Primary Prevention: Family Physicians' Awareness On REDs

Relative Energy Deficiency in Sport (REDs) is a condition affecting multiple body systems, yet it remains underrecognized in primary care. Early recognition in all athletes is critical to prevent severe health consequences. PURPOSE: To assess family physicians' awareness of REDs, their familiarity with severe primary indicators, prevention, and specific attention to menstrual health in sports physicals. METHODS: A cross-sectional survey collected responses from 22 family physicians (4 attendings, 18 residents). The survey measured knowledge of REDs, its components, primary indicators, prevention practices, and the level of attention paid to menstrual health. RESULTS: Awareness: While 59.1% of respondents still used the term "female athlete triad," only 45.5% identified all three components accurately. Knowledge of REDs was limited, with 36.3% correctly defining it, and 31.8% recognizing primary prevention strategies. Primary Indicators: All respondents acknowledged that REDs affects multiple organ systems and that oral contraceptive pills (OCPs) could mask severe REDs indicators. Severe indicator identification varied: 54.5% noted primary amenorrhea, 86.4% recognized prolonged secondary amenorrhea, and only 13.6% identified low testosterone. None identified all severe indicators, though each identified at least one. Menstrual Health: Over half (52.4%) indicated they closely attended to menstrual health questions in the NCHSAA pre-participation evaluation. Chi-squared analysis found no significant difference between residents and attendings regarding menstrual health attention (χ2 = 2.44, p = 0.118). Screening Tools: IOC REDs CAT2 was the most recognized tool (72.7%), although some (22.7%) chose SCAT5. 90.9% supported primary care and multidisciplinary team involvement in REDs prevention. Variation in Knowledge: Responses on the female athlete triad components varied widely. Common responses included “amenorrhea” and “bone density loss,” while many lacked “low energy availability.” CONCLUSIONS: Survey results reveal significant variability in family physicians' understanding of REDs, particularly concerning primary prevention and identification of severe indicators. Standardized education on REDs could strengthen primary prevention.