Therapy for Relative Energy Deficiency in Sport (REDs)
Specialized REDs Therapy for Athletes in Cherry Hill, NJ
Athletes experiencing Relative Energy Deficiency in Sport or REDs deserve specialized mental health support that understands the unique mental challenges of energy deficiency in sport. At Serendipity Counseling, our specialized therapist for REDs provides evidence-based treatment addressing the complex relationship between low energy availability, athletic performance, and mental well-being for both male and female athletes.
What is Relative Energy Deficiency in Sport?
REDs (Relative Energy Deficiency in Sport) occurs when an athlete’s energy intake is does not meet their energy expenditure, leading to a negative energy balance. It can affect both male and female athletes and goes beyond simple caloric restriction. REDs disrupts multiple body systems including endocrine, metabolic, immune, cardiovascular, gastrointestinal, and skeletal functions.
Where it came from?
Relative Energy Deficiency in sport came from the female athlete triad, which originally focused on low energy availability, menstrual dysfunction, and decreased bone mineral density. In 2014, the International Olympic Committee expanded this definition to recognize that energy deficiency affects male athletes as well, and that the consequences of REDs extend to virtually every organ system.
Why Understanding REDs is Important
When an athlete’s energy intake fails to meet their high energy demands, the body begins conserving energy by suppressing functions it considers non-essential, including reproductive, immune, and bone-building processes.
REDs can affect individuals of all genders and is characterized by a low energy balance that can lead to serious health issues, including low bone mineral density and menstrual dysfunction. Many athletes develop REDs not through intentional restriction but simply by failing to match their food intake to their high training volume.
Symptoms of Relative Energy Deficiency in Sport
Physical Symptoms
fatigue
recurrent injuries
hormonal disruptions
missed periods (for female athletes)
gastrointestinal distress
persistent exhaustion
reduced testosterone (for male athletes)
diminished libido
brittle nails
hair loss
feeling chronically cold.
Performance Symptoms
decline in performance
poor recovery
weakened immune
declining endurance
reduced strength,
impaired concentration
lifts feel heavier
adaptation plateaus regardless of effort
slowed recovery between training sessions
Stress fractures and soft tissue injuries
Psychological Symptoms
guilt when training is disrupted
loss of joy in sport
fear of weight gain
rigid food rules
perfectionism and overcontrol
depression
irritability
diminished self esteem
anxiety specifically around certain food groups, exercise habits, and rest days
Why Someone Might Seek Help for REDs
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Athletes typically seek therapy for REDs when they recognize that performance issues may be coming from inadequate fueling rather than training problems. When faster splits, stronger lifts or better endurance feelings intangible despite proper nutrition protocols, or what they believe is adequate fueling, something deeper may be at work.
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Physical symptoms often reach a tipping point that affects athletes beyond sport. Missed periods, recurring stress fractures, chronic fatigue that permeates daily life, and negative effects on mood and relationships prompt many to seek help.
Young athletes and young adults may notice these symptoms interfering with school, social activities, and overall well being.
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Many athletes need professional support to address psychological barriers to proper nutrition. Even when understanding that they need more calories, fear of weight gain, rigid eating habits, and anxiety around food groups can prevent behavior change.
Disordered eating patterns, even without meeting criteria for an eating disorder diagnosis, require specialized therapeutic support.
Our REDs Therapy Approach
Individual Therapy Sessions
One-on-one therapy targets the psychological factors maintaining energy deficiency in athletes. Sessions focus on reducing food fears, exercise compulsions, and performance anxiety that prevent athletes from meeting their nutritional needs.
Therapy for REDs focuses on addressing mental health that contribute to low energy availability. This helps athletes manage things like:
anxiety
perfectionism
their relationship with food and exercise
Using evidence-based approaches including Cognitive Behavioral Therapy (CBT) and Radically Open Dialectical Behavior Therapy (RO-DBT), we help athletes challenge distorted beliefs about food, body weight, and athletic identity.
Collaborative Care Team
Treating Relative Energy Deficiency in sport requires a team approach. This involving healthcare providers such as:
sports dietitians
physicians
mental health therapists
Together they help restore energy balance and support overall health. Our collaborative approach ensures therapy goals align with nutritional rehabilitation and medical monitoring protocols.
The Process of Working with a REDs Therapist
Step 1: Schedule a free 15 minute consultation call.
