Mirror reflections and energy deficits: Exploring the role of body image as a predictor of relative energy deficiency in sport (REDs)

Abstract

Body image is a powerful psychological construct, shaping how athletes perceive, engage, and endure within their sport. Yet, its critical role in the etiology and perpetuation of Relative Energy Deficiency in Sport (REDs) remains underestimated. Although diagnostic frameworks such as the REDs Clinical Assessment Tool (REDs CAT) identify key behavioural and physiological indicators, body image disturbances, despite their associations with disordered eating, compulsive exercise, and psychological distress, are not explicitly emphasized.

This review examines the intricate nexus between body image and REDs, elucidating its role as a catalyst for maladaptive behaviours and a harbinger of physiological and psychological decline. Athletes, particularly those in lean-body and aesthetic sports, face disproportionate vulnerability, as the cultural valorisation of performance and appearance converges with internalised body dissatisfaction to exacerbate energy deficits and psychological distress. Despite mounting evidence, body image remains a peripheral concern in REDs screening and intervention.

We advocate for an expanded research agenda that positions body image not as a diagnostic criterion, but as a potentially important upstream factor in REDs risk. Longitudinal, theory-driven studies are needed to clarify its role in both the development and resolution of REDs, and to inform more holistic screening and intervention strategies. Recognizing body image as both a possible contributor to and consequence of REDs may support more tailored, psychologically informed approaches to athlete care.

This call-to-action invites researchers, clinicians, and sport organizations to reimagine REDs through a lens that prioritises psychological resilience alongside physical performance, ensuring a more sustainable future for athletes.