The quote above is a phrase I’ve heard in different variations. And while it may come from a place of trying to normalize stress, it can also reflect a deeper misunderstanding of what might really be going on. When an athlete seems low on drive, emotionally flat, or increasingly anxious about food, weight, or performance, it’s easy to assume the issue is purely psychological. And yes—sometimes it is. But REDs can mimic burnout, low confidence, or overtraining. If we focus only on mindset without considering potential physiological causes, we risk reinforcing the very patterns that are harming the athlete. This risk is especially high in environments where discipline, lean bodies, and mental toughness are celebrated—where skipping meals, pushing through pain, or hiding fatigue are seen as marks of commitment. In those settings, the early signs of REDs aren’t just overlooked—they’re sometimes misinterpreted as dedication, a lack of motivation, or simply the expected fatigue of intense training phases.

REDs refers to a condition where an athlete’s energy intake is insufficient to meet the demands of training, recovery, and physiological functioning. The IOC defines REDs as “a syndrome of impaired physiological and/or psychological functioning experienced by female and male athletes that is caused by exposure to problematic (prolonged and/or severe) low energy availability (LEA). The detrimental outcomes include, but are not limited to, decreases in energy metabolism, reproductive function, musculoskeletal health, immunity, glycogen synthesis and cardiovascular and haematological health, which can all individually and synergistically lead to impaired well-being, increased injury risk and decreased sports performance.” (Mountjoy et al., ​2014​ / ​2023​).

Recent studies indicate a high prevalence of REDs among athletes, ranging from 45% (​Heikura et al., 2025​) to 67.2% (​Marzuki et al., 2023​), with particularly high risk in female, weight-class, and intermittent sport athletes. REDs is frequently associated with disordered eating, compulsive exercise, and body image concerns (​Vardardottir et al., 2023​), which can contribute to both physiological impairments and significant psychological strain (​Langbein et al., 2021​).

While widely discussed, recent research has raised important questions about how REDs is defined and identified in practice. ​Jeukendrup and colleagues (2024)​ emphasize that many symptoms linked to REDs—such as fatigue, disrupted menstrual cycles, poor concentration, or decreased performance—can also be caused by other factors like psychological stress, sleep disturbances, or illness. The core challenge lies in accurately assessing energy availability and distinguishing its role from other potential contributors to an athlete’s health or performance issues.

As sport psychologists, we are not responsible for diagnosing REDs—and many of us are not specifically trained to identify it. However, we do play a critical role in noticing potential warning signs and initiating conversations that can lead to the right support. Subtle shifts in mood, motivation, energy levels, or emotional regulation may point to something deeper than mental fatigue. When these patterns arise, it’s essential that we collaborate within a multidisciplinary team—including physicians, nutritionists, and other health professionals—to ensure the athlete receives a thorough assessment and appropriate care. Our role is to create a space for reflection, to ask thoughtful, non-judgmental questions, and to support athletes in reconnecting with values, self-care, and long-term health. By staying within our scope and referring when needed, we protect the athlete’s well-being and contribute to a safer, more responsive performance environment.

When we start to notice signs that could point toward REDs—like persistent fatigue, mood shifts, increased anxiety, disrupted recovery, or emotional distress—it’s important not to jump to conclusions, but also not to ignore what we’re seeing. These early signs are an invitation to pause, reflect, and respond with care. From my own practice, here are some steps I’ve found helpful:

• Create a Safe Space for Conversation
  You could begin by gently exploring how the athlete is doing overall—not just in training, but as a person. Focus on energy, recovery, and well-being rather than nutrition or weight. I’ve often said things like:
  “You’ve seemed more tired lately—how are you feeling physically and mentally these days?”
  “How’s recovery been for you recently? Are you noticing any changes in how your body responds to training?”
  These open the door without pressure or assumption.
  
  
• Normalize and Validate
  If the conversation touches on struggles with food, fatigue, body image, or pressure to maintain a certain physique, you could normalize how common these challenges are in sport. This helps reduce shame and defensiveness.
  “A lot of athletes I work with feel pressure to always be lean or look a certain way. That’s a tough space to be in—especially when the body is just doing its best to keep up.”
  
  
• Stay Within Your Scope—and Know When to Refer
  I’m not trained to diagnose REDs, and it’s important I don’t try. But I am and I think we are trained to spot concerns and help athletes get the right support. When REDs seems likely, I might say something like:
  “From what you’ve shared, I wonder if it might be helpful to speak with a sport nutritionist or medical professional—just to check in on how your body is doing. I’d be happy to help connect you.”
  It’s not about alarming the athlete—it’s about showing that we care enough to involve the right people.
  
  
• Collaborate with the Team
  When possible, and with the athlete’s consent, involve trusted professionals in the athlete’s environment—coaches, doctors, nutritionists—so that the athlete is supported holistically. Respect confidentiality and center the athlete’s autonomy in this process.
  
  
• Keep Supporting the Psychological Side
  Even after a referral, our role continues. We support the athlete emotionally through the process—navigating self-doubt, fear of change, or resistance to slowing down. REDs isn’t just about physiology—it touches on identity, control, pressure, and self-worth.

There’s no one script for these situations, but what I’ve learned is this: Our words and presence matter more than we think. When we approach with care and confidence—while also knowing our limits—we can be the link that helps an athlete get what they need before things go too far.

REDs can be a difficult and often hidden issue in high-performance sport—but together, we can bring more awareness, compassion, and clarity to how we support athletes. If you’ve worked with an athlete affected by REDs or successfully navigated conversations around energy availability—I’d love to hear from you. Your experiences, reflections, and insights can help us all grow. Because as always: we’re powerful alone, but better together.