Low energy availability (LEA) is one of those issues many dietitians recognise quickly  but often find harder to clearly define in practice.

An athlete presents with recurring injuries, poor recovery, changes in menstrual function or energy, or a sense that performance just isn’t adapting as expected. Intake looks reasonable on paper. The training load seems appropriate. And yet, something doesn’t quite add up.

In these moments, the challenge isn’t understanding what LEA is – it’s knowing how to confidently screen for it, what sits within scope, and which tools genuinely add value. This is where screening tools like the LEAF-Q and LEAM-Q enter the conversation and where many nutrition professionals pause. 

What do they actually tell us, and how should they support clinical reasoning rather than replace it?

What Are the LEAF-Q and LEAM-Q?

The LEAF-Q and LEAM-Q are screening tools designed to help identify athletes who may be at risk of low energy availability (LEA).

The LEAF-Q was first developed back in 2014, originally as a way to screen for risk of the Female Athlete Triad in physically active women. Rather than focusing on food intake alone, it looked at the kinds of physiological warning signs that tend to show up when energy availability has been low for a while – things like recurring injuries, gut symptoms, and changes to menstrual function (1).

Over time, the LEAF-Q has been used more broadly to help flag potential LEA-related risk across different sporting populations, and the LEAM-Q was later developed to extend this type of screening to male athletes. Together, these tools help us pick up patterns across areas we’re already discussing with athletes every day, including:

• Training load and recovery
• Injury and illness history
• Gastrointestinal symptoms
• Menstrual function (LEAF-Q)
• Libido, fatigue, and recovery markers (LEAM-Q)

What Does the Broader Evidence Show?

When we look at the research, the LEAF-Q consistently shows up as a useful way to flag potential LEA risk in athletes. In the original study by Melin and colleagues (3), the LEAF-Q was able to pick up athletes who were already showing physiological signs linked to chronic low energy availability, including menstrual disruption and higher injury rates. Using a cut-off score of ≥8, the questionnaire demonstrated a sensitivity of around 78% and a specificity of around 90% for identifying athletes with LEA-related risk indicators supporting its role as an effective early screening tool rather than a diagnostic measure.

Since then, LEAF-Q has been used across a range of sporting contexts, with studies in collegiate and elite female athletes repeatedly finding that a meaningful proportion of athletes screen as “at risk” despite appearing healthy and training well.

What This Means in Practice

For dietitians working in applied settings, these findings matter because athletes rarely present with “low energy availability” as the complaint. Instead, LEA often shows up through subtle, easily normalised signs – fatigue, performance plateaus, niggles, gastrointestinal issues, or inconsistent recovery.

In practice, this means screening can:

• Support earlier identification of potential LEA risk, before injuries or health consequences escalate
• Provide structure when symptoms are vague or multifactorial
• Help move practice beyond appearance-based assumptions, recognising that LEA can occur across a wide range of body types
• Reduce the risk of missing warning signs in athletes who appear to be fuelling well on the surface
• Create a clear, non-weight-focused way to guide conversations about energy availability, recovery, and training demands

What Are Dietitians Actually Doing in Practice?

Interestingly, research suggests that tools like the LEAF-Q are not yet consistently embedded in sports dietetic practice. 

A 2022 survey (2) exploring how sports dietitians assess and manage athletes at risk of low energy availability found that fewer than half reported “always” or “often” using the LEAF-Q as part of their assessment. Rather than reflecting poor practice, this likely speaks to the uncertainty many practitioners feel around screening – particularly questions of scope, interpretation, and how to integrate results meaningfully into care. 

From an education perspective, this highlights an important opportunity: building clarity and confidence around how screening tools like the LEAF-Q and LEAM-Q can be used intentionally, ethically, and alongside clinical reasoning to support athlete health and performance.

Screening Is a Starting Point

One of the most important distinctions to make is that screening does not equal diagnosing. A high LEAF-Q or LEAM-Q score should prompt curiosity, not conclusions:

• Is energy distributed adequately across the day?
• Are recovery, sleep, and stress supporting adaptation?
• Are psychosocial or cultural factors influencing fueling?
• Is referral or collaboration with medical or psychology professionals required?

So, Should Nutrition Professionals Use These Tools?

Overall, yes – when they’re used for what they’re designed to do.

The LEAF-Q and LEAM-Q are not diagnostic tools, and they shouldn’t replace clinical judgement. But when applied thoughtfully, they can help dietitians identify potential LEA risk, prompt deeper assessment, and support informed conversations within multidisciplinary teams.

Rather than asking whether we should use these tools, a more useful question is how we can use them well in a way that complements clinical reasoning and genuinely supports athlete health and performance.

Looking to Build Confidence in Practice?

Screening tools like the LEAF-Q and LEAM-Q are only one part of good practice. What matters most is having the knowledge and confidence to interpret what you’re seeing and respond thoughtfully.

That’s what Compeat Academy is here for — supporting dietitians to build clarity, apply evidence in real-world settings, and navigate complex topics like LEA and REDs with confidence.

If you’re looking to learn, reflect, and grow alongside like-minded professionals, join Compeat Academy and be part of a community committed to athlete-centred, evidence-informed practice.

References:

1. Ferraris C, de Cassya Lopes Neri L, Amoroso AP, Bosio F, Fiorini S, Guglielmetti M, Nappi RE, Tagliabue A. Screening tool for the identification of relative energy deficiency in Sport risk: validation of the low energy availability in female questionnaire – Italian version (LEAFQ-ITA). J Int Soc Sports Nutr. 2025 Dec;22(1):2550317. doi: 10.1080/15502783.2025.2550317. Epub 2025 Aug 22. PMID: 40844031; PMCID: PMC12377126.
2. Bowler, Amy-Lee & Coffey, Vernon & Cox, Gregory. (2022). Sports Dietitian practices for assessing and managing athletes at risk of low energy availability (LEA). Journal of Science and Medicine in Sport. 25. 10.1016/j.jsams.2022.02.002
3. Melin A, Tornberg AB, Skouby S, Faber J, Ritz C, Sjödin A, Sundgot-Borgen J. The LEAF questionnaire: a screening tool for the identification of female athletes at risk for the female athlete triad. Br J Sports Med. 2014 Apr;48(7):540-5. doi: 10.1136/bjsports-2013-093240. Epub 2014 Feb 21. PMID: 24563388.