What if Parents of an Athlete with an Eating Disorder Are in Denial? Q&A with Dr. Paula Quatromoni

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 do you do when parents are in denial about their athlete struggling with a possible eating disorder, even when the athletic trainer is in on that conversation?

This is a common question from coaches. With this context, we will take this question as being posed by a coach. Since there is an expectation of parental involvement, we will assume that this is an adolescent (middle- or high-school athlete) rather than an adult/collegiate athlete.

A: Presenting concern about a possible eating disorder to parents requires a lot of sensitivity, empathy, and professional competence and confidence. It should not be entered into lightly, and it should not be entered into without objective data, documented observations, an informed action plan, and a set of recommendations and referrals.

This is a context where the Athletic Trainer (AT) needs some specialized training as well as some policies and procedures in place with the support of Athletics Administration. The AT is the licensed health professional at the center of the athlete care team. In a high school setting, the AT constitutes the accessible core of sports medicine expertise available to athletes on a daily basis. In a collegiate setting, the AT staff have the back-up of the sports medicine physician(s) who may primarily be orthopedic specialists who attune to sports injuries. This means that if a sports medicine doctor is accessible, they may not be trained in recognizing or treating REDs (relative energy deficiency in sport), eating disorders, or the endocrine and hormonal disturbances that occur in the setting of a restrictive eating disorder. Also in the collegiate setting, there may be a sports dietitian, sport psychologist, and/or mental health counselor. These members of the multidisciplinary care team can support the actions of the AT when they work collaboratively as an eating concerns team. Rarely are these other health professionals available to athletes in the high school setting. Collaborating with the school counselor may, therefore, be appropriate in order to fully assess the situation and to help the AT prepare to communicate their concerns to the parents.

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Eating Disorder Education for Athletic Staff With Limited Funds? Q&A With Dr. Paula Quatromoni

Coach: We want to bring more eating disorder education into our athletic programs for coaches, parents, and athletes, but I was told by my Athletic Director that the funding is lacking for bringing in speakers. They went on to express that if we only address eating disorders, we are missing out on many other topics that could also be addressed. Even the education and support for coaches is sorely lacking. It’s also been reported by our Athletic Trainer (AT) that even when parents are confronted about a possible eating disorder in their child, there is often denial and little if any response. What do we do?

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Is it Appropriate for Coaches to Weigh Pole Vaulters? Dr. Quatromoni Q&A

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.

Q: Is it appropriate for coaches to weigh pole vaulters for equipment safety reasons?

PQ: Yes, the weighing protocol specific to pole vault athletes is unique and altogether different from a weighing protocol applied to other athletes in track and field, cross-country, or other competitive sports. In pole vault, there are issues of safety, injury prevention, and liability involved in selecting the piece of equipment that the athlete needs to safely perform their event. In this context, the athlete’s body weight is central to the selection of the right pole, and specific protocols are in place to ensure safety.

We consulted with some coaches and equipment managers to more fully inform our response to this question. What we learned is that every pole has a weight rating that should be greater than or equal to the athlete’s body weight. If the athlete’s body weight is more than the rating on the pole, this is one of several factors that could contribute to the risk of the pole breaking during the jump attempt. Athletes who vault with a pole that is rated below their actual weight risk serious injury.

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5 Things Coaches Should Avoid Saying to Adolescent Athletes

By: Amanda Feldman 

Amanda Feldman is a graduate student in Boston University’s Nutrition and Dietetics program pursuing her RDN credential with a special interest in sports nutrition and eating disorders. Outside of the classroom, she is a high school Varsity Softball and Cross Country coach at the Dana Hall School in Wellesley, MA, where she graduated before continuing on to play 2 years of collegiate softball at Trinity College in Hartford, CT. In her free time, Amanda is an avid long-distance runner and is passionate about sharing her love for running, athletics, and nutrition education.

Eating disorders are serious mental illnesses that come in all shapes and sizes.1 Male-identifying and female-identifying. Those in larger and smaller bodies. They can occur in runners, football players, soccer players, dancers, fencers and everything in between.

As a former athlete and a current high school coach myself, I am aware of the unique role coaches play in an adolescent athlete’s life. We act as role models, mentors, and individuals our athletes are trying to impress. In some cases, the internal pressure to impress a coach is so high our athletes will do anything and everything asked of them to get on the field, be a starter, become a captain, or earn a coach’s respect. Because of this, everything from the way coaches talk about goal setting, fueling and food, athletes’ bodies, and body changes can have a profound impact on an athlete – be that positive or negative.

Some individuals have a predisposition that puts them at a higher risk for developing an eating disorder. Eating disorders are “complex traits,” and multiple environmental and genetic factors play a role in their development.1 This includes individual’s genetics, past experiences, societal pressures, traumas, and other mental health diagnoses to name a few factors. It is hard for us to identify exactly who is at high risk for developing one, but what we do know is that adolescence is a vulnerable period,2 one in which eating disorders too commonly manifest. This is why we need to place high importance on eating disorder prevention.

