Eating Disorder Symptoms and Energy Deficiency Awareness in Adolescent Artistic Gymnasts: Evidence of a Knowledge Gap

Background/Objectives: Pressure to stay lean may lead adolescent athletes to dietary restraint and disordered eating. Lack of nutrition awareness can also contribute to suboptimal dietary habits, increasing the risk of eating disorders and Relative Energy Deficiency in Sport [RED-S], though evidence in competitive athletes is limited. This study explored eating disorder symptoms and RED-S knowledge in adolescent artistic gymnasts. Methods: Eighty-four female artistic gymnasts, thirty-nine international and national level gymnasts [high-level; 14 [14, 15] y] and forty-five recreational and club level gymnasts [low-level; 14 [13, 15] y] completed the Eating Disorder Examination Questionnaire [EDE-Q 6.0], the RED-S knowledge Questionnaire and provided training details. Results: Seventeen gymnasts (20.2%) scored above the cutoff point on the EDE-Q. In addition, high-level gymnasts scored higher than low-level on EDE-Q [2.21 ± 1.37 (35.9%) vs. 1.19 ± 0.79 (6.7%), respectively; p < 0.001] and on its subscales: Restraint, Eating Concerns, Weight Concerns, and Shape Concerns [p < 0.001 to 0.009], thus indicating more severe disordered eating symptoms. No group differences were found in binge eating and compensatory behaviors. An important percentage of gymnasts reported at least one episode of binge eating and excessive training [39.3–58.3%], while four gymnasts reported self-induced vomiting. RED-S knowledge did not differ between groups. On average, gymnasts were unaware of correct answers related to RED-S [51.5%], its definitions [79.8–92.9%], and its association with menstrual disturbances and bone health [54.8–86.9%]. However, gymnasts reported better awareness of the impact of food restriction on illness and performance [47.6–84.5%]. Conclusions: Elite artistic gymnasts exhibited a higher prevalence of eating disorder symptoms than lower-level peers. Gymnasts at all levels demonstrated limited knowledge of the effects of RED-S on menstrual and bone health. Failure to recognize these risks may influence gymnasts’ eating behaviors and delay RED-S detection and management.