In this Q&A series, Dr. Paula Quatromoni (DSc, RD) answers some of the biggest questions coaches and athletic staff have to better prevent and assist athletes who may be struggling with eating disorders.
Coach Question: An athlete from another team appeared underweight and was still competing this season. Parents of athletes on my team have expressed concern about a possible eating disorder. We have no idea if parents, athletic staff, or the coach of this team have intervened, but it doesn’t appear so because the athlete is still competing. Any thoughts about how to handle this? Is this a situation where I could reach out to the coach to express our concerns? The athletic director of that school? The athletic trainer?
Dr. Paula Quatromoni: I do think it’s appropriate for you as a coach to raise your concern with the coach of the other team. I would not sit back and ignore a potential red flag. However, you also cannot jump to conclusions or pass judgement.
When you do express your concern, you have to stick with what you’ve observed and what your concern is. Have you known or seen this athlete before to know that what you are seeing is a recent, significant weight loss? Keep in mind that there could be other explanations for what you are observing. Maybe this athlete has a chronic health condition that contributes to their low weight. From one observation, we don’t know if this athlete has always been low weight or if they recently experienced a dramatic weight loss. So, while it may be tempting to interpret what we see as an eating concern, we can’t be judgmental or jump to conclusions. We need more information.
All you can do is reach out to this coach, express your concern for this athlete, tell the coach that parents and athletes on your team have raised concerns about the possibility of an eating disorder and that is why you are bringing it forward simply to share the concern for the student-athlete’s well-being.
I think you can confidently tell the other coach that you have a heightened appreciation and awareness of the risk of eating disorders in sport, so this is important to you as a coach which is why you are bringing your concern forward. Hopefully, this will open a discussion of “yes, we are concerned and are doing xyz,” or “yes, we are concerned and have no idea what to do about it,” or “no, we aren’t touching that with a 10-foot pole!” You will have to respond accordingly, but at least you will get some insight to then direct your concern elsewhere (beyond the coach, to the athletic trainer) if needed.
With the coach, I think all you can do is offer to share any information he/she, the athletic trainer, or parents may want/need that could be helpful in terms of resources, risk assessment, and referrals for full evaluation and treatment planning. At a minimum, you can direct them to the NEDA website and the NEDA Coach and Athletic Trainer Toolkit. If you know of mental health, eating disorder, and/or sports nutrition professionals in your local area who you refer to yourself, you can share that referral information and stress the importance of an evaluation with the athlete’s primary care provider.
If you don’t know this coach at all, then I do think reaching out directly to the school’s athletic trainer is appropriate, applying all the same guidelines noted above.
Paula Quatromoni is a senior consultant for Walden Behavioral Care, a registered dietitian, and one of the leading experts for eating disorders in athletes. She has published several papers on both clinical experiences and qualitative research on recovery experiences of athletes. Dr. Quatromoni is the Department Chair of Health Sciences and a tenured associate professor of Nutrition and Epidemiology at Boston University where she maintains an active, funded research program. In 2004, she pioneered the sports nutrition consult service for student-athletes at Boston University. Dr. Quatromoni was named a 2016 Outstanding Dietetics Educator from the Nutrition and Dietetic Educators and Preceptors (NDEP) Council. She earned her B.S. and M.S. degrees in Nutrition from the University of Maine at Orono and her Doctorate in Epidemiology from the Boston University School of Public Health.