Many athletes fail to consume enough calories. While this can be the result of disordered or restrictive eating, this can also occur inadvertently as some athletes are not aware of their high energy needs. Underfueling can result in the syndrome of relative energy deficiency in sport (RED-S).

Below are some signs and symptoms of RED-S, disordered eating, and underfueling. It should never be assumed that an athlete is fine just because they appear to be at a healthy weight, or even if they are overweight. Athletes may be in an energy deficit despite having a stable body weight due to reductions in resting metabolic rate. RED-S can occur in athletes of any sport, across any age, body size, culture, socioeconomic status, and athletic ability.

Early identification and treatment is important to prevent the long-term health outcomes of RED-S.

Physical signs:

  • Missing or irregular periods in females
  • Low sex drive and decline in morning erectile function in males
  • Changes in weight or lack of expected growth and development in adolescent athletes
  • Recurring injuries and illness
  • Reduced body temperature and increased sensitivity to the cold
  • Gastrointestinal issues such as constipation or bloating
  • Downy growth of hair on the body

Behavioural signs:

  • Restrictive eating such as cutting out food groups, counting, measuring, or weighing foods
  • Avoiding food-related social activities
  • Secretive behaviour regarding food intake and/or exercise
  • Pre-occupation with food, calories, body shape, and weight
  • Additional training above what is required and/or difficulties taking rest days
  • Disturbed sleep and sleeping difficulties

Psychological signs:

  • Becoming withdrawn and reclusive
  • Anxiety, irritability, and difficulties concentrating
  • Increased attention and/or criticism of body
  • Body image dissatisfaction and distortion

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