Understanding Relative Energy Deficiency in Sport

Relative energy deficiency in sport (REDs) is a clinical condition resulting from low energy availability that affects physiological function and performance in athletes of all genders and ages. REDs is increasingly recognized in pediatric populations, particularly in endurance, aesthetic, and weight-class sports, such as long-distance running, gymnastics, and wrestling, respectively. REDs is a multisystem condition characterized by hormonal dysfunction, low bone density, or psychological disturbances, and is associated with increased injury risk and impaired performance. Management centers on restoring energy balance through nutritional and behavioral interventions, and prevention strategies emphasize education and early recognition. This review synthesizes current evidence on REDs in adolescent athletes, emphasizing current understanding of risk factors, clinical presentation, practical approaches to evaluation and management, and prevention strategies to support pediatricians in the management of REDs in the primary care setting.