The barriers and facilitators of improving energy availability amongst females clinically diagnosed with Relative Energy Deficiency in Sport (REDs).

Background: Relative Energy Deficiency in Sport (REDs) is a serious clinical condition. However, there is little research in athletes with a clinical diagnosis and limited evidence on the recovery of REDs.

Methods: This is a cross-sectional retrospective study whereby 55 (25.62±6.33 years) female patients with a prior diagnosis of REDs by an experienced medical specialist participated in an online questionnaire designed to capture their experience of a sports dietitian consultation and subsequent implementation of a personalized energy availability (EA) plan.

Results: A 31% increase (N.=4 vs. N.=16, P=0.002) in normal menstruation, a 22% reduction (N.=39 vs. N.=27, P=0.032) in gastrointestinal symptoms, and a 94% reduction (N.=16 to N.=1) in a very poor/poor appetite were reported following the consultation and plan implementation. Required energy intake (EI) was under-estimated by 93% of participants. Intake pre-exercise was implemented most frequently (69%, N.=38), and least likely to elicit feelings of stress and anxiety (69%, N.=38). Weight gain/shape change was the most frequently reported barrier to implementation (62%, N.=34). Eating to a planned regime (35%, N.=19) and following a timing of intake (33%, N.=18) gave the most confidence.

Conclusions: Providing an athlete with an education of their current and required EA, alongside an illustrated personalized EI plan structured around exercise, may provide the "lightbulb" moment needed to overcome the associated anxiety when increasing their EI when recovering from REDs.