Bone health in a culture of extremes
Bone health rarely gets the attention it deserves, overshadowed by a cultural obsession with appearance. But beneath the surface, popular lifestyle trends, like restrictive dieting and aesthetics-driven fitness, may be gradually compromising our bone health.
In this article we challenge common myths and explore how modern ideals of body image and ‘wellness’ could be putting our bones at risk.
Restrictive diet culture
Severe calorie restriction to achieve a slender body has repeatedly come in and out of fashion. However, the level of restriction required for many people to achieve this can have a number of negative consequences, including muscle and bone loss, electrolyte imbalances, nutritional deficiencies, hormonal disruption and abnormal heart rhythms.
Diet culture often promotes thinness as a marker of success, with restrictive eating frequently disguised as ‘clean eating’ in the media. Similarly, the ‘no days off’ mentality, portraying exercise as a way of ‘earning’ food, or framing it as punishment, can appear aspirational but, in reality, fosters harmful beliefs and behaviours.
According to guidelines from the National Institute for Health and Care Excellence (NICE), a ‘low-energy diet’ (defined as 800 to 1,200 kilocalories per day) is only recommended as part of a structured obesity management strategy, or for individuals who are overweight with type 2 diabetes. Under these conditions, the diet must also be supervised by a registered dietitian or qualified nutrition professional, be nutritionally complete, and last no longer than 12 weeks.
Impact on bone health
When the body does not get enough energy:
- Bone formation slows down
- Bone breakdown (resorption) increases
- Hormonal changes (such as reduced oestrogen) accelerate bone loss (particularly relevant during and after menopause)
- Bone marrow fat may increase, potentially weakening bone structure
Over time, this can result in reduced bone density and strength, increasing the risk of fractures.
Over- and under-exercising
Bones are ‘anti-fragile’, meaning they strengthen under appropriate stress. With mechanical loading such as walking and resistance training, bone resorption decreases and bone density increases. Exercise is therefore essential for bone health.
However, excessive training, particularly alongside under-fuelling, can:
- Decrease bone mineral density
- Increase the risk of stress injuries (e.g. stress fractures)
- Increase the risk of other musculoskeletal conditions and discomfort
- Contribute to hormonal disruption
- Negatively affect bone formation over time
Relative Energy Deficiency in Sport (RED-S)
Under-fuelling, combined with over-exercising, is particularly evident in Relative Energy Deficiency in Sport (RED-S), where the body lacks enough energy to support both exercise and basic bodily functions.
RED-S can affect both males and females, but is particularly prevalent in:
- Aesthetic or judged sports (e.g. gymnastics, dance)
- Endurance sports (e.g. long-distance running, cycling)
- Weight-class and combat sports
Potential consequences:
- Poor bone health
- Impaired metabolism
- Reduced immunity
- Irregular or absent menstrual cycles in females
- Hair loss
- Increased injury recovery time
- Reduced performance
- Decreased training response
- Low mood (including irritability and depression)
- Poor concentration and impaired judgement
If you are experiencing symptoms associated with RED-S or are concerned about your nutrition, training or recovery, it is important to seek advice from a qualified healthcare professional for appropriate support.
What actually supports healthy bones
Instead of the extremes, bone health thrives on balance.
Adequate nutrition
Adequate nutrition is not just “eating enough,” but consistently providing the body with sufficient energy (calories) to support daily function, movement and recovery. As a general guide, moderately active adults may require around 2,500 kcal per day for men and 2,000 kcal per day for women. However, requirements vary depending on activity levels, body size, age, hormones and overall health. We need protein for our bone matrix (the material that makes up our bones) and for muscle support. Carbohydrates are used to fuel energy and fats are required for hormone production.
These nutrients play a key role in bone strength and quality and can be found in the following:
Calcium Sources | Vitamin D Sources | Protein Sources | Other Important Nutrients |
Dairy (e.g. milk, yogurt and cheese) Fortified plant milks (e.g. soy, almond and oat) Leafy greens (e.g. kale and pak choi) Calcium-set tofu Sardines and salmon (with soft bones) Almonds and sesame seeds | Sunlight exposure Oily fish (e.g. salmon and mackerel) Egg yolks Fortified foods (e.g. spreads, cereals and plant milks) Vitamin D supplements during times of limited sun exposure (e.g. October to March) | Meat, fish and eggs Dairy Legumes, tofu and lentils Nuts and seeds | Magnesium (nuts, seeds, whole grains and leafy greens) Vitamin K (green vegetables such as spinach and broccoli) Phosphorus (dairy, meat and whole grains) |
Lifestyle Factors
Healthy bones are supported not just by nutrition, but also by balanced lifestyle habits that allow the body to adapt, recover and stay strong over time.
- Strength and weight-bearing exercise – 2-3 times a week if appropriate, tailored to the individual and introduced at a safe intensity.
- Rest and recovery – Needed for tissue repair and body remodelling. Watch for the warning signs of under-fuelling such as fatigue, frequent injuries, missed periods, low mood or poor performance.
- Sustainable habits over time – Avoiding negative mindsets like all-or-nothing thinking or guilt around rest days.
It is time to rethink the messages we hear about health, fitness and body image. Society’s pursuit of the ‘ideal body’ is constantly evolving, but the science of bone health has not changed.
Bone health is not just an issue affecting older adults; it is also being shaped by the pressures and choices influencing younger generations.
Today’s culture of extreme dieting, aesthetic-driven fitness, performance enhancement and rapid weight-loss solutions has a significant impact on how people view and treat their bodies. While these approaches may promise quick, visible results, they can quietly undermine bone strength in ways that are not immediately apparent, often with long-term consequences.
By challenging harmful myths surrounding diet and exercise, and shifting the focus towards balanced, sustainable habits, we can build stronger foundations to protect our bodies for the future.