Best Practice Case Studies-Case 113 Asset 3 IOC Consensus Statement: Relative Energy Deficiency in Sport

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The International Olympic Committee (IOC) convened an expert panel to update and replace its 2005 guidance on the Female Athlete Triad. The new consensus broadens the concept to “Relative Energy Deficiency in Sport” (RED-S), recognizing that the underlying problem is low energy availability (energy intake minus exercise energy expenditure relative to fat-free mass) and that the consequences extend well beyond menstrual function and bone health—and affect male athletes as well.<br /><br />RED-S is defined as impaired physiological function caused by an energy deficiency relative to the energy required for health, daily living, growth, and sport. Affected systems can include metabolic rate, reproductive function (eg, functional hypothalamic amenorrhea in females), bone health, immunity, protein synthesis, cardiovascular function, and psychological health. Disordered eating often contributes, but RED-S can also arise unintentionally through mismatched intake and training load. The statement emphasizes that psychological issues may precede RED-S or result from it.<br /><br />The document summarizes health and performance consequences, including nutrient deficiencies, fatigue, illness risk, endocrine disruption, reduced muscle protein synthesis, unfavorable lipid/endothelial changes, impaired bone accrual (especially during adolescence/early adulthood), stress fractures, and reduced training response and performance.<br /><br />Screening is recommended during annual Periodic Health Examinations and whenever athletes present with weight loss, menstrual dysfunction, recurrent injuries/illness, decreased performance, or mood changes. Diagnosis focuses on identifying low energy availability and its causes; assessment of eating disorders, menstrual dysfunction (as a diagnosis of exclusion), and bone mineral density (DXA) is outlined.<br /><br />Treatment prioritizes restoring energy availability via increased intake (often +300–600 kcal/day), reduced exercise, and multidisciplinary care (medical, nutrition, mental health). Hormonal contraception may mask the problem and does not address the cause. The IOC introduces practical “Sport Risk Assessment” and “Return-to-Play” models using red/yellow/green risk categories to guide sport participation and safe return. The statement also provides prevention recommendations for athletes’ support networks and sport organizations, and calls for improved research and validated screening/energy-availability tools across sexes, ethnicities, and para-sport populations.

Meta Tag

Edition 4th Edition

Related Case 4th Edition, Case 3

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Keywords

Relative Energy Deficiency in Sport (RED-S)

Female Athlete Triad update

low energy availability

International Olympic Committee (IOC) consensus statement

functional hypothalamic amenorrhea

bone mineral density (DXA)

disordered eating in athletes

sport risk assessment and return-to-play model

multidisciplinary treatment (nutrition, medical, mental health)

performance and health consequences (fatigue, stress fractures, endocrine disruption)

4th Edition

4th Edition, Case 3

Ankle