Extended periods of low energy intake also place female athletes at risk for the female athlete triad, which refers to the interrelationships among low energy intake, menstrual dysfunction (called amenorrhea), and bone loss (osteoporosis). Inadequate energy intake may result from eating disorders (such as anorexia nervosa or bulimia nervosa), intentional caloric restriction in an attempt to reduce body fat or weight, or because she is unintentionally eating inadequate calories to meet the increased energy needs of an athlete. Doing what the U.S. Gymnastics Team used to do—not eating during their long training hours—may make it difficult to consume adequate energy and essential nutrients during the remaining portion of the day. When energy intake is inadequate for an extended time, the processes that are necessary to sustain reproductive and bone health are impaired, and this can have life-long consequences that are not reversed even when energy balance is later restored.

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