THE PHYSICIAN AND SPORTSMEDICINE - VOL 30 - NO. 12 - DECEMBER 2002
Wrestling Rules Pin Harmful Weight Cutting
Fairness, Validation Concerns Color Debate
Three college wrestling deaths in 1997 thrust weight-cutting practices into the public eye, prompting the quick passage of rule changes at the college and high school levels to further control unhealthy weight-cutting methods.
Five years later, most agree that the rules have been effective. A recent study1 that followed a National Collegiate Athletic Association (NCAA) Division 1 wrestling team the first two seasons after the rule changes found that 56% of them weighed in 10 lb or more above the previous year's competition weight, and 28% weighed 20 lb or more than previously. Randall R. Wroble, MD, an orthopedic surgeon in Columbus, Ohio, and a sports medicine adviser to the Ohio High School Athletic Association, says health problems and parent complaints have dropped off greatly with the recent rule changes.
Controversy, however, still simmers about the pitfalls of body fat testing and the fairness of minimum weight rules among certain athletes. Some wonder if the unique culture of wrestling—along with the mental and physical toughness required of its weight-cutting ritual—will suffer from or adapt to ongoing tweaking of the rules.
Current Rules Status
Following the deaths, the NCAA set a 5% body fat minimum weight limit, and the National Federation of State High School Associations (NFHS) recommended a 7% body fat limit for male high school wrestlers. In April 2002, the sports medicine committee of the NFHS recommended a 12% body fat cutoff for female wrestlers. Both groups banned certain weight-cutting practices, such as working out while wearing plastic suits and use of laxatives. They have also discouraged excessive or unhealthy weight cutting by mandating that weigh-ins take place within 1 or 2 hours of meets and tournaments.
Jerry Diehl, NFHS assistant director and liaison to the wrestling rules committee, says that after several years of input from the wrestling coaches and the sports medicine committee, final language for the wrestling rules should be in place after the annual rules committee meeting in April 2003. Several states, including Wisconsin, Michigan, Minnesota, Virginia, Iowa, New Jersey, New York, North Carolina, Nevada, and Connecticut, have already established minimum weight certification programs. At its April 2002 meeting, the NFHS standardized 2-hour weigh-ins for regular and postseason tournaments and formally added the 215-lb weight class, which had been optional. (The addition increases the number of weight classes to 14.)
NCAA wrestling rules are also evolving. New to the 2002 season is a rule giving wrestlers the option of competing at a higher weight while safely losing weight to compete in a lighter division. Wrestlers must select between the one-certification or two-certification options at the beginning of the season.
Body Fat Percentages Spur Discussions
As wrestling rules take shape, some members of the sports medicine community have questioned the validity and fairness of the 7% body fat minimum weight recommendation for high school students. Wroble believes that the main problem with weight cutting is the method employed, not the amount lost. Dehydration and rapid short-term weight loss are dangerous, he says, "But I don't believe there is a problem with low body fat." Wroble notes that a small but significant portion of the population is naturally at or below 7% body fat.
Vito A. Perriello, Jr, MD, a pediatrician in Charlottesville, Virginia, and chair of the sports medicine advisory committee of the Virginia High School League, says that low body fat and weight cutting have been part of the wrestling culture for two reasons. There's a belief, though not scientifically proven, that wrestlers have a performance advantage by wrestling at a lower weight class for their height because of improved leverage. Also, weight cutting helps wrestling coaches fill out a complete weight-class roster and put the best wrestlers in selected weight classes.
Perriello says he believes that the 7% body fat minimum should be considered a "bottom bar," not a goal. NCAA and NFHS percentages (5% versus 7%) have good reasons to differ, he says, noting that most high school competitors have not completed puberty and still have open physes. Most of the wrestlers who push the 7% body fat minimum are the less physically mature participants who tend to gravitate to the lighter classes, Perriello says. "Those are the very ones that, as a physician, you hate to see weight cutting," he says. Many states have an appeal system that allows wrestlers whose natural weight is below 7% body fat, as determined by their personal physician, to compete. Perriello says the number of wrestlers who are naturally below 7% is very low, as are the number who compete near 7%.
Wroble counters that he believes that the intensity of competition and extreme weight cutting at the college level aren't as dramatic at the high school level. "Concern still needs to be there, but the desire to lose weight and the amount of weight loss is not nearly as pervasive," he says.
William O. Roberts, MD, a family practice physician in White Bear Lake, Minnesota, and medical adviser to the Minnesota State High School League, says that though the 7% body fat recommendation might not be truly evidence based, "I'm comfortable with the level because it seems safe and fair."
Problems With Skinfold Testing
At the June annual meeting of the American College of Sports Medicine in St Louis, some who attended a symposium on wrestling minimum weight issues raised concerns about the validity of skinfold testing, which is the technique most state athletic associations use to help determine wrestlers' minimum weight. Though skinfold testing is the technique that has the highest validity in high school wrestlers, studies have not considered racial differences.
