When it comes to differentiating between REDS in athletes and eating disorders in athletes, I often hear this:
“Do I really need to screen a REDS athlete for an eating disorder if the symptoms are the same?”
The short answer: Yes. Absolutely.
I stand firmly in my belief that any athlete that presents with having Relative Energy Deficiency in Sport (REDS) more than once and/or struggles to make the recommended changes should be assessed for an eating disorder. Treating REDS in athletes without considering an underlying eating disorder is like putting water on a gas fire. It won’t solve the problem.
You may have two houses on fire, but treating both with water when one is caused by a gas fire won’t result in both fires being put out.
Why It’s Critical to Differentiate REDS in Athletes from Eating Disorders in Athletes
Getting to the root cause of an athlete’s struggles is essential for long-term recovery, optimal well-being, and peak performance.
I feel we do a good job of this already when it comes to physical injuries (ex. we acknowledge there’s only so much physical therapy can do to help with the pain and function of a torn ligament). But why do we treat mental health and eating disorders any differently?
Stigma…
I cringe when I hear a provider state “It is just REDS,” as it makes me think “Is it really?” Without properly ruling out eating disorders in athletes, we risk giving incomplete or ineffective care.
Our athletes deserve the resources and attention to fully recover. If we rule out any potential mental health concerns, we are not giving them the level of care they deserve.
REDS in Athletes vs. Eating Disorders in Athletes
REDS does not always result from an eating disorder or disordered eating, but it often does. Making the distinction between REDS alone and REDS + eating disorder is incredibly important.
In the words of Dr. Kate Bennett:
“The difference between a driven athlete and a disordered athlete is that the driven athlete will do whatever it takes to stay in sports and perform their best.”
Recognizing When REDS in Athletes Signals an Eating Disorder
There may be some educating and unlearning that has to happen. Keep in mind, the driven athlete without an eating disorder has no problem correcting the energy deficit that led them to develop REDS once they learn this is the way to get back in their sport and perform their best.
- Imagine a basketball coach recommending that an athlete get more practice shots in, and upon hearing that, the athlete experiences significant anxiety, fear, or denial.
- Imagine a strength coach recommending that an athlete lift heavier in the weight room, and upon hearing that, the athlete experiences significant anxiety, fear, or denial.
- Imagine an athletic trainer recommending that an athlete do additional mobility work before training, and upon hearing that, the athlete experiences significant anxiety, fear, or denial.
Were any of these scenarios to happen, you would likely question what more is going on with this athlete.
A sports dietitian recommending that an athlete increase their calorie or carbohydrate intake in order to improve their performance and recovery, and the athlete experiencing significant anxiety, fear, or denial, is no different. It should be a red flag that is addressed appropriately.
The athlete with an eating disorder will have a much harder time correcting the energy deficit and doing what’s needed to recover than an athlete without an eating disorder.
The REDS + eating disorder athlete may therefore also experience recurrent bouts of REDS. This isn’t because they aren’t driven to do well. It’s because they have a disorder that creates a barrier to making the changes we know would benefit them.
Treatment: Addressing the Root Cause
While an athlete with REDS alone and one with REDS+ eating disorder have similar manifestations when it comes to sport, the clinical approach to treatment must be different to address the underlying cause and prevent recurrence.
- Athletes with REDS only can often recover by addressing energy imbalance through nutrition and training modifications.
- Athletes with REDS and eating disorders need integrated support, including eating disorder treatment, to break the cycle of recurrent REDs.
By making this distinction, we not only help athletes heal, but also set them up for sustained performance and overall health.
Support for Athletes and Athlete Providers
Are you an athlete seeking support? Join the waitlist for my upcoming Athlete Nutrition Challenge.
Want deeper training on REDS in athletes? Join the REDS Provider Masterclass!