Athletes are often celebrated for their discipline, commitment, and ability to push beyond perceived limits. Dedication is closely tied to behaviors such as increased training volume, careful attention to nutrition, and pursuit of performance goals.
However, when the demands placed on the body consistently exceed the energy available to support health and daily function, the consequences can extend beyond performance. Relative Energy Deficiency in Sport (REDs) is one condition that highlights the importance of recognizing when an athlete’s commitment to sport may be accompanied by physiological and psychological costs. For providers working with athletes, understanding REDs requires looking beyond food intake alone. It requires considering the complex relationship between sport culture, performance expectations, mental health, nutrition, and an athlete’s individual experiences.
Rebecca McConville, MS, RD, LD, CSSD, CEDS-C, works at this intersection of sports nutrition and eating disorder treatment. She has seen how important it is for providers across disciplines to understand both the physiology of underfueling and the psychological factors that may contribute to disordered eating.
What Is REDs?
Relative Energy Deficiency in Sport occurs when there is insufficient energy availability to support the demands of exercise, normal physiological functioning, and overall health. An athlete is not consistently taking in enough energy to meet the combined needs of training and the body’s essential functions.
The International Olympic Committee (IOC) first introduced the RED-S concept in 2014 as an expansion of the Female Athlete Triad model. The Triad focused primarily on low energy availability, menstrual dysfunction, and bone health. RED-S recognizes that low energy availability can affect multiple body systems and can occur across genders.
The updated IOC consensus statement describes REDs as involving potential impacts across areas including:
- Metabolic function
- Reproductive health
- Bone health
- Immune function
- Cardiovascular health
- Gastrointestinal function
- Psychological health
- Athletic performance
McConville often educates clinicians on REDs to help highlight the significance:
“I like explaining [REDs] in terms of money. There are not enough deposits coming in for the amount of withdrawals. The overdraft comes at the expense of the body as it conserves or shuts down function to conserve energy being spent such as their menstrual cycle or bone health.”
REDs and Eating Disorders: Understanding the Overlap Without Assuming the Cause
Because REDs involves inadequate energy availability, it is closely connected to conversations about eating disorders and disordered eating. However, providers must be careful not to assume that every case of REDs is caused by an eating disorder or that every athlete struggling with an eating disorder will present with obvious signs of REDs.
McConville emphasizes that athletes bring their entire lived experience into treatment.
“Athletes can face additional stressors due to an increased focus on body composition or aesthetics, as well as the energy demands of training,” she explains. “But it can also be important to recognize that an athlete may have experiences contributing to disordered eating or maladaptive coping before sport ever became part of the picture. Sometimes sport becomes a place of protection or identity.”
This distinction matters clinically.
For some athletes, sport environments may reinforce harmful beliefs about body size, weight, or performance. For others, sport may be an important source of connection, purpose, and resilience. Providers must approach each athlete’s story with curiosity rather than assumptions.
Why REDs Can Be Difficult to Recognize
Athletes are often praised for behaviors that can overlap with warning signs of disordered eating or problematic low energy availability:
- Training despite fatigue or injury
- Strict adherence to food rules
- Fear of rest days
- Increased focus on body composition
- Difficulty adapting nutrition to changes in training demands
This can create challenges for coaches, athletic trainers, physicians, therapists, and dietitians who are trying to determine when commitment has shifted into a concern.
McConville references an important distinction shared by sports psychologist Dr. Kate Bennett:
“A driven athlete will do whatever you ask them to do to excel at their sport. A disordered athlete will struggle as the disorder comes to the surface.”
The difference is not motivation. Many athletes with eating disorders or REDs are incredibly motivated. The difference is whether behaviors remain flexible and supportive of health or whether they become rigid, distressing, and harmful.
The Role of the Athlete Support Team
Coaches, athletic trainers, and team physicians are often among the first people to notice changes in an athlete. However, many professionals working closest with athletes receive limited training in eating disorders and REDs recognition.
McConville encourages support teams to understand that raising concern does not require having all the answers.
“You can bring up concern simply by encouraging the athlete to see a provider and ensuring they have done everything they need to help them perform their best,” she says.
This approach does not require a coach or teammate to diagnose REDs or an eating disorder. Instead, it creates a pathway toward appropriate evaluation and specialized care.
A supportive conversation might sound like:
“We want to make sure you have everything you need to perform and feel your best. I think it would be helpful to connect you with someone who can support your health and recovery.”
Early conversations can create opportunities for athletes to receive help before concerns become more severe.
Moving From Awareness to Application
While awareness of REDs has grown, Rebecca identifies an ongoing gap: translating awareness into clinical application.
This was one reason she developed a REDs-informed provider certification program.
“We have awareness, but there was a gap in application,” she explains. “This certification equips clinicians with not only assessment skills, but also how to provide athletes with skills to avoid falling back into REDs again.”
For providers, effective REDs care requires more than recognizing symptoms. It requires understanding:
- How sport culture influences beliefs and behaviors
- How to assess risk without creating shame
- How to collaborate across disciplines
- How to support sustainable recovery while respecting an athlete’s goals
The sports world has made progress in understanding performance nutrition, but McConville notes there is still work to do around understanding malnutrition and the consequences of inadequate fueling.
How Providers Can Support Athletes
Providers working with athletes can consider:
1. Ask questions early
Concerns do not need to reach a crisis point before they are addressed.
Examples:
- “How has your fueling been matching your training demands?”
- “Have there been changes in your eating patterns recently?”
- “How do you feel when you miss a workout or change your routine?”
2. Look beyond appearance
Athletes with REDs or eating disorders may present across body sizes and competitive levels.
3. Consider the whole athlete
Performance, mental health, relationships, identity, and sport culture all influence an athlete’s relationship with food and their body.
4. Collaborate
REDs-informed care often requires coordination among medical providers, mental health professionals, dietitians, and sport professionals.
The Takeaway
Athletes deserve care that supports both performance and long-term health.
Understanding REDs means recognizing that fueling is not simply about maximizing output—it is about ensuring the body has the resources needed to function, recover, and thrive.
For providers, the goal is not to take away an athlete’s dedication or passion for sport. The goal is to help athletes pursue their goals without sacrificing their health along the way.
As McConville’s work demonstrates, the future of athlete care depends on bridging the gap between sports nutrition, eating disorder treatment, and compassionate, informed clinical practice.
References
Mountjoy, M., Ackerman, K. E., Bailey, D. M., Burke, L. M., Constantini, N., Hackney, A. C., Heikura, I. A., Melin, A., Pensgaard, A. M., Stellingwerff, T., Sundgot-Borgen, J. K., Torstveit, M. K., Jacobsen, A. U., Verhagen, E., Budgett, R., Engebretsen, L., & Erdener, U. (2023). 2023 International Olympic Committee’s (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs). British Journal of Sports Medicine, 57(17), 1073–1097. https://doi.org/10.1136/bjsports-2023-106994
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