Eating Disorders and Low Energy Availability in Athletes: Understanding the Overlap
Learn how eating disorders and low energy availability overlap in athletes, why RED-S can occur with or without an eating disorder, and when to seek support from an eating disorder psychologist in Perth.
Athletes are often encouraged to train harder, eat “clean,” and optimise every aspect of their performance. While nutrition and training are essential for success, there is an important distinction that is often misunderstood: not every athlete with low energy availability has an eating disorder, but many athletes with an eating disorder experience low energy availability.
Understanding where these conditions overlap and where they differ, is essential for athletes, coaches, parents, and healthcare professionals.
At OM Psychology, we work with athletes experiencing both eating disorders and the psychological consequences of low energy availability (LEA) and Relative Energy Deficiency in Sport (RED-S). Recognising the signs early can protect both performance and long-term health.
What is Low Energy Availability?
Low Energy Availability (LEA) occurs when an athlete does not consume enough energy to support both the demands of training and the body’s essential physiological functions.
After exercise, the body still needs energy for:
- Brain function
- Hormone production
- Bone health
- Growth and development
- Immune function
- Cardiovascular health
- Recovery
- Reproductive health
When there is insufficient energy remaining after exercise, the body begins to conserve energy by reducing these important functions.
Over time, persistent LEA can contribute to Relative Energy Deficiency in Sport (RED-S), a condition affecting multiple body systems and athletic performance.
An eating disorder is a complex mental health condition characterised by persistent disturbances in eating behaviours, thoughts, emotions, and body image that significantly affect physical health and psychological wellbeing.
Eating disorders involve much more than food. They often include perfectionism, anxiety, rigid thinking, fear of weight gain, body dissatisfaction, and an excessive influence of weight or shape on self-worth.
Where Do Eating Disorders and Low Energy Availability Overlap?
This is where confusion commonly occurs. Many athletes with eating disorders experience low energy availability because they are unable to consume enough energy to meet the demands of training. However, not every athlete with low energy availability has an eating disorder.
Some athletes develop LEA because they:
- Underestimate their nutritional requirements
- Have busy training schedules
- Miss meals unintentionally
- Travel frequently for competition
- Have reduced appetite after exercise
- Lack nutrition education
Others experience LEA because they intentionally restrict food intake due to:
- Fear of gaining weight
- Body image concerns
- Pressure to achieve a certain physique
- Performance beliefs
- Weight-category requirements
- Eating disorder symptoms
The physiological consequences may be similar, but the psychological drivers can be very different.
Understanding the Spectrum
Rather than viewing LEA and eating disorders as separate conditions, it can be helpful to think of them as existing on a spectrum.
Low Energy Availability without an Eating Disorder
- Unintentional under-fueling
- Inadequate sports nutrition knowledge
- High training demands
- No significant body image disturbance
↓
Disordered Eating
- Increasing food rules
- Avoidance of certain foods
- Weight or physique concerns
- Compensatory exercise
- Increasing rigidity
↓
Clinical Eating Disorder
- Persistent restrictive eating or binge/purge behaviours
- Significant psychological distress
- Distorted body image
- Impaired functioning
- Medical complications
At every stage, athletes may develop RED-S if energy availability remains too low.
Why This Distinction Matters
Treating LEA is not always as simple as “eat more.”
If the athlete is intentionally restricting food because of fear, anxiety, perfectionism, or body image concerns, psychological treatment is often an essential part of recovery.
Similarly, athletes with eating disorders require more than nutritional advice alone.
Recovery often involves addressing:
- Body image
- Fear of weight gain
- Identity beyond sport
- Performance anxiety
- Perfectionism
- Compulsive exercise
- Self-worth
Understanding the underlying reason for low energy availability helps guide the most effective treatment.
Psychological Signs That May Suggest More Than LEA
Some warning signs suggest an athlete may be experiencing an eating disorder rather than simply under-fueling.
These include:
- Persistent fear of gaining weight
- Intense body dissatisfaction
- Feeling guilty after eating
- Avoiding social situations involving food
- Obsessive calorie counting
- Rigid food rules
- Exercising despite illness or injury
- Mood changes related to eating
- Self-worth becoming dependent on body shape or weight
These signs warrant assessment by a psychologist experienced in eating disorders.
Physical Signs of Low Energy Availability
Athletes experiencing LEA or RED-S may notice:
- Persistent fatigue
- Recurrent illness
- Frequent injuries
- Bone stress injuries
- Declining performance
- Slow recovery
- Poor concentration
- Sleep disturbances
- Hormonal changes
- Menstrual irregularities
- Reduced libido
These physical symptoms often occur alongside changes in mood and motivation.
The Role of Mental Health
The brain is one of the body’s highest energy users.
When energy availability remains low, athletes commonly experience:
- Increased anxiety
- Irritability
- Depression
- Emotional sensitivity
- Reduced concentration
- Brain fog
- Reduced motivation
- Increased perfectionism
Sometimes these psychological changes improve as adequate fueling is restored.
However, when an eating disorder is present, psychological symptoms usually require dedicated mental health treatment alongside nutritional rehabilitation.
Recovery Requires Individualised Care
Because athletes experience LEA for different reasons, recovery should never follow a one-size-fits-all approach.
Effective care often involves collaboration between:
- A psychologist
- A sports physician
- An accredited practising dietitian
- Coaches (where appropriate)
- Family members for younger athletes
Treatment focuses not only on restoring adequate energy availability but also on helping athletes rebuild a healthy relationship with food, exercise, and their body.
When Should an Athlete Seek Help?
Consider seeking professional support if you or someone you know is experiencing:
- Ongoing fatigue despite training adjustments
- Recurrent injuries
- Anxiety around eating
- Fear of rest days
- Significant body image concerns
- Food restriction
- Declining performance
- Mood changes
- Loss of enjoyment in sport
Early intervention often leads to better physical and psychological outcomes.
How OM Psychology Can Help
OM Psychology provides evidence-based psychological support for adolescents and adults experiencing:
- Eating disorders
- Disordered eating
- Low energy availability
- RED-S
- Body image concerns
- Performance anxiety
- Perfectionism
- Athlete mental health
Working collaboratively with sports physicians and accredited practising dietitians, we aim to help athletes recover their health while supporting a sustainable return to training and competition.
Whether low energy availability stems from the demands of training or from an underlying eating disorder, understanding the psychological factors involved is an important step toward long-term wellbeing.
Frequently Asked Questions
Can you have RED-S without an eating disorder?
Yes. Many athletes develop RED-S because they unintentionally consume too little energy for their training demands. However, eating disorders are a common cause of persistent low energy availability.
Does every athlete with an eating disorder develop RED-S?
Not necessarily, but athletes with restrictive eating behaviours are at significantly increased risk of developing RED-S due to prolonged low energy availability.
Can low energy availability affect mental health?
Yes. Low energy availability can contribute to anxiety, low mood, irritability, poor concentration, reduced motivation, and emotional changes because the brain does not have sufficient energy to function optimally.
How can a psychologist help?
A psychologist can help athletes address body image concerns, perfectionism, fear of weight gain, compulsive exercise, anxiety around food, and the psychological factors that contribute to disordered eating and eating disorders.
