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Authors’ 2015 additions to the IOC consensus statement: Relative Energy Deficiency in Sport (RED-S)
  1. Margo Mountjoy1,
  2. Jorunn Sundgot-Borgen2,
  3. Louise Burke3,
  4. Susan Carter4,
  5. Naama Constantini5,
  6. Constance Lebrun6,
  7. Nanna Meyer7,
  8. Roberta Sherman8,
  9. Kathrin Steffen2,9,
  10. Richard Budgett9,
  11. 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, 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, 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 Margo Mountjoy, Department of Family Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada; mmsportdoc{at}

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In April 2014, the International Olympic Committee (IOC) published a Consensus Statement in this journal entitled “Beyond the Female Athlete Triad: Relative Energy Deficiency in Sport (RED-S)”.1 In reference to that Consensus Statement, Professor Mary Jane De Souza and colleagues published an editorial (July 2014).2 The editorial below expands on the original Consensus Statement and comments on the 2014 Editorial by Professor Mary Jane De Souza and colleagues.

Relative Energy Deficiency in Sport (RED-S)

Albert Einstein said: “The important thing is to never stop questioning.” A group of 11 IOC authors have called attention, as others in the past,3 ,4 to a problem that is wider and more complex than originally identified when the term ‘Female Athlete Triad’ (Triad or FAT) was first coined in 1992. Just as knowledge evolves, so too should ideas and constructs on how to address it.

Given the evolution of science since 1992, and to more accurately describe the clinical syndrome originally known as the Female Athlete Triad, the IOC introduced a more comprehensive, broader term: Relative Energy Deficiency in Sport. The syndrome of RED-S refers to impaired physiological functioning caused by relative energy deficiency, and includes but is not limited to impairments of metabolic rate, menstrual function, bone health, immunity, protein synthesis, and cardiovascular health.

Our April 2014 Consensus statement identifies the aetiological factor underpinning the syndrome as: an energy deficiency relative to the balance between dietary energy intake and the energy expenditure required to support homeostasis, health and the activities of daily living, growth and sporting activities.

We reaffirm the principle that the IOC Consensus Statement highlights about energy deficiency/low energy availability among exercising people. De Souza and colleagues’ editorial criticises the use of the word ‘balance,’ suggesting that the IOC authors have confused the terms energy availability and energy balance. We used the term …

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