2023 International Olympic Committee's (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs)
Comprehensive Overview
Published in the British Journal of Sports Medicine in 2023, this consensus statement addresses how inadequate nutrition relative to exercise demands can silently damage the health and performance of athletes, a condition called Relative Energy Deficiency in Sport, or REDs, which occurs when an athlete's dietary energy intake fails to cover both daily bodily functions and the energy burned through training. A panel of 17 international experts spanning four continents, including sports physicians, an endocrinologist, dietitians, physiologists, a coach, and an athlete representative, was convened by the International Olympic Committee to update its 2018 guidance by systematically reviewing the scientific literature published since then and voting through a structured, two-round consensus process on statements summarizing the current evidence. The topline result was a substantially expanded understanding of REDs, including new evidence that inadequate carbohydrate intake specifically can worsen REDs-related health problems even when overall energy intake seems adequate, a clearer picture of how REDs overlaps with overtraining syndrome, growing recognition that REDs affects male as well as female athletes, and the introduction of a redesigned four-tier diagnostic tool to help clinicians identify and grade the severity of REDs in individual athletes.
Outcomes and Implications
The single most important development was the introduction of a new, more sophisticated diagnostic tool, the IOC REDs Clinical Assessment Tool-Version 2, which replaces a simpler three-category system with a four-color traffic-light scale, green to red, that grades an athlete's severity and risk by combining multiple primary and secondary clinical indicators rather than relying on any single test. The panel emphasized that REDs is not confined to female athletes with menstrual irregularities, its most historically recognized presentation, but also impairs male athletes through reduced testosterone, low libido, and impaired bone health, and can affect athletes with physical disabilities, who may face added risk from equipment and training constraints. The statement also detailed how REDs can quietly damage nearly every body system, including bone density, the gut, immune function, sleep, mood, and cardiovascular health, while simultaneously undermining performance through reduced strength, endurance, recovery, and motivation, and it highlighted new evidence that restricting carbohydrate intake specifically, even without an overall calorie deficit, can independently worsen these outcomes. For clinicians, coaches, and sports organizations, the authors stress that prevention depends on educating athletes and their support teams to recognize early warning signs, since REDs often develops gradually and its symptoms can be mistaken for normal training fatigue. They recommend a coordinated, multidisciplinary treatment approach centered on restoring adequate energy intake relative to exercise demands, while cautioning that body composition assessment carries real psychological risks and should be approached cautiously, especially in athletes under eighteen.