Table 1

Relative Energy Deficiency in Sport risk assessment model for sport participation (modified from Skårderud et al)140

High risk: no start red lightModerate risk: caution yellow lightLow risk: green light
▸ Anorexia nervosa and other serious eating disorders
▸ Other serious medical (psychological and physiological) conditions related to low energy availability
▸ Extreme weight loss techniques leading to dehydration induced haemodynamic instability and other life-threatening conditions
▸ Prolonged abnormally low % body fat measured by DXA or anthropometry using The International Society for the Advancement of Kinanthropometry ISAK141 or non-ISAK approaches142
▸ Substantial weight loss (5–10% body mass in 1 month)
▸ Attenuation of expected growth and development in adolescent athlete
▸ Healthy eating habits with appropriate energy availability
▸ Abnormal menstrual cycle: FHA amenorrhoea >6 months
▸ Menarche >16 years
▸ Abnormal hormonal profile in men
▸ Normal hormonal and metabolic function
▸ Reduced BMD (either from last measurement or Z-score < −1 SD).
▸ History of 1 or more stress fractures associated with hormonal/menstrual dysfunction and/or low EA
▸ Healthy BMD as expected for sport, age and ethnicity
▸ Healthy musculoskeletal system
▸ Athletes with physical/psychological complications related to low EA/disordered eating - ECG abnormalities- Laboratory abnormalities
▸ Prolonged relative energy deficiency
▸ Disordered eating behaviour negatively affecting other team members
▸ Lack of progress in treatment and/or non-compliance
  • BMD, bone mineral density; DXA, dual-energy X-ray absorptiometry; EA, energy availability; FHA, functional hypothalamic amenorrhoea; ISAK, International Society for the Advancement of Kinanthropometry