BMIs and sporting performance in the General Classification of Grand Tour Events
Our results show decreasing mean BMI trends for the top five men’s road cyclists in the GC of the Grand Tours between 1992 and 2022. These findings suggest that lower BMIs are increasingly associated with top GC finishing positions and supplement similar anecdotal [20] and scholarly evidence [27, 28, 29]. For example, using a model based on the 2004 Tour de France, Torgler showed how a lower BMI substantially increased an athlete’s probability of finishing in the final top twenty-five positions [27]. Likewise, Prinz and Wicker evaluated Tour de France performances between 2002 and 2004 and found that lower BMIs had a significant positive effect on the ranking of individual racers [28]. Additionally, results from Coupe and Gergaud reported that higher BMIs negatively influenced a cyclist’s performance in the Tour de France as measured by both cumulative time and finishing position [29].
Researchers have discussed how lesser weight and body mass can be beneficial to cyclists seeking to gain a competitive advantage whilst riding considerable distances uphill [30, 31]. In Grand Tour events, courses encompass multiple segments with sizable elevation changes and mountain climbing terrains; as an example, the 2023 Tour de France will involve one section with over five thousand metres of elevation gain [32]. For athletes hoping to achieve success in alternative categories, like sprinters in the Points Classification, maintaining a lower body mass may be deemed less advantageous because of the importance of power over shorter distances and flatter sections [30, 31]. Accordingly, less mass may benefit the top finishers in the GC category that we investigated, where riders need to achieve consistent results, including uphill and mountain terrain. Nonetheless, in the authors’ opinion, it could follow that the top GC competitors show higher BMI trends than those in the Mountains Category, as GC riders must also perform consistently in individual time trial stages that require sprinting [14]. This goes beyond the scope of the current study and more research is needed to understand these category-based differences.
Implications For Athlete Wellbeing
Although the mean BMIs across the Grand Tour races captured in our results (20.76 in the Giro d’Italia, 20.80 in the Tour de France, and 20.42 in the Vuela a España) do not meet severity criteria from the DSM-5 for EDs [6], declining BMI trends may raise questions about weight-related issues and athlete health. For us, these concerns could be increasingly pronounced since consistently low BMI has been noted as a risk factor for various medical conditions, such as depression [33], respiratory diseases [34], hypothermia [35], osteoporosis, and osteoporotic fracture [36]. For the latter, high incidences of low bone mineral density and higher possibilities for fractures has already been established amongst elite-level riders [37].
Owing to the performance-based associations of low weight and environmental and social influences, clinical and subclinical EDs and harmful weight-management behaviours may be prevalent within cycling [10]. Evidence indicates that elite-level riders can often adopt an extreme approach to weight loss, including disordered eating [11, 17], fasting [13], self-induced vomiting [9], the use of laxatives [13], and weight cycling in the lead up to competitions [38]. Significantly, such practices could render athletes vulnerable to comorbid physical and mental health conditions; alongside associations with clinical and subclinical ED presentations [39], adverse weight-management behaviours have been linked to low energy availability and increased risks for RED-S [9, 40], heart disease [8], obsessive compulsive disorder [41] substance use disorders [42], and exercise addiction [10]. Furthermore, there have been reports of support teams, medical staff, and other stakeholders closely monitoring racers’ anthropometrics, body mass composition, and optimal weight, which has amplified weight-related pressures and injurious habits [9, 18, 43].
As unhealthy weight-management behaviours may be a widespread phenomenon, elite-level cyclists could conceivably not consider these practices to be pathological [11], inhibiting symptom recognition and health-seeking tendencies. This may be exacerbated by the enduring stigmatisation that surrounds ED symptoms in males [44] and challenges for primary care providers in detecting ED relevant symptoms [45]. In certain situations, weight-loss pressures have resulted in medicolegal repercussions for elite-level cyclists, who have consumed prohibited dietary supplements; one rider received a year-long doping ban for using the substance, methylhexanamine, which is prohibited by the World Anti-Doping Agency [16].
