Fistic Medicine: A Perfect Example of MMA’s Willful Ignorance

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Weight-cutting has been part of the fabric of combat sports since “The Fancy” decided that size mismatches were unfair at some point in the 19th century. The spectacle of the weigh-in quickly became a cornerstone of the pomp and ceremony around professional fighting, even in heavyweight boxing, where the weight of the athletes doesn’t actually matter. MMA has taken this process to the extreme, however, with fighters cutting 8-12% of their weight on a regular basis, with some going as high as 15%. Despite claims that this is wrestling’s influence on the sport, this amount is actually close to double that seen in wrestling or any other combat sport. The methods used are well-documented and almost lionized by fans, promoters, media and the fighters themselves. A competitor who dehydrates himself just a bit more than his opponent is hailed as a “professional.” The person who starves himself for one day more is “doing what a true fighter does.”

This collective acceptance of such practices is matched by our common knowledge of the dangers and risks of extreme weight cutting. Fighters collapsing during weigh-ins has become a relatively common occurrence, while Darren Till famously lost his vision during a failed attempt to make weight. These are situations that could have ended up much, much worse. This was made very clear by Daiane Silva being left in a coma due to her weight-making practices at a Bellator MMA event in September. Daiane thankfully appears to have recovered. In a recent interview with MMAFighting.com, Daiane’s manager, Alex Davis, discussed what happened that day, as well as how quickly the event staff acted to get Silva the medical attention she needed. The interview also provides an example of the willful ignorance that we as the MMA community have when it comes to extreme weight cutting.

Davis spent the months following the incident in question providing updates about Silva’s condition and eventual recovery. There is little doubt that Davis cares about Silva and has her best interests at heart, and it’s clear from the interview that the event organizers reacted quickly and with a high level of professionalism and concern. Some of the topics of discussion, however, provide illustrations of how we all as a sports community, perhaps subconsciously, excuse our collective lack of action in reducing extreme weight-cutting as a whole.

The theme of the piece revolves around Davis’ surprise at how close to they came to tragedy. Should he have been surprised, given how much experience he has in MMA and how many times he admits he has witnessed fighters falling ill during their weight cuts? Davis even provides an example of him seeking medical attention for a fighter from another team when they were clearly falling ill during their weight cut. This is in addition to the death of Yang Jian Bing in ONE Championship, which led to that promotion attempting to reduce extreme weight cutting by adapting its rules. While this may be the only death in a major company, a medical case report discusses an MMA fighter collapsing and passing away due to extreme dehydration causing rhabdomyolysis. There is also no shortage of regular weight-cutting incidents, as evidenced by Erik Magraken’s excellent resource documenting each one. In short, no one should be surprised at just how serious a mismanaged weight cut can be. We all know about the dangers, but the sport as a whole chooses to be willfully ignorant about it.

So what can be done? As previously mentioned, ONE Championship has a hydration policy as part of its bout agreements. This has been held up as being a positive step, which it is in the sense that at least someone is trying something. Despite multiple claims that this prevents fighters from dehydrating, including Davis in his interview, this myth has been dispelled many times, including by Dr. Oliver Barley and Jordan Sullivan. Both of these debunkings matter, as Barley and Sullivan regularly lead elite fighters successfully through their weight cuts, including for ONE events. These two people know how to cheat a hydration test, as do the fighters. Despite this, fans and media still tend to give ONE credit for this policy. Unfortunately, it appears that this has become another thing for us to hide behind in the hope that everything is going to be fine.

Another solution could be for promotions to utilize the extra weight divisions that already exist in the unified(ish) rules. The Ultimate Fighting Championship’s refusal to do so seems to revolve around an argument that it would water down the sport. This seems to come from the history of boxing, where its fans bemoan the addition of multiple new belts from the 1960s onwards. This proliferation was, however, due to the fragmenting of the sanctioning bodies rather than the adding of more weight classes. In reality, allowing more divisions with smaller gaps in between contributed to much lower weight cuts and far fewer incidents in that sport. Today, boxers on average lose about 3-5% of their weight before a bout. Using the extra divisions that exist in MMA would likely have a similar effect of reducing weight-cutting severity.

A final solution is education. Regulatory bodies and promotions are very much aware of the dangers and have been known to discuss how to manage and reduce weight-cutting. I was invited to speak about the physiological effects of weight-cutting on both health and performance at the Association of Boxing Commissions annual convention in 2022 (full presentation between 1:40-2:25). The UFC Performance Institute also employs several highly respected physiologists and nutritionists to help teams with weight-cutting and to educate coaching staffs on safer methods. It’s not clear, however, how many coaches or athletes are being reached by this information. This should, therefore, be a key focus for everyone involved in MMA—promotions, coaches, media, fans and fighters alike. We need to be honest about what we’re seeing every time a fighter steps on the scale. There needs to be better discussion and promotion of the safer and more effective weight-cutting methods that have been available for well over a decade. There also needs to be more done to highlight the evidence from three different studies (here, here and here) that at the higher levels of the sport there is no effect of weight-cutting on winning or losing. When looking at all standards of MMA from beginner through regional to elite, winners may regain more weight than losers after weighing in. This effect, however, disappears when only elite events are examined. This suggests that when athletes become more evenly matched, an extra pound of weight lost and regained doesn’t actually matter.

Davis discussed in his interview how this incident has opened his eyes to these dangers. From his other talking points, however, it seems that he was already aware of the problems and that he did what we all tend to do when there is an uncomfortable truth. We are all guilty of such willful ignorance in MMA for several reasons; another example could be the acceptance of brain damage. Davis’ open and frank discussions about how quickly and easily something can go wrong should be a siren for everyone in the sport. We need a sport-wide culture change involving more and better education, additional weight classes and more honest discussions with regards to weight-cutting before we are faced with another near-miss, or more deaths.

Dr. Christopher Kirk is Senior Lecturer of Sport and Exercise Physiology at Sheffield Hallam University in the United Kingdom. His research specialism is the physiological effects and consequences of training and competing in combat sports, with a focus on MMA and Brazilian jiu-jitsu.