RED-S is the result of insufficient caloric intake and excessive energy expenditure. It is common among athletes in various sports at different performance levels, and the underlying cause is problematic low energy availability (LEA).
Consequences of this low-energy condition can alter many physiological systems, including metabolism, menstrual function, bone health, immunity, protein synthesis, and cardiovascular and psychological health.
Last week, Dublin played host to the Sport Ireland Institute event ‘HPX’, a conference sponsored by National Dairy Council that brought together experts in the fields of sports science and nutrition to discuss the evolving landscape of body composition assessment and its implications for athletes.
Professor Kate Pumpa, exercise physiologist and sports nutrition expert, stressed the need to educate coaches about the significance of body composition assessment, especially in identifying issues like low energy availability, stating: “We need to put a lot of time and effort into educating coaches on the importance of evaluating body composition as part of a holistic screening assessment, not just to be taking in isolation the number.”
She explains that the landscape of assessment has changed dramatically, explaining that 15 years ago, “athletes were probably in low energy availability, but skin fold assessments were being used to stratify those athletes into a ‘fat club’ to make them work harder, which was therefore exacerbating that problem.”
Now she notes that while progress has been made in body composition assessment, the key needs to be a better-rounded approach, stating: “It’s important to put the value of body composition assessment into a different context, so not just the measurement of physique.”
Body composition assessment
Gary Slater, national performance nutrition network lead at the Australian Institute of Sport, delved into the evolution of body composition assessment in high-performance sports over the past few decades.
He noted the shift from traditional surface anthropometry methods to more advanced techniques like DEXA scanning (a type of X-ray that measures bone mineral density), highlighting that standardised procedures, education, and interdisciplinary approaches are crucial aspects to address concerns related to body composition assessment in sports.
Slater raised awareness of potential risks associated with excessive focus on body composition in athletes in weight-category sports, explaining practitioners and athletes place too much importance on physique changes assuming that changes always improve performance, and this can increase risk of eating disorders especially in younger athletes.
He noted that this could be down to a limited understanding of the relationship between physique and performance, noting that “There is such little research to be able to understand those issues at hand”, but adding that it is important to "deemphasise the association between physique and competitive success.
“To better support athletes within weight category sports, it is important to recognise their nuances within those spaces and to take a multidisciplinary approach to things to be able to address highly complex issues.
“We're becoming aware of the vulnerability of our athletes and are now exploring longitudinal monitoring to improve identification of at-risk athletes,” he concluded.
Body composition and eating disorders
Adding weight to Slater’s perception, sports dietitian and eating disorders specialist Alexandra Cook shed light on the delicate relationship between body composition, performance, and eating disorders in athletes, underscoring the need to prioritise performance metrics over body weight and composition.
She drew attention to initiatives such as ‘Project RED-S’ providing guidelines designed by registered sports dieticians for health, performance, and RED-S prevention.
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Prevention of Relative Energy Deficiency in Sport (RED-S)
A new review by authors from Norway recently addressed RED-S primary, secondary and tertiary prevention strategies and recommends best practice prevention guidelines.
The authors conclude: “Best practice guidelines to prevent RED-S and related consequences include a multipronged approach targeting the athlete health and performance team, the athlete entourage and sport organisations, who all need to ensure a supportive and safe sporting environment, have sufficient REDs knowledge and remain observant for the early signs and symptoms of RED-S.”
The authors explain that primary prevention of RED-S seeks to minimise exposure to and reduce behaviours associated with problematic LEA, strategies of which include educational initiatives and de-emphasising body weight and leanness, particularly in young and sub-elite athletes.
Recommended strategies for identifying athletes at risk include self-reported screening instruments, individual health interviews and/or objective assessment of REDs markers.
Tertiary prevention (clinical treatment) seeks to limit short-term and long-term severe health consequences of RED-S.
Yet as Cook emphasised, the priority needs to be placed on primary prevention, as RED-S can develop into disordered eating.
She added that when seeking treatment, wait lists are excessive, noting that the public healthcare system in England (NHS) experience 60-100 eating disorder referrals a month, with a wait time of six months to a year for an assessment and treatment wait time can be up to one year.
Journal: British Journal of Sports Medicine
https://bjsm.bmj.com/content/57/17/1119
Primary, secondary and tertiary prevention of Relative Energy Deficiency in Sport (REDs): a narrative review by a subgroup of the IOC consensus on REDs
Authors: Monica Klungland Torstveit, Kathryn E Ackerman, Naama Constantini, Bryan Holtzman, Karsten Koehler, Margo L Mountjoy, Jorunn Sundgot-Borgen, and Anna Melin.