We will have a quick chat to see if we are a good fit. Our REDs therapist will chat with you about what brought you in and what you are looking to accomplish in therapy, along with answering any questions you have about the process.
Step 2: Meeting You Where You Are
The first step in therapy for Relative Energy Deficiency in sport is to figure to get to know each other and where you are struggling. REDs is complicated and has a lot of different ways of showing up. I am not here to tell you how to change. I am here to help you figure out what needs adjusting.
Step 3: Active Therapy Phase
Weekly therapy sessions use evidence-based approaches to address the mental barriers to REDs recovery and healthy fueling. We work on building flexibility around eating, challenging perfectionism, and developing sustainable exercise habits that support your individual goals.
Work with a REDs Therapist in Cherry Hill, NJ
Take the first step toward REDs recovery by contacting Serendipity Counseling to schedule your initial consultation. Located in Cherry Hill, Serendipity serves athletes in-person throughout South Jersey.
Whether you’re a competitive athlete developing RED-S symptoms, a recreational exerciser concerned about your relationship with food, or a parent worried about a young athlete’s eating and exercise patterns, we provide specialized REDs therapy tailored to your situation.
Location: Cherry Hill, NJ – serving athletes throughout South Jersey Scheduling: Wednesdays limited in-person availability
Other Services at Serendipity Counseling
Comprehensive treatment for eating disorders in athletes and non-athletes
Mental skills training for competitive athletes
Support for athletes struggling with appearance concerns and self esteem
Therapy for adolescents and their families focused on eating disorder recovery
Frequently Asked Questions
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REDs is classified as a syndrome rather than a psychiatric disorder. It represents a cluster of symptoms resulting from energy deficiency. It is recognized formally in sports medicine literature since the IOC consensus statement in 2014. While REDs often overlaps with eating disorders and disordered eating, having REDs does not necessarily mean meeting diagnostic criteria for anorexia, bulimia, or other clinical eating disorder diagnosis. The condition is medical and accompanied by physical, metabolic, hormonal, and psychological concerns.
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Diagnosis relies on a multidisciplinary approach involving sports medicine physicians, dietitians, and mental health professionals. The process can involve screening questionnaires like the RED-S Clinical Assessment Tool, comprehensive athletic and medical history review, laboratory testing for hormonal and metabolic markers, and bone density assessment via DEXA scan. There is not one thing that can directly tell you if you have REDs, but rather a collection of information from your team.
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Recovery focuses on restoring energy availability by increasing food intake and potentially reducing energy expenditure from training. This requires collaboration between mental health professionals, sports dietitians, and medical providers. Nutritional rehabilitation addresses the energy deficit while therapy targets the mental barriers like food fears, perfectionism, and exercise compulsion. Medical monitoring ensures safe recovery, particularly for bone health and hormonal restoration.
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Female athletes with REDs typically experience irregular periods or amenorrhea (missed periods for three or more consecutive months). Reduced estrogen levels lead to low bone mineral density and increased risk of stress fractures, particularly in the hips, spine, and tibia. Metabolic changes include low thyroid hormone, decreased leptin, and altered reproductive hormones affecting fertility. Long-term health consequences include early osteoporosis and compromised reproductive health if left untreated.
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Athletes describe persistent exhaustion that doesn’t get better with rest, along with feelings of cold, low energy, and brain fog.
Emotional symptoms include anxiety, irritability, and guilt (particularly around meals and rest days).
Performance feels incredibly harder: slower times despite consistent training, reduced strength, and difficulty recovering between sessions.
Physical signs may include brittle nails, hair loss, and stomach discomfort. Many athletes experience decreased motivation and a loss of joy in sport that once brought so much happiness.
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The primary cause is energy imbalance. When an athlete’s energy intake is not enough, relative to energy expenditure. There are so many factors that can contribute to not fueling enough. A few may be high training volume without matching calories, limited nutrition knowledge, restrictive dieting, pressure from weight class or aesthetic sports, and sport culture emphasizing leanness.
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REDs recovery can involve weight fluctuations. During energy deficiency, metabolic rate slows and the body adapts to conserve energy. When athletes begin eating enough calories during recovery, initial weight gain is often necessary to restore hormonal function. For female athletes, adequate body fat is essential for estrogen production and resumption of menstrual function. This weight normalization is a sign of healing, not a problem to avoid.