Body Image, Disordered Eating, and Relative Energy Deficiency in Sport Risk in Female Athletes: Associations Across Psychological and Behavioural Factors

Background: Relative Energy Deficiency in Sport (REDs) is traditionally conceptualised as a physiological consequence of low energy availability, yet emerging evidence implicates psychological and behavioural mechanisms in its development. This study examined the associations among body image, disordered eating, social physique anxiety, and female health knowledge to clarify psychosocial antecedents of REDs risk in female athletes.

Methods: 105 female athletes (mean age = 21.7 ± 3.4 years) completed validated measures assessing body image, social physique anxiety, disordered eating, REDs risk, and female health knowledge. Pearson correlations, multiple regression, and mediation analyses were performed to examine psychological predictors and mediating pathways of REDs risk.

Results: Negative body image was strongly associated with REDs risk (r = 0.61, p < 0.001) and remained the dominant independent correlate (β = 0.48, p < 0.001). Disordered eating was identified as a significant statistical mediator of the association between negative body image and REDs risk (indirect = 1.17, 95% CI [0.46, 1.86]), while the direct effect persisted (c′ = 1.89, 95% CI [0.91, 2.87], p < 0.001). Positive body image exerted a protective influence (B = −1.47, p < .001), and social physique anxiety showed a small, non-significant association (β = 0.18, p = 0.054). Female health knowledge demonstrated a significant inverse bivariate association with REDs risk (r = −0.28, p = 0.002), although this relationship was not retained in multivariable analyses. The model explained 44 % of variance (R² = 0.44, p < 0.001).

Conclusions: Findings support an association between body image disturbance, disordered eating behaviours, and REDs risk in female athletes. Positive body image and female health knowledge may serve protective roles. Integrating psychological screening and assets-based education into REDs prevention could shift practice from reactive physiological detection toward proactive, holistic athlete health care.