Chances are, you became a coach to help people reach their athletic potential, not to be a therapist, nutritionist or detective. However, you are in a position to cultivate an environment conducive not only to prevention of RED-S, but recognition and treatment too. Fortunately, there is considerable overlap between those practices that keep athletes healthy and those which improve and sustain their performances - so it's a win-win for us all.
- Be aware of the signs and symptoms of RED-S
- Be aware of our over-achieving tendencies. Us athletes are often eager to eke out every ounce of our potential and can be prone to pursuing any performance advantage - even if it means overlooking the long-term health consequences. You're here to help us think long-term about our performance and our bodies
- Help us set realistic, individual goals that we can enjoy progressing towards over time
- Help us embrace flexibility and avoid rigidity when it comes to our training plans. Be aware the athlete who sticks to a plan like glue, even if it means training through injury or illness, or missing out on important occasions etc...
- Try to avoid over-analysis of numbers with those of us who already display obsessive personality traits. Beware the athlete who simply has to do a 2.0 mile warm down and a 12.0 mile Sunday at 6 min mile pace...
- Encourage us to strike a healthy balance between training, other hobbies, studies, work and social lives
- Motivate us to maximise our potential by adopting optimum nutrition, rest and training practices that facilitate a lifetime of enjoyment in sport, not just short-term success
- De-emphasise our weight and appearance (more on this below)
- Try to remind us now and then that above all else, that sports should be enjoyable – no matter what our level or goals
Never mind what the laws of physics and certain ‘racing weight’ articles may say about thinner = faster – the reality is that being under-fueled over time, regardless of weight, is not conducive to health or performance longevity. Your athletes most likely trust and respect your opinions, so please 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.
You can do your bit to de-emphasise the importance of our weight/appearance by not passing comment, weighing us, or comparing us to Susan from Southport AC who may be running fast because she shed a few pounds lately. Weight can be a seriously sensitive topic for many athletes and comments from an important influence like you can be perilous - no matter how subtle or well-intended.
Here are a few examples of how things can get misinterpreted:
Coach comment: “Sam, you’re looking super strong after all that strength and conditioning work. Nice one.”
Sam's thought: “Damn, I knew S&C would make me bulky. Now I need to find a way to get leaner”.
Suggested coach comment: “Sam, how are you finding your S&C? You seem to be pushing on strong towards the end of your reps. Great work!”
What would help is to emphasize other avenues of improvement: strength, aerobic endurance, technical skills and the mental and emotional components of performance. Help us celebrate our growth and success beyond physical appearance or even short-term success and if body composition is a real concern, then please, find a suitable dietitian who can help.
Coach comment: “Alex, you’re looking lean. Are you eating well?”
Alex's thought: “Cool, what I'm doing is clearly working. I'll keep cutting back on carbs”.
Suggested coach comment: “Alex, how are you feeling? Do you have the support you need staying fit and healthy through the long season ahead?”
Early, directly, supportively and confidentially. Try not to make off the cuff comments but have a proper conversation at a suitable time. RED-S can be caused by a number of reasons, ranging from simply underestimating the nutritional demands of their activities to intentional calorie restriction, so try not to jump to any conclusions. The last thing you want is for your athlete to feel ‘accused’ of, or ashamed of, anything.
You could start by asking how they are, or expressing concern about a particular event. For example, “Alex, is everything ok? I’ve noticed you’ve been fatigued a lot recently and your mood seemed really low today. Do you want to talk about it?”. If they choose to open up to you - great, but be prepared for a brief or dismissive response. If the symptoms you’ve noticed are a result of intentional calorie restriction, the athlete may well be in denial about it, or afraid of judgement from someone like you, who they trust and respect.
Do your best to reassure them by reminding them how athletes who train as hard as they do often need nutritional or psychological support. Then you could ask if they’d be open to seeking some. Remember, it’s not your job to diagnose anything or provide nutritional or medical advice (unless you’re qualified to). What you can do, is be there for your athlete in an open, non-judgmental way while helping to direct them towards professionals who can help. Sending them the link to this website could be a good place to start 😉.
Since RED-S occurs along a spectrum of severity, recovery time can differ greatly across individuals. The first step is find the appropriate support resources, i.e. experienced professionals who can assess an athlete’s nutritional, physical, and mental health. Where there is presence of an eating disorder or disordered eating behaviours, psychological help is often required. As a coach, you don’t need to hold the answers to how long it'll take for your athlete to recover, but rather who to turn to for guidance on how.
To our knowledge, there is no clear guidance on this matter. However, in our experience, it is possible to continue some exercise while recovering from RED-S. Often, a period of rest will be recommended in the first instance since the priority is to address the issue of low energy availability.
As explained by Currie on the topic of eating disorder recovery in sport (cite), “there is a clear parallel here with the athlete returning to sport after a serious injury. Returning to a light training load is the first step and as recovery progresses the training load increases until eventually the athlete is ready to return to competition. A graded return like this can serve as a powerful reward for making progress in therapy. As with injury rehabilitation, close cooperation between the therapist/physician and coach/athlete is essential".
Again, as explained by Currie (2010): "Difficult and painful decisions such as taking time away from training can be made easier when there is an open and trusting working relationship between athletes, coaches and clinicians and where processes are explicit from the outset. A coach and athlete should be in agreement about what each expects from the other. A professional athlete under a contract should be clear about what medical support will be provided, in what circumstances and what is expected in return. This might include subjecting him or herself to health screening and being expected to take advantage of health care when it is offered. The criteria to be used if an athlete is not allowed to train or compete on health grounds may need to be stated. Applicable criteria include acute medical conditions that make it unsafe to compete or more chronic conditions that are incompatible with sustained training or competition. Many contracts are also explicit about the circumstances under which the contract will end. This is usually a consequence of deteriorating performances, ill health or injury (or a combination of the three). An athlete should expect that all health problems (whether injury, eating disorders or any other illness) are treated equally. It would be unhelpful and unjust to apply different criteria to exclude an athlete with an eating disorder".
Currie A. (2010). Sport and eating disorders - understanding and managing the risks. Asian journal of sports medicine, 1(2), 63–68. https://doi.org/10.5812/asjsm.34864
Sherman, R. T., & Thompson, R. A. (2001). Athletes and disordered eating: Four major issues for the professional psychologist. Professional Psychology: Research and Practice, 32(1), 27–33. https://doi.org/10.1037/0735-7028.32.1.27