Relative energy deficiency in sport (REDs) is emerging from the shadows as a major threat to athlete health and careers, with warning signs that can be subtle and, if missed, devastating. The condition — caused when caloric intake fails to match the demands of training and everyday life — can undermine performance, cause repeated injury and trigger long‑term medical problems.
A warning from the frontline
British long‑distance runner Jake Smith describes a rapid descent from promising professional to a body that was breaking under strain. By 23 he had secured a contract with Nike and represented Great Britain, yet a relentless cycle of racing, illness and injury was masking an underlying energy deficit. Following an intensive training camp in Uganda, Smith returned weighing just 8 stone (51kg) at 5ft 5in (1.7m), with bones so fragile he was told his career could be over.
"If you keep this up, you'll be in a wheelchair at 30."
Smith suffered two stress fractures within four months before seeking professional help and being diagnosed with REDs. His story highlights how athletes — and those around them — can miss the symptoms until serious damage has already occurred.
Symptoms, consequences and why men are overlooked
REDs can present with a range of signs that affect both physical health and performance. Clinicians warn that it is not solely a women’s issue: men are equally vulnerable but are less likely to be identified because of stigma and less obvious clinical markers.
- Common symptoms: bone stress injuries, disrupted sleep, persistent fatigue and low mood.
- Long‑term risks: osteoporosis, cardiovascular disease and fertility problems if untreated.
- Detection challenges: psychological stigma, variable symptoms and limited awareness among coaches and support teams.
Dr Nicky Keay, an expert in hormone health, underlined how central endocrine function is to the condition. She explained that when energy supply is insufficient the hormonal systems that regulate countless bodily processes are compromised.
"Hormones go to every single bit in your body. So, if your hormones are not working well for you, you're going to feel it in all sorts of different areas,"
Her remarks point to why REDs can produce a baffling constellation of symptoms — from mood changes to increased injury risk — which are easily misattributed to overtraining or life stress.
High‑profile cases and the hidden scale
The issue has gained fresh attention after tennis player Emma Navarro revealed her diagnosis and opted to step away from competition until 2027. Such disclosures have helped lift part of the veil, but experts say many athletes remain undiagnosed, especially men who may conceal disordered eating or attribute problems to simple fatigue.
The practical effects are stark: repeated stress fractures and illness interrupt training cycles, reduce selection prospects and can shorten careers. For individual athletes, the toll is medical and psychological; for teams and governing bodies, there are implications for talent management and duty of care.
What this means for sport
Recognising REDs early requires education of athletes, coaches and medical staff and routine screening for symptoms that go beyond body weight or appearance. Where diagnosis is made, multidisciplinary support — including nutrition, endocrinology and psychological care — is essential to recovery and to preventing recurrence.
| Issue | Implication |
|---|---|
| Under‑recognition in men | Delayed diagnosis and prolonged harm |
| Hormonal disruption | Widespread bodily effects impacting health and performance |
| Stress fractures and injuries | Career interruptions and longer recovery times |
The growing willingness of high‑profile athletes to disclose their struggles is shifting the conversation from stigma to safeguarding. For sporting organisations, the challenge is to turn that conversation into systematic prevention and support so that fewer careers — and bodies — are left damaged by a preventable condition.
REDs is not confined to elite sport; the mechanisms are the same at grassroots level where education and access to medical advice are often even more limited. Bringing REDs into the mainstream of sports medicine and coaching practice is therefore not just a specialist concern but a broad public‑health priority for the sporting community.
