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  • Intersection of mental health issues and Relative Energy Deficiency in Sport (REDs): a narrative review by a subgroup of the IOC consensus on REDs

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Intersection of mental health issues and Relative Energy Deficiency in Sport (REDs): a narrative review by a subgroup of the IOC consensus on REDs
  1. Anne Marte Pensgaard1,
  2. Jorunn Sundgot-Borgen2,
  3. Carla Edwards3,
  4. Astrid Urenholdt Jacobsen4,
  5. Margo Mountjoy5,6
  1. 1 Sport and Social Sciences, Norwegian School of Sports Sciences, Oslo, Norway
  2. 2 Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
  3. 3 McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
  4. 4 Norwegian Olympic and Paralympic Committee and Confederation of Sports, Oslo, Norway
  5. 5 Association for Summer Olympic International Federations (ASOIF), Lausanne, Switzerland
  6. 6 Department of Family Medicine, Hamilton, Hamilton, Ontario, Canada
  1. Correspondence to Professor Anne Marte Pensgaard, Sport and social sciences, Norwegian School of Sports Sciences, Oslo 0863, Norway; annemp{at}nih.no

Abstract

Overall athlete health is a stated priority by the International Olympic Committee (IOC), yet it can be difficult for athletes to safely balance nutritional needs, training load, recovery, social interactions, expectations and other demands. The effect of energy intake and, especially, low energy availability (LEA) on athlete mental health, is understudied. In this narrative review, we examine research that has included psychological factors and mental health variables when investigating the effect of LEA, dieting/restrictive eating and Relative Energy Deficiency in Sport (REDs), since the 2018 IOC consensus statement on REDs. Based on currently available data, early psychological indicators associated with problematic LEA are mood changes, fatigue and psychological conflict. More severe mental health outcomes associated with REDs are reduced well-being, elevated anxiety, depressive symptoms and eating disorders. We propose a psychological model that helps structure how possible risk factors (eg, body dissatisfaction, environmental demands or increased training load) and moderating (eg, gender, sport) and/or potential mediating (eg, social climate, self-esteem) factors are associated with LEA and ultimately REDs. The current scientific literature underscores the importance of including mental health factors when screening for REDs and for developing a clinical approach to address the psychological sequelae of REDs once diagnosed. An interdisciplinary perspective is recommended. Lastly, and importantly, the athlete perspective urges clinicians to not underestimate the drive for success and denial of health consequences that athletes demonstrate when pursuing their sport goals.

  • Relative Energy Deficiency in Sport
  • Sports medicine
  • Psychology, Sports
  • Energy intake

https://doi.org/10.1136/bjsports-2023-106867

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    Footnotes

    • Twitter @Edwards10Carla, @margo.mountjoy

    • Contributors All authors were involved in the conception, drafting, discussion, revising and approval of the final manuscript prior to submission.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests MM is a deputy editor of the BJSM and a member of the BJSM IPHP Editorial Board.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.