Understanding REDs
Recognizing the signs, finding support, and seeking treatment
This page was created in collaboration with our friends at AthleatMD.
What Is REDs?
Relative Energy Deficiency in Sports (REDs) is a condition in which an athlete may experience health and performance consequences as a result of not eating enough to meet the demands of their training. The REDs framework replaced the more limited/less inclusive female athlete triad, which is now considered a subset of REDs.
What are common warning signs of REDs?
Signs of REDs may include:
Fatigue
Mood changes
Weight loss or suppression/failure to keep pace with expected gains
Difficulty concentrating
Changes in eating habits
Gastrointestinal issues
Feeling cold
Menstrual irregularities (in females)
Low testosterone levels (in males)
Injuries including bone stress fractures
Is REDs an eating disorder?
No. While REDs and eating disorders have many shared features, it is possible to have REDs and not have an eating disorder and vice versa. (1) REDs applies specifically to athletes, and low energy intake may be ‘accidental/unintentional’ in REDs (for example, due to a lack of education or knowledge of sports nutrition principles). Also, (2), REDs is a medical diagnosis (not a psychiatric illness).
Are there specific sports or athletes at an increased risk of REDs?
While REDs is more common in aesthetic or weight-sensitive sports (i.e. wrestling, running, dance), it is common across all sports and across all body types. REDs is often overlooked in athletes who are not thin-appearing. The prevalence of REDs across all sports is higher in females overall. There is evidence that males often sustain lower energy availability before showing symptoms of REDs.
What type of treatment is available for REDs?
The typical treatment team is comprised of a medical provider, registered dietitian, and psychologist (and possibly other disciplines, such as physical therapy) with expertise in REDs. The clinical team collaborates closely with family and the athlete’s performance team (coaches, trainers, etc.). Treatment goals include (1) identification/resolution of related medical issues, (2) full nutritional restoration (which requires weight restoration for most athletes) and (3) developing a return-to-training plan (when applicable) and (4) ensuring the athlete is safe to participate/remain in sport.
What’s the difference between the female athlete triad and REDs?
The RED-S framework replaced and retired the less inclusive “female athlete triad,” which was established in 1992. The female athlete triad described 3 symptoms frequently experienced by female athletes who weren’t properly fueling: menstrual dysfunction, decreased bone density, and problematic eating behavior. The triad failed to acknowledge the consequences that occur across the gender spectrum, and missed the many other symptoms and dangers that can step from inadequate intake. Female athlete triad symptoms are considered a ‘subset’ of REDs.
How can coaches and trainers reduce the risk of REDs in athletes?
A strong Athlete-Performance team relationship is vital for athlete well-being and development. Coaches can foster a healthy sport environment by:
- Promoting healthy fueling: Limit “diet” foods, avoid fad diets, prioritize a food-first approach for needs, and encourage regular fueling.
- Mindful weight practices: Evaluate weight monitoring, avoiding public weigh-ins and treating data confidentially. Conduct body composition tests infrequently and cautiously, especially with body image concerns or disordered eating history; avoid testing youth without medical necessity.
- Focusing on health over appearance: Emphasize health and performance metrics instead of body shape or type.
- Understanding risk & symptoms: Recognize that all body types and athletes are at risk, and most with REDs/eating disorders are not underweight. Avoid minimizing REDs/eating disorder symptoms (e.g., low heart rate, fatigue, bone stress injuries).
- Positive communication: Avoid weight/shape comments or comparisons. Expect bodies to change.
- Building a support network: Develop relationships with REDs-savvy providers to assist the performance team.
Coaches may also consider including screening questions to assess risk of REDs. There are many screeners available, such as:
- Low Energy Availability in Females Questionnaire (LEAF-Q)
- Low Energy Availability in Males Questionnaire (LEAM-Q)
- REDs specific screening tool (RST)
ANAD has developed a resource hub to help coaches and trainers working with athletes promote healthy self-image and support athletes in eating disorder recovery.
Where can I learn more about REDs?
For more information on eating disorders in athletes and REDs, visit the following:
AthleatMD
AthleatMD was designed for athletes across all sports and skill levels who need additional support with sports nutrition, disordered eating & eating disorders, and/or relative energy deficiency in sport (REDs). It is is a fully virtual, multi-state medical and nutrition practice, led by nationally-recognized clinical experts.
ANAD's Athletes & Eating Disorders
With the support of our friends from Athlete EDGE® at EDCare, we hope this page will answer your questions and connect you with resources related to eating disorders in athletes.
Allison's Story: My Personal Experience with REDs
As an active woman, Allison always prioritized being healthy, but the years she was most invested in optimizing my health were actually harming my fitness and doing more harm than good. We’re grateful for her willingness to share her story with us.
Project REDs
Project RED-S shines a light on Relative Energy Deficiency in Sport, a condition that occurs when energy intake does not meet the demands of activity. We provide expert guidance and tools to help active individuals stay healthy, strong, and unstoppable.