The Athlete's Body Image in the Context of Relative Energy Deficiency in Sport-A Scoping Review

Background: Relative Energy Deficiency in Sport (REDs) results from an imbalance between energy intake and expenditure, leading to low energy availability (LEA) and impairments of physiological and/or psychological functions in female and male athletes. While physical determinants of REDs are well documented, psychological factors such as body image (BI) have received comparatively little attention. The aim of this scoping review was to synthesize the current scientific evidence on the relationship between BI and REDs. Methods: A scoping review examined the current literature, including quantitative and qualitative studies. The scoping review was conducted in April 2025 in PubMed, Web of Science, MEDLINE, SPORTDiscus, APA PsycArticles, APA PsycInfo, CINAHL and OpenDissertations. Studies were included if they examined BI aspects in relation to LEA or REDs in a sporting context, regardless of participants' gender, age, level or sport. Inclusion criteria were based on the Population-Context-Concept (PPC) framework. Results: Seven studies met the inclusion criteria, covering athletes from various ages, genders, sports, and performance levels. Findings indicate that BI dissatisfaction-manifesting, for example, as a drive for thinness or muscularity, exercise dependence, and disordered eating-represents a relevant psychological factor associated with LEA in both female and male athletes. Conclusions: The relationship between BI and REDs is complex and insufficiently explored. Future research should address this link systematically across sports, performance levels, genders, and age groups. In sports medicine practice, screening tools should systematically incorporate psychological risk factors such as BI disturbances to enable early detection, targeted intervention, and prevention of long-term health consequences.