"Although my feeling is that the differences are minimal, this is a legitimate complaint," says Perriello. Bone density is thought to vary among ethnic groups, and he says the influence of racial artifacts on skinfold testing is a topic that he and his colleagues are studying.
But other physicians state that anecdotal evidence suggests minimal racial differences. Robert B. Kiningham, MD, a family practice physician at the University of Michigan and medical adviser to the Michigan High School Athletic Association, says that he is also going to track racial differences over the next wrestling season. "However, in Michigan where we have large African-American and Middle Eastern populations, we have not seen more appeals from wrestlers in these groups," he says. "If there is a discrepancy, the coaches and athletes have not noticed it." (Wrestlers who dispute skinfold testing results can appeal the finding and undergo underwater weighing, considered the gold standard in body fat testing.)
Fair to Football Players?
In efforts to curb rapid weight cutting, proposed NFHS wrestling rules state that competitors cannot lose more than 1.5% body weight per week, which many say is primarily a concern among football players who join the wrestling team as football season ends. This is especially a concern at smaller schools that have difficulty filling the heavier weight classes.
Roberts says Minnesota rules have acknowledged this difficulty among football player-wrestlers and require at least 1 week between seasons. Except for players on teams that advance to the playoffs, the gap is generally 2 to 4 weeks, he says. "My general observation is that kids who work hard in practice will melt off excess weight without much difficulty or harm," Roberts says.
The main concern about rapid weight loss, says Perriello, is that it cannot be accomplished without dehydration. "We understand and sympathize with the football players, but it's still not healthy to lose weight that rapidly," he says.
A Work in Progress
Perriello feels strongly that the sport of wrestling will survive and thrive without extreme weight-cutting rituals. Creative solutions in the future—such as allowing more than one wrestler to compete in a weight class—might enhance the safety and competitiveness of the sport, he says. Roberts suggests matside weigh-ins to put equal wrestlers on the mat.
And Kiningham and others say that when medical controversies are settled, public focus can shift to the athletic and competitive aspects of the sport. Perriello says: "Wrestling has everything you would want in a sport: character, mental toughness, good physical conditioning, work ethic, perseverance, and competitive equity."
A Fine Olympic Flu-Busting Performance
Rapid influenza tests and oral oseltamivir phosphate were used successfully at the 2002 Winter Olympics in Salt Lake City to avoid a flu epidemic, according to a report presented in October at the annual meeting of the Infectious Diseases Society of America.
When athletes and other workers reported to the Olympic Village Polyclinic with flulike symptoms, the plan stipulated that they be given two diagnostic tests for the flu—the rapid test and the 6-hour test. If the physician's suspicion of influenza was high or either test was positive, the patient was prescribed oseltamivir. The strategy of identifying and treating viral illness is believed to be an Olympic first. Influenza outbreaks were a problem at the 1998 Winter Olympics in Nagano, Japan.
The Polyclinic recorded 729 primary care visits from athletes, coaches, security workers, employees, and volunteers. Of those, 188 had upper respiratory symptoms and were evaluated with viral diagnostic tests. Tests confirmed influenza in 36 patients, which affected three athletic teams and one security team. (Because of a confidentiality agreement, the specific teams cannot be named.)
Merle Sande, MD, an internist at the University of Utah School of Medicine in Salt Lake City who cowrote the report and assisted with medical planning for the Salt Lake City Olympics, says that similar strategies can help in public health efforts to prevent antibiotic resistance. "In the Olympic clinic, only 15% of patients received antibiotics, and most of these were prescribed for streptococcal pharyngitis," he says.
Exercise a Helpful Adjunct for Gulf War Veterans Symptoms
Chronic symptoms reported by Gulf War veterans—among them fatigue, stress, and mental health problems—can be alleviated by regular exercise and group talk therapy, according to a study presented at the annual meeting of the American College of Rheumatology in October in New Orleans.
Though national medical panels have concluded that chronic health complaints of Gulf War veterans do not constitute a unique disease, these veterans' symptoms, such as muscle pain and fatigue, overlap with other conditions, such as fibromyalgia and chronic fatigue syndrome, that have been shown to respond to exercise and other lifestyle interventions.
The study consisted of 1,092 veterans at 18 hospitals who were randomly assigned to one of four groups: weekly cognitive behavioral therapy (CBT) group sessions, low-impact exercise three to four times a week with the assistance of a once-weekly session with an exercise therapist, both interventions, and usual treatment. Participants were assessed before the study and at 3, 6, and 12 months. Those who had CBT and exercise improved the most. Exercise consisted of activities that the study participants had easy access to, such as walking and jogging.