Contributing Factors to Low Energy Availability in Female Athletes: A Narrative Review of Energy Availability, Training Demands, Nutrition Barriers, Body Image, and Disordered Eating

Abstract

Relative Energy Deficiency in sport is experiencing remarkable popularity of late, particularly among female athletes. This condition is underpinned by low energy availability, which is a byproduct of high energy expenditure, inadequate energy intake, or a combination of the two. Several contributing factors exist that may predispose an athlete to low energy availability, and therefore a holistic and comprehensive assessment may be required to identify the root causes. The focus of the current narrative review is to discuss the primary contributing factors as well as known risk factors for low energy availability among female athletes to help practitioners increase awareness on the topic and identify future areas of focus.

Keywords: energy expenditure; energy intake; female athletes; health; low energy availability.

Figure 1

A theoretical framework outlining potential risk factors and contributors to LEA and RED-s.

Figure 2

The spectrum of eating behaviour in the high performance athlete from optimised nutrition to disordered eating to eating disorders. DSM-5, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Figure originally published by: Wells, K.R., et al. The Australian Institute of Sport (AIS) and National Eating Disorders Collaboration position statement on disordered eating in high performance sport. Br. J. Sports Med. 2020 Nov; 54(21): 1247–1258.

Figure 3

Etiological model showing the interplay of eight risk or causal risk constructs (shown in circles) considered as factors in the development of disordered eating in athletes (Petrie & Greenleaf, 2012). Used with permission from license # 5232220735165, granted on 18 January 2022. Cited within Stoyel, H., Slee, A., Meyer, C., Serpell, L. Systematic review of risk factors for eating psychopathology in athletes: A critique of an etiological model. Eur. Eat Disord. Rev. 2020 Jan; 28(1): 3–25.

Figure 4

Disordered-eating management protocol: outpatient setting. Figure originally published by: Bonci, C.M., Bonci, L.J., Granger, L.R., Johnson, C.L., Malina, R.M., Milne, L.W., Ryan, R.R., Vanderbunt, E.M. National Athletic Trainers’ Association Position Statement: Preventing, Detecting, and Managing Disordered Eating in Athletes. J. Athl. Train 2008 Jan–Feb; 43(1): 80–108.