For years, Relative Energy Deficiency in Sport (REDs) has been associated with a very specific image: the visibly thin athlete who appears obviously undernourished. But that stereotype is one of the biggest reasons REDs continues to go undiagnosed, because REDs does not have a body type. Athletes experiencing chronic low energy availability can exist at any weight, any BMI, and in any sport. In fact, some athletes may even gain weight while physiologically underfueling. So while it may be surprising, yes… you can absolutely have REDs at higher weights and without any weight loss.
If we continue relying on appearance, BMI, or weight loss alone to identify REDs, we will continue missing athletes who are struggling long before their body weight changes.
REDs at Higher Weight: Why BMI Fails Athletes
Here’s the thing about BMI… it was never designed to assess athletic health.
It does not distinguish between:
- fat mass
- muscle mass
- hydration
- bone density
- or metabolic health
Yet BMI continues to dominate healthcare conversations around nutrition and body weight, which becomes especially problematic in athletic populations.
At the 2016 Summer Olympics, athletes across many sports fell into BMI categories labeled “overweight” despite competing at the highest levels of human performance. Sports like rugby and weightlifting routinely demonstrate why BMI fails to capture athletic physiology.
An athlete can have excellent performance capacity, high lean body mass, and significant physiological dysfunction… all while appearing “healthy” according to BMI charts.
This is why REDs at higher weight is so frequently overlooked.
Can You Have REDs Without Weight Loss?
One of the most common misconceptions about REDs is this: “If my weight hasn’t changed, I must be eating enough.”
Unfortunately, physiology is far more complex. When the body experiences prolonged low energy availability, it adapts in order to survive.
One major adaptation is suppression of resting metabolic rate (RMR).
Instead of continuing to burn energy normally, the body begins conserving energy by slowing down physiological processes:
- metabolism decreases
- hormones shift
- recovery slows
- digestion changes
- and performance eventually declines
In some athletes, this adaptation can actually contribute to weight stability or even weight gain despite inadequate fueling.
This means body weight alone tells us very little about whether the body is functioning optimally.
An athlete may appear “fine” and “healthy” externally while internally experiencing:
- hormonal disruption
- chronic fatigue
- poor recovery
- low libido
- GI distress
- impaired immunity
- sleep disruption
- or declining bone health
Why REDs at Higher Weight Is Often Missed
Because healthcare providers are trained to associate undernutrition with visible thinness, athletes in larger bodies are frequently overlooked.
It’s common for their symptoms to be blamed on stress, aging, hormones, burnout, anxiety, or overtraining.
I recently worked with an endurance athlete in her 40s who experienced:
- fatigue
- irregular menstrual cycles
- GI symptoms
- poor sleep
- anxiety
- and prolonged soreness
Her symptoms had repeatedly been dismissed as “just perimenopause.”
No one assessed her fueling, reviewed her training load, or investigated low energy availability.
When further evaluation and labs were completed, the picture became much clearer:
- low ferritin
- suppressed thyroid markers
- low estradiol
- low white blood cells
- and signs of chronic underfueling
Her weight had never raised concern, and that’s exactly the issue.
The Body Adapts to Energy Deficiency
REDs is not simply about weight loss. It is a complex physiological adaptation to insufficient energy availability.
The body is smart… it prioritizes survival over performance.
Over time, this can affect nearly every system in the body, including:
- endocrine function
- metabolism
- bone health
- digestion
- immune function
- cardiovascular health
- and psychological well-being.
In more advanced cases, the body may even begin breaking down skeletal muscle tissue to conserve energy, which is a major no-go!
Ironically, this can sometimes leave athletes with reduced lean mass, poorer recovery, and unchanged or relatively higher body fat percentages, despite all the hard work they’re putting in during training.
This is why appearance alone is such a poor screening tool.
Symptoms Matter More Than Weight
Some of the most important REDs warning signs have nothing to do with body size.
Symptoms that deserve attention include:
- persistent fatigue
- recurrent injuries
- low libido
- menstrual irregularities
- GI issues
- frequent illness
- sleep disruption
- mood changes
- food rigidity
- poor workout recovery
- declining performance
- cold intolerance
- brain fog
An athlete does not need to “look underweight” to be physiologically struggling.
Moving Beyond Weight-Centric Thinking
The sports world has spent decades equating thinness with discipline, performance, and health. But health is not determined by appearance, and performance achieved through chronic physiological suppression comes at a cost (a major one at that!).
As providers, coaches, and clinicians, we must learn to:
- assess beyond BMI
- recognize REDs at higher weight
- understand the body’s adaptive responses to chronic underfueling
Because athletes in all body sizes deserve to be seen, assessed, and supported appropriately.
Learn a Better Way to Assess Athletes
If you’re ready to learn a better way to assess athletes through a REDs-informed lens (not a weight-centric one!), I invite you to join my REDs Informed Provider Certification Program®!
Right off the bat in module 1, we’ll address these biases within sport (like the one that believes REDs only occurs with weight loss!). I’ll help you create screening and assessment tools to help you better serve your athletes and teach you how to actually assess energy availability (with and without body composition). This isn’t just about a weight-based assessment, but a systems-level assessment.
This is a research-based program designed to help you implement effective REDs care while using the right language and techniques with real athletes.
Join the next live cohort starting soon (10 CEUs available)!