The Role of Social Factors in Relative Energy Deficiency Risk for Female Collegiate Athletes


  • Lauren Masden, BA Department of Exercise Science, Bellarmine University, Louisville, Kentucky, USA
  • Allison Tripure BA, CSCS Department of Exercise Science, Bellarmine University, Louisville, Kentucky, USA
  • Sara Mahoney, PhD, FACSM Department of Exercise Science, Bellarmine University, Louisville, Kentucky, USA



RED-S, female athlete, low energy availability


BACKGROUND: Relative Energy Deficiency in Sport (RED-S) refers to compromised functioning of one’s metabolism, reproductive system, immune system, cardiovascular system and more due to a relative energy deficiency. Most prevailing RED-S research has focused on its physiological symptoms, yet little data exists regarding the psychological and social aspects that might contribute to its development.  The purpose of this study is to determine the role of psychosocial      factors in RED-S risk for female collegiate athletes.

METHODS: 105 female collegiate athletes under National Collegiate Athletic Association (NCAA) jurisdiction were surveyed representing a variety of varsity sports. All participants were assessed for low energy availability using the Low Energy Availability in Females Questionnaire (LEAF-Q) through an online survey battery, which also included sources of nutrition information scale (SONI scale), the revised group environment questionnaire (GEQ), and the revised exercise group social provisions scale (EXSPS questionnaire).      The participants were sorted into an At Risk (AR) and Not At Risk (NAR) group based on their LEAF-Q scores. One-tailed independent t-tests and chi square tests were used to determine the difference between AR and NAR for dependent measures, and multiple linear regression determined the relationship between risk of LEA and GEQ, EXSPS, and SONI.

RESULTS: Overall, 66 participants (62.8%) were at risk for LEA based on LEAF-Q scores. Significant differences were identified between the AR (11.5%; 66.7%) and NAR (40.0%; 37.0%) groups regarding comfort with discussing nutrition with coaches or teammates, respectively (p = 0.034, p = 0.035). However, none of the social measures predicted LEA risk (group cohesion: R = 0.04,  p = 0.92; social support: R = 1.85, p = 0.09; SONI: p = 0.136) Awareness of RED-S (using a Yes (1) or No (0) question) was also found to be not significantly different between the AR (0.28  ± 0.45, 29%) and NAR (0.39 ± 0.50, 41%) groups (p = 0.12).

CONCLUSION: Overall, risk for RED-S is high in female collegiate athletes, however group cohesion, social support, and the athletes’ sources of nutrition information did not predict RED-S incidence.


Logue, D.M., et al., Low Energy Availability in Athletes 2020: An Updated Narrative Review of Prevalence, Risk, Within-Day Energy Balance, Knowledge, and Impact on Sports Performance. Nutrients, 2020. 12(3).

Otis, C.L., et al., American College of Sports Medicine position stand. The Female Athlete Triad. Med Sci Sports Exerc, 1997. 29(5): p. i-ix.

Mountjoy, M., et al., The IOC consensus statement: beyond the Female Athlete Triad--Relative Energy Deficiency in Sport (RED-S). Br J Sports Med, 2014. 48(7): p. 491-7.

Mountjoy, M., et al., IOC consensus statement on relative energy deficiency in sport (RED-S): 2018 update. Br J Sports Med, 2018. 52(11): p. 687-697.

Dipla, K., et al., Relative energy deficiency in sports (RED-S): elucidation of endocrine changes affecting the health of males and females. Hormones (Athens), 2021. 20(1): p. 35-47.

Civil, R., et al., Assessment of Dietary Intake, Energy Status, and Factors Associated With RED-S in Vocational Female Ballet Students. Front Nutr, 2018. 5: p. 136.

Coelho, A.R., et al., The Female Athlete Triad/Relative Energy Deficiency in Sports (RED-S). Rev Bras Ginecol Obstet, 2021. 43(5): p. 395-402.

Wasserfurth, P., et al., Reasons for and Consequences of Low Energy Availability in Female and Male Athletes: Social Environment, Adaptations, and Prevention. Sports Med Open, 2020. 6(1): p. 44.

