In this Q&A series, Dr. Paula Quatromoni (DSc, RD) answers some of the biggest questions coaches and athletic staff have to better prevent eating disorders in athletes, and assist athletes who may be struggling. Sign up for our email list to get more Q&As/stories like this directly to your inbox.
Q: What is the role of the athletic director in a school’s eating disorder protocol?
PQ: The Athletic Director (AD) should know the role of the Athletic Trainer (AT) as a sports medicine professional, but not all ADs are educated and trained on this topic. At the same time, not all ATs are fully trained or making it known that they have expertise, confidence, or the capacity to take a leadership role on eating disorders. Just as it hasn’t been a priority topic brought to life at Coaching clinics or AT conferences, eating disorders in sport are not likely headlining conferences that ADs attend or features in webinars or continuing education directed at ADs.
Unfortunately, many schools (at least in the athletics context) won’t deal with eating disorders until they have to. In most places, it is not handled as a priority health concern worthy of investing screening and/or prevention resources into. This stands in stark contrast to the topic of concussions, for example, where there is proactive action invested to address it with all stakeholder groups (ATs, ADs, athletes, parents, school nurses and counselors, etc), and address it competently. This is where the AD can play an important leadership role, by allocating resources to effectively address eating concerns through education, training, policies and procedures, and multidisciplinary collaborative working groups that empower prevention and intervention strategies at their school.
What you often see play out is based on the faulty belief system that the coach is somehow educated, trained, qualified, and prepared to take a leadership role on this topic with a family if or when it does come up. That may or may not be appropriate, from one case to the next. In most cases, it is not. In a few, highly select cases, it may be so. Consequently, eating disorders may not be addressed until they reach a crisis point, and they may be handled in ways that perpetuate shame, stigma, stereotypes, and healthcare avoidance.
The reality is that the way this is handled may be entirely random in some places and highly variable from school to school. This will be the case in a school where there is no written policy and set of procedures for identifying, evaluating, and addressing eating concerns. And that leaves athletes and families at risk for mismanagement. We can and must do better here!
Once an eating concern is identified, how the message is delivered and deciding what to do next is best managed by a licensed health professional, like an Athletic Trainer or team physician. The most effective eating concerns teams are multidisciplinary and include behavioral health experts like school counselors and a nutrition professional. Read more about how to assemble an eating concerns team at your school here: https://runninginsilence.org/the-professionals-to-bring-in-for-student-athletes-with-eating-disorders-qa-with-paula-quatromoni/. The AD’s commitment to this level of comprehensive oversight will set them apart as a leader in addressing this important sports-related health concern.
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.