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Coach-facing warning sign triage
Recognizing RED-S
in Athletes
For coaches and parents who need a clear RED-S warning-sign screen without drifting into diagnosis
Warning signs of energy deficiency that coaches must recognize and address.
Evidence-basedCoach-safeReferral requiredNot diagnosticCitations on sheet
Keep the conversation private, factual, and referral-oriented.
Low Risk (Green)
No primary red flags and only one mild secondary signal.
Action: tighten fueling basics, keep notes, and watch whether the pattern resolves quickly.
Moderate Concern (Yellow)
One primary red flag or two to three secondary signals.
Action: refer soon, document what changed, and do not let the pattern linger unaddressed.
High Risk (Red)
Two or more primary red flags or one severe presentation.
Action: stop participation, escalate immediately, and follow school safety protocol the same day.
Risk Clusters
Behavioral
- Preoccupation with food, calories, or body weight.
- Skipping meals, cutting out carbs, or denying hunger repeatedly.
- Avoiding team meals or creating rigid food rules.
- Bathroom trips immediately after meals or food hiding.
- Visible stress when fueling plans change.
Physical
- Unexpected weight loss or stalled growth in a growing athlete.
- Bone stress injuries, repeat pain, or fractures that should raise urgency.
- Persistent fatigue, heavy legs, or slower recovery between sessions.
- Frequent illness, dizziness, feeling cold, or reduced training tolerance.
- Missed periods, longer cycles, or absent puberty milestones when relevant.
Psychological
- Irritability, low mood, or unusual withdrawal from teammates.
- Anxiety around food, team meals, or body comparison.
- Trouble concentrating, flat affect, or low motivation out of pattern.
- Perfectionism around restriction or praise-seeking around control.
- Body manipulation talk framed as discipline or performance.
Immediate Referral TriggersRefer to athletic trainer or physician today if you notice:
Rapid weight loss or marked drop in training tolerance
Bone pain, stress injury history, or recurrent fractures
BP < 90/45 or resting HR < 45 bpm when clinically concerning
Fainting, severe dizziness, or inability to finish easy sessions
What Not To Say
- Avoid body comments or praise for visible restriction.
- Do not say “you just need more discipline” or “you look lean.”
- Do not coach through obvious RED-S signals as a toughness issue.
- Do not wait for lab confirmation before taking a concerning pattern seriously.
Coach Action Steps
- 1Do not diagnose. Observe and record factual patterns only.
- 2Document: what changed, when you noticed it, and who else saw it.
- 3Have the conversation privately and without body commentary.
- 4Involve the athletic trainer, parent/guardian, and sports medicine support fast.
- 5Use performance, recovery, and health language instead of trying to debate food rules or motives.
Need more family support?
Scan to join the free Aspire Runner Fueling Lab.
https://aspireperformancerd.com/runner-fueling-lab?source=handout-recognizing-red-s-in-athletes-print