The Rise in REDs and Why Athletes Should Be Aware of It

As awareness of the condition increases, more and more athletes are being diagnosed with REDs (Relative Energy Deficiency in Sport). But while what an athlete eats is a contributory factor to REDs, it is not the only thing to be aware of.

As we explored in a previous article REDs, Relative Energy Deficiency in Sport, is the result of low energy availability. This means that REDs occurs when there is insufficient energy in the body to enable the individual to do ‘the work’ that they want to do. By ‘work’ we mean both training, but also everything from daily movement to biological processes within the body (such as keeping the brain, heart, and digestive systems going).

REDs is often associated with professional or elite level athletes due to their high training loads, competitive environments, and aspects of athlete mentality. However, emerging evidence has demonstrated that REDs can impact anyone who is physically active.

We live in a world where the prevalent message is “Move more and eat less” and while this may prove important for some population groups, it is neither relevant nor appropriate for those of us who are physically active. In fact, physiological studies suggest, “Move more and eat more.”

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A study in 2016 (Joy et al) reported that the prevalence of disordered eating was 20% higher in athletes compared with their non-athletic peers. More recently, Trott et al (2020) demonstrated that individuals who have an exercise dependency are four times more likely to develop disordered eating.

While incidences of disordered eating in athletes is widespread, eating disorders are less common - but still prevalent. 13.5% of elite athletes are cited to to have eating disorders, meaning a serious mental illness with diagnostic criteria. If we extend this population group to include recreational athletes that number would be higher.

The difference between disordered eating and eating disorders

Eating disorders such as Anorexia, Bulimia or Binge Eating have strict criteria by which they are diagnosed and generally have severe consequences to both mental and physical health.

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Disordered eating is a term coined for dysfunctional relationships with food. However, it can often be disguised and may go unnoticed because of “wellness” or nutrition trends. It usually avoids the removal of one or more food groups and exists with a strict set of rules and beliefs related to food and more often, exercise. While it may have started out with good intention, it can lead to heightened anxiety and an inability to consume food socially, resulting in isolation and thus potential risk to well-being.

Why athletes need to be aware of REDs

We live in a society that demands us to prove our worth through our achievements, and for athletes this means sporting success. While healthy competition doesn’t hurt, it can also create anxiety and define one’s worth.

We must remember that athletes of all levels tend to be a certain type of personality trait. They are often driven, obsessive, focused, self-critical and perfectionist. While these exact traits are what make them good at their sport, if they are not managed appropriately, they can tip into dysfunctional behaviours around food, body image and training.

All human behaviour has a purpose, and is often related to protecting oneself from difficult and uncomfortable emotions. Being a perfectionist means that you often never feel good enough; continually pushing and cracking the whip provides you with a false sense of security that you are working towards a goal, but sadly a goal that will never be attained because as soon as you hit that target, you raise the bar again. It is much easier to project this discomfort of not being good enough onto food, body image and training as these are solid, tangible traits you can measure, as opposed to dealing with our thoughts, feelings, and emotions.

REDs: It's about more than what you eat

While REDs is underpinned by low energy availability, it is important to remember that this is a condition that is multi-faceted. Dysfunctional relationships with food are one potential spoke. Another characteristic I have observed also include under recovery both in day-to-day training but also competitively.

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With the rise of ultra-distance events, many individuals are motivated to enter a number of races. While it is great to have a goal, it can become an issue when someone competes in many events during a short space of time, with little opportunity to recover.

Similarly, in the recreational world we all have busy lives. Many of us have full time jobs and families, but we want to train like an athlete. This leads a lot of people to skimp on sleep or valuable downtime to fit training in around the other aspects of their lives.

All of these behaviours add pressure on to our nervous systems, and it is this layering of stress that can also lead to REDs.

It is easy to believe that the human body is invincible, because for a long-time it will work for you. However, it is important to remember that for longevity and to be a more sustainable athlete, you may need to learn to manage aspects of your personality, your expectations and your behaviours.