Relative energy deficiency in sport (RED-S)

The challenge

When exercise occurs in an environment of low energy availability … there are potential significant negative effects on mental well-being, bone, endocrine and metabolic health… there needs to be an increase in the awareness of, and education about, relative energy deficiency in sport… (Gould et al. 2023)

What we know

Relative energy deficiency in sport (RED-S) happens when someone burns more calories than they take in. It used to be called ‘female athlete triad’ referring to disordered eating, menstrual disturbance and low bone density. But it changed to RED-S because it also affects men and broader health areas. Common signs and symptoms could include weight loss, fatigue, irregular or stopped periods, recurring illnesses like colds, declining sports performance, gastro, bone or cardiovascular issues, and shifts in mood and mental health.

RED-S is caused by ‘low energy availability’, when ongoing energy intake does not meet energy expenditure. This mismatch can be intentional, if someone restricts their eating, but it can also be unintentional and unrelated to body image. The risk is greater in sports that emphasise leanness or weight, such as endurance events and gymnastics.

Teenagers are especially vulnerable because they are growing and need more energy. RED-S often goes undiagnosed in adolescents because symptoms vary and awareness is low. Studies show up to 80% of elite young female athletes and 60% of high school female athletes have at least one symptom. While it’s important to encourage physical activity among teens, low energy availability undermines the benefits and can lead to long-term health issues. That’s why greater awareness and education are so important.

Insights for coaches and officials

It is critical for coaches and officials to understand energy demands and RED-S risk. If you notice warning signs, encourage the participant (or their parents for those under 18) to speak with their doctor. Other ways you can support people experiencing RED-S are:

• Coaches – focus on the need for consistent education on the condition, impacts of the condition on health and ramifications for participation in sport. Focus on creating a safe environment where dialogue is open, healthy participation in sport is supported, and participants can focus on creating better connection with their body and what it needs (this may include more rest, different fuelling and different training regimens).
• Officials – focus on understanding how the condition may impact someone’s need in the built environment, particularly around injury prevalence. While you may not know who has been diagnosed with the condition, for those officiating, particularly in endurance sports, consider how you can educate yourself and create supportive and safe competition environments.

More resources

Source article: https://www.thieme-connect.com/products/ejournals/html/10.1055/a-1947-3174

Further reading: https://www.perthsportsmedicine.com.au/relative-energy-deficiency-in-sport-perth-claremont-cockburn-wa.html https://www.swimming.org.au/performance/athlete-resources/ignite-athlete-program/red-s-relative-energy-deficiency-in-sport