Br J Sports Med 48:491-497 doi:10.1136/bjsports-2014-093502
  • Consensus statement

The IOC consensus statement: beyond the Female Athlete Triad—Relative Energy Deficiency in Sport (RED-S)

Editor's Choice
  1. Arne Ljungqvist9
  1. 1Department of Family Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
  2. 2Department of Sports Medicine, The Norwegian School of Sport Sciences, Oslo, Norway
  3. 3Department of Sports Nutrition, Australian Institute of Sport, Belconnen, Australia
  4. 4University of Northern Colorado, University of Colorado Medical School, Lakewood, Colorado, USA
  5. 5Orthopedic Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
  6. 6Department of Family Medicine, Faculty of Medicine & Dentistry, Glen Sather Sports Medicine Clinic, University of Alberta, Edmonton, Alberta, Canada
  7. 7Health Sciences Department and United States Olympic Committee, University of Colorado, Colorado Springs, Colorado, USA
  8. 8The Victory Program at McCallum Place, St. Louis, Missouri, USA
  9. 9IOC Medical and Scientific Department, Lausanne, Switzerland
  1. Correspondence to Dr Margo Mountjoy, Department of Family Medicine, Michael G. DeGroote School of Medicine, McMaster University Waterloo Regional Campus, 10-B Victoria Street South, Kitchener, Ontario, Canada N2G 1C5; mmsportdoc{at}
  • Accepted 3 February 2014


Protecting the health of the athlete is a goal of the International Olympic Committee (IOC). The IOC convened an expert panel to update the 2005 IOC Consensus Statement on the Female Athlete Triad. This Consensus Statement replaces the previous and provides guidelines to guide risk assessment, treatment and return-to-play decisions. The IOC expert working group introduces a broader, more comprehensive term for the condition previously known as ‘Female Athlete Triad’. The term ‘Relative Energy Deficiency in Sport’ (RED-S), points to the complexity involved and the fact that male athletes are also affected. The syndrome of RED-S refers to impaired physiological function including, but not limited to, metabolic rate, menstrual function, bone health, immunity, protein synthesis, cardiovascular health caused by relative energy deficiency. The cause of this syndrome is energy deficiency relative to the balance between dietary energy intake and energy expenditure required for health and activities of daily living, growth and sporting activities. Psychological consequences can either precede RED-S or be the result of RED-S. The clinical phenomenon is not a ‘triad’ of the three entities of energy availability, menstrual function and bone health, but rather a syndrome that affects many aspects of physiological function, health and athletic performance. This Consensus Statement also recommends practical clinical models for the management of affected athletes. The ‘Sport Risk Assessment and Return to Play Model’ categorises the syndrome into three groups and translates these classifications into clinical recommendations.