Auditing the Representation of Active Girls, Women, and Female Athletes in Low Energy Availability Research: A Decade-Long Review of the Literature
DOI:
https://doi.org/10.53646/eqtkdk87Keywords:
low energy availability, female athlete triad, Relative energy deficiency in sport, female athleteAbstract
BACKGROUND: Low energy availability (LEA), or a mismatch between energy intake and exercise energy expenditure, is a major concern for physically active individuals, particularly females. Although more female athletes are participating in sport today than ever before, they remain underrepresented in sport and exercise science research. However, it remains unclear how well physically active females are considered in research on LEA and LEA-related conditions. This study aimed to (a) evaluate the representation of physically active female in LEA research, and (b) explore the methodological characteristics underpinning LEA research.
METHODS: This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Three databases were searched for publications that investigated LEA in active individuals and athletes from 2014-2024. The number of total participants (male/female), title, topic/focus, and methodological characteristics were recorded for each publication. Data were expressed in frequencies and percentages. Chi-square goodness-of-fit tests, independent t-tests, and Chi-square tests of homogeneity (χ2) were used to compare sex counts across studies, sex-specific studies, and proportions of study population based on methodological characteristics, respectively. Across 296 publications, 34,818 participants were included in analyses.
RESULTS: There was a significant imbalance between the total number of female (n = 28,738; 82.5%) and male participants (n = 6,080; 17.5%) (χ²(1, n = 34,818) = 14,744.81, p < .001). Overall, 56% of studies included females-only, 22% included males-only, and 22% included both sexes, demonstrating female bias (t(229) = 2.196, p < .001, d = .321). Between 2015 and 2023, mixed-sex cohort publications increased by 800%, female-only cohort publications increased by 420%, and male-only cohort publications rose from 0 to 10, demonstrating substantial growth across all cohorts during this period.
CONCLUSION: A majority of research on LEA is conducted on physically active females, which contrasts with other areas of sports science research.
References
1. Paul RW, Sonnier JH, Johnson EE, et al. Inequalities in the Evaluation of Male Versus Female Athletes in Sports Medicine Research: A Systematic Review. Am J Sports Med. 2023;51(12):3335-3342. doi:10.1177/03635465221131281
2. Cowan SM, Kemp JL, Ardern CL, et al. Sport and exercise medicine/physiotherapy publishing has a gender/sex equity problem: we need action now! Br J Sports Med. 2023;57(7):401-407. doi:10.1136/bjsports-2022-106055
3. Cowley ES, Olenick AA, McNulty KL, Ross EZ. “Invisible Sportswomen”: The Sex Data Gap in Sport and Exercise Science Research. Women Sport Phys Act J. 2021;29(2):146-151. doi:10.1123/WSPAJ.2021-0028
4. Walton CC, Gwyther K, Gao CX, Purcell R, Rice SM. Evidence of gender imbalance across samples in sport and exercise psychology. Int Rev Sport Exerc Psychol. Published online December 5, 2022:1-19. doi:10.1080/1750984X.2022.2150981
5. Murata A, McGuire CS, Robertson M, et al. Girls, Women, and Female Athletes in Sport Psychology: A Decade-Long Review of the Literature. Women Sport Phys Act J. Published online 2023:1-11. doi:10.1123/wspaj.2023-0022
