Intersection of mental health issues and Relative Energy Deficiency in Sport (REDs): a narrative review by a subgroup of the IOC consensus on REDs
Abstract
Overall athlete health is a stated priority by the International Olympic Committee (IOC), yet it can be difficult for athletes to safely balance nutritional needs, training load, recovery, social interactions, expectations and other demands. The effect of energy intake and, especially, low energy availability (LEA) on athlete mental health, is understudied. In this narrative review, we examine research that has included psychological factors and mental health variables when investigating the effect of LEA, dieting/restrictive eating and Relative Energy Deficiency in Sport (REDs), since the 2018 IOC consensus statement on REDs. Based on currently available data, early psychological indicators associated with problematic LEA are mood changes, fatigue and psychological conflict. More severe mental health outcomes associated with REDs are reduced well-being, elevated anxiety, depressive symptoms and eating disorders. We propose a psychological model that helps structure how possible risk factors (eg, body dissatisfaction, environmental demands or increased training load) and moderating (eg, gender, sport) and/or potential mediating (eg, social climate, self-esteem) factors are associated with LEA and ultimately REDs. The current scientific literature underscores the importance of including mental health factors when screening for REDs and for developing a clinical approach to address the psychological sequelae of REDs once diagnosed. An interdisciplinary perspective is recommended. Lastly, and importantly, the athlete perspective urges clinicians to not underestimate the drive for success and denial of health consequences that athletes demonstrate when pursuing their sport goals.
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Psychological symptoms are very common in athletes with REDs, including fatigue, mood changes, irritability, and elevated anxiety.
“In addition to the physiological impacts of underfueling, psychological symptoms are very common in athletes with REDs.These psychological effects can include, but are not limited to, fatigue, mood changes, irritability, and elevated anxiety [16].”
From Low Energy Availability and Relative Energy Deficiency in Sport: A Systematic Review and Meta-analysis (2025) · cites this paper as [16]
Cites
The PHQ-9: Validity of a brief depression severity measure
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001) · Journal of General Internal Medicine · doi:10.1046/j.1525-1497.2001.016009606.x · Cited by 44,910 · see citing works
Defining Training and Performance Caliber: A Participant Classification Framework
McKay, A. K. A., Stellingwerff, T., Smith, E. S., Martin, D. T., Mujika, I., Goosey-Tolfrey, V. L., Sheppard, J., & Burke, L. M. (2022) · International Journal of Sports Physiology and Performance · doi:10.1123/ijspp.2021-0451 · Cited by 3,093 · see citing works
Psychological flexibility as a fundamental aspect of health
Kashdan, T. B., & Rottenberg, J. (2010) · Clinical Psychology Review · doi:10.1016/j.cpr.2010.03.001 · Cited by 3,054 · see citing works
Mountjoy, M., Sundgot-Borgen, J., Burke, L., Carter, S., Constantini, N., Lebrun, C., Meyer, N., Sherman, R., Steffen, K., Budgett, R., et al. (2014) · British Journal of Sports Medicine · doi:10.1136/bjsports-2014-093502 · Cited by 1,469 · see citing works
Self-citationMountjoy, 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., et al. (2023) · British Journal of Sports Medicine · doi:10.1136/bjsports-2023-106994 · Cited by 724 · see citing works
Self-citationConstruct validity of the Profile of Mood States — Adolescents for use with adults
Terry, P. C., Lane, A. M., & Fogarty, G. J. (2003) · Psychology of Sport and Exercise · doi:10.1016/s1469-0292(01)00035-8 · Cited by 622 · see citing works
Nutritional psychiatry: Towards improving mental health by what you eat
Adan, R. A. H., van der Beek, E. M., Buitelaar, J. K., Cryan, J. F., Hebebrand, J., Higgs, S., Schellekens, H., & Dickson, S. L. (2019) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2019.10.011 · Cited by 454 · see citing works
The SCOFF questionnaire: a new screening tool for eating disorders
Morgan, J. F. (2000) · Western Journal of Medicine · doi:10.1136/ewjm.172.3.164 · Cited by 272 · see citing works
Wasserfurth, P., Palmowski, J., Hahn, A., & Krüger, K. (2020) · Sports Medicine - Open · doi:10.1186/s40798-020-00275-6 · Cited by 190 · see citing works
Åkesdotter, C., Kenttä, G., Eloranta, S., Håkansson, A., & Franck, J. (2022) · BMJ Open Sport & Exercise Medicine · doi:10.1136/bmjsem-2021-001264 · Cited by 63 · see citing works
Kuikman, M. A., Mountjoy, M., & Burr, J. F. (2021) · Nutrients · doi:10.3390/nu13082601 · Cited by 50 · see citing works
Self-citationPsychological Flexibility Among Competitive Athletes: A Psychometric Investigation of a New Scale
Johles, L., Gustafsson, H., Jansson-Fröjmark, M., Classon, C., Hasselqvist, J., & Lundgren, T. (2020) · Frontiers in Sports and Active Living · doi:10.3389/fspor.2020.00110 · Cited by 38 · see citing works
Langbein, R. K., Martin, D., Allen-Collinson, J., & Jackman, P. C. (2022) · Performance Enhancement & Health · doi:10.1016/j.peh.2021.100214 · Cited by 20 · see citing works
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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., et al. (2023) · British Journal of Sports Medicine · doi:10.1136/bjsports-2023-106994 · Cited by 724 · see citing works
Self-citationGallant, T. L., Ong, L. F., Wong, L., Sparks, M., Wilson, E., Puglisi, J. L., & Gerriets, V. A. (2025) · Sports Medicine · doi:10.1007/s40279-024-02130-0 · Cited by 75 · see citing works
- Authors
- Pensgaard, A. M., Sundgot-Borgen, J., Edwards, C., Jacobsen, A. U., & Mountjoy, M.
- Affiliations
- Norwegian School of Sport Sciences (NO)
- McMaster University (CA)
- Corresponding author
- Pensgaard, Anne Marte
- Venue
- British Journal of Sports Medicine
- Publisher
- BMJ
- Published
- 2023-09
- Volume
- 57
- Issue
- 17
- Pages
- 1127-1135
- ISSN
- 0306-3674 (ISSN-L)
- 1473-0480
- OpenAlex
- W4387036481
- Cited by
- 56
- References
- 13
- Citations by year
- 2026: 19 · 2025: 18 · 2024: 16 · 2023: 3
- FWCI
- 2.84
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- British Journal of Sports Medicine (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Keywords
- relative energy deficiency in sport, low energy availability, athlete mental health, eating disorders, anxiety, depressive symptoms, body dissatisfaction, restrictive eating, psychological model, psychological sequelae, training load, social climate, self-esteem, gender differences
- MeSH terms
- Relative Energy Deficiency in Sport, Feeding and Eating Disorders, Humans, Mental Health, Sports, Athletes
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