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Consensus statement
2023 International Olympic Committee’s (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs)
  1. Margo Mountjoy1,2,
  2. Kathryn E Ackerman3,
  3. David M Bailey4,
  4. Louise M Burke5,
  5. Naama Constantini6,
  6. Anthony C Hackney7,
  7. Ida Aliisa Heikura8,9,
  8. Anna Melin10,
  9. Anne Marte Pensgaard11,
  10. Trent Stellingwerff8,9,
  11. Jorunn Kaiander Sundgot-Borgen12,
  12. Monica Klungland Torstveit13,
  13. Astrid Uhrenholdt Jacobsen14,
  14. Evert Verhagen15,
  15. Richard Budgett16,
  16. Lars Engebretsen16,
  17. Uğur Erdener17,18
  1. 1 Family Medicine, McMaster University Michael G DeGroote School of Medicine, Waterloo, Ontario, Canada
  2. 2 Games Group, International Olympic Committee, Lausanne, Switzerland
  3. 3 Wu Tsai Female Athlete Program, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts, USA
  4. 4 Israel Cycling Academy, Tel Aviv, Israel
  5. 5 Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
  6. 6 Sports Medicine Center, Shaare Zedek Medical Center, The Hebrew University, Jerusalem, Israel
  7. 7 Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA
  8. 8 Canada Sport Institute Pacific, Victoria, British Columbia, Canada
  9. 9 Exercise Science, Physical & Health Education, University of Victoria, Victoria, British Columbia, Canada
  10. 10 Department of Sport Science - Swedish Olympic Committee Research Fellow, Linnaeus University, Kalmar, Sweden
  11. 11 Department of Sport and Social Sciences, Norwegian School of Sports Sciences, Oslo, Norway
  12. 12 Department of Sport Medicine, Norwegian School of Sports Sciences Department of Sport and Social Sciences, Oslo, Norway
  13. 13 Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
  14. 14 International Olympic Committee Athlete’s Committee, Lausanne, Switzerland
  15. 15 Amsterdam Collaboration on Health & Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Science, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
  16. 16 Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
  17. 17 Department of Ophthalmology, Hacettepe University, Ankara, Turkey
  18. 18 World Archery, Lausanne, Switzerland
  1. Correspondence to Clinical Professor Margo Mountjoy, Family Medicine, McMaster University Michael G DeGroote School of Medicine, Waterloo, ON, Canada; mountjm{at}mcmaster.ca

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.

  • relative energy deficiency in sport
  • sports medicine
  • nutritional sciences
  • psychology, sports
  • athletes

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Footnotes

  • Twitter @margo.mountjoy, @DrKateAckerman, @LouiseMBurke, @AC_Hackney, @IdaHeikura, @AnnaMelin4, @TStellingwerff, @Jorunn_SB, @MMonicakt, @Evertverhagen

  • Correction notice This article has been corrected since it published. Figure 6 has been updated in the online version only and not in print.

  • Contributors All authors were involved in the conception, drafting, voting, in-person discussion, revising and approval of the final manuscript prior to submission. MM was responsible for leading the consensus project and for coordinating the consensus statement manuscript. AUJ represented the athlete’s voice, and DMB represented the coach’s voice. RB, UE and LE represented the International Olympic Committee’s Medical and Scientific Department.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests MM is a Deputy Editor of the BJSM and a member of the BJSM IPHP Editorial Board. KEA is a Deputy Editor of the BJSM and an Associate Editor of the BJSM IPHP. EV is an Associate Editor of the BJSM, an Associate Editor of the BJSM IPHP and Editor in Chief of BMJ Open Sports and Exercise Medicine. RB is the IOC Medical and Scientific Director. LE is the IOC Head of Science Activities and an Editor of BJSM IPHP. UE is an IOC member and the Chair of the IOC Medical and Scientific Commission.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.