Introduction Relative Energy Deficiency in Sport (REDs) can impair both physical and mental health in athletes. This study investigates REDs symptoms and physical and mental health in three biathlete age cohorts at the start of the season and explores their association with end-of-season competition results. Method This is a national cross-sectional study including prospective registration of performance outcomes. Biathletes aged 16-20 years completed a digital survey including demographics and validated health questionnaires, followed by a clinical diagnostic interview if eating disorders (EDs) were indicated. Athletes aged =18 years were additionally invited to laboratory assessments comprising blood tests, resting metabolic rate (RMR), heart rate, blood pressure, body composition, and bone mineral density (BMD). Results Seventy-two athletes (55% female; mean age 17.8 ± 1.4 years) were included, with mean tier level 2.7 ± 0.9 and training volume 13.3 ± 3.3 hours per week. The prevalence of REDs symptoms was 32%, clinical EDs 6%, depressive symptoms 15%, and incontinence 4%. Among 28 athletes (43% female) completing laboratory assessments, 11% had low BMD, 7% bradycardia, 18% hypotension, 18% elevated cholesterol and 25% low ferritin. Few symptoms overlapped, but REDs symptoms were more common in females and increased with age. Associations with end-of-season results will be analyzed and presented. Conclusion REDs symptoms were prevalent in young biathletes. The range of health indicators underscores the need for broad medical screening and improved competence within sports medicine teams to identify and address REDs early, preventing long-term health issues and potential early career termination.
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