User:Tiger Daisy/Relative energy deficiency in sport

Treatments
The underlying cause of the RED-S is an imbalance between energy taken into the body (through nutrition) and energy used by the body (through exercise). The treatment includes correcting this imbalance by either increasing calories in a diet or by decreasing calories burned by exercise for 12 months or longer. Typically, it is recommended that athletes increase their consumption of calories by 300-600 kcal per day in the early stages of treatment, but there is no standard when it comes to increasing calories over time. Part of the treatment includes an assessment that determines the cause of low energy availability, as treatment needs to be specialized based on the presence of disordered eating or an eating disorder. Persons with RED-S should get treatment from a multi-disciplinary team that includes a physician, dietitian, and mental health counselor, and seek support from family, friends, and their coach. It is important that physicians are aware of the signs of refeeding syndrome, as this can be life threatening if not detected early.

Because a symptom of the RED-S is menstrual dysfunction, some physicians may recommend oral contraceptives because those pills will regulate the menstrual cycle. However, the underlying cause of the menstrual disorder is an energy imbalance, and using pills to regulate the menstrual cycle without changes in diet and behavior is likely to mask the food deficiency and delay appropriate treatment. A menstruating person taking contraceptives to treat menstrual dysfunction without correcting this energy imbalance will continue to lose bone density. Bone density should be measured using dual energy X-ray absorpitiometry (DEXA) to determine severity of bone loss, especially if there is an absence of menstruation.

Psychological Treatment

Although Relative Energy Deficiency in Sport is often regarded as a physiological issue, it can have psychological impacts in the process of treatment and psychological stress may contribute to the development of RED-S, as athletes may use excessive exercise and decreased energy consumption as a means to manage stress levels. Many athletes strive for perfection and this can exacerbate mental stress as well as put athletes at a greater risk for developing an eating disorder. The main reasons why athletes would be resistant to treatment for RED-S is due to psychological factors. A mental health counselor who is experienced in eating disorders should provide treatment. If there are other comorbid psychological disorders, such as depression and anxiety, a risk of self harm, medical complications and lack of progress in an outpatient level of care, the person struggling with RED-S may need more intensive care at an inpatient, residential, partial hospitalization or intensive outpatient level. At each level of care, treatment modalities include cognitive-behavioral therapy, dialectical behavioral therapy or family-based therapy.