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Energy Deficiency and Performance in Female Athletes


*I wrote this article for Figure Skater Fitness Magazine, published: July 2016, Vol. 2 issue 3.

An athlete’s optimal performance is achieved with a great amount of energy output. This means that nutrient intake is a key factor in an athlete’s energy availability (EA). Low EA can compromise sport performance as well as the overall health of athletes and is a growing concern in competitive sports, particularly for female athletes. The International Olympic Committee published a consensus statement in 2005 on the female athlete Triad pointing to three major elements of low EA including disordered eating, menstrual irregularities, and a decreased bone mineral density (BMD). More recently a statement was released in 2014 about Relative Energy Deficiency in Sport (RED-S) expanding on the Triad to describe a “clinical status that results from energy deficiency affecting numerous aspects of physiological health and psychological health” (36). Understanding the fundamentals of both can improve the health of female athletes.

The amount of daily energy differs for every athlete and depends on factors such as duration and intensity of training. Essentially, EA is “dietary energy (kilocalorie) intake minus the energy used to support basal energy needs—thermoregulation, cellular maintenance, respiration, and immunity—as well as locomotion, thermic effect of food and growth” (36).

The first component of the female athlete Triad condition involves disordered eating and eating disorders. It indicates that disordered eating is a temporary change in eating behaviours, however, if an athlete displaying these irregularities is not educated on the required caloric intake, they can adapt to having a clinical eating disorder. Both can be detrimental to an athlete’s health and well-being. The second part of the Triad consists of menstrual dysfunction, including a delayed menarche, short infrequent menses, or the absence of menstruation, which can lead to a negative impact on bone health. The third element of the Triad concerns BMD, one aspect of bone strength. Low BMD can increase the risk of stress fracture and may be caused by an absence of menstruation.

Similar to the Triad, RED-S principal issue is that energy intake isn’t supporting the energy output. The difference is that it includes other variables that a low EA could negatively affect, such as psychological patterns.

In order to help prevent the Triad or RED-S, screenings should “occur at annual health examinations, and when an athlete has other problems such as a stress fracture, recurring illness or injury, a decrease in physical performance, severe weight loss, or [absence of menstruation]” (36). Ultimately, the best way to identify the Triad or RED-S is for the coaches and training professionals to work with a support team that includes a physician, Sports Registered Dietitian, and psychologist. Conclusively, coaches and trainers should engage in ongoing education surrounding the warning signs and guidelines to protect the health of the athletes.


Melinda W. Valliant. The Female Athlete Triad and Relative Energy Deficiency In Sport: Knowledge of Both Can Improve the Health of Female Athletes. Strength and Conditioning Journal: The Professional Journal of The National Strength and Conditioning Association 38: 35-39, 2016.


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