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 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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How Do You Address Jokes Being Made About Eating Disorders? Q&A with 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 more Q&As/stories like this directly to your inbox.

Q: “How would you suggest addressing jokes being made about eating disorders?”

A: Eating disorders are no joke. They are serious mental health conditions that people die from. Death occurs from the life-threatening complications of malnutrition or by suicide. The burdens of pain, suffering, psychological, emotional, and physical distress are beyond what most people comprehend. Eating disorders are crises that affect interpersonal, familial, and social relationships; they also disrupt one’s ability to function in school, at work, and in society. Eating disorders steal lives and they steal quality of life over years if not decades.

When someone makes a joke about an eating disorder, it reflects both insensitivity to the plight of others and their low awareness about the seriousness of the disease. Would one joke about cancer or suicide? Eating disorders are no different. Yet as mental health disorders, they are both misunderstood and highly stigmatized.

The discomfort you might experience when a joke is made in poor taste or at your or someone else’s expense may completely disarm your ability to respond. You may be taken aback, caught off guard, experience a degree of shock, and be at a total loss for words. Or, you may laugh nervously because it feels awkward and you just want to escape or quickly change the subject.

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The Role of an Athletic Director in a School’s Eating Disorder Protocol

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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 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.

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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 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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An Athlete on Another Team Looks Underweight–What Should I Do? Dr. Paula 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 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.

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Need a Dietitian, But Can’t Afford One? Q&A with Dr. Paula Quatromoni

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Paula Quatromoni, DSc, MS, RD is a registered dietitian, academic researcher, and one of the country’s leading experts in the prevention and treatment of eating disorders in athletes. Dr. Quatromoni is a tenured associate professor of Nutrition and Epidemiology, and Chair of the Department of Health Sciences at Boston University where she maintains an active program of research. She publishes widely on topics including clinical treatment outcomes and the lived experiences of athletes and others with and recovering from eating disorders. In 2004, she pioneered the sports nutrition consult service for student-athletes at Boston University, and in 2016, she led the creation of the GOALS Program, an athlete-specific intensive outpatient eating disorders treatment program at Walden Behavioral Care where she serves as a Senior Consultant. Dr. Quatromoni is an award-winning educator. 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.

In this Q&A series, Paula answers some of the biggest questions coaches and athletic staff have to better prevent and assist athletes who may be struggling with eating disorders.

What if an athlete needs a dietitian’s support but says they can’t afford one?

Dr. Paula Quatromoni: If the athlete is otherwise healthy and is seeking general nutrition advice or recommendations for performance nutrition, there are many resources, noted below.

If it is a situation of a health concern, like GI distress, food allergy or intolerance, disordered eating or an eating disorder, the athlete needs a medical evaluation and individualized treatment. The athlete should consult their doctor and be fully evaluated to determine the next steps.

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

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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

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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

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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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