Beyond the Female Athlete Triad? Leading researchers suggest caution over recent IOC statement

A few months ago we added a new post with ‘breaking news’ that the International Olympic Committee expert working group had introduced a broader, supposedly more comprehensive term for the condition previously known as ‘Female Athlete Triad’.

The term ‘Relative Energy Deficiency in Sport’ (RED-S), is said to point to the complexity involved and the fact that male athletes are also affected. We offered the following links to the latest information on this topic here and in The British Journal of Sports Medicine.

Since the release of this IOC statement and publication, however, leading Female Athlete Triad researcher, Professor Mary Jane De Souza and 26 of her colleagues from across the United States and Canada, have responded with an article in the British Journal of Sports Medicine titled ‘Misunderstanding the Female Athlete Triad: Refuting the IOC Consensus Statement on Relative Energy Deficiency in Sports (RED-S)’. In this paper, the authors argue that ‘new terminology (RED-S) is insufficiently supported by scientific research to warrant adoption at this time’ (p. 1). Moreover, they argue:

“While we appreciate the need for improved thinking in medical science, we strongly believe it is unwise and misleading to propose a new approach based on faulty science. We strongly believe that it is unwise to distract and mislead the medical community from the well-known term ‘the Female Athlete Triad’. The IOC paper lacks scientific integrity in two ways. First, the scientific evidence of RED-S as it applies to men, non- Caucasians and disabled individuals is in its infancy and is not sufficiently developed to warrant a new theoretical construct. … Second, the IOC paper is fraught with errors and misinterpretations of the scientific literature per se” (p. 1).

Professor De Souza and colleagues also published the ‘2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad’ in the British Journal of Sports Medicine to offer a set of recommendations developed following the 1st (San Francisco, California, USA) and 2nd (Indianapolis, Indiana, USA) International Symposia on the Female Athlete Triad. According to the authors, “It is intended to provide clinical guidelines for physicians, athletic trainers and other healthcare providers for the screening, diagnosis and treatment of the Female Athlete Triad and to provide clear recommendations for return to play” (p. 1).

So, while one group of researchers is working to inform the IOC consensus statement regarding the use of RED-S instead of the Female Athlete Triad, another group are strongly arguing against this decision based on lack of scientific evidence, and are warning athletes, coaches, and others in the sport and exercise industry to take caution regarding this change in terminology and action.

One of our key aims here at Fuel Aotearoa is to make the latest research accessible to our readers. While we were initially excited to see the IOC acknowledging the complexities of these health issues for athletes and investing in research and action with the aim to protect the health and wellbeing of both female and male athletes, we recognize the need for such progress to be sufficiently informed by the most appropriate research. Thus, we will continue to refer to the ‘Female Athlete Triad’ rather than RED-S on our site. However, we are explicitly aware of ongoing debates surrounding terminology and action, and we promise to keep our readers updated as to the latest progress and advancements on this very important topic.