Swim England Competitive Swimming Hub
Low Energy Availability Guidance
October 3, 2023It’s quite common to have low energy availability in aquatics but there is little awareness of the signs and symptoms.
Swim England has produced guidance documents on the subject of how to identify low energy availability and the potential health and performance consequences this may have. Knowing how to identify this early should help athletes get the support they need. This may be from a local GP, a charity or a private organisation.
Please see the links below to download these documents.
Guidance for coaches and support staff.
Guidance for athletes and parents.
Identification of Low Energy Availability
Low Energy Availability (LEA) happens when the body does not have enough energy to support all physiological functions needed to maintain optimal health, i.e. when there is a mismatch between energy in vs energy out. The body uses energy for exercise before using energy for crucial bodily functions, such as menstruation, bone development and growth.
Low energy availability can be happening due to relative energy deficiency in sport (RED-S), overtraining syndrome, disordered eating or an eating disorder. Below are brief definitions of what these are:
RED-S
Impaired physiological factors causing impairments of metabolic rate, menstrual function, bone health, immunity, protein synthesis and cardiovascular health.
Overtraining syndrome
Performance decrement lasting over two months, maladapted physiology (psychological, neurological, endocrinological, immunological systems), and an additional stressor not explained by other disease.
Disordered eating
Food related behaviors that don’t meet the threshold for recognized eating disorders (EDs) but may still negatively affect someone’s physical, mental, or emotional health.
Eating disorder
An eating disorder is a mental health condition where you use the control of food to cope with feelings and other situations.
Accessing support services for disordered eating and eating disorders
This is information only and organisations are not endorsed by or affiliated with Swim England. This document is to be reviewed yearly, so organisations may change what they offer.
NHS Adults
Connect
Service: Set up in 2018, the Community and Outreach Service offers MDT support for over 18’s. Inpatient support also available.
Access by: Referral from GP or healthcare professional.
NHS Children and Young People*
MindMate
Referral is through Leeds MindMate Single Point of Access (SPA).
Charity
Freed
Set up in 2017, FREED stands for ‘First Episode and Rapid Early Intervention Service for Young Adults with Eating Disorders’ and is for young people aged 18 to 25 who have developed an eating disorder within the last three years.
Private
Insight Eating
Service: Separate assessment for nutrition and psychology then the athlete is given recommendations from each.Sessions: There are no set number of sessions.
Age supported: 15+, however, if the person has avoidant/restrictive feeding intake disorder (ARFID) they can be seen younger, 12+.
Fees: Dietitian appointment: £100, Sport psychologist appointment: £110-£140.
Waiting times: six weeks but usually can be seen here sooner
Online and face to face appointments.
Importantly, this organisation frequently works with athletes.
NHS Adults
Greater Manchester Mental Health
Service: Specialist community service for adults over 18 who have anorexia nervosa, bulimia nervosa, binge eating disorder or atypical eating disorders.Access by: Referral from GP or healthcare professional.
NHS Children and Young People*
Greater Manchester Mental Health
The Young People’s Community Eating Disorder Service provides assessment, treatment and support for young people with eating disorders and their families.
Charity
SEED Lancashire
Support and Education for Eating Disorders (SEED) offers information, advice, education and practical help for individuals who are living with eating disorders and support for their carers.
Private
The Bridge
Location: Manchester, M3 4DN.Age supported: 10+ to under 25’s.
How to access: Self-referral – 5% off to book online.
Fees: Initial appointment £180 then £90 thereafter.
Waiting times: Up to 10 weeks.
Contact number: 0161 820 8010.
It is expected that the individual has an assessment in person for the first session then subsequent sessions can be completed online.
NHS Adults
Sheffield Health and Social Care
Service: Outpatient support and treatment for people aged 16+ who have a moderate or severe eating disorder, such as anorexia or bulimia.Waiting times: 2-6 weeks.
Location: St George’s Community Health Centre, Winter Street, Sheffield, S3 7ND.
Access by: Referral from GP or a mental health professional or SYEDA.
