High school girls’ wrestling is one of the fastest-growing sports in the United States, and a similar pattern is expected to occur at the collegiate level as the National Collegiate Athletic Association (NCAA) recently announced the official installation of a national championship for women’s wrestling.

While wrestling itself isn’t new, with origins tracing back to the early days of Olympic sports in Greece, the opportunity for female wrestlers to not only compete but compete in standalone divisions is. Though women’s wrestling has been part of the modern Olympic games since 2004, the lack of an NCAA division left a competition vacuum for the majority of athletes after high school, discouraging enrollment at all levels. Now that has changed.

But with any “new” sport, there is the need to critically review policies and procedures to ensure the health, safety and equal performance opportunities for the athletes competing. So too with girls’ and women’s wrestling.

A primary component of the sport of wrestling is the weight certification process, which sets in place the minimal wrestling weight and subsequent minimal weight class that a wrestler will be able to compete in. In brief, this entails a preseason body composition assessment to determine current weight and body fat percentage. This information is then used to calculate what the minimal wrestling weight will be, assuming a wrestler is not allowed to dip below a specific minimum body fat percentage.

Currently, that minimum is 12% for high school and collegiate female wrestlers. However, there have been recent concerns raised regarding the potential safety and health risks of allowing a female wrestler to achieve a body fat percentage that low. Specifically, the concern is that a female wrestler who gets that lean may be predisposed to adverse health effects such as amenorrhea, hormonal disruptions, poor bone health and an increased risk for injury and illness — all of which are commonly associated with conditions such as the Female Athlete Triad and Relative Energy Deficiency in Sports (RED-S). These conditions are underpinned by low energy availability, in which athletes consume inadequate amounts of energy for their high level of daily activity.

Moreover, the concern is that weight certification policies allowing such low body fat percentages may also increase the likelihood of rapid weight loss techniques such as intentional energy restriction, fluid restriction, dehydration and the use of laxatives. Because of the novelty girls’ and women’s wrestling, it is currently unknown what the long-term implications of these weight loss techniques, as well as frequent weight cycling, may be.

Therefore, my coauthors and I set out to produce an ACSM Contemporary Issue article on the subject, which has now been published in Current Sports Medicine Reports. The primary focus of our article was to summarize the potential health risks associated with rapid weight loss in female wrestlers, as well as the concerns about achieving a low body fat percentage and extended periods of low energy availability. Secondly, we highlighted several areas for future research. Lastly, we proposed raising the minimum body fat percentage threshold to between 18 and 20% in an effort to preclude wrestlers from achieving an unhealthy level of body fatness and deter excessive weight cutting throughout the season. This is particularly important for younger female wrestlers who may still be growing and developing during adolescence.

Andrew Jagim, Ph.D., is director of sports medicine research at the Mayo Clinic Health System and first author of the recent ACSM publication “Contemporary Issue: Health and Safety for Female Wrestlers.”