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Should Climbers Face Strict BMI Rules?

“We know in certain sports like horse racing, where lightness is favorable, that if jockeys weigh in too low on the morning of a race, they ride with additional weights. Climbers should too.”

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Last December, in an interview with Peter Stafford at an IFSC Summit, Janja Garnbret called eating disorders the “biggest problem of our sport right now.” She went on to say, “We have to ask ourselves, what kind of message do we want to send to others? Do we want to raise the next generation of skeletons? It’s definitely not going in the right direction.”

From the crowd, a representative from the Swedish Climbing Federation asked: “Would you support strict BMI limits for the competitors on the—”

He hadn’t quite finished saying “World Cup circuit” when Garnbret answered emphatically: “Yes!” She pointed to other sports, which not only have strict BMI limits, but rules also with regard to how the measurements are taken. Girls shouldn’t be allowed to weigh themselves in jackets, she added. 

“Maybe, if you are underweight, you get a warning, and then if you are the same in the next competition, you cannot compete.That’s how it should be,” she says. Garnbret believes these stricter policies should be implemented ASAP—before the 2023 World Cup season.

It’s hard to argue with Garnbret—the most accomplished competition climber in history. The topic of eating disorders is a long-standing issue within our community. In this very magazine, the topic was addressed by Stefanie Forté in an article published in 1996. Forté was likely the first American woman climber to write about the topic. In a follow-up email conversation with her last year, she wrote: “If I wrote that essay today, the ending would not be tied up in a bow. The impact of an eating disorder on my life has been far-reaching and multi-layered.”

Eating disorders have side effects that surpass the afflicted; they are passed on from one generation to the next. By underplaying or not addressing eating disorders, we gaslight those who are suffering—telling them it’s OK, that it’s not that big of a deal. But it is.

“We don’t want to have this race to the bottom,” says Dr. Jennifer Gaudiani, the founder and medical director of the Gaudiani Clinic and author of Sick Enough: A Guide to the Medical Complications of Eating Disorders. Dr. Gaudiani spoke with Climbing over the phone. “I’ve cared for a number of climbers in my practice. And, you know, a number of them can’t climb anymore. They’re in and out of programs.”

Eating disorders are fundamentally isolating experiences. They are akin to an addiction because those who have them often cannot see a way out. Your whole world becomes filtered through a singular limited thought while bodily systems break down around it. Over time, a person’s heart rate may slow down. Sex hormone production may decrease. Men may have lower testosterone, women may lose their ability to menstrate. Gastroparesis (delayed emptying of the stomach) often occurs, which may cause bloating, pain, and damage to all major organs. Thinking can slow—studies show malnourished individuals lose gray matter, the outermost layer of the brain. These and more are “signs of a body that is desperately slowing its energy use in order to save the person’s life,” says Dr. Gaudiani. They lead to myriad mental psychological effects as well—individuals may become irritable, anxious, or depressed. 

Unfortunately, there’s no easy way to diagnose an eating disorder. No singular test, questionnaire, or vital sign will give it away. “Eating disorders have to be diagnosed by understanding someone’s behaviors, and by understanding how their brain is feeling,” says Dr. Gaudiani. “So it’s not easy. It takes somebody with a certain degree of experience to ask key questions.”

Screening Procedures

Currently, the IFSC has BMI screening procedures. Screenings have been carried out by the IFSC sporadically since 2012, and on a regular basis to all semifinalists in Boulder and Lead World Cups since 2021. There are no repercussions for athletes “flagged” as having low BMIs—however the athlete’s National Federation is notified. If an athlete’s BMI is found to be below 17.5 and 18.5 for women and men, respectively, the athlete is required to sign an acknowledgement at having received the BMI data. 

On Thursday, January 19, the IFSC released a statement on the topic, noting that their executive board had “decided to evaluate and adopt future new measures to protect the health and safety of the athletes participating in IFSC events, and to further promote fair competition. These measures will be implemented in 2024, in addition to what has already been in place in 2021 and 2022, and, just like the current measures, they may result in the suspension of an athlete’s license.”

The statement did not elaborate on what the measures will be, but added that new age limits will be discussed as well as further educational activities. It’s unclear whether age limits and education are the extent of those new measures. Climbing was unable to reach Maddie Dunn, the IFSC’s Sport Director, for comment, and the IFSC would not disclose any data or statistics related to their screenings. 

USA Climbing (USAC) has been a bit more proactive in efforts to safeguard athletes. In 2022, all National Team members and World Cup eligible athletes were asked to complete a Pre-Participation Physical Exam (PPE), which included medical history, a physical exam, and the SMHAT-1 questionnaire, which is used by the International Olympic Committee to identify athletes at risk of or experiencing mental health symptoms and disorders. 

Climbing spoke with Zack DiCristino, who conceived of the mandatory PPE test and manages athletes who are at risk of being “flagged” with a low BMI at IFSC events. DiCristino has been the medical manager and National Team physical therapist for USAC since 2020 and has been a licensed sports physical therapist since 2003 . 

