Athletes are often seen as the epitome of health and fitness, but many struggle with serious health issues beneath the surface. One of the most concerning is the prevalence of eating disorders. Estimates vary by sport, population and assessment method, and disordered eating behaviors do not necessarily meet diagnostic criteria for an eating disorder. The relentless pursuit of peak performance and ideal body composition can push athletes toward harmful behaviors that jeopardize their health and longevity. THE BALANCE lists Dr. Indhira Ghyssaert as a family physician and nutritionist. This article discusses eating-disorder risks in athletes, related energy deficiency and assessment-led care.
Some athletes face increased eating-disorder risk because of intense pressure to achieve a body shape or weight perceived as crucial for performance. The competitive nature of sports can drive athletes to adopt extreme dietary practices or overtrain, leading to energy imbalances and disordered eating patterns. Some sports emphasize leanness or a specific body type, which can further exacerbate the risk. The culture of discipline and perfectionism in athletics can also contribute to unhealthy relationships with food and body image. Eating disorders can be difficult to recognize, even when an athlete appears to perform well. Relative Energy Deficiency in Sport (RED-S) is a separate syndrome associated with problematic low energy availability; it can occur with or without an eating disorder.
Relative Energy Deficiency in Sport (RED-S, also termed REDs) involves impaired physiological and/or psychological functioning caused by problematic, prolonged and/or severe low energy availability. This means too little dietary energy remains after exercise to support the body’s other functions; a brief energy deficit alone does not establish RED-S. This energy imbalance can lead to many health problems, including menstrual disturbances, decreased bone density, immune dysfunction, and hormonal imbalances. The IOC introduced RED-S in 2014 to broaden the Female Athlete Triad framework beyond menstrual function and bone health and to include male athletes. Low energy availability may arise from unintentional underfuelling, dietary restriction, high exercise demands or an eating disorder. Eating disorders are illnesses, not deliberate choices. If left unchecked, RED-S can severely impact performance and long-term health.
Athletes in endurance, aesthetic and weight-category sports may face particular risks because of high energy demands or pressure to maintain a low body weight. Examples include distance running, cycling, gymnastics, figure skating, wrestling and boxing. RED-S is not restricted to these sports, and risk should be assessed individually.
At THE BALANCE, eating-disorder assessment and treatment are considered for selected adults. Residential care in Mallorca or Zurich is considered only after medical and nutritional suitability and the necessary specialist capability are confirmed, with treatment planning individualized. Clinical assessment of suspected eating disorders considers physical and mental health, pulse, blood pressure, hydration and relevant blood tests; an ECG may be needed according to risk. Low testosterone can occur with low energy availability but needs medical assessment rather than an assumption about its cause. Homoeopathy is not an established treatment for low testosterone and should not replace evidence-based care.
We focus on restoring proper energy balance through nutritional rehabilitation and offer psychological support to address underlying issues related to body image, anxiety, and perfectionism. Our multidisciplinary team includes nutritionists, psychologists, and medical professionals who work together to guide athletes back to health, with the aim of supporting recovery. Athletes with suspected eating disorders or RED-S should seek assessment from clinicians experienced in eating disorders and sports medicine, with specialist dietetic and psychological input as appropriate. Treatment may require increased dietary intake and reduced or paused exercise; return to sport should follow individualized medical risk assessment. Severe dehydration, severe malnutrition, major electrolyte disturbances or signs of organ failure require urgent medical care, potentially in hospital. Nutritional rehabilitation after substantial restriction may require monitoring for refeeding syndrome.
The issue of eating disorders among athletes is a complex and often overlooked challenge that requires a nuanced understanding and a comprehensive approach to treatment. Sport-related pressures can increase eating-disorder risk, while problematic low energy availability can cause RED-S with or without an eating disorder. At THE BALANCE, we recognize the importance of addressing these disorders’ physical and psychological aspects. Depending on assessed needs and confirmed specialist capability, our plans may include nutritional rehabilitation, appropriate medical care and psychological support. Residential accommodation is not a substitute for hospital care when medical stabilization or hospital-level monitoring is needed. Recovery and any return to sport require individualized review; peak health or athletic performance cannot be guaranteed.
