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Information Directly from the USOPC

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Low Energy Availability in Competitive Athletes 

What is Energy Availability?

Energy availability is the amount of dietary energy remaining after exercise, available for other physiological functions such as growth, muscle recovery and homeostasis.

Low energy availability (LEA) occurs when the calorie intake of an athlete is insufficient to meet the energy required for daily living plus the demands of training. Energy intake should never drop below resting metabolic rate.

Low Energy Availability in Sport

LEA is associated with the majority of consequences of relative energy deficiency in sport (RED-S) and the Female Athlete Triad. Consequences include, but are not limited to: suppressed metabolic rate; menstrual dysfunction (females) or reduced testosterone levels (males); and impairments of bone health, immunity, protein synthesis and cardiovascular health. The consequences can occur in as little as five days and be acute, intermittent or chronic.

Calories consumed by diet


Calories expended to meet demands of healthy physiology 
& physical activity

Performance Consequences 

  • Decreased endurance performance 

  • Increased injury risk 

  • Decreased training response 

  • Impaired judgement 

  • Decreased coordination 

  • Irritability 

  • Decreased concentration 

  • Depression 

  • Decreased glycogen stores 

  • Decrease muscle strength 

Health Consequences 

  • Immunological

  • Menstrual function 

  • Bone health 

  • Endocrine 

  • Metabolic 

  • Hematological 

  • Psychological 

  • Growth & Development 

  • Cardiovascular 

  • Gastrointestinal 

Risk Factors for Developing Low Energy Availability

  • Participation in aesthetic, weight-making or endurance sports

  • Failure to increase calorie intake with increased or hard training loads

  • Attempts to lose weight when training loads are high 

  • Restricted calorie intake due to physical impairments, gut tolerance, or medical conditions 

  • Excessive focus by coaches and other support staff on weight and body fat as opposed to performance  in sport 

  • Presence of disordered eating behaviors, either in the athlete or in their training partners

  • Inadequate food availability (e.g. limited financial resources, hectic travel schedule, cramped living/cooking spaces or very busy lifestyles where food is of low priority)

  • Diets very high in fiber and low in energy density (e.g. large salads lacking in carbohydrate, tendency to only eat very specific “healthy” foods, extensive use of diet products)

Signs and Symptoms of LEA 

  • Reduced training capacity

  • Repeated injury or illness

  • Delayed or prolonged recovery times

  • Change in mood state

  • Failure to lose weight

  • Reduced or low bone density

  • Reduced libido

  • Cessation or disruption in menstrual cycle

  • Excessive fatigue

Long Term Health Consequences of LEA

  • Suppressed metabolic rate, which can cause long-term difficulties with body composition 

  • Menstrual dysfunction (females)

  • Reduced testosterone levels (males)

  • Slowed protein synthesis compromising the athletes ability to build/repair soft tissue and recover from strenuous training

  • Reduced bone density, increasing the risk of stress fracture and other bone stress injuries 

  • Compromised immunity and frequent illness 

  • Compromised cardiovascular function 

  • Increased risk of psychological harm including, depression, social insecurity, and decreased ability to manage stress 

  • Acute and chronic health problems including gastro-intestinal issues and infertility 


Step 1:

Take the LEAF-Q Quiz to find out!

What do your results mean?


0 -7



Risk Level:

Minimal Risk for Triad

At Risk for the Triad

High Risk for Triad


Let us help you achieve Energy Balance!


Step 2: 

Get balanced to prevent injury and optimize performance

What is the number of calories you need to prevent overuse injury & optimize your performance?

12 Week LEA/Overuse Prevention Program:  $250

  • 4 Body Comp Assessments 

  • LEAF-Q Questionnaire (Pre & Post)

  • Eating Attitude Questionnaire (Pre & Post)

  • Energy Balance Questionnaire (Pre, end of week 4, end of week 8, Post)

  • Personalized Plan 

    • Access to TRUathletes program with performance education & movement video library ​

    • Access to homepage with recommendations & informational videos

  • 30 minute consultation with Dr. Johnson or Dr. Martin

Our Planned Process


  • Register at conclusion of talk on a first come first serve basis

  • Priority scheduling for consultations w/ Doctors


  • Data Capture of Body Comp at Practice (Sycamore Park, 5PM Start)

  • Send participating athletes online forms to complete 

    • Energy Balance Questionnaire

    • LEAF-Q Questionnaire

    • Eating Attitude Questionnaire


  • Send athletes personalized plans with access to how-to page 


  • Official start date of first 4 week plan


  • Consults with Doctors begins

    • Review Questionnaires

    • Provide Individualized Recommendations

      • Nutrition, Hydration, Sleep, & Movement Recommendations

    • Answer any questions they may have regarding the program

10/10 (End of first four weeks)

  • Second round of Body Comp testing at practices (Sycamore Park, 5 PM Start)

  • Re-send Questionnaires

    • Energy Balance Questionnaires 

    • How is Your Plan Going Questionnaire (anonymous)

    • Consultations for those who would like further assistance

11/07 (End of  8 weeks)

  • Third round of Body Comp testing at practices (Sycamore Park, 5 PM Start)

  • Re-send Questionnaires

    • Energy Balance Questionnaires

    • How is Your Plan Going Questionnaire (anonymous) 

    • Consultations for those who would like further assistance

12/05 (End of 12 weeks)

  • Fourth round of Body Comp testing at Mustang Facilities (Time to be determined)

  • Re-send Questionnaires

    • Energy Balance Questionnaires 

    • How is Your Plan Going Questionnaire (anonymous)

    • Consultations for those who would like further assistance

12/15/2023 (Recommended Mustang Meeting - Athletes, Parents, Coaches)

  • Final in person meeting with all participants to review the 12 weeks of programming to see how it went for all participants and to review final results between all age groups + club as a whole.

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