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Kamila Valieva’s Tragedy is Not An Isolated Incident

Guest Post By Matt Stranberg

Matt Stranberg, MS RDN LDN CSSD CSCS is a Sports Nutrition and Exercise Science Specialist helping athletes and non-athletes improve their relationship to food and exercise. To learn more visit: https://www.mattstranbergconsulting.com/ Follow Matt on instagram: @matt_stranberg_consulting

Olympic trials have always had their fair share of controversies and dramas, dating back to the early 1900’s and the spectacle of Nazi Berlin to more recent media frenzies surrounding Simone Biles’s 2021 withdrawal. This year is no different as young Russian figure skating prodigy, Kamila Valieva was plunged into scandal following a positive drug test as well as more recent stories highlighting her series of falls in competition resulting in a media explosion exploring the cruel treatment by coaches during her heartbreaking moments of public anguish.

Many critics, including International Olympic Committee President Thomas Bach have derided Kamila’s treatment as “disturbing, cold, harsh and chilling to see.”[i] Numerous media outlets have framed this tragedy as yet another “confrontation between Russia and international institutions,”[ii] that has reignited debates regarding possible age limits for Olympic competition.[iii]

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Avoiding Eating Disorder Triggers: Athletes Can’t Talk About Food? Q&A With Dr Paula Quatromoni

This Q&A was originally part of the third Q&A here, but is republished below to separate and make it easier to find questions/topics. This is part of a Q&A series with the leading expert in eating disorders and sports and registered dietitian, Dr. Paula Quatromoni.

 

Q: One running program forbids athletes to talk about or even post about food on social media because they think it will help stop the spread of eating disorders. What are your thoughts?

A: To me, this is silly. Eating habits, food behaviors, and attitudes about food are contagious in our culture regardless of social media. A different approach for the leadership in this program could be to invest in educating their athletes about responsible use of social media and working to build a supportive team culture where there is zero-tolerance for food shaming, body shaming, or promotion of restrictive eating or dieting culture. Social media posts and open discussions about food, if managed strategically and with some ground rules, can be quite positive and can role model healthy strategies for fueling athletes and sharing evidence-based recommendations.

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What if an Athlete Denies Having a Possible Eating Disorder? Q&A with Dr. Paula Quatromoni

This Q&A was originally part of the second Q&A here, but is republished below to separate and make it easier to find questions/topics. This is part of a Q&A series with the leading expert in eating disorders and sports and registered dietitian, Dr. Paula Quatromoni. For more Q&As click here.


Q: What do you do if an athlete denies having an eating disorder, but the coach (or anyone else) really feels that something is wrong?

You should fully expect denial and you should prepare for it. The tips suggested here are the keys to the conversation: state your concerns, stick to the facts, rely on your own observations, and make your referral to talk to an expert. When the athlete denies and refuses, simply return the conversation with authority and confidence to what it is you recommend: a conversation with the athletic trainer (AT).

Let the AT do the rest of the work by fully assessing the situation. The AT has access to screening tools that can help discern the scope of the problem and bring awareness to the athlete and to the parents. ATs are trained to assess, treat, and refer athletes for appropriate interventions. This is their job.

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Can Coaches Tell Athletes to Lose Weight? Q&A with Dr. Paula Quatromoni

This Q&A was originally part of the first Q&A here, but is republished below to separate and make it easier to find questions/topics. This is part of a Q&A series with the leading expert in eating disorders and sports and registered dietitian, Paula Quatromoni. For more Q&As click here.

Q: Can coaches tell athletes to lose weight?

A (Dr. Quatromoni): Weight concerns should be managed by a qualified nutrition professional, not a coach. So if a coach has a concern about an athlete’s weight, he/she should express that concern to the nutrition professional (not to the athlete). The coach should let the nutritionist assess the athlete, determine whether weight change is appropriate, and initiate a proper plan of nutrition intervention.

The work between the nutritionist and the athlete should remain private and confidential. A coach should place full trust that the nutritionist is managing the case and monitoring the athlete’s progress towards goals. This allows the coach to focus interactions with the athlete on skill, technique, and training, not on weight.

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Should Coaches Weigh Their Athletes? Q&A with Paula Quatromoni

This Q&A was originally a part of the first Q&A here, but was republished as a new post to separate and make it easier to find questions/topics. This is part of a Q&A series with leading expert in eating disorders and sports and registered dietitian, Paula Quatromoni.
For more Q&As click here.

Q: Should coaches weigh their athletes to make sure their weight doesn’t get too low?

A (Paula Quatromoni): Coaches should NOT be weighing athletes.

If necessary for concern about an eating disorder, weight should only be monitored by a sports medicine professional (MD, AT or Nutritionist) – not the coach. An athlete that a coach is concerned about their weight dropping too low needs medical evaluation and supervision, and most likely they need intervention and treatment as well. All of these tasks are beyond the scope of the coach’s expertise, making it clear that monitoring weight is not the coach’s responsibility.

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The Professionals to Bring in for Student-Athletes With Eating Disorders (Q&A with Paula Quatromoni)

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.

Q: Who is Needed on the Athlete Care Team For an Athlete With Disordered Eating?

A: Athletics programs at every level need to have someone identified as the point person for eating concerns, if not a full Eating Concerns Team that meets and communicates regularly about athletes at risk or in treatment. In most situations, an athletic trainer (AT) would fill this leadership role. The other members of an Eating Concerns Team would be multidisciplinary, to the extent that these providers exist.

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