# Knowledge of Eating Disorders and Relative Energy Deficiency in Sports among Public Health Nurses at Elite Sport Schools

## TL;DR

Public health nurses at elite sport schools have limited knowledge of Relative Energy Deficiency in Sports (REDs), but better understanding of eating disorders, suggesting a need for targeted education.

## Contribution

The study identifies a gap in public health nurses' knowledge of REDs and highlights the effectiveness of specialized courses in improving their competence.

## Key findings

- PHNs have limited knowledge of REDs and its underlying cause, low energy availability.
- Prior attendance in subject-specific courses was associated with significantly greater knowledge of REDs.
- PHNs prefer 'meet-the-expert' courses over self-directed learning materials.

## Abstract

Introduction: Eating disorders (EDs) are increasingly common, and their prevalence among athletes is approximately three times higher than in the general population. In athletes, EDs can be more difficult to detect, yet they carry serious clinical consequences, particularly due to their association with Relative Energy Deficiency in Sport (REDs), characterized by impaired health and performance.
Objective: This study investigated public health nurses’ (PHNs) knowledge and perceived competence when working with athletes at elite sport middle and high schools in identifying and managing EDs and REDs. The effect of years with work experience and course attendance was investigated, and we also explored their preferred course format.
Methods: This cross-sectional study invited PHNs from all elite sport middle and high schools in Norway to respond to a questionnaire in 2025. A total of 58 PHNs were invited, of which 22 (37.9%) consented to participate and responded to a digital survey.
Results: The findings indicated that PHNs have limited knowledge of REDs and its underlying cause, low energy availability. In contrast, their understanding of EDs was generally satisfactory. Notably, prior attendance in subject-specific courses was associated with significantly greater knowledge of REDs (g = 1.1, p = 0.03), while years of professional experience showed no such effect. PHNs expressed a preference for “meet-the-expert” courses over self-directed learning materials such as books and reports.
Conclusion: These results highlight the need for targeted education, and interdisciplinary collaboration between schools and PHNs, to equip PHNs with the specialized competence and position required to support adolescent athletes effectively.