexes. In adolescents, controlling weight through exercise rather than diet restriction seems to carry less risk for the development of eating disorders . Researchers believe that numerous low-calorie diets, weight loss programs, and the increase in articles and advertisements on dieting in women’s magazines and the media are associated with the increase in eating disorders . They have studied television as a purveyor of cultural standards of beauty and have found that the female characters are thinner and younger than the male characters . By 1990, researchers had concluded that Western culture’s emphasis on slimness in women was related to the development of eating disorders .