Medical Care for Athletes with Eating Disorders or RED-S

Professional and recreational athletes experience unique challenges in the event of having an eating disorder or managing undernourishment issues, commonly identified as Relative Energy Deficiency in Sport (RED-S). Elite athletes often face the pressure of managing their medical issues while balancing their need and desire to participate in their sport for a variety of reasons, including maintenance of athletic scholarship funds while in school, employment if professionally involved in their sport, and, of course, personal enjoyment, stress relief, and community. The Gaudiani Clinic provides comprehensive medical care to athletes of all types and expert medical oversight as part of a multi-disciplinary team approach.

The Gaudiani Clinic approaches medical issues from a patient values-based perspective and works collaboratively with patients and their teams, often consisting of a therapist, dietitian, athletic trainer, and coach, to improve medical and performance issues.

Athletes who are experiencing signs of body suffering or have concerns about athletic performance are invited to meet with our physicians for a comprehensive overview looking at all body systems.

What is Relative Energy Deficiency in Sport (RED-S)?

Relative Energy Deficiency in Sport (RED-S) replaced the term Female Athlete Triad. The term RED-S not only acknowledges that athletes of all genders (not just females) can suffer from low energy availability, but also highlights that the health consequences of improper fueling for sport are far greater than just reproductive and bone health. The 2014 International Olympic Committee (IOC) consensus statement on RED-S clearly outlines how under fueling for sport can negatively impact the physical and psychological health of an athlete. RED-S can lead to dysfunction of many body systems which can decrease athletic performance and increase risk of serious health complications.

Body systems at risk for being affected by RED-S include: immunological, gastrointestinal, cardiovascular, psychological, hematological, metabolic, endocrine, bone health, menstrual function, and overall growth and development.


Physical/Medical Signs of
Disordered Eating/Eating Disorders/RED-S

Slow resting heart rate (bradycardia)
Faster heart rate for same activity/intensity
Heart arrhythmia 
Low blood pressure
Reduced heart mass
Iron deficiency
Loss of menstrual period (amenorrhea)
Abnormal blood electrolytes
Low bone mineral density (osteoporosis/osteopenia)
Decreased sex hormones
Decreased sex drive (libido)
Stress fractures
Slowed digestion
Mood swings/irritability
Increased perfectionism/rigidity in cognitive processing

Impact on Athletic Performance with
Disordered Eating/Eating Disorders/RED-S

Decreased exercise capacity
Decreased performance
Decreased response to training
Decreased muscle strength
Decreased concentration
Increased muscle cramping and muscle fatigue 
Increased risk of injury


Athletes at Risk of Eating Disorders/Disordered Eating/RED-S

Athletes of all genders are at risk for developing RED-S and/or an eating disorder. While the popular narrative is that only female athletes experience medical complications and pressure to be a certain size or shape, the reality is that male athletes in a variety of sports are often severely impacted by eating disorders and undernourishment issues. The following are sports where RED-S or eating disorders/disordered eating might be more prevalent:

  • Gymnastics

  • Diving

  • Swimming

  • Dance

  • Intensive gym or home-based strength and conditioning programs

  • Running/ultrarunning/track and field

  • Rock climbing

  • Wrestling

  • Football

  • Bodybuilding

  • Cycling

  • Crew (rowing)

  • Martial arts

  • Cheerleading

Red Flags for Athletes

  • Increased training without increased fueling

  • Continued exercise through injury and/or overtraining

  • Loss of menstrual period

  • Preoccupation with food or highly restrictive diets

  • Emphasis on a certain aesthetic or “look” that one must have for their sport