6. Kuikman MA, Smith ES, Mckay AKA, et al. Fuelling the Female Athlete: Auditing her Representation in Studies of Acute Carbohydrate Intake for Exercise. Med Sci Sports Exerc. Published online 2022. doi:10.1249/MSS.0000000000003056
7. Kuikman MA, McKay AKA, Smith ES, et al. Female Athlete Representation and Dietary Control Methods Among Studies Assessing Chronic Carbohydrate Approaches to Support Training. Int J Sport Nutr Exerc Metab. 2023;33(4):198-208. doi:10.1123/ijsnem.2022-0214
8. Pandit A, Tran TB, Letton M, et al. Data Informing Governing Body Resistance-Training Guidelines Exhibit Sex Bias: An Audit-Based Review. Sports Medicine. 2023;53(9):1681-1691. doi:10.1007/s40279-023-01878-1
9. Smith ES, McKay AKA, Kuikman M, et al. Auditing the Representation of Female Versus Male Athletes in Sports Science and Sports Medicine Research: Evidence-Based Performance Supplements. Nutrients. 2022;14(5):953. doi:10.3390/nu14050953
10. Kelly MK, Smith ES, Brown HA, et al. Auditing the Representation of Females Versus Males in Heat Adaptation Research. Int J Sport Nutr Exerc Metab. Published online January 11, 2024:1-11. doi:10.1123/ijsnem.2023-0186
11. Emmonds S, Heyward O, Jones B. The Challenge of Applying and Undertaking Research in Female Sport. Sports Med Open. 2019;5(1):51. doi:10.1186/s40798-019-0224-x
12. Merone L, Tsey K, Russell D, Nagle C. Sex Inequalities in Medical Research: A Systematic Scoping Review of the Literature. Womens Health Rep (New Rochelle). 2022;3(1):49-59. doi:10.1089/whr.2021.0083
13. Lin CY, Casey E, Herman DC, Katz N, Tenforde AS. Sex Differences in Common Sports Injuries. PM R. 2018;10(10):1073-1082. doi:10.1016/j.pmrj.2018.03.008
14. Pascoe M, Pankowiak A, Woessner M, et al. Gender-specific psychosocial stressors influencing mental health among women elite and semielite athletes: a narrative review. Br J Sports Med. 2022;56(23):1381-1387. doi:10.1136/bjsports-2022-105540
15. Jagim AR, Fields J, Magee MK, Kerksick CM, Jones MT. Contributing Factors to Low Energy Availability in Female Athletes: A Narrative Review of Energy Availability, Training Demands, Nutrition Barriers, Body Image, and Disordered Eating. Nutrients. 2022;14(5). doi:10.3390/nu14050986
16. Wasserfurth P, Palmowski J, Hahn A, Krüger K. Reasons for and Consequences of Low Energy Availability in Female and Male Athletes: Social Environment, Adaptations, and Prevention. Sports Med Open. 2020;44(6):1-14. doi:10.1186/s40798-020-00275-6
17. Mountjoy M, Ackerman KE, Bailey DM, et al. 2023 International Olympic Committee’s (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs). Br J Sports Med. 2023;57(17):1073-1097. doi:10.1136/bjsports-2023-106994
18. McNulty KL, Taim BC, Freemas JA, et al. Research Across the Female Life Cycle: Reframing the Narrative for Health and Performance in Athletic Females and Showcasing Solutions to Drive Advancements in Research and Translation. Women Sport Phys Act J. 2024;32(1). doi:10.1123/wspaj.2024-0064
19. Yeager KK, Agostini R, Nattiv A, Drinkwater B. The female athlete triad: disordered eating, amenorrhea, osteoporosis. Med Sci Sports Exerc. 1993;25(7):775-777. doi:10.1249/00005768-199307000-00003
20. De Souza MJ, Nattiv A, Joy E, et al. 2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad: 1st International Conference held in San Francisco, California, May 2012 and 2nd International Conference held in Indianapolis, Indiana, M. Br J Sports Med. 2014;48(4):289-289. doi:10.1136/bjsports-2013-093218
21. Mountjoy M, Sundgot-Borgen J, Burke L, et al. The IOC consensus statement: beyond the Female Athlete Triad—Relative Energy Deficiency in Sport (RED-S). Br J Sports Med. 2014;48(7):491-497. doi:10.1136/bjsports-2014-093502
