Nutrition and Health Sciences, Department of



Mary Jane De Souza, The Pennsylvania State UniversityFollow
Nancy I. Williams, The Pennsylvania State UniversityFollow
Aurelia Nattiv, University of California, Los Angeles
Elizabeth Joy, Intermountain Healthcare, Salt Lake City, Utah
Madhusmita Misra, Massachusetts General Hospital, Boston
Anne B. Loucks, Ohio University, Athens, Ohio
Gordon Matheson, Stanford University School of Medicine
Marion P. Olmsted, University of Toronto
Michelle Barrack, Stanford University School of Medicine
Rebecca J. Mallinson, Pennsylvania State University
Jenna C. Gibbs, University of Waterloo, Waterloo, Ontario
Marci Goolsby, Hospital for Special Surgery, New York, New York
Jeanne F. Nichols, University of California, San Diego
Barbara Drinkwater, Washington, USA
Charlotte (Barney) Sanborn, Texas Woman’s University, Denton, Texas
Rosemary Agostini, Group Health, Seattle, Washington
Carol L. Otis, WTA Tour Player Development, Portland, Oregon
Mimi D. Johnson, University of Washington, Seattle
Anne Zeni Hoch, Medical College of Wisconsin, Milwaukee
Julia M. K. Alleyne, University of Toronto
L. Tyler Wadsworth, Advanced Orthopedics and Sports Medicine, St Louis, Missouri
Karsten Koehler, University of Nebraska-LincolnFollow
Jaci VanHeest, University of Connecticut, Storrs
Paula Harvey, University of Toronto
Amanda K. Weiss Kelly, University Hospitals Case Medical Center, Cleveland, Ohio
Michael Fredericson, Stanford University
George A. Brooks, University of California, Berkeley
Emma O'Donnell, University of Toronto
Lisa R. Callahan, Hospital for Special Surgery, New York, New York
Margot Putukian, Princeton University
Lauren Costello, Princeton University
Suzanne Hecht, University of Minnesota
Mitchell J. Rauh, San Diego State University
Jacalyn McComb, Texas Tech University

Date of this Version



Published in British Journal of Sports Medicine 48:20 (October 2014), pp 1461–1465. doi:10.1136/bjsports-2014-093958


Copyright © 2014 BMJ Publishing Group Ltd & British Association of Sport and Exercise Medicine. Used by permission.


We are concerned that readers of the IOC paper will be confused and misled by the poorly referenced statements and frank (and sometimes dangerous) errors in the paper. The IOC authors should publish a correction of these and other errors noted. Broadening research of low energy availability in other groups, such as the male athlete, athletes of diverse ethnicities and the disabled athlete may help to advance science and may one day warrant introduction of a specific term for whatever serious clinical sequelae of energy deficiency may be discovered in future research on men.

Research on the “Female Athlete Triad” has forged a platform from which a broad array of healthcare providers (e.g., physicians, sport dietitians, mental health professionals and athletic trainers) have made great strides in learning how to manage and treat affected women. Research on the “Female Athlete Triad” has also been translated to the lay public such that more and more affected female athletes and exercising women willingly seek education, prevention and treatment.

Meanwhile, subsuming the term “Female Athlete Triad” under the umbrella of the term RED-S has the potential to confuse rather than enlighten, and undo decades of work educating and advocating for awareness, prevention and treatment for the Triad. The individual most impacted by the de-emphasis on the Triad will be the female athlete herself. The overwhelming clinical importance of the Female Athlete Triad compared with other conditions under the proposed RED-S umbrella will continue to make a specific reference for the Triad useful for those who deal with it, including physicians, coaches, sport dietitians, athletics trainers, parents and, most importantly, female athletes. As such, efforts promoting awareness, prevention and treatment of the Female Athlete Triad remain critically important and should not be overshadowed by an ill-conceived and poorly defended new construct.