Relative Energy Deficiency in Sport (REDs): Risk Assessment in Collegiate Female Athletes
Kelsea Nunes1, Kelly Pritchett1, Robert Pritchett1
1Department of Health Sciences, Central Washington University, Ellensburg, WA, 98926, USA.
International Journal of Exercise Science
|July 28, 2026
Summary
Low energy availability (LEA) and Relative Energy Deficiency in Sport (REDs) risk is low in Division II female athletes. Disordered eating, indicated by elevated Eating Disorder Examination Questionnaire (EDE-Q) scores, is a key risk factor for REDs.
Area of Science:
- Sports Medicine
- Exercise Physiology
- Sports Nutrition
Background:
- Low energy availability (LEA) is a risk factor for Relative Energy Deficiency in Sport (REDs) in female athletes.
- Division II collegiate athletes, particularly those in ball sports, may be susceptible to LEA due to energy intake (EI) and exercise energy expenditure (EEE) imbalances.
- Chronic LEA can progress to problematic LEA, increasing the risk of REDs and associated health issues.
Purpose of the Study:
- To assess the prevalence and severity of REDs in Division II female collegiate ball sport athletes.
- To evaluate REDs risk using the REDs Clinical Assessment Tool 2 (CAT2) and the Female Athlete Triad Cumulative Risk Assessment (FAT CRA) tool.
- To identify factors contributing to REDs risk, including disordered eating patterns and physiological markers.
Main Methods:
- Twenty-seven female athletes from volleyball, soccer, basketball, and rugby participated.
- Data collected included demographics, injury history, depression, eating disorders (EDs), Eating Disorder Examination Questionnaire (EDE-Q), Low Energy Availability in Females Questionnaire (LEAF-Q), and dual X-ray absorptiometry (DXA).
- REDs risk was determined using the REDs CAT2 Tool and Triad risk using the FAT CRA.
Main Results:
- 85.2% of athletes presented with no or low risk of REDs, while 15% had mild risk.
- An elevated EDE-Q score was more prevalent in athletes with mild REDs risk (p<0.001).
- Global and shape concerns on the EDE-Q were strongly associated with increased REDs risk (rs(25)=0.61, p<0.001; rs(25)=0.6, p<0.001).
Conclusions:
- REDs risk was generally low in this cohort of Division II female ball sport athletes.
- Elevated EDE-Q global scores, indicating disordered eating, were the most significant indicator of REDs risk.
- Disordered eating risk appears to be as influential as physiological markers in identifying athletes at risk for REDs.