“When concern for inadequate nutrition or low BMI is identified, further medical evaluation (to be determined by the examining physician, but likely including lab work [like] a bone density test and a test for examining the heart’s rhythm and strength) will be requested, and referrals to nutrition and mental health specialists will be made,” says DiCristino. “USAC has recently made arrangements with the University of Utah and the US Olympic and Paralympic Committee to provide PPEs, necessary medical evaluations, and nutrition and mental health services to National Team members at no cost to the athletes.”

Working alongside DiCristino is Dr. Julia Rawlings of the University of Utah. Dr. Rawlings serves as the USAC team physician and specializes in sports medicine, pediatrics and emergency medicine. For the 2023 session, all National Team members and World Cup athletes will be required to submit a PPE to Dr. Rawlings and, to DiCristino, a physician-signed form stating their medical eligibility in order to compete at any IFSC event. USAC currently has no prohibitive rules regarding low BMI, however the organization and its Medical Committee has repeatedly reached out to the IFSC to express interest in refining the rules and protocols prior to the 2023 World Cup season.

Additionally, USAC offers various online educational resources for all athletes. USAC has held virtual discussions for climbing coaches and is working to provide future virtual and in-person opportunities to all members of our community.

“I believe education is the best preventive defense, and more athletes sharing their stories is helping,” says DiCristino. “I hope it can empower those who have or suspect they have a disorder to ask for help.”

“Climbers Should Carry Weights”

Dr. Gaudiani thinks we can do so much better. 

“This is completely unacceptable; the climbing world has to savvy up,” she says. “I think until the sporting body says you can’t compete and get sponsorship, money, prizes, scholarships, and advance in the sport, then everyone’s going to keep [under eating], because it is too irresistible and advantageous. Literally, the sport is setting people up for dangerous lifelong health habits.”

A common misconception surrounding the topic of eating disorders is that the problem fixes itself over time—that athletes simply cannot perform at a high level with an eating disorder across a season or even across multiple seasons. But the short- and long-term medical side effects of an eating disorder vary from person to person. 

“There are people who genetically can deal with incredibly adverse circumstances and keep performing really well,” says Dr. Gaudiani. “We know this from athletes who choose to perform through injuries, who perform through a dreadful event in their life, and from people who are performing through malnutrition. Some people just keep on performing at a high level.”

The choice must be removed from the equation. While Dr. Gaudiani admitted others will disagree, she proposed increasing BMI limits from 17.5 and 18.5 to 18.5 and 19.5 for women and men, respectively. 

“We know in certain sports like, for instance, horse racing, where lightness is favorable, that if jockeys weigh in too low on the morning of a race, they ride with additional weights. Climbers should too … I think it would transform the sport. There will be people who squeak [by the minimum standard], but the reality is that’s probably the only healthy way forward.”

Dr. Gaudiani adds that based on what she’s observed in her patients, strict rules such as the ones she suggested would come as a relief to many athletes. The pressure would be gone, the competitive advantage would be gone, and the normalization of thinness would be gone. 

The pressure to codify strict BMI limits is on: the IFSC is planning further discussions at an upcoming XIX IFSC General Assembly in Singapore and consultations with its Medical Commission, the Athletes’ Commission, legal experts, and the International Olympic Committee.

How to Talk to At-Risk Athletes

Not everyone will react warmly to being confronted with concerns regarding a possible eating disorder. Some may deny it. Others may refuse to listen. But as someone who had an eating disorder, I can say that there is always a small part of those suffering that wants to be confronted—that needs it. If no one confronts you about your eating disorder, then it feels like you’ve been given confirmation that what you’re doing is normal and healthy, which only serves to progress the problem.

Dr. Gaudiani encourages asking open-ended questions. “Say, ‘I’m worried about you. What’s going on?’ And then just pause.” She suggests doing it in a safe space—not in public. If the person isn’t ready to talk about it, she suggests saying, “I’m not going to push you. But I just want to share with you that I know you, and I’m worried. I know you’re not taking care of yourself. This looks like an eating disorder to me. I know those are serious. I hope you get help, and I’ll be here if you want to talk.”

While teammates shouldn’t feel responsible to save fellow climbers, parents and coaches need to take initiative, especially for people who are still legally children, Dr. Gaudiani says. She suggests saying: “I have a responsibility for your well being. And what I’m seeing is that you are off your growth curve, and your body is too lean. I’ve followed you your whole life; I know sort of where, genetically, your weight should be. I’m watching your eating behaviors, and you’re not fueling how an athlete needs to be fueling. This not only puts you at risk for a mental illness that carries an extremely high death rate, it comes along with a huge amount of suffering, and it’s also ultimately going to impact your performance as an athlete. So we’re going to get an expert’s evaluation.”

As a final note: Be informed and wary of biases. Medical professionals are just as susceptible to internalized size-bias as everyone else. Speaking for myself, I had clear indications of an eating disorder for years, and yet multiple doctors told me I was fine. They saw a star athlete, an A+ honors student, a picturesque model of American body ideals. They did not see my suffering because their biases didn’t allow for it.

Anorexia nervosa carries the highest mortality rate of any mental illness, second only to opioid misuse disorder. Eating disorders are the third most common chronic illness among adolescents. Depending on severity, there’s many irreversible long-term side effects.

Here is a list of recommended eating disorder resources. Dr. Gaudiani’s Clinic info may be found here.

Further Reading: