What Do You Do if Parents Switch to a New Doctor After an Eating Disorder is Suspected? Q&A With Dr. Quatromoni

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In this Q&A series, Dr. Paula Quatromoni (DSc, RD) answers some of the biggest questions coaches and athletic staff have to help prevent or address eating disorders in athletes and assist athletes who may be struggling. Sign up for our email list to get the next link to the newest Q&A right to your inbox. If you have a question to submit to Dr. Quatromoni, please reach out at our contact page here: https://runninginsilence.org/contact/ 

Q: A multi-sport athlete gets diagnosed with a bone stress injury and their doctor suspects there is an underlying eating disorder. What do you do if parents refute this suggestion and instead, switch to a new doctor whose second opinion dismisses the eating concerns and allows the athlete to continue to train and compete, going against the best judgement of the coach?

A (Paula Quatromoni): First, it’s important to set the context for this situation.

Most medical doctors (MDs) do not have sufficient training in nutrition, sports medicine, or eating disorders to diagnose an eating disorder or recognize relative energy deficiency in sport (REDS), both of which contribute to poor bone health and recurrent bone stress injuries in athletes. There is, unfortunately, a large degree of variability across MDs and other health professionals with regards to competence in these areas. This is one of several contributing factors to the reality that eating disorders and REDS are under-diagnosed and under-attended to, including among athletes where the risk is substantially higher than in the general population. This leaves our athletes highly vulnerable to emotional and physical suffering, and oftentimes athletes are “on their own” to identify qualified providers and seek help.

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What Do You Do if You Don’t Have an Athletic Trainer? Q&A With Dr. Quatromoni

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In this Q&A series, Dr. Paula Quatromoni (DSc, RD) answers some of the biggest questions coaches and athletic staff have to help prevent or address eating disorders in athletes and assist athletes who may be struggling. Sign up for our email list to get the next link to the newest Q&A right to your inbox.

Q: How does a coach support an athlete who may have an eating disorder when there is no athletic trainer on staff at their high school?

A: A coach who has a concern about an eating disorder in their athlete should trust their gut and act on their concerns. They should not ignore their observations, and they should act sooner rather than later. Watchful waiting risks more harm than good, for a whole host of reasons. We know that the keys to successful treatment and recovery from an eating disorder are early recognition and timely intervention. Especially in the case of an adolescent where growth, development (of the body and brain), and puberty are physiologic priorities, the urgency to act is heightened. Coach must first recognize that eating disorders are serious, life-threatening conditions that are mental health crises. They are not to be dismissed and coaches are not in any position to manage this themselves.

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Is it Okay to Have a Scale in the Weight Room? Q&A With Dr. Paula Quatromoni

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In this Q&A series, Dr. Paula Quatromoni (DSc, RD) answers some of the biggest questions coaches and athletic staff have to help prevent or address eating disorders in athletes and assist athletes who may be struggling. Sign up for our email list to get the next link to the newest Q&A right to your inbox.

Question: Our strength trainer has a scale near the entrance of the high school weight room. Is this okay? I worry that athletes may focus too much on the scale, weigh themselves too often (and in public), and struggle with body image concerns. Should I ask our strength trainer about this? If the strength trainer is weighing athletes, is this okay, or should it only be done by a medical professional?

Answer: Absolutely, your concerns are valid. I support your desire to have a conversation with the strength coach about what you observe and what you’re concerned about.

The short answer to this question is this:

To be most weight-inclusive and body positive, and to lower the risk of an undue emphasis being placed on body weight, shape, size, or appearance as a contributing factor to sports performance or an athlete’s value (a common risk factor for dieting, disordered eating, and eating disorders), it would be best to remove the scale from the open space in the school’s weight room.

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Is it Okay to Weigh Athletes for Hydration Purposes? Q&A With RD Rebecca McConville

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Rebecca McConville MS RD LD CSSD CEDRD-C is a sports dietitian, eating disorder specialist, and author of Finding Your Sweet Spot- How to Avoid REDs. Becca has a passion to take complex concepts like REDS and make it relatable. She has a REDs informed provider certification program and co-leads with MBE an annual Eating Disorder in Sport workshop.

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RM: Hydration can be one of the most overlooked yet impactful components of athletic performance. Unfortunately, body weight is often used to determine hydration needs. However, we don’t need to step on a scale to determine if we are adequately hydrating. There are other methods to gauge fluid losses during activity without involving weight.

Measuring body weight has been a popular method to “guesstimate” one’s hydration status. By weighing an athlete before and after training and subtracting their fluid consumption (oz) during training, we can estimate what that athlete’s hydration needs would be per hour to maintain adequate hydration. The theory is that the weight change that occurred during training correlates with the amount of sweat loss that occurred. We can then determine a target amount of fluid consumption that would compensate for those losses. However, this is not a very accurate method to determine hydration needs. Many uncontrollable, unpredictable factors affect weight, making it a measurement that is actually quite volatile. 

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

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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 the next link to the newest Q&As right 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

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In this Q&A series, Dr. Paula Quatromoni (DSc, RD) answers some of the biggest questions coaches and athletic staff have to help prevent or address eating disorders in athletes and assist athletes who may be struggling. Sign up for our email list to get the next link to the newest Q&A right to your inbox.

 

Coach (Anonymous): 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

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In this Q&A series, Dr. Paula Quatromoni (DSc, RD) answers some of the biggest questions coaches and athletic staff have to help prevent or address eating disorders in athletes and assist athletes who may be struggling. Sign up for our email list to get the next link to the newest Q&A right to your inbox.

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

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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

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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

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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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