Why REDs has become a hot topic in women’s sport
Written by
Simon Austin
March 10, 2025
REDs has become one of the hottest topics (and acronyms) in women’s sport over the course of the last few years.
Speaking at the recent Teamworks Women’s Health in Performance Webinar, Darren Crocker, Senior Coach at AFWL side North Melbourne, said: “A big thing in the female space is REDs, which is Relative Energy Deficiency Syndrome.
“I had no idea about this in my first few seasons of coaching in the female space, but we recently partnered with a big University over here who are doing research into REDs.
“We had a list of 30 players and out of those, six tested to REDs, which means they are not bringing in the energy, the nutrients they need that’s going out the door the other way in how much they are expending.
“It’s a big thing in women’s sport that can lead to lack of sleep, poor recovery and lack of performance. They are just a couple of the barriers that are still here but we are starting to get a greater awareness about it.”
Dr Tenley Murphy, Assistant Athletic Director, Sports Medicine, at Clemson University, added: “We have created performance teams for each individual sport, so we are constantly collaborating about each individual student athlete and their needs to make sure we are addressing REDs.
“We have so many kids who just don’t know how to fuel correctly for participating at the collegiate level, and walking 20,000 steps around Campus to go to class and then they can’t figure out why they don’t perform.
“Having a group that can come together that were all invested in our female student athletes from the beginning has helped us make invaluable changes.”
Prevalence… and challenge
REDs describes how low energy availability can cause a range of detrimental health and performance outcomes, including increased injury risk, as well as decreases in reproductive function, musculoskeletal health and immunity.
The model was first introduced in the 2014 IOC Consensus Statement, building on the Female Athlete Triad Consensus Paper published in 1997. Now athletes are diagnosed with REDs, the model is mentioned in mainstream media and there are even specialist REDs clinics.
A study of 60 players from three Norwegian football teams, published in the European Journal of Sports Science last May, found that 22% of the cohort were at risk of REDs (17% mild risk, 3% moderate to high and 2% with very high/ extreme risk).
However, a recent paper (September 2024), published in Sports Medicine provided a “critical review of the model,” asking the question, “Does Relative Energy Deficiency in Sport Syndrome Exist?’
The paper encouraged practitioners not to “hold on to terminology at all cost,” with the eight co-authors arguing that REDs had become too “calorie centric”, with low energy availability (LEA) attributed as the single cause of REDs, when in fact there were “many causes”.
REDs is a model and a model is a simplified representation of reality.
Because energy availability is “impossible to measure accurately enough in the field”, REDs tended to be diagnosed by “studying symptom presentation and risk factors,” the authors said.
The symptoms – which include menstrual irregularities, poor bone health, compromised immune function, fatigue and poor mental health – are “rather generic and the causes likely multifactorial,” they added.
“REDs is a model and a model is a simplified representation of reality.”
Instead, the authors proposed a “more holistic athlete health approach” and put forward an Athlete Health and Readiness Checklist that could be used as a “multi-dimensional monitoring tool.”
The Checklist is made up of eight categories of factors that “alone or in combination… cause of host of clinical manifestations and symptoms that overlap greatly with those described as REDs symptoms.”
These are:
- Training-related stress (loads, intensity, monotony etc)
- Non training-related stress (family, coach relationship, body image, societal etc).
- Mental health (psychiatric conditions, life stress etc).
- Eating disorders
- Nutrition
- Sleep
- Infectious aetiology (ongoing fatigue and recurrent illness symptoms)
- Undiagnosed clinical conditions (eg thyroid problems, diabetes, cardiac problems etc)
“We are not dismissing the importance of energy availability at all; however, rather than having a calorie-centric approach… we are advocates of a more holistic, less biased approach that considers LEA as one of many possible causes,” the paper concluded.
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