22. Mountjoy M, Sundgot-Borgen JK, Burke LM, et al. IOC consensus statement on relative energy deficiency in sport (RED-S): 2018 update. Br J Sports Med. 2018;52(11):687. doi:10.1136/bjsports-2018-099193
23. Ackerman KE, Rogers MA, Heikura IA, et al. Methodology for studying Relative Energy Deficiency in Sport (REDs): a narrative review by a subgroup of the International Olympic Committee (IOC) consensus on REDs. Br J Sports Med. 2023;57(17):1136-1147. doi:10.1136/bjsports-2023-107359
24. McKay AKA, Stellingwerff T, Smith ES, et al. Defining Training and Performance Caliber: A Participant Classification Framework. Int J Sports Physiol Perform. 2022;17(2):317-331. doi:10.1123/ijspp.2021-0451
25. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. Published online March 29, 2021:n71. doi:10.1136/bmj.n71
26. Costello J, Bieuzen F, Bleakley C. Where are all the female participants in Sports and Exercise Medicine research? Psychology, Social Sciences, and Humanities. 2014;14(8):847-851. doi:https://doi.org/10.1080/17461391.2014.911354
27. Kuikman MA, Smith ES, Mckay AKA, et al. Fueling the Female Athlete: Auditing Her Representation in Studies of Acute Carbohydrate Intake for Exercise. Med Sci Sports Exerc. 2023;55(3):569-580. doi:10.1249/MSS.0000000000003056
28. Smith ES, McKay AKA, Kuikman M, et al. Managing Female Athlete Health: Auditing the Representation of Female versus Male Participants among Research in Supplements to Manage Diagnosed Micronutrient Issues. Nutrients. 2022;14(16):3372. doi:10.3390/nu14163372
29. Mountjoy M, Sundgot-Borgen J, Burke L, et al. The IOC consensus statement: Beyond the Female Athlete Triad—Relative Energy Deficiency in Sport (RED-S). Br J Sports Med. 2014;47(4):15-28. doi:10.1136/bjsports-2014-093502
30. Schofield KL, Thorpe H, Sims ST. Where are all the men? Low energy availability in male cyclists: A review. Eur J Sport Sci. 2021;21(11):1567-1578. doi:10.1080/17461391.2020.1842510
31. Hackney A, Melin AK, Ackerman KE, Torstveit MK, Burke LM, Mountjoy ML. REDs alert: male athletes be wary and scientists take action! Br J Sports Med. 2023;57(17):1066-1067. doi:10.1136/bjsports-2023-106719
32. Vardardottir B, Olafsdottir AS, Gudmundsdottir SL. A real-life snapshot: Evaluating exposures to low energy availability in male athletes from various sports. Physiol Rep. 2024;12(12). doi:10.14814/phy2.16112
33. McGuire A, Warrington G, Doyle L. Low energy availability in male athletes: A systematic review of incidence, associations, and effects. Transl Sports Med. 2020;3(3):173-187. doi:10.1002/tsm2.140
34. Martínez-Rosales E, Hernández-Martínez A, Sola-Rodríguez S, Esteban-Cornejo I, Soriano-Maldonado A. Representation of women in sport sciences research, publications, and editorial leadership positions: are we moving forward? J Sci Med Sport. 2021;24(11):1093-1097. doi:10.1016/j.jsams.2021.04.010
35. Cowley ES, Moore SR, Olenick AA, McNulty KL. “Invisible Sportswomen 2.0”—Digging Deeper Into Gender Bias in Sport and Exercise Science Research: Author Gender, Editorial Board Gender, and Research Quality. Women Sport Phys Act J. Published online 2023:1-8. doi:10.1123/wspaj.2023-0039
36. Elliott-Sale KJ, Minahan CL, de Jonge XAKJ, et al. Methodological Considerations for Studies in Sport and Exercise Science with Women as Participants: A Working Guide for Standards of Practice for Research on Women. Sports Medicine. 2021;51(5):843-861. doi:10.1007/s40279-021-01435-8
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Ahnna E. Faust, Alexis V. Viehl, Melissa T. Lodge
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.