Fitness models and physique competitors strive to attain an extreme aesthetic of a sculpted, lean body.
The process of achieving this look, however, causes physical afflictions. These closely resemble the symptoms of starvation since the lean competition body is essentially in a state of chronic malnutrition. Malnutrition produces various dysfunctions that affect multiple organs within the cardiovascular, gastrointestinal, endocrine, skeletal, and central nervous systems. As the body attempts to conserve energy, there is also a ‘decrease in resting energy expenditure (REE), and changes in metabolic hormone concentrations.’ These adaptations can lead to lowered respiration and basal metabolic rates; electrolyte imbalances; cardiac arrhythmias; and even place the individual at risk of cardiac arrest.
During the cutting phase of competition preparation, most competitors suffer from various symptoms caused by the reduction in energy availability. More, however, have difficulty coping with the decrease of one particular macronutrient. Carbohydrates are lowered in the final few weeks in order to rapidly lose retained water and fat. Fat loss is the result of several metabolic changes which occur when carbohydrates are reduced to less than 20g per day. Since the body lacks sufficient glucose to produce energy, fat stores are catabolised, releasing ketones that can be used as fuel. When ketones accumulate within the body, however, this results in ketosis whose side effects include ‘nausea, headache, mental and physical fatigue’. In order to avoid these side effects, and maintain strength and muscle mass, competitors ‘cycle’ carbohydrates. Cycling involves enduring several consecutive ‘low’ days in which carbohydrate allowance is drastically reduced and typically limited to green vegetables. This period is followed by a high carbohydrate ‘refeed’ day to boost metabolism and ensure continual fat loss.
Even with carbohydrate cycling, however, the ‘low’ days, in addition to reduced calorie intake, trigger a multitude of physiological problems. The most common symptom is ‘constant hunger’ which competitors attempt to alleviate via behavioural methods and the frequent use of potentially dangerous food substitutions. Increasing liquid intake mutes hunger, particularly ‘ice cold water’ and ‘diet fizzy drinks.’ Chewing gum and consuming sugar-free products help to resist appetite and curb cravings. These, however, can cause toxic side effects owing to artificial sweeteners that are added to ‘diet’ foods and beverages in place of sugar. One of the most commonly used sweeteners is aspartame, an additive that is associated with 92 different side effects, including nausea, memory loss, and seizures. Furthermore, 50% of aspartame is comprised of the neurotoxin phenylalanine, a chemical that ‘excites the neurons in the brain to the point of cellular death’. Competitors who consume large amounts of sugar-free products throughout the cutting process report experiencing symptoms such as dizziness, headaches, heart palpitations and severe bloating.
Bloating during competition preparation also results from food intolerances that can develop owing to the overconsumption of certain foods. ‘Cheat meals’ or binging on ‘forbidden’ treats likewise lead to bloating since the digestive system is unaccustomed to foods containing large amounts of fat and sugar. In addition, bloating is often the product of following a low carbohydrate diet. Lack of carbohydrates means that there is also a reduced intake of the dietary fibre that is necessary for digestion. Owing to these factors, some competitors report undergoing pre-competition colonic hydrotherapy in order to remedy these bowel dysfunctions.
Ironically, the methods that are employed in order to attain the fit, model aesthetic are damaging to physical health. In order to cut the last ounce of fat, or lose the last drop of retained water, competitors push their bodies to the brink of destruction.
 http://emedicine.medscape.com/article/89260-overview#a0101%5Baccessed 8/01/15], anemia, chronic fatigue, increased risk of infection and illness, esophagitis, electrolyte imbalance, slowing of the metabolic rate, decrease production of growth hormone, unfavorable lipid panels, endothelial dysfunction, reduced muscle protein synthesis, unexpected pregnancy, possible long term reproductive repercussions, and depression
 Drive for Thinness Score: One More Way to Identify Athletes at Risk, Reprinted from Eating Disorders Review
May/June 2007 Volume 18, Number 3, ©2007 Gürze Books, http://eatingdisordersreview.com/nl/nl_edr_18_3_4.html [accessed 20/01/15]
 Academy for Eating Disorders Report 2011 http://www.anad.org/wp-content/uploads/2011/10/AED-Medical-Risk-Management.pdf [accessed 09/01/15]