When to use this
When warning signs start clustering in one athlete and the adults around her need to decide what to say and who to call.
- An athlete is showing two or more flags at once — cycle changes, bone stress, constant fatigue, or a mood shift.
- A coach is preparing for a careful one-on-one conversation and wants the language right before it starts.
- Training volume just jumped — new season, doubles, or an altitude camp — and the staff wants fueling norms set early.
Advanced lab
The screening conversation and the referral tree
The sheet lists the flags. What a coach may ask, what a coach never asks, and the point where noticing becomes referral are here — because the conversation is where most adults get stuck.
This framework helps adults notice and refer — it is not a diagnostic tool. Evaluation and the plan belong with a sports medicine physician and a sports dietitian, with mental health support added whenever it would help.
Evidence sources
These references support the handout’s general education. Individual medical, supplement, laboratory, or injury questions should be handled by the appropriate qualified clinician.
- Mountjoy M, Ackerman KE, Bailey DM, et al. IOC consensus statement on Relative Energy Deficiency in Sport (RED-S): 2023 update. Br J Sports Med. 2023.
- De Souza MJ, Nattiv A, Joy E, et al. 2014 Female Athlete Triad Coalition consensus statement on treatment and return to play. Br J Sports Med. 2014.
- Logue DM, Madigan SM, Delahunt E, et al.Low energy availability in athletes: a review of prevalence, dietary patterns, and health consequences.Sports Med.2018.
Where to go next
