Written and developed by Morgan Muchez, Dietetic Intern
What is it?
RED-s (Relative Energy Deficiency in Sport) is a fairly new term that describes the consequences and physiological effects of not consuming enough calories. Unlike the Female Athlete Triad, which describes the combination of disordered eating and the loss of a menstrual cycle leading to bone health consequences, RED-s encompasses several other health complications. These include, metabolic slowing; immune system decline; GI complications like delayed gastric emptying and constipation; hormone imbalances like hunger and growth hormone suppression; cardiovascular risks; and decreased rate of protein synthesis or building. When an athlete restricts caloric intake for long periods of time, the lack of nutrients can hinder both performance and lead to long-term health consequences.
Who is at Risk?
Athletes participating in highly competitive sports or those that require skin-tight uniforms that show more of their physique. Often times, an individual can be triggered to start “clean” or restrictive eating to improve sports performance or due to comments by parents, coaches, and teammates.
There is a fine line between disordered eating and an eating disorder. Be aware of some signs of disordered eating so that the individual can be helped before it develops into an eating disorder:
What Can I do if I notice someone who has these tendencies?
Navigate a conversation with them - let them know you are there to support them. It is important to intervene before it becomes an eating disorder. Please tread with caution as food is always a tricky subject to talk about. You can talk to a dietitian, like Allison, who specializes in sports nutrition and eating disorders. She can give you suggestions on how a conversation can go, or even meet with the individual.
Want a print out that you can share with others? See the attached printable handout below!
Photo Credit: https://pixabay.com/en/users/Myriams-Fotos-1627417/
Do any of you hate clothes shopping as much as I do? Stereotypes tell me that, as a woman, I should love shopping (especially with my girlfriends at a mall) … well, I really hate it! Not only because of the overwhelming feelings that ensue upon walking into a Kohls, but also because of the never-ending search for the perfect fitting jeans. I may end up at 8 different stores trying on a million sizes until I find one pair that fits.
Clothes sizing is extremely complicated for women. And manufacturers have made it a little (a lot) more complicated due to a little thing called “vanity sizing”. This trick, which is also called size inflation, is when clothing manufacturers label clothes smaller than the actual cut of the item. For example, size 10 jeans, may actually be closer to a size 12 or 14. The Washington Post published an article in 2015 showing the sizing deviations via charts… A size 14 in 1958 is now considered a size 8. Sizing is also SUPER inconsistent between stores – they can vary as much as 4 or 5 inches!
Why do they do this, you ask? Manufacturers are lowering sizes on labels to influence consumers’ buying decisions, and ultimately to inspire them to buy more. Would you feel better walking out of Forever 21 with a size 14 or a size 10? Are you more likely to purchase more if you are buying a size 10, rather than a size 16? By changing the labels on clothing, manufacturers are making consumers feel skinnier, which makes them feel good. This also means they are sending a message to women that they need to be smaller. Men are not free from this deception either. A journalist found and wrote in Esquire that his size 34 pants from Old Navy actually measured at a 39.
My question is, why does pop culture and our fat-phobic society think that EVERYONE wants to be skinnier? What about women who embrace their curves; think Beyonce and Melissa McCarthy. This kind of deception from manufacturers is dangerous. Women feel that they have to “perfectly” fit into their size at every store. If they are a size 4 at one store, but a size 8 at another, this leads to obsession, which leads to dieting, excessive exercise, and weighing, which leads to disordered eating. All just to meet that smaller body standard set by society. But, who ever said smaller bodies were healthier anyways?
Research suggests that, except at extremes, body mass index (BMI) only weakly predicts how long someone will live; and that people who are overweight or moderately obese (by BMI standards) live as long as normal weight people; and oftentimes longer. In fact, one of the most comprehensive reviews of body weight and mortality risk research pooled data from 26 studies and over 350,000 subjects and found overweight to be associated with greater longevity than normal weight. Of course, we do know that obesity is associated with an increased risk for many diseases; however, causation is less well-understood. Epidemiological studies rarely include factors like activity, nutrient intake, or socioeconomic status when looking at the connection between BMI and disease. Yet all of these factors play a role in determining health and disease risk. When studies do control for these factors, risk of disease is significantly reduced or completely disappears. It is likely that these factors, like a sedentary lifestyle, increases disease risk while also increasing the risk of a higher BMI.
The most frustrating thing about all of this is that our society continues to send messages to women that they need to be in thinner bodies for their health, when the research is just not there to back that up.
Bacon, L., & Aphramor, L. (2011). Weight science: evaluating the evidence for a paradigm shift. Nutrition journal, 10(1), 9.
Campos, P., Saguy, A., Ernsberger, P., Oliver, E., & Gaesser, G. (2005). The epidemiology of overweight and obesity: public health crisis or moral panic?. International journal of epidemiology, 35(1), 55-60.
Flegal, K. M., Graubard, B. I., Williamson, D. F., & Gail, M. H. (2005). Excess deaths associated with underweight, overweight, and obesity. Jama, 293(15), 1861-1867.
Flegal, K., Graubard, B., Williamson, D., & Gail, M. (2008). Supplement: response to “can fat be fit”. Sci Am, 297, 5-6.
McGee, D. L., & Diverse Populations Collaboration. (2005). Body mass index and mortality: a meta-analysis based on person-level data from twenty-six observational studies. Annals of epidemiology, 15(2), 87-97.
Warning – major rant ahead!
I have to tell my readers about something that happened today. Something so frustrating and enraging that I cannot stop thinking about it. This something is a conversation I had. Here is an overview of what went down:
I saw an adolescent patient today that presented with severe disordered eating – restricting most days by only drinking water and sometimes milk, with one large binge per week, followed by purging. This patient reports a 25 pound weight loss since July and that these behaviors have been going on for several months. The complicating factor is that this patient is a normal weight/a bit overweight. The only difference between this patient and the other patients I see struggling with eating disorders is the fact that she has a normal BMI. The conversation that I mentioned above, involves my being asked my reasoning for wanting to treat the disordered eating. When I explained what was relayed to me by the patient, this person said, “I don’t know why you’re worried about her weight. Patients like this are okay not eating for a couple weeks” ...
I was flabbergasted! Of course, I am not worried about her weight; I don’t focus on weight! What I am worried about is her severely disordered and dangerous behaviors around food. Letting this continue and not helping her through her struggles with food and body image is setting her up for an extremely harsh and difficult relationship with food for a long time. My question is, why is everyone so focused on weight? Why can’t we help people of all shapes and sizes that struggle with disordered eating and a poor body image? Here are just a few examples of some of the patients I have worked with that have developed eating disorders due to weight-related issues:
The most important thing to realize about weight bias and judging others because of their body size is that it makes you judgmental about yourself and robs you of your compassion and connection with others. Just stop it already. Also, please understand that people of all shapes and sizes suffer from eating disorders; not just thin, white women. And they all deserve help.
Allison Tropf, MS, RD, CSSD
Allison is a Sports Dietitian in Michigan. She enjoys helping others reach their nutrition and fitness goals through reliable and trustworthy recommendations.
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