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This is How You Raise Healthy Female Athletes

We examine how to #FixGirlsSports and raise a stronger, healthier generation, as well as how to re-evaluate our own body image for the better.

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Experts, athletes, coaches, and parents agree that raising healthy female athletes requires careful navigation through many challenges, especially during and after puberty. We’re only starting to understand what it takes to help them flourish. Partly, perhaps, because we’re only starting to understand what it takes to help ourselves truly flourish.

In this five-part investigative report, we examine both how to #FixGirlsSports and raise a stronger, healthier next generation, as well as how to re-evaluate our own body image for the better, including the resources you need to rebuild or fortify one of the most important relationships of all—the one with yourself.

When Sara Hall looks back on how she discovered running, she remembers gravitating toward it because it allowed a sense of freedom that nothing else offered at age 13. A naturally curious and adventurous child, her parents let her take off on the trails near their home in Santa Rosa, California, unsupervised.

“I would try to do the same loop faster every day,” says Hall, now 37 and a top U.S. distance runner. “I won my first race in seventh grade, in a sprint finish against the league champion. I was hooked.”

Hall went on to compete in cross-country and track through high school, winning the prestigious Foot Locker Cross Country Championships in 2000, and then to Stanford University, where she led her team to the 2003 NCAA cross-country title. But her talent grew organically; her parents and coaches didn’t apply pressure. If she wanted to run more (or less) she was given the leeway to forge her own direction. And usually she chose to run farther.

“In middle school, I would run to practice and then I would do hill sprints to failure on the way home. I really loved that my parents and coaches always gave me a lot of freedom to push and find my limits on my own,” Hall says. “I don’t think it’s high mileage, in my opinion, that burns kids out. I think it’s being forced to run high mileage, because for me, I really loved it. And I was the one initiating it.”

Hall’s talent was nurtured and channeled in a way that allowed her to flourish. She was surrounded by the people who helped her make the right choices at each phase of her running career. But Hall also was taught early on that running is a long game. That if she could not give in to immediate desires for wins, she could succeed through a gauntlet that often derails young women in sports: puberty, menstruation, hormones, and changing bodies.

According to the Women’s Sports Foundation (WSF), 40 percent of teen girls are not participating in sports. Girls also drop out of sports by age 14 at two times the rate of boys. In fact, a WSF study cosponsored by Dick’s Sporting Goods Foundation surveyed 3,041 boys and girls between the ages of 7 and 17 (and their parents). Among the reasons that girls lose interest? “Feeling awkward about their bodies and not liking the way they look,” according to the research.

Distance running can be especially fraught with problems. The sport’s culture has long tied less body weight to better results. And while power-to-weight ratios will always be important to performance, the way in which topics like ideal body composition and nutrition are discussed has to change—particularly when it comes to girls.

Minding the Shift

A lot happens to young female runner’s body during adolescence—from age 11 to 21, through three stages of development.

When a girl hits puberty, body fat increases to prepare for menstruation. It’s not unusual for girls to gain 12 to 23 pounds as an increasing volume of estrogen flows through their systems. With that weight gain can come a dip or a plateau in performance. The Women’s Sports and Fitness Foundation has found that as girls start experiencing premenstrual symptoms, they may also have a temporary reduction in aerobic capacity and strength.

That’s a lot of change for anybody to cope with—in fact, a 2016 study in the Journal of Pediatrics found that more than half of 9- to 14-year-old girls wish they were thinner. And girls who develop a poor body image during this time are of course more likely to diet at a critical period in their growth, which can lead to eating disorders, injuries, low bone density, and a variety of other long-term health problems. Now experts more commonly refer to RED-S, relative energy deficiency in sport, which is the discrepancy between caloric intake and energy expenditure.

Hall recalls her the summer before her senior year in high school, when she went off to Holland on a mission trip. She indulged in all the European treats and wasn’t running as much. This was on top of the normal process of “getting curves and stuff.” She didn’t see many improvements in her times.

