RELATIVE ENERGY DEFICIENCY IN SPORT (RED-S): A TERM ALL RUNNERS SHOULD KNOW
By: Kaitlin Kellner and Emily Harris, Craftsbury GRP Runners, and their coach Jamie Norton
The effects of RED-S on the body. Adapted from Mountjoy et al.
Lots of people in the endurance sport community, particularly those in distance sports, are talking about Relative Energy Deficiency in Sport (RED-S). This month, we want to use our GRP platform to offer some useful background information on RED-S and discuss our team’s perspective and priorities surrounding nutrition and body image.
RED-S is a condition where a person’s caloric intake (from food) is not adequate to meet the energy demands of their sport. In other words, the input falls below the energy output. A whole host of factors can contribute to under-fueling, from being too busy to take care of proper meal prep to living with a restrictive eating disorder. Researchers estimate that indicators of RED-S occur in 18-58% of track and field athletes, suggesting this is a widespread issue that is holding back many athletes at all levels from reaching their full potential, and potentially leading to lifelong negative health consequences.
Historically, some RED-S indicators, like low bone density and absence of menstrual periods, fell under the name “female athlete triad.” Recognizing that the effects of low energy and poor health extended beyond those three factors – bone health, periods, and disordered eating – and applied to male athletes as well as female athletes, the International Olympic Committee coined the more comprehensive term RED-S in 2014. In addition to bone health and menstruation, researchers have shown that RED-S touches an athlete’s mental health, cardiovascular fitness, immune and digestive function, and affects their levels of hormones. Ultimately, this cascade of RED-S’s effects on the body can render the athlete injury-prone, irritable, unhappy, and unable to meet their peak performance - on and off the track.
RED-S continues to find itself at the center of sporting world news. Most recently, an article in the Oregonian outlined rigid and arbitrary practices surrounding weight and body composition monitoring that led many members of the University of Oregon track and field team to develop disordered eating behaviors. Incorrect understanding of best practices around managing body composition to maximize performance are pervasive at every level of running. GRP Run strives to do our part to decrease the prevalence of RED-S in our sport by promoting a healthy culture on our team, influencing our local communities, and encouraging runners to ask for help when needed.
Many track and field athletes train on teams. While athletes benefit in numerous ways from being around their teammates, the team atmosphere also makes it easier for unhealthy practices to spread. Such unhealthy practices can include restrictive eating (a behavior that can be particularly evident when teammates share meals), obsessive monitoring of weight, and overexercising. On high school and college teams, younger athletes tend to look up to older ones, especially their older teammates who are running well that season. If those role models engage in unhealthy eating and exercise patterns, freshmen may copy, having a skewed perspective about what is necessary to achieve success in the sport.
The tricky element of unhealthy weight loss is that for a very short time, it might seem to work: the athlete might experience a brief period of improved performance before their body develops full-blown RED-S and breaks down. Younger runners see the initial success of their older peers, but often disregard their subsequent downfall. For this reason, it is essential to have team leaders who promote a healthy culture so that it trickles down to younger members.
The top tier of leadership in track and field teams is often the coach. As a coach, it can be tempting to ignore signs of RED-S when an athlete is running personal bests. The coaches of GRP Run are aware of the warning signs of developing RED-S and will help the athlete before their body begins to deteriorate. The coaches will encourage the athletes to nourish their bodies, rather than aim for a specific body-fat composition. If they suspect an athlete may be struggling with disordered eating, they will recommend that the athlete seek professional help and cease training, even if they are running well at the moment.
What checks and balances are present in your training? This is where formal coaching relationships, or an honest, loving training buddy can be helpful in encouraging you to reflect on your fueling and training. An outside perspective, and one that cares about your well-being as an athlete and person, can be massively beneficial in making sure you’re taking positive steps in the direction of your health and goals.
In addition to promoting a healthy culture on our team through positive coaching, GRP Run team members also aim to advocate for healthy lifestyles in their individual running communities. One unique aspect of GRP Run is that we are scattered across the country and embedded in our local running communities as well as our GRP community. This gives us, collectively, the opportunity to set a good example for runners across the country. Since we will be competing at a high level, we will ideally show others in our communities that fueling oneself properly will lead to a long career of strong and fast running.
Lastly, GRP Run will watch out for others, both within our team and within our local running communities. While prevention is the ultimate goal, it is also critical to know how to help a friend who is struggling. It can be intimidating to approach the subject of under-fueling with your training partner, especially when you’re unsure about how much - or even whether - your friend is struggling. But ultimately these are important, worthwhile conversations to have. Luckily, experts have compiled helpful suggestions and tips for broaching the topic, like this page from Brown University and these thoughts on fast-women.org.
GRP Run is committed to discrediting the common idea in our sport that under-fueling can lead to a successful running career. We aim to set a good example that appropriate fueling and a strong body composition leads to long-term success in running. Hopefully, this will contribute in a small, but important, way to decreased prevalence of RED-S within the sport of track and field.
Other resources we admire
There are lots of experts and athletes who have offered their important perspectives about RED-S specifically, and eating and body image in sport more generally. Here are just a few of our favorites:
Kate Raphael, on why we should stop telling runners “You look fit”
“As the elite women assembled at the start line, I observed surprising variation in bodies and builds. They were sinewy yet solid; they had boobs and butts and body fat.”
Maddie Alm’s Fueling Forward blog, from her perspective as an elite athlete and registered dietician
“You only get one body, both for your time as an athlete and beyond.”
Q + A with Lauren Fleshman, on how to approach eating with a team
“And finally, recognize the power you all have to influence one another for either success or failure in this area. We can be a healthy, well adjusted team that improves incrementally and sets ourselves up for many years of success.”
David Proctor, former BU track runner, and Paula Quatromoni, registered dietician, on RED-S in male athletes
“I realized, the more I fuel myself, the more I perform and the better I perform.”