Relative Energy Deficiency in Sport (RED-S) is a clinical syndrome comprising low energy availability (LEA) as a result of over-training and a negative calorific balance. This syndrome has a wide range of biological, physiological and psychological effects on athletes. These include hormonal changes, low bone density and depression. Diagnosis of RED-S is challenging, as often initial signs are subtle and not widely recognized by general physicians, and access to imaging can be difficult. In this narrative review we discuss the consequences of RED-S, risk factors for the condition and management. Emergence of educational resources such as the BASEM (British Association of Sports and Exercise Medicine) Health and Performance website and the RED-S Clinical Assessment Tool (CAT) is improving understanding of this condition. We highlight a literature gap which is leading to difficulty identifying and managing athletes with health consequences subsequent to low energy availability. Notably, there is a dearth of research in para-athletes, minority group athletes and adolescents. Thus, we propose an increase in implementation of previous research and further funding for large scale studies to define the long-term health and performance consequences of LEA, which will in turn educate and lead to better outcomes for patients.
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