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11

Rapid Weight Loss and Low Energy

Availability in Young Combat Sport
Athletes: Risk Factors, Clinical

Presentation, and Prevention

Strategies

Martin Šporin and Dorjana Zerbo Šporin

© 2026 Martin Šporin and Dorjana Zerbo Šporin
https://doi.org/10.26493/978-961-293-570-2.11

Introduction
From Female Athlete Triad to Relative Energy Deficiency in Sport
Female athletes experiencing amenorrhea have been reported to exhibit
reduced vertebral bone mineral density (BMD) compared with otherwise
comparable eumenorrheic athletes (Drinkwater et al., 1986). The Amer-
ican College of Sports Medicine (ACSM) later identified weight-related
pressures placed on young female athletes – particularly expectations to
attain or maintain an unrealistically low body mass – as a key etiological
factor in the development of the Female Athlete Triad (FAT). The triad
is a pathophysiological constellation comprising three tightly intercon-
nected clinical domains: low energy availability (with or without disor-
dered eating), menstrual dysfunction (classically functional hypothala-
mic amenorrhea), and impaired skeletal health manifested as low bone
mineral density or osteoporosis. These disturbances are mutually rein-
forcing and can compromise athletic performance while increasing the
risk of morbidity and, in severe cases, mortality (Otis et al., 1997).
Low energy availability (LEA) is a state in which energy intake is in-
sufficient to support both exercise energy expenditure and the energy
required to maintain normal physiological functioning (Oxfeldt et al.,
2023), is considered the primary etiological factor underlying the tri-
ad, precipitating menstrual dysfunction and contributing to subsequent

Plevnik, M., & Dobnik, M. (2026). Safe wrestling.
University of Primorska Press.