Body Image, Disordered Eating, and the Behavioural Pathways to Relative Energy Deficiency in Sport: Evidence for a Biopsychosocial Model

Abstract

Background: Relative Energy Deficiency in Sport (REDs) is traditionallyconceptualised as a physiological consequence of low energy availability,yet emerging evidence implicates psychological and behaviouralmechanisms in its development. This study examined the associationsamong body image, disordered eating, social physique anxiety, andfemale health knowledge to clarify psychosocial antecedents of REDs riskin female athletes.Methods: 105 female athletes (mean age = 21.7 ± 3.4 years) completedvalidated measures assessing body image, social physique anxiety,disordered eating, REDs risk, and female health knowledge. Pearsoncorrelations, multiple regression, and mediation analyses were performedto examine psychological predictors and mediating pathways of REDsrisk.Results: Negative body image was strongly associated with REDs risk (r =.61, p < .001) and remained the dominant independent predictor (β =.58, p < .001). Disordered eating partially mediated this relationship(indirect = 1.10, 95% CI [0.88, 1.36]), while the direct effect persisted(c′ = 1.10, 95% CI [0.85, 1.34], p < .001). Positive body image exerteda protective influence (B = −1.47, p < .001), and social physique anxietycontributed modestly (β = .18, p = .013). Female health knowledge wasinversely related to REDs risk (r = −.28, p = .002). The model explained44 % of variance (R² = .44, p < .001).Conclusions: Findings support a psychological–behavioural framework inwhich body-image disturbance amplifies REDs vulnerability through bothdirect and disordered-eating-mediated pathways. Conversely, positivebody image and female health literacy may serve protective roles.Integrating psychological screening and assets-based education into REDsprevention could shift practice from reactive physiological detectiontoward proactive, holistic athlete health care