Alarming weight cutting behaviours in mixed martial arts: a cause for concern and a call for action.

Some nutritional practices in mixed martial arts (MMA) are dangerous to health, may contribute to death, and are largely unsupervised. MMA is a full contact combat sport (often referred to as cage fighting) that emerged to western audiences in 1993 via the Ultimate Fighting Championship (UFC). MMA is one of the world’s fastest growing sports and now broadcasts to over 129 countries and 800 million households worldwide. Underpinning the focus on weight controlling practices, lies MMA’s competition structure of 11 weight classes (atomweight, 47.6 kg; strawweight 52.2 kg; flyweight, 56.7 kg; bantamweight, 61.2 kg; featherweight, 65.8 kg; lightweight, 70.3 kg; welterweight, 77.1 kg; middleweight, 83.9 kg; light-heavyweight, 93 kg; heavyweight, 120.2 kg; super-heavyweight, no limit) that are intended to promote fair competition by matching opponents of equal body mass. Athletes aim to compete at the lowest possible weight, usually achieved by rapid weight loss methods reliant on acute/chronic dehydration (eg, saunas, sweat suits, diuretics, hot baths, etc). Weigh-in occurs on the day before (24–36 h prior) competition therefore permitting athletes what is ‘perceived’ as sufficient time to rehydrate and refuel. Although limited accounts exist of weight-making practices in MMA, athletes have tested positive for diuretics, failed to make weight, and have withdrawn from contests due to adverse effects of weight cutting for example, nausea, vomiting, headaches, cramping, seizures, feinting, flu-like symptoms. In September 2013, Brazilian MMA athlete Leandro Souza died in a sauna after attempting to lose 20% of body mass (approximately 15 kg) in 7 days. Such extreme dehydration and chronic use of non-steroidal anti-inflammatory drugs (NSAIDs) also resulted in high-profile fighters hospitalised (and forced to retire) with kidney disease.