NHS Children and Young People*
Sheffield Children’s Service
Sheffield Eating Disorder Assessment Treatment Team (SEDATT) support those under 16. They assess and manage young people who have disordered eating, examples include anorexia, bulimia, binge eating disorder (BED) and avoidant/restrictive food intake disorder (ARFID).
Charity
SYEDA
NHS service linked with local charity SYEDA (South Yorkshire Eating Disorder Association) – self referral available here (syeda.org.uk/referrals).You may be able to be seen by the NHS by going through the SYEDA charity self-referral route, as they can refer to the NHS.
Private
No private team support in person in the community, although there is specialist inpatient support at Riverdale.
See ‘online support’ section.
NHS Adults
Nottinghamshire Health Care
Service: An outpatient service is available for those 18+ with more severe presentations of anorexia nervosa and bulimia nervosa. A mental health team made up of nursing, psychological and psychiatric health professionals.Location: Mandala Centre on Gregory Boulevard in Nottingham.
Access by: Referral from GP or healthcare professional.
NHS Children and Young People*
CAMHS
You can be referred to this service by a healthcare or educational professional. Parents/carers and young people can also self-refer for CAMHS support using the online form on the website or by calling 0115 854 2299.
Charity
First Steps
Referrals can either be made by yourself, by a parent/carer, or professional support worker. After making a referral, First Steps aim to make contact within 10 workings days.
Private
No private team support in person.
See ‘online support’ section.
NHS Adults
Birmingham and Solihull Mental Health
Service: Outpatient support for people (aged 16+ in Solihull and 25+ in Birmingham) who have severe and/or complex cases of eating disorders that require specialist treatment such as anorexia nervosa, bulimia nervosa and binge eating disorder.Access by: Referral from GP or healthcare professional.
NHS Children and Young People*
Forward Thinking Birmingham, in partnership with Birmingham NHS Trust
You can be referred to this service by a healthcare or educational professional.
Parents/carers and young people can also self-refer. This service is for those aged 0-25 years.
Charity
Forward Thinking Birmingham, in partnership with Birmingham NHS Trust
You can be referred to this service by a healthcare or educational professional.
Parents/carers and young people can also self-refer. This service is for those aged 0-25 years.
Private
Schoen Clinic Newbridge
Based in Sutton Coldfield, offers highly specialised treatments for children and young people (8-25 years) with eating disorders such as bulimia nervosa, anorexia nervosa, ARFID and Binge Eating Disorder.
NHS Adults
Cambridgeshire and Peterborough
Service: Outpatient/inpatient.Waiting times: one to 28 days.
Location: The Springs, Aslake Close Sprowston, Norwich, Norfolk NR7 8ET.
Access by: Referral from GP or healthcare professional.
NHS Children and Young People*
Norfolk and Suffolk NHS Foundation Trust
Helps under 18’s with anorexia nervosa or bulemia nervosa. Also help support the families and carers of those suffering from these disorders.
Charity
Eating Matters
Referrals can be made via self referral or NHS.Location: Chalk Hill Cottage, Norwich.
Age supported: 11+.
Private
Newmarket House Private Hospital
Founded in 1996, Newmarket House is an independent residential hospital dedicated solely to the treatment of eating disorders. It continues to be a dynamic, developing service, maintaining the highest standards.
NHS Adults
No support available through the NHS to support adults experiencing eating
disorders in High Wycombe.
NHS Children and Young People*
Oxford CAMHS
Oxford Health Foundation Trust provide Child and Adolescent Mental Health Services (CAMHS) in Bath and NE Somerset, Buckinghamshire, Oxfordshire, Wiltshire and Swindon areas only. If you live outside these areas, please contact your GP or your local CAMHS service.
Charity
SWEDA
Referrals can either be made by yourself, by a parent/ carer, or professional support worker. After making a referral, we aim to make contact within 10 workings days.
Private
Priory Wellbeing Centre
Service: Outpatient support for those aged 16+, available through self-referral.Location: Oxford.
Fees: The initial appointment costs £400, then a follow up appointment with Doctor Webster costs £200, then £200 follow up with consultant. It is not listed online but when spoke to reception, they said individuals can access this service through a private medical insurance policy with Bupa, Vitality, Aviva, Cigna, WPA or AXA PPP.
