Eating disorders, the female athlete triad and relative energy deficiency in sport (RED-S) in young athletes: a narrative review of screening and assessment tools

Abstract

Background: Disordered eating (DE), the Female Athlete Triad and Relative Energy Deficiency in Sport (RED-S) are common, consequential and frequently concealed conditions in young athletes, and because restrictive eating and heavy training are normalised in sport their detection depends on appropriate screening rather than reactive diagnosis. Aim: To summarise, compare and critically appraise the screening and assessment tools used to detect DE and eating disorders (ED), low energy availability (LEA), the Triad and RED-S in adolescent and young adult athletes, and to define how these instruments should be combined in practice. Material and methods: Narrative review of 41 open-access publications identified through PubMed, Scopus, Web of Science and SPORTDiscus, encompassing narrative and systematic reviews, validation and prevalence studies, and consensus-derived clinical tools relevant to young athletes of both sexes. Results: Generic ED screens (EAT-26, SCOFF, EDI, EDE-Q) dominate practice but were not developed for athletes; athlete-specific tools (BEDA-Q, EDSA, ATHLETE, Physiologic Screening Test) perform better in this population; and LEA/RED-S tools (LEAF-Q, LEAM-Q, RED-S CAT/CAT2, Triad Cumulative Risk Assessment, DEAQ) capture physiological risk. At-risk prevalence is high but tool-dependent: a meta-analysis of 6,118 athletes reported LEA in 44.7%; 64.7% of youth footballers were at Triad/RED-S risk on the LEAF-Q (sensitivity 78%, specificity 90%); and the EDSA showed sensitivity 96% and specificity 80% in males. No validated male-specific ED tool exists and RED-S awareness is low. Conclusions: No single instrument suffices; pairing a validated athlete-specific ED screen with a LEA/RED-S tool, confirming positive screens by clinical interview within a multidisciplinary team, and embedding screening in education is the most defensible approach, particularly for male, younger and non-aesthetic-sport athletes.