“I was having the slowest times I’d ever had in cross-country,” Hall says. “Fortunately I had really good support in my life. The coach I was working with was like, ‘Just make slow improvements and focus on healthy eating.’ It was very incremental, nothing drastic. I finished the season winning the Foot Locker Championships. Even though my body had still retained some of that weight, I was learning to be stronger and grow into it.”

Soon Hall had to navigate another difficult transition for young women: competing collegiately. Research shows that more than one-third of female NCAA athletes experience symptoms of eating disorders like anorexia.

“I was very, very mindful of that when I was going on recruiting trips. You could tell when there was a toxic culture of eating disorders—and no matter how much I loved a school, I didn’t want that kind of environment,” she says. “My Stanford teammates were really balanced in their lives of academics and athletics and social, and there wasn’t a really cutthroat environment on the team.”

That was where where Hall met teammate Lauren Fleshman, who would graduate with five national titles and become a 15-time All-American, leading to a professional career where she became a two-time 5,000-meter national champion.

“Lauren was kind of like my big sister and mentor the first couple of years,” Hall says. “She was always really encouraging me to have a healthy outlook on food and how it related to running well.”

Fleshman, now 38, is retired from competition, but she’s become an outspoken advocate for changing how girls and women are coached. She is the coach of an all-women’s pro training group called Little Wing in Bend, Oregon, and is currently working on a book tentatively titled Good for a Girl.

In 2017, Fleshman wrote a column for MileSplit, a website that covers high school track and field. The piece was a letter to her younger self. “Dear High School Lauren,” it began—and it became an instant hit and a tool for coaches everywhere to jumpstart conversations with girls about how to cope with their changing bodies.

“You notice what happens sometimes to female athletes…she is confused; she is working harder than ever,” Fleshman wrote. “Clueless adults who are overly invested in her ‘performance’ will grieve, as if her worth is based solely on PRs. This makes you scared of growing up.”

The piece saw a resurgence in November 2019 after Mary Cain, 23, a high school phenom who turned pro as a teen under coach Alberto Salazar, came forth with allegations that Salazar demanded she lose weight and shamed her publicly when she didn’t lose enough. Her experience, Cain says, led to depression, suicidal thoughts, stress fractures, and the loss of her period for three years.

Salazar, who has denied wrongdoing, is currently serving an unrelated four-year coaching ban for doping violations, which he is appealing. He is also serving a suspension from the U.S. Center for Safesport, an independent organization that investigates and sanctions emotional, physical, and sexual abuse and misconduct in Olympic sports.

“When the Mary Cain story happened, I thought what we need is a comprehensive guide for coaches and athletes and the running community to fix girls’ sports,” Fleshman says. “No article or exposé or news hit can get to the heart of why these things are happening and what needs to be different for them to stop happening.”

Are Runners at Greater Risk?

On one hand, your running habit protects you: Exercise generally boosts body image. Even one hour of movement left previously sedentary women feeling better about their appearance, a 2017 study found. And by and large, many runners find support and connection in the community. Still, there are some reasons female runners may feel dissatisfied with their bodies.

First, there’s the notion—oversimplified at best—that weight and body composition are critical to running faster. While they might matter, they’re only two of at least 40 factors that play a role in performance, says Riley Nickols, Ph.D., a sport psychologist and eating-disorders specialist who heads up the Victory Program for athletes at the McCallum Place Eating Disorder Centers in St. Louis. Some coaches use this as a basis for abuse, while others may be well-intentioned but ill-informed. Regardless, this overemphasis can leave many runners focused on arbitrary body goals, and some devastated if they can’t reach them.

There’s also the apparel many runners wear. Even if you’re not wearing short shorts yourself, seeing images across your social-media feeds can lead some to question whether they truly own a “runner’s body.” Plus, if you started running to change the shape of your body—in other words, to lose weight—the degree to which that happens, or doesn’t, can also send your self-worth on a nosedive, Nickols points out.

Read On

How Coaches and Parents Can Keep Girls Running

What is Healthy Body Image, Anyways?

6 Factors That Can Affect Your Body Image

9 Simple Tools for a Stronger Body Image