The impact that relative energy deficit (RED-S) can have on a player’s health and wellbeing is increasingly being recognised. This BJSM paper, featuring staff from a FIFA Medical Centre of Excellence, reviews the evidence relating to disordered eating (DE), a potential cause of RED-S, and provides excellent information about a practical approach to players with this problem.

Disordered eating (DE) sits on a spectrum between optimum nutrition and an eating disorder (ED), but does not fulfil the criteria for either. Player’s with DE may regularly engage in behaviours such as skipping meals, compulsive exercise or restrictive eating, but do not fully meet the criteria for an ED. Unfortunately there are health and performance implications regardless of where a player falls along the spectrum and these risks increase when DE develops into a diagnosed ED. It is important to recognise that not all players with DE have RED-S.

It is widely accepted that the early identification and appropriate management of DE leads to better outcomes for the players who are involved. This paper highlights that everyone involved with sport has a potential role to play in the recognition of DE (and eating disorders). It is suggested that coaches, support staff and anyone involved with sport, should be educated about the risk factors and warning signs or red flags for DE and EDs and that effective communication channels should be developed to allow them to voice any concerns. Once a player has been identified however, it is suggested that they should be assessed and managed by an appropriate multi-disciplinary team. The authors suggest that core members of this team should include a doctor, sports dietitian and a psychologist.

Once identified, the player needs to have a comprehensive assessment. The paper outlines an evidenced based approach to this assessment including estimating energy availability, assessing bone health and the assessment of body composition. The importance of the players psychological wellbeing and support structures in their treatment are also highlighted.

To learn more about these issues consider reviewing the ‘Nutrition’ and ‘Female Athlete’ modules in the FIFA Diploma in Football Medicine. Finally it is worth highlighting that this is not solely a ‘female’ problem and that men can also suffer from DE, EDs and RED-S.

Reference
1. Wells KR, Jeacocke NA, Appaneal R, et al The Australian Institute of Sport (AIS) and National Eating Disorders Collaboration (NEDC) position statement on disordered eating in high performance sport British Journal of Sports Medicine Published Online First: 13 July 2020. doi: 10.1136/bjsports-2019-101813