Waiting times: 3-4 months.
NHS Adults
Service: Community outpatient support. Day care available at Albert Suite, Farnham Road Hospital in Guildford.
Waiting times: 2-6 weeks.
Location: Guildford, Surrey GU2 7LX.
Location: Epsom, Surrey KT19 8NX.
NHS Children and Young People*
Surrey and Borders Partnership
Age supported: For under 18’s.
Charity
SWEDA
Referrals can either be made by yourself, by a parent/ carer, or professional support worker. After making a referral, we aim to make contact within 10 workings days.
Private
The Surrey Centre
Service: Referrals to The Surrey Centre for Eating Disorders can be made via self referral, GP, Consultant Psychiatrist/Psychologist, Psychotherapist/Counsellor or other appropriate professional.Location: Epsom Surrey, KT18 6LS.
Fees: £275.
Age supported: Under 25.
NHS Adults
Avon and Wiltshire Mental Health Partnership NHS Trust: The STEPs Eating Disorders Community Team
Service: Outpatient community service providing compassionate and evidence-based care to adults in Bristol with a suspected or confirmed eating disorder diagnosis.Location: The Coppice, Callington Road Hospital, Marmalade Lane, Brislington, Bristol, BS4 5BJ
Waiting times: 1-28 days.
NHS Children and Young People*
Avon and Wiltshire Mental Health NHS Partnership
There are five locality CAMHS teams across Bristol, North Somerset and South Gloucestershire.
Charity
Bristol Eating Disorder Group
The Bristol Eating Disorder Peer Support Group has been running for over thirty years. The group provides a space for those experiencing eating disordered (aged 18 years and over) and for friends/families/carers to offer support and understanding to one another.
Private
Priory Wellbeing Centre
Service: Outpatient supportLocation: Oxford available through self-referral.
Age supported: 16+.
Fees: The initial appointment costs £400, then a follow up appointment with Doctor Webster costs £200, then £200 follow up with consultant. It is not listed online but when spoke to reception, they said individuals can access this service through a private medical insurance policy with Bupa, Vitality, Aviva, Cigna, WPA or AXA PPP.
Waiting times: 3-4 months.
* Most children and young people’s mental health services should accept self-referrals now, so GPs don’t have to be the gate keepers and treatment should be started within four weeks of the referral.
Getting support online
If you think someone’s relationship with food or exercise may have become unhealthy or disordered, the following resources may be able to help.
Websites
https://www.beateatingdisorders.org.uk/
The UK’s leading eating disorder charity.
https://trainbrave.org/resources/
The #TRAINBRAVE campaign aims to inspire more athletes to share their stories and raise awareness of the risks of eating disorders and RED-s.
https://www.bbc.co.uk/sport/cycling/62600029
Athlete’s perspective of RED-S.
https://red-s.com/info-hub/resources
Created by athlete, Pippa Woolvern to raise awareness of RED-S.
https://anorexiafamily.com/?v=79cba1185463
For families with anorexia.
https://newmaudsleycarers-kent.co.uk/
Showing males have anorexia too.
Books
View Book on Amazon
Anorexia and other eating disorders: how to help your child eat well and be well: Practical solutions, compassionate communication tools and emotional support for parents of children and teenagers
View Book on Amazon
Orthorexia: When Healthy Eating Goes Bad.
Getting online private support
See below for organisations that offer support online. They charge a fee for their service.
The three listed below are made up of a multidisciplinary team and have extremely experienced dietitians, who have previously, or still do, work for the NHS and/or lecture on university courses for student dietitians.
This support is ideal for those wanting to access support quickly, as there would be minimal wait times and can be accessed online, in the comfort of your own home.
- Renee McGregor
- Insight Eating
- Light of Mind
- Optimise Potential
Hannah Stoyel is a Sport Psychologist and founder of Optimise Potential.
Hannah is a sports psychologist with a special interest in disordered eating and eating disorders amongst athletes. She uses an integrative approach with an emphasis on Cognitive Behavioural Therapy and Acceptance Commitment Therapy and has a special interest in disordered eating and eating disorders among athletes.