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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What Can Parents Do if They Notice Eating Disorder Behaviors? Q&A with Dr. Quatromoni

This is part of a Q&A series with leading expert in eating disorders and sports, Paula Quatromoni. For more Q&As click here.

Q: My daughter started running and quickly developed a highly restrictive diet. She tries to eat no carbs. She has lost so much weight, but it’s never enough for her. She enjoys running, but I’m afraid she is using it as a punishment and has to do “workouts” in the morning and before bed. I am very worried about her, but she doesn’t want to talk about eating as a problem, because anything that helps her lose weight is a “good thing”. What can I do?

A (Paula Quatromoni, DSc, MS, RD, LDN): You are right to be concerned. This is a place where you have to trust your intuition and continue to observe the warning signs: restrictive eating, food rules (no carbs), substantial weight loss with a continued, strong, driven mission to lose more, and what could be compulsive exercise. This young woman is dieting and exercising, yet is not fueling properly to meet her nutritional demands. This creates a condition called “relative energy deficiency in sport” (RED-S). The consequences of RED-S are far-reaching and put her physical health, her emotional well-being, and her sports performance at risk. The fact that she “doesn’t want to talk about eating” is a hallmark of the denial that anything could possibly be of concern.

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Video: How Dad Responded to My Eating Disorder

For Mother’s Day, I shared videos from the Running in Silence YouTube channel about how my mom responded to my eating disorder. I figured it was good timing to interview my dad for this past Father’s Day. Both of my parents offer different but important perspectives of their understanding of eating disorders. I was also fortunate to have parents who were willing to support me through it despite their confusion from the onset.

Eating Disorder Recovery with my Mom: A Video Interview

From the first few chapters of Running in Silence my mom doesn’t suspect anything is wrong as I embark on a raw food diet. She doesn’t question my intense obsession with food and running fast, mostly because I kept the worst of the obsession to myself.

And then you get to the chapter where I come out about my binge eating disorder. But we both don’t know what monster we are dealing with. We are confused and lost. She gives the typical answers to “cure” what I’m dealing with by telling me I can just eat less to lose weight again. It was a seemingly “normal” response from someone who doesn’t understand and just wants to help.

What did my mom do right? She offered to get me professional help. My mom brought me to an eating disorder support group to see a therapist and dietitian. She took on the role of eating disorder researcher, attended the parent support group meetings, and listened to me talk for hours about what I was going through. Read more

When Loved Ones Can’t Understand Your Eating Disorder

Trigger warning: eating disorder behaviors mentioned.
Post updated 3/5/21 to reduce triggers and update the writing because I am still a perfectionist. :)


“How can you physically keep stuffing in more and more food?” my dad asked one night. “I mean, I get to the point where enough is enough in one meal.”

My dad and I had agreed to sit down to talk about my eating disorder the summer going into my senior year of college, and it wasn’t off to a great start. At that moment on the couch, in the darkness of one summer evening, I felt I had to explain to my dad exactly what was going on within. Then, then he would “get it.”

The conversation went a little like this:

Me: “When you hold back on food for so long–like my two-year restriction–then your body is going to try to make up for it. It’s going to go for the simplest sugars. That’s why many people crave high-calorie food at the end of the day if they don’t eat enough. Your body wants to find the most calorie-dense form of food so that it can break it down fast and use it. And with an eating disorder–with your body in that desperation mode–you often stuff yourself until you are uncomfortably full, even if it hurts.”

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A Father of Food: My Dad Dealing with the Eating Disorder

My dad loves food–it has been his love language to prepare and serve our family food ever since I was born. He has always encouraged my sister and I to try new foods, to enjoy meals with the family, and to embrace food from different cultures.

So when I started a raw food diet, my dad didn’t know how to respond. And when my mom told him I was struggling with an eating disorder over a year later, he was at a loss.

My dad’s love language for his daughter seemed to be crumbling.

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Relationship With My Mom: Discussing Eating Disorder Triggers

Before I told my mom about my eating disorder, any comments she made about my food or hers felt like a knife slicing through my chest. The eating disorder twisted her words to make them sound like a jab at me. The comments could be about how much I ate, what kind of food I was eating, and how full she felt.

I know that my mom was not trying to be cruel when she made comments about my food. My mom just didn’t understand the impact these comments had on someone with an eating disorder hissing through their mind. But the more I opened up to her, the more I was able to voice my concerns about these triggering comments. In turn, she learned to avoid the triggers as I worked through recovery.

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