In November 2024, The Royal Ballet School spent REDs Awareness Week educating on undernutrition. Given the prevalence of relative energy deficiency in sport (REDs) amongst athletes, the School is keen to raise awareness for dancers everywhere.
Staff hosted informative talks for students and parents, which featured insights from the School’s Healthcare Team professionals and Pippa Woolvern of Project RED-S. Staff also served themed snacks at White Lodge and Upper School and took to social media, posting video interviews and an informative REDs infographic.
Beyond REDs Awareness Week, the School’s Artistic and Healthcare teams work year-round to identify REDs signs and symptoms as early as possible. Staff also encourage open conversations about body image, nutrition, rest, and recovery to prevent and manage health risks.
What Is REDs?
REDs refers to a syndrome where athletes don’t consume enough food to fuel the energy demands of their training or lifestyle. This results in declining athletic performance.
Left untreated, REDs can disrupt reproductive health, hormonal balance, bone health, the immune system, the metabolism, and cardiovascular health. For dancers, this can mean impaired coordination, frequent injuries, slow recovery, and a decreased ability to perform.
By extension, dancers may experience negative effects on their mental health. They may feel isolated, anxious, and/or depressed. They may also find it difficult to concentrate or feel motivated.
REDs can affect athletes of all genders and abilities.
Why Are Dancers Susceptible to REDs?
As dance training requires a huge amount of energy, dancers’ nutritional needs are different to most. This is especially the case for dancers who are training during adolescence and are still growing. They need even more nutritional fuel during this time. As such, it’s easy for dancers to under-fuel their bodies without realising.
Insufficient recovery periods can also make dancers more susceptible to REDs. It can be easy to cut a recovery period short when wanting to continue with a rigorous dance training schedule.
On top of this, the perceived aesthetic requirement for dancers can cause under-fueling. Dancers are three times more likely to experience eating disorders than the normal population.
How Can Dance Schools Prevent and Treat REDs?
Educating students on their nutritional needs is critical to preventing REDs. At The Royal Ballet School, the nutrition team encourages students to eat at least three balanced meals and three snacks every day. These should comprise a range of healthy carbohydrates, proteins, fats, vitamins, and minerals.
Students also learn how to fuel strategically and recognise that high training loads can cause athletes to suppress hunger cues. The School Nutritionist works with them on a personal level too, supporting them with their nutritional needs and post-training recovery.
Treating REDs can look very different for different students. At The Royal Ballet School, a Healthcare Team of over 20 professionals crafts holistic treatment plans tailored to a student’s needs. In the case of REDs, this may include blood tests or various scans.
How Can Dance Schools Identify REDs?
It isn’t always easy to identify REDs. Because of this, The Royal Ballet School emphasises that early detection, multidisciplinary support, and comprehensive care are essential should a student exhibit symptoms. This is clear in two case studies that the School has shared.
Case Study 1
During a routine wellness check, the Healthcare Team’s School Nurse noted that a student had a low body weight and poor circulation and was experiencing dizziness. The 14-year-old student also often caught colds and had been missing school due to illness.
Blood tests confirmed various abnormalities and undernutrition, leading to a REDs diagnosis. Amongst these abnormalities, the student had not had a menstrual cycle for almost one year.
The Sports Medicine Consultant advised her to stop all physical activity during her recovery. However, being unable to dance had a significant impact on her mental health. As a result, frequent sessions with the Mental Health Team were central to her treatment plan.
The School’s Psychologist worked with the student to help her address body image challenges. In this case, it was essential to overcome the student’s fear of weight gain, which was preventing her from fuelling her body with the nutrition she needed.
Over the year, the student progressed back up to 15 training hours per week. Her menstrual cycles returned after nine months, and she had enough energy to grow to full adult height within the year.
Case Study 2
Another student, age 17, sought medical advice from the Healthcare Team as he was experiencing pain in his big toe after an awkward landing from a jump. He received support from various members of this team:
● The physiotherapist’s examination identified a soft tissue sprain.
● During a wellness check, the School Nurse identified his fatigue, weight loss, and frustration with class performance.
● The School Nutritionist then identified that he wasn’t eating snacks during the day. She asked him to keep a detailed food diary for four days. Upon analysing the diary, she found that he wasn’t meeting his energy requirements for his age, height, weight, and activity levels. She concluded that he was in a state of low energy availability.
This multifaceted approach allowed the School to quickly find the root of the student’s symptoms. Staff arranged for him to have a blood test, which revealed that his vitamin D and some of his hormone levels were low, and that he had REDs.
To support this student, The Royal Ballet School implemented a multidisciplinary treatment plan:
● The nutrition team educated him on his energy requirements. They showed him how to plan the timing of meals, explained the food types he needed, and advised on the total amount of nutrition to consume each day.
● The Artistic team helped him manage his participation levels during training throughout recovery to avoid overexertion.
● The School Nurse scheduled regular check-ins to repeat blood tests and monitor recovery.
● The School Counsellor met with him every week to discuss his emotional health and encourage healthy behaviours.
This support enabled the student to restore normal blood biochemistry levels and safeguard his long-term health. His energy, body composition, and dance performance improved, and he became stronger in class.
About The Royal Ballet School’s Support for Students
Supporting students’ physical, emotional, and psychological health is central to The Royal Ballet School’s ethos. Its holistic approach — involving collaboration between the Healthcare and Artistic teams — supports students in the present while empowering them to continue monitoring their health throughout their careers.
Beyond supporting its students, the School also serves the broader dance community with a high level of research into sports science and dancer well-being.