Jagim, A.R., et al., Contributing Factors to Low Energy Availability in Female Athletes: A Narrative Review of Energy Availability, Training Demands, Nutrition Barriers, Body Image, and Disordered Eating. Nutrients, 2022. 14(5).

Langbein, R.K., et al., "I'd got self-destruction down to a fine art": a qualitative exploration of relative energy deficiency in sport (RED-S) in endurance athletes. J Sports Sci, 2021. 39(14): p. 1555-1564.

Arthur-Cameselle, J.N. and Quatromoni, P.A. Factors related to the onset of eating disorders reported by female collegiate athletes. The Sport Psychologist, 2011. 25(1): p. 1-17.

Chang, C., et al., Mental health issues and psychological factors in athletes: detection, management, effect on performance and prevention: American Medical Society for Sports Medicine Position Statement-Executive Summary. Br J Sports Med, 2020. 54(4): p. 216-220.

Engel, S.G., et al., Predictors of disordered eating in a sample of elite Division I college athletes. Eat Behav, 2003. 4(4): p. 333-43.

Henriksen, K., et al., Consensus statement on improving the mental health of high performance athletes. International Journal of Sport and Exercise Psychology, 2020. 18(5): p. 553-560.

Hefner, J. and Eisenberg, D. Social support and mental health among college students. Am J Orthopsychiatry, 2009. 79(4): p. 491-9.

Zimanyi, Z., Wolff, W., and Schüler, J. Too Much of a Good Thing? Exercise Dependence in Endurance Athletes: Relationships with Personal and Social Resources. Int J Environ Res Public Health, 2021. 18(6).

Brawley, L.R., Carron, A.V., and Widmeyer, W.N. Assessing the cohesion of teams: Validity of the Group Environment Questionnaire. Journal of Sport and Exercise Psychology, 1987. 9(3): p. 275-294.

Cutrona, C.E. and Russell, D.W. The provisions of social relationships and adaptation to stress. Advances in personal relationships, 1987. 1(1): p. 37-67.

Melin, A., et al., The LEAF questionnaire: a screening tool for the identification of female athletes at risk for the female athlete triad. British journal of sports medicine, 2014. 48(7): p. 540-545.

Mahoney, S.E., Wójcicki, T.R., and Carnes, A.J. Sources of Nutrition Information in Recreational Ultra-marathon Runners: A Mixed Methods Analysis. Journal of Human Performance in Extreme Environments, 2020. 16(1): p. 1.

Embry, A., Luttrell, E., and Smith, C. A Study of Athletes and Bodybuilders Use and Assessment of Nutritional Sources. Journal of the Academy of Nutrition and Dietetics, 2023. 123(10): p. A14.

Zaccagni, L. and Gualdi-Russo, E. The Impact of Sports Involvement on Body Image Perception and Ideals: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health, 2023. 20(6).

Mrazik, M., et al. A qualitative review of sports concussion education: prime time for evidence-based knowledge translation. Br J Sports Med, 2015. 49(24): p. 1548-53.

Shanley, E., et al., Heads Up Football Training Decreases Concussion Rates in High School Football Players. Clin J Sport Med, 2021. 31(2): p. 120-126.

Boidin, A., et al., The effectiveness of nutrition education programmes on improving dietary intake in athletes: a systematic review. Br J Nutr, 2021. 125(12): p. 1359-1373.

Gu, S. and Xue, L. Relationships among Sports Group Cohesion, Psychological Collectivism, Mental Toughness and Athlete Engagement in Chinese Team Sports Athletes. Int J Environ Res Public Health, 2022. 19(9).

Holland, G. and Tiggemann, M. A systematic review of the impact of the use of social networking sites on body image and disordered eating outcomes. Body Image, 2016. 17: p. 100-10.

McHaffie, S.J., et al. Normalising the conversation: a qualitative analysis of player and stakeholder perceptions of menstrual health support within elite female soccer. Sci Med Footb, 2022. 6(5): p. 633-642.







How to Cite

The Role of Social Factors in Relative Energy Deficiency Risk for Female Collegiate Athletes. (2023). Journal of Women’s Sports Medicine, 3(3), 30-38.

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