Supporters' role in RED‑S prevention
If someone you know is struggling with RED-S, or you want to play your part in prevention, you're in the right place. No one wants to see their child, partner, teammate, client, friend, or the athlete they coach in a difficult position. Here's how we think you can help.
1. Be aware of early warning signs. We know this sounds obvious but the initial signs and symptoms of RED-S can be subtle. Athletes, who are often driven individuals and inclined to push on where possible, may not be the first to pick up on a potential issue themselves. If you can help identify when a cold is taking too long to shift; fatigue is becoming persistent; injuries are recurring or not healing properly; or eating/exercise behaviours are becoming obsessive or rigid*, then you assist prevention, or recovery from, a longer-term issue. We would recommend starting these conversations as quickly, supportively and confidentially as possible, since recovery outcomes can be greatly improved with early recognition and intervention. RED-S doesn't always involve an eating disorder or even disordered eating, but we think the general principles from this advice article about how to approaching an athlete are pretty helpful in most cases.
2. Be aware of reasons to fall into RED-S. There are many reasons why an athlete may fall into RED-S related issues. Typically these surround either, a) deliberate calorie restriction and/or high training volumes in an attempt to alter or improve body composition or power-to-weight ratio, or, b) underestimating/not understanding the energy requirements of exercise. It's important to consider the root cause(s) of the issue before knowing how to approach the athlete: you never want to make them feel 'accused' of doing anything deliberate but you do want to help them seek appropriate support. Be aware that the reasons for RED-S may not always be what it seems on the surface. For example, has the athlete recently cut out gluten for legitimate medical reasons? Or as a way to restrict carbohydrates? Have they started showing a keen interest in increasing their training load of out of pure enjoyment of the sport, or as a way to 'earn' their food?
3. Help athletes think long-term about their performance and health - this is something any member of their support system can do. We'd recommend encouraging discussion of realistic, individual goals that the athlete can enjoy progressing towards over time. You can also help motivate your athlete to maximise their potential by encouraging optimum nutrition, rest and training practices that facilitate a lifetime of enjoyment in sport, not just short-term success.
4. Help athletes embrace flexibility and avoid rigidity - particularly when it comes to training and nutrition. Where possible, try to encourage your athlete to strike a healthy balance between training, other hobbies, studies, work and social lives. Beware the athlete who sticks to a plan like glue, even if it means training through injury or illness, or missing out on important occasions. Avoid over-analysis of numbers with those who already display obsessive personality traits can be helpful. Beware the athlete who MUST do a 2.0 mile warm down and a 12.0 mile Sunday at 6 min mile pace. Try to remind your athlete every now and again that, above all else, sports should be enjoyable – no matter what their level or goals.
De-emphasise weight and appearance. Never mind what the laws of physics say about thinner = faster, the reality is that being under-fueled over time, regardless of weight, is not conducive to longterm health or performance. You can do your bit to de-emphasise the importance of weight/appearance by not passing comment about their appearance, weighing athletes, or comparing them to others. Weight can be a seriously sensitive topic and comments from an important influence like you can be perilous - no matter how subtle or well-intended.
Be aware of your influence. Your athletes most likely trust and respect your opinions, so be aware of the influence your messaging can have (no matter how well-meaning) when combined with the pressures of competition alongside harmful cultural ideals about body weight/composition. Instead of commenting on issues surrounding body composition and power-to-weight ratio's, what would help is for you to emphasise other avenues of improvement: strength, aerobic endurance, technical skills and the mental and emotional components of performance. Help your athlete to celebrate their growth and success beyond physical appearance or even short-term success. If body composition is a real concern then you can find a suitable dietitian who can help.
Know where to go for support. Finally, if an athlete you know is struggling, it helps to know where to turn for support. You can find some tried and trusted resources here, and more detailed, scientific information about RED-S here and here. *Unfortunately, behaviours like calorie counting, restricting specific foods/food groups, or following strict diets are often normalised within sport settings, but can greatly contribute to nutritional risk. Similarly, excessive exercise without adequate rest and recovery can increase risk of RED-S and demonstrate a sign of compulsion.