Multidisciplinary physician survey assessing knowledge of the female athlete triad and relative energy deficiency in sport

Alexandra E Warrick; Brandon Hassid; Brandon Coleman; Catherine Cansino; Marcia Faustin

doi:10.1186/s40337-023-00800-4

Multidisciplinary physician survey assessing knowledge of the female athlete triad and relative energy deficiency in sport

J Eat Disord. 2023 May 9;11(1):70. doi: 10.1186/s40337-023-00800-4.

Authors

Alexandra E Warrick¹, Brandon Hassid¹, Brandon Coleman¹, Catherine Cansino², Marcia Faustin³

Affiliations

¹ Department of Physical Medicine and Rehabilitation, University of California Davis School of Medicine, 4860 Y Street, Suite 3850, Sacramento, CA, 95817, USA.
² Department of Obstetrics and Gynecology, University of California Davis School of Medicine, 2521 Stockton Blvd, 4th floor, Sacramento, CA, 95817, USA.
³ Department of Family & Community Medicine, University of California Davis School of Medicine, 4860 Y street Suite 3850, Sacramento, CA, 95816, USA. [email protected].

Abstract

Background: Short and long-term health consequences surrounding Low Energy Availability can be mitigated by recognizing the risk factors and making early diagnosis of the Female Athlete Triad (Triad) and Relative Energy Deficiency in Sport (RED-S). While awareness of the Triad among physicians and allied health professionals has been studied, there are very few studies that assess physician awareness of both the Triad and RED-S.

Methods: Our study assesses Low Energy Availability, the Triad, and RED-S knowledge with an electronic survey, educational handout, and follow up survey among physicians across multiple specialties at a single academic institution.

Results: Among 161 respondents, respective Triad and RED-S awareness among surveyed specialties was highest in Orthopedic surgeons (100%, 100%), followed by Physical Medicine & Rehabilitation (70%, 53%), Family Medicine (67%, 48%), Internal Medicine (54%, 36%), Obstetrics and Gynecology (46%, 32%), Pediatrics (45%, 29%), Endocrinology (33%, 33%), and Other (33%, 33%). Comparing the initial survey results to the follow-up survey results, there was an increase from 37 to 72% of physicians who correctly identified that the presence of low BMI or recent weight loss is not a required component of the Triad or RED-S. Both the initial and follow-up survey revealed a continued misperception surrounding the use of hormonal contraception to resume menstrual cycles, with 33% of physicians on initial survey and 44% of physicians on follow-up survey incorrectly answering that question.

Conclusions: Multidisciplinary physicians have various levels of knowledge surrounding the Triad and RED-S, and there is a need for improved physician awareness, diagnosis, and treatment of the Triad and RED-S. Misperceptions exist surrounding the role of hormonal contraception in female athletes with the Triad and RED-S to regain and regulate menses.

Keywords: Athlete; Energy deficiency in sport; Female; Low energy availability; RED-S; Relative; Triad.

Plain language summary

When there is insufficient energy intake compared to energy output, leading to low energy availability, this lack of energy can strain the body’s metabolic needs. The Female Athlete Triad (Triad) and/or Relative Energy Deficiency in Sport (RED-S) refer to this strain that affects organ systems. While these syndromes exist, it is unclear if there is a differential in awareness among physicians from different specialties. Our study confirms that physician awareness varied among different specialties, and misperceptions continue to exist surrounding hormonal contraception and regulating menses.