2023 International Olympic Committee’s (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs)

TLDR

The IOC introduced REDs in 2014 to describe the health and performance harms of low energy availability, and since the 2018 consensus more than 170 studies have expanded knowledge on carbohydrate, mental health, and male LEA effects. This statement presents a physiological model of LEA’s complex effects, guidelines for safe body‑composition assessment, prevention and treatment principles, and methodological best practices to guide sports organisations and researchers. A new REDs Clinical Assessment Tool‑Version 2 is offered to detect and diagnose REDs through severity and risk stratification, with accompanying training and competition recommendations. The work updates Health and Performance Conceptual Models and introduces a novel Physiological Model of REDs.

Abstract

Relative Energy Deficiency in Sport (REDs) was first introduced in 2014 by the International Olympic Committee’s expert writing panel, identifying a syndrome of deleterious health and performance outcomes experienced by female and male athletes exposed to low energy availability (LEA; inadequate energy intake in relation to exercise energy expenditure). Since the 2018 REDs consensus, there have been >170 original research publications advancing the field of REDs science, including emerging data demonstrating the growing role of low carbohydrate availability, further evidence of the interplay between mental health and REDs and more data elucidating the impact of LEA in males. Our knowledge of REDs signs and symptoms has resulted in updated Health and Performance Conceptual Models and the development of a novel Physiological Model. This Physiological Model is designed to demonstrate the complexity of either problematic or adaptable LEA exposure, coupled with individual moderating factors, leading to changes in health and performance outcomes. Guidelines for safe and effective body composition assessment to help prevent REDs are also outlined. A new REDs Clinical Assessment Tool-Version 2 is introduced to facilitate the detection and clinical diagnosis of REDs based on accumulated severity and risk stratification, with associated training and competition recommendations. Prevention and treatment principles of REDs are presented to encourage best practices for sports organisations and clinicians. Finally, methodological best practices for REDs research are outlined to stimulate future high-quality research to address important knowledge gaps.