The first step in being able to identify relative energy deficiency in sport (RED-S) in one of our athletes, as physical therapists, coaches or trainers, is to have an awareness of RED-S and what it is. You can start, by reading up on RED-S here.
Part of understanding RED-S is knowing that we can’t SEE it by looking at someone, which makes our ability to evaluate and assess if it could be a variable to consider, even more important. It is likely that RED-S is occurring much more often than we realize in our athletes and in order to find out, we can start screening for RED-S using a screening tool, or our excellent communication skills, particularly in adolescent and female athletes.
Recognize the risk factors for RED-S:
Certain sports put athletes at higher risk for energy deficiency. These include those that expend lots of calories such as endurance sports like cycling and running, as well as sports that require cutting weight, like wrestling.
History of, or current, eating disorder, or disordered eating, is another risk factor for RED-S. While disordered eating is hard to define, typically it involves an complicated, if not unhealthy, relationship with food that can contribute to low energy availability with sport. A referral to a knowledgeable Registered Sports Dietitian and a mental health therapist could be very beneficial, so it’s important to ask all of our athletes about their current relationship with food and their history of food related disorders.
Recognize the signs of RED-S in athletes
In addition to screening for RED-S, you can screen for current signs of energy deficiency.
- Gut issues or GI disturbances
- Training plateaus
- Disturbed sleep
- Menstrual disturbances (aka menstrual changes from that person’s normal)
- History of stress fracture
- Mood changes
- Understanding of fueling demands for their sport
- Energy levels
At the same time, you may observe changes in the athlete, that could clue you in to a possible change in energy status:
- Change in desire to perform
- Flat affect
- Obsession with performing well
- Food rules or adopting a new diet
- Increased effort for same tasks
- Leanness talk
- Recurrent injuries
- Talk of diet restriction (of ANY kind)
- Talk of weight loss coupled with increased activity
Make the appropriate referral
It truly does take a team to help support athletes struggling with RED-S. Once we recognize it, we need to establish that treatment team.
Typically speaking, a referral to a knowledgable registered dietitian, familiar with the unique needs of athletes, is a great starting point. If finding an RD seems challenging, look for providers who practice Heath at Every Size and Intuitive Eating strategies.
Other referrals to make or clinicians to reach out to could include a therapist or counselor and physician.
If you’re unsure, reach out to our team below to inquire about local or regional referral providers we trust for performing athletes struggling with RED-S. If you want to learn more about RED-S check out this podcast, this podcast or watch this video.