Equally, it is not just elite-level domains that are affected by these paradigms; detrimental eating habits have also been identified in junior competitions [9]. This is concerning as adolescent athletes could be impressionable, especially given elite-level riders may be considered to be role models; adolescent groups are highly vulnerable for developing harmful eating habits and ED symptoms [46]. Comparably, depicting cycling’s “obsession with weight”, media commentators have noted how amateur participants can exhibit “copycat” behaviours, associating low weight with sporting success and attempting to emulate the body composition of top-level riders [9, 43]. Analogously, when asked to provide advice to those “starting in the sport”, a key recommendation from an elite-level rider was that “a very important thing is to be light” [47]. These aesthetic and cultural influences may render this a wider scale problem; here, images of elite-level riders with unhealthy weight profiles may impinge upon the connotations of the sport as offering “health benefits”, which is an institutional goal of the UCI [48].
Towards Increased Regulatory Attention And Interventions
The declining BMI trends in our data and the evidence of harmful behaviours and attitudes in cycling suggest that multifactorial regulatory measures may be required. To that end, screening tools can help identify ED symptomatology in various sporting disciplines [7, 49], which could prove beneficial if implemented within elite-level cycling. Nonetheless, as Ribel et al. discuss, self-reported instruments might not necessarily be reliable because deleterious weight-management practices may be normalised [11] and diagnostic tools would need to be adapted to account for inherent gender biases [50]. Consequently, the UCI could consider compulsory regular weight and body composition screenings for riders and mandating obligatory follow-up measures for athletes outside of a healthy range. These may be particularly applicable intra-race, since cyclists can seek to drop weight prior to these events [38] under the assumption that they will return to a healthy BMI outside of competition.
To further address weight-based issues across elite-level domains and beyond, we believe that the UCI should also focus on modulating entrenched sociocultural perspectives through targeted prevention measures. These could be embedded in the organisation’s new “health and wellbeing policy” that is a stated commitment in their 2030 Agenda [48]. Extending psychoeducation could allow riders to recognise risk factors, underlining the health consequences of the “win at all costs” dogma [16] and the performance-oriented culture that pervades the sport. Moreover, given that male EDs remain heavily stigmatised [44], culturally tailored information may be needed to effectively convey the short- and long-term dangers of harmful weight-loss practices [45]. Similarly, disseminating dietary materials and increasing access to counselling would be important, as limited nutritional knowledge in cyclists has been linked to the development of EDs [51]. Detailed education may be useful for support teams, including coaches and medical and nutritional staff; this is especially pertinent as previous research shows that elite-level coaches in other sports may not consider EDs to be a concern, lack sufficient education, or have difficulty distinguishing adverse behaviours [52]. Additionally, support teams may employ severe restriction diets for performance-enhancement reasons pre-race [18]. In our view, teams have a duty of care to their athletes and should take requisite steps to uphold their welfare.
Again with the aim of protecting rider’s health, the UCI could take lessons from apposite initiatives in other disciplines and consider a lower weight limit for riders in relation to their height using evidence-based recommendations. For example, in 2019, the Fédération Internationale de l'Automobile, which regulates Formula One, amended the car and driver weight calculation by stipulating that a driver and their seat must weigh up to a minimum of 18kg; this was positively received by the community, as exemplified by one competitor: “I have been able to actually eat” [53]. Correspondingly, although they have elicited criticism for how they do not account for outlying body compositions [23], the ISF inaugurated successful BMI-based guidelines for ski length, enforcing equipment parameters to reduce weight-based advantages [22].
In cycling, there is already precedent for similar measures. For different reasons, in 2000, the UCI previously instituted a minimum weight for bicycles of 6.8kg [54]. This coincided with the uptake in carbon fibre frames, which the UCI feared would result in stress cracking and possibilities for accidents (and therefore increased risks to athletes). The feasibility and efficacy of a newer BMI or weight-based policy for riders needs careful evaluation, specifically for its potential for encouraging weight cycling and its ergometric consequences. For the latter, detailed research is needed to understand how this could affect competition categories distinct from the GC. Nonetheless, discussions around this could provide a starting-basis for regulatory processes to address weight-management concerns in the sport. We believe that these dialogues might be increasingly necessary given our results and the evidence-base in the popular media and sports medicine literature around unhealthy weight-management practices across the peloton.