REF-956 · Williamson & Hannah, 2026 · Sports Health: A Multidisciplinary Approach · Paper · PubMed

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

Blimited evidenceMeasured on a mixed groupWritten before October 2026, being re-checked

In this cross-sectional study, 105 female athletes (21.7 ± 3.4 years, mean age) filled in validated questionnaires on REDs risk, disordered eating, body image, female health knowledge and social physique anxiety.

Negative body image showed a strong link with REDs risk and stayed the main independent correlate in regression; disordered eating emerged as a significant statistical mediator of that link, while the direct effect persisted. Positive body image went with lower REDs risk.

Female health knowledge was inversely associated with REDs risk in the bivariate analysis, but this did not hold in multivariable analyses. The authors conclude that the data support a link between disturbed body image, disordered eating behaviours and REDs risk, and suggest adding psychological screening and education to REDs prevention.

Participants

Female athletes (n = 105), mean age 21.7 ± 3.4 years. Sports, competitive level and body mass are not given in the abstract.

Protocol

Each athlete completed validated measures (questionnaires) once, covering REDs risk, disordered eating, body image, social physique anxiety and female health knowledge.
Pearson correlations, multiple regression and mediation analyses.

Key Results

REDs risk was strongly associated with negative body image (r = 0.61; P < 0.001), which stayed the main independent correlate (β = 0.48; P < 0.001).
Part of the link from negative body image to REDs risk ran through disordered eating, a significant statistical mediator (indirect = 1.17; 95% CI, 0.46, 1.86); the direct effect remained (c′ = 1.89, P < 0.001; 95% CI, 0.91, 2.87).
Positive body image: β = -1.47; P < 0.001 (the abstract's wording is "exerted a protective influence"; the design shows an inverse association).
Social physique anxiety: a small, nonsignificant association (β = 0.18; P = 0.05).
Female health knowledge: inverse bivariate association with REDs risk (r = -0.28; P = 0.002), not retained in multivariable analyses.
The model explained 44% of variance (R² = 0.44; P < 0.001).

Practical Application

"Is how I feel about my body connected to under-fuelling?" In 105 female athletes surveyed once, a more negative body image went together with a higher REDs risk score (r = 0.61), partly through disordered eating — this is a correlation, not a cause: the study cannot tell whether body dissatisfaction leads to under-fuelling, under-fuelling to body dissatisfaction, or a third factor to both.
What it supports: the athlete's attitude to her body and to eating belongs in a low-energy-availability screen alongside the physical signs — the authors' own proposal is to integrate psychological screening into REDs prevention. It was not tested as a screening tool here.
Not from this paper; the base's own practice: the physical indicators and the rule "screen, name the concern, refer" are in REF-341 and SYNTH-54; a suspected eating disorder goes to a clinician, not into a training plan.
Knowledge of female health was linked to lower risk only before adjustment; Inference, not tested here: education alone is unlikely to be the lever.

Limitations

Cross-sectional: associations only; the "mediator" is statistical and does not establish a causal pathway.
REDs risk was a questionnaire score, not a clinical diagnosis or a measured energy availability.
105 female athletes, mean age 21.7 years; no men; sports and level not given in the abstract.
Self-report measures throughout.
Online ahead of print. Written from the abstract and record metadata only (full text not read).
How this entry was checked and changed
Why this level

cross-sectional correlation in 105 athletes, self-report measures; the journal's own label is Level 4