Reading Passage: Introduction to RED-S

Module 1: Introduction to RED-S

Relative Energy Deficiency in Sport (RED-S) is a condition that occurs when athletes intentionally or mistakenly fail to consume enough calories for the cumulative amount of exertion they partake in over an extended period of time. Inadequate caloric intake or excessive expenditure leads to low energy availability, which is the ultimate driving factor for RED-S. This energy imbalance in athletes leads to dysfunction of the body’s organ systems. Understanding the risk factors, symptoms and consequences of RED-S is crucial for coaches, athletes and healthcare professionals who work with athletes to help prevent, identify and manage this condition.

While certain traits such as perfectionism, high pain tolerance, and motivation may be desirable in competitive athletes, they can also increase the risk of developing disordered eating. External pressures from coaches, peers, parents, and social media can also influence athletes' behavior. Comments from coaches about weight or appearance have been linked to the development or continuation of disordered eating and RED-S in athletes.

RED-S can be caused by a combination of factors such as restrictive eating, weight loss practices, and excessive energy expenditure through training and competition.

The condition can have a wide range of negative effects on the athlete's health and performance, including decreased immunity, decreased muscle mass, and decreased cognitive function. RED-S reduces the intensity and duration that athletes can train and participate which leads to missed practices and competitions, diminished performance, and increased injuries. It can also lead to more serious health consequences such as amenorrhea and osteoporosis. In addition to the physical effects, RED-S can also negatively impact an athlete's mental health, leading to decreased motivation, increased stress and anxiety, and even depression. The condition can also be derived from or lead to disordered eating patterns and, in some cases, eating disorders.

The prevalence of RED-S varies by research study but has been shown to be up to 79% of athletes with another 25% at moderate to high risk of lower energy availability. This percentage might be even higher in sports that promote leanness such as gymnastics, wrestling, or swimming. It is important to note that RED-S is not only a problem for athletes in weight-class sports or aesthetic sports, but it can occur in any sport where there is pressure to maintain a certain body composition or weight. It can also affect female athletes disproportionately due to the more definitive presentation of RED-S as amenorrhea.

Early identification and intervention is crucial in managing RED-S and preventing long-term health consequences. Coaches routinely interact with high-risk high school athlete populations which make them a crucial group for the prevention, early identification, and intervention of RED-S. As mentors for their athletes, coaches also have a unique ability to influence many of the thought patterns and behaviors that can place an athlete at high risk for developing RED-S. Coaches also are the ones who determine the duration, intensity, and structure of athletic training schedules, and these factors greatly contribute to this energy deficit.

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