- Former British cycling champion Brian Smith has revealed he suffered from bulimia and REDs (Relative Energy Deficiency in Sport) throughout his competitive career, including during his appearance at the 1996 Atlanta Olympics, and now lives with lasting physical consequences including multiple severe stress fractures.
- Sports physician Dr. Nicola Keay reports that male athletes are increasingly seeking help for REDs but often present in “bad shape,” frequently describing the condition as burnout rather than recognizing it as a clinical syndrome.
- British Cycling chief medical officer Dr. Nigel Jones says the organization has shifted its internal language over the past decade, replacing weight-loss messaging with performance-based conversations about the dangers of under-fuelling.
Brian Smith Opens Up: Olympic Cyclist’s Hidden Battle With Bulimia and REDs
Former British road cycling champion Brian Smith has spoken candidly about the eating disorder and mental health condition he carried throughout a career that took him to the 1996 Olympic Games in Atlanta. Smith, now 59, says he developed bulimia as a direct result of cycling’s deeply entrenched obsession with body weight — a culture that left him chasing a number on the scales at the cost of his long-term physical health. Competing in the Olympic road race for Great Britain should have been the defining moment of his sporting life, but behind that achievement, Smith was battling a condition he did not fully understand.
“I always felt like I was overweight. Everybody was under pressure regarding weight, but nobody really spoke about it,” Smith says. Standing just under six feet tall with, in his own words, “large glutes and thigh muscles,” Smith raced professionally at 68kg — a weight he describes as “quite skinny” for his frame. He pushed further still. “I even got down to about 66kg and when I got down to that, I felt underpowered, I felt bad,” he says. Smith only learned he had been suffering from Relative Energy Deficiency in Sport (REDs) — a syndrome caused by a mismatch between an athlete’s energy intake and expenditure — after he took up running eight years ago and subsequently developed three severe stress fractures, including one in his femur, a hallmark of the bone density damage REDs can cause when left unaddressed over years.
The Long-Term Physical Toll of a Weight-Obsessed Sport
The damage Smith describes is not abstract. It is the accumulated consequence of years of chronic under-fuelling during what should have been peak physical conditioning. He is unequivocal in his assessment of professional cycling’s failure to protect its athletes, and equally direct about what he would tell any young person considering following the same path. “It really is not healthy,” he says. “If you want to go to the highest levels of the sport, you will suffer later on in life. You’re destroying your body.” He reserves particular criticism for the structures around elite riders: “Sporting teams don’t care – all they’re worried about is performance. So they will nurture a rider, they will feed a rider, they’ll get a rider to be a certain weight. They don’t care about what happens to them later in life.” He closes with a sentiment that speaks to the broader cost of institutional silence: “I’m suffering now and I’ve so many regrets. I just wish I’d known more about this.”
Men With REDs: Reluctance, Mislabeling, and the Burnout Barrier
Smith’s experience reflects a wider pattern that sports physician Dr. Nicola Keay is observing in her clinical practice. Keay works with athletes across all competitive levels recovering from REDs, and while the majority of her patients are women, she reports a growing number of men are coming forward — though typically only after the condition has progressed significantly. “I think the men are maybe more reluctant than the women, or maybe they don’t realise they’ve got it. Sometimes they might use a different word for it, they say burnout,” Keay says. She is pragmatic about the terminology: “I don’t mind that though because there is definitely a psychological aspect to REDs. Why are you doing this? Why are you not eating the carbohydrates?”
The answer is not always straightforward. For some athletes, under-fuelling is entirely unintentional — stemming from a genuine lack of understanding about caloric and carbohydrate requirements, or from failing to increase food intake when training volume or intensity rises. For others, like Smith, the restriction begins with deliberate intent shaped by cultural and competitive pressure. Both pathways lead to the same physiological damage, and both are complicated by the fact that REDs remains poorly understood among general healthcare providers and the public alike. Former GB runner Pippa Woolven, who experienced the condition firsthand, established Project REDs, a dedicated website providing information and practical resources for athletes, coaches, parents, and healthcare professionals navigating the syndrome.
British Cycling’s Response: Shifting the Conversation Toward Performance
British Cycling acknowledges that its sport has historically contributed to the problem, but argues that meaningful structural change is underway. The organization now conducts annual physical and psychological screenings and begins REDs education at academy level. Dr. Nigel Jones, British Cycling’s chief medical officer, told BBC Sport that the core change has been in how the subject is framed in conversations with athletes. “One of the big things we’ve done in the past 10 years is try and turn this into a performance-related conversation,” Jones explains. “Now, we couch the conversation with an athlete around ‘if you under-fuel, you will not be able to perform at your best’, whereas previously, conversations in power-to-weight ratio sports might have been ‘you need to be lighter’.” Jones stops short of claiming the problem is solved: “I think it would be naive to say REDs is never going to be an issue. But I would like to believe that its prevalence will reduce with the work that we’re doing,” he adds. Smith, for his part, believes the sport still has a long way to go in genuinely changing its culture.
Why This Matters
REDs is not a fringe concern. It affects athletes across genders and disciplines, from elite Olympic competitors to amateur runners, and its consequences — stress fractures, hormonal disruption, cardiovascular risk, and lasting psychological harm — can extend well beyond an athlete’s competitive career, as Brian Smith’s case powerfully illustrates. The difficulty in recognizing REDs, the stigma preventing male athletes from seeking help, and the historical complicity of team structures in promoting dangerous weight targets all point to a systemic problem that requires more than individual awareness. Initiatives like Project REDs and policy shifts within governing bodies such as British Cycling represent steps forward, but advocates and clinicians stress that cultural change within sport must accompany clinical intervention if the next generation of athletes is to be genuinely protected.
Frequently Asked Questions
What is REDs and how does it affect athletes?
Relative Energy Deficiency in Sport (REDs) is a syndrome that occurs when an athlete’s energy intake is insufficient to support both the demands of their sport and normal bodily function. It can cause serious long-term health consequences including bone stress fractures, hormonal disruption, impaired cardiovascular health, and mental health difficulties. It affects both male and female athletes and can result from intentional food restriction or unintentional under-fuelling due to inadequate nutritional knowledge.
Where can athletes or coaches find help and information about REDs?
Former GB runner Pippa Woolven founded Project REDs, a dedicated website offering information and practical resources specifically designed for athletes, coaches, parents, and healthcare professionals. Sports physicians such as Dr. Nicola Keay also work with athletes at all competitive levels to support recovery from the syndrome.
Why are male athletes less likely to be diagnosed with REDs?
According to Dr. Nicola Keay, male athletes tend to be more reluctant to seek help and may not recognize the condition in themselves. Many describe their symptoms using alternative language — most commonly “burnout” — rather than identifying it as a clinical syndrome. This delay in seeking treatment means that when male athletes do present for help, they are often, in Keay’s words, in “bad shape.”
