In plain language
Impaired health and performance from prolonged or severe low energy availability, affecting bone, reproduction, metabolism, immunity and psychological health across sexes and body sizes.
Clinical Significance & Management
Too little energy remains for physiology after exercise expenditure. A physician, sports dietitian and mental-health support when needed assess causes and restore fueling while adjusting training. Exclude alternative diagnoses; weight or a single test is insufficient.
Symptoms & Clinical Presentation
Persistent fatigue, poor recovery, recurrent injury or declining performance
Bone stress injuries, menstrual changes, low libido or eating/mood concerns
Etiology & Injury Mechanisms
- Intake failing to match training, sometimes unintentionally
- Restriction, weight pressure or eating disorders
Diagnostics & Imaging Guide
Diet/training and reproductive history, examination and selected blood tests
Risk-based bone assessment; IOC REDs CAT2 requires clinical expertise
Treatment Options
Individualized fueling, training changes and correction of deficiencies
Multidisciplinary care for eating disorders/high risk, with training restriction when needed
Rehabilitation Milestones & Timeline
Rehabilitation depends on the diagnosis, procedure and associated injuries. Progression requires assessment of healing, symptoms and function; elapsed time or a single test cannot determine readiness for sport.
Stabilize
Address medical risk and establish sufficient regular intake
Recover
Monitor symptoms, hormones and bone; timelines differ
Return
Progress by clinical risk and response, not weight alone
Evidence-Based Clarifications
Normal weight or temporarily good performance does not exclude REDs. Hormone-related bleeding does not establish natural cycle or energy recovery.
Sources & References
2023 IOC consensus statement on Relative Energy Deficiency in Sport (REDs)
International Olympic Committee / British Journal of Sports Medicine
Functional Hypothalamic Amenorrhea: Clinical Practice Guideline (2017)
Endocrine Society
Educational clinical definitions synthesized from AAOS, Cleveland Clinic, Mayo Clinic, and HSS. Individual diagnosis and surgery require professional medical evaluation.
Publication date
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