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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Questions Athletes Can Ask about Nutrition, Weight, & Mental Health in College Programs (with Dr. Paula Quatromoni)

I was asked by an athlete what questions she could ask a college coach she was considering running for. After being directed to some great questions to ask (and not ask), it sparked my own questions: How could athletes see if the college coach they want to compete for has a healthy attitude toward nutrition and weight? How could they ask about available resources should an athlete struggle or need questions answered down the road?

So of course, I went right to expert Dr. Paula Quatromoni, registered dietitian (RD) at Boston University, for advice about navigating this important and delicate topic. She pointed out that many coaches are interested in these very same questions and are actively working to identify resources and build a positive team culture around these very issues. But, like resources, attitudes and culture can vary widely from one college or university to another. So, it is best not to assume that the coach shares your philosophy or is as equally engaged on this as you might hope. One way to find out is to exercise your strong communication skills. Be prepared to ask some very direct questions.

Paula suggested asking the following:

What is the culture like on your team with regards to athletes’ nutrition, weight, and overall wellness?

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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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3 Ways Coaches Can Help Prevent Eating Disorders in Athletes (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: What can coaches do to prevent eating disorders?

Education

First, coaches need to get educated about eating disorders in sport from credible professional sources like the National Eating Disorders Association (www.nationaleatingdisorders.org/sites/default/files/Toolkits/CoachandTrainerToolkit.pdf). Coaches and athletics administrators can also bring professionals in to educate athletes and support staff about eating disorders in sport.

Eating disorders are poorly understood, probably more so inside sport than in the general public. There are stereotypes and sources of stigma that perpetuate faulty beliefs about who is at risk and what an eating disorder “looks like.” Coaches, strength coaches, athletic trainers (ATs), doctors, parents and athletes all need education about eating disorders in sport, the unique sport-specific risk factors, the negative impact on health and sport performance, and the diverse ways in which eating disorders present. There is no one universal sign or symptom of an eating disorder. Eating disorders do not discriminate; they occur in males and females, in individuals in smaller bodies and larger bodies, and in all sports.

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What Can Coaches Do When Athletes Are Not Fueling Properly? (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: What should a coach do when they suspect an athlete is not fueling properly and needs assistance with nutrition?

A: Best practice is to refer your athlete to a Registered Dietitian (R.D.) for an individualized assessment by a trained nutrition professional. It is wise to build relationships or, at a minimum, a referral network of providers in your local area. You can use the search engine of the Academy of Nutrition and Dietetics (www.eatright.org) to Find an Expert by zip code. You can search for specialty areas of practice, like sports nutrition.

Direct your athletes to books written by Registered Dietitians and credible websites managed by sports nutrition professionals. These are great resources for coaches to educate themselves as well! Here are some reliable “go-to” resources:

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What Can You Do if a Coach is Uncomfortable Addressing Eating Disorders? (Q&A with Paula Quatromoni)

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

Q: There is suspicion that there are girls struggling with eating disorders on a high school sports team. The coach hasn’t addressed these issues even though he is concerned and is aware that it’s a problem. A mom, amongst a few other parents, brought this up and feels eating disorders/body image should be addressed. Should parents bring it to the attention of the athletic trainers next? Bring in the school counselor?

A: It sounds like this mom has a concern about the culture on this team in relation to body image and unsafe dieting practices, and she wants it addressed. That the coach is aware and reportedly concerned but is not taking action is a red flag to me. The coach sets the tone for team culture and, to a certain extent, is responsible for the safety and well-being of his athletes in relation to how he coaches, communicates, and interacts with them. By ignoring his concerns, he is silently (or maybe actively) condoning the culture that endorses, perpetuates and sustains unhealthy behaviors. This puts athletes at risk of injury and other physical and emotional consequences.

Don’t Accept Inaction

There are several possible scenarios, but none condone inaction. It could be that the coach is uneducated about the dangers of eating disorders and the risks of this culture to his athletes’ well-being. It could be that the coach actually holds and role models the common yet faulty belief system that thinness is the key to athletic performance. If the coach is giving his athletes advice about nutrition that includes weight loss, fad diets or restrictive eating, he is creating a potentially dangerous situation for his athletes. No matter how well-intentioned, the coach is not likely a trained nutrition professional qualified to give accurate and appropriate nutrition advice. Through his behaviors and/or his words, he could be setting expectations either overtly or covertly that are driving disordered eating behaviors in his athletes. It could also be that the coach simply has no idea how to address eating disorders, is afraid of doing the wrong thing, or believes it is not his “turf,” so he is opting not to intervene.

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How Can a Coach Support an Athlete With an Eating Disorder? Paula Quatromoni Q&A

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 (Anonymous): I’m a coach with an athlete who told me she is struggling with an eating disorder and is getting treatment. She asked me to keep her accountable. How can I do this? Should I monitor her weight and food?

Accountability

A (Paula Quatromoni, DSc, MS, RD, LDN): I would ask the athlete, “What do you mean by “keep me accountable?” Can you say more about specifically what you are asking of me?” I would not make any assumptions about what the athlete means. It is very important to set some boundaries and clear expectations about what the coach can and cannot do related to appropriate kinds of support for an athlete with an eating disorder. Leaving expectations vague leaves room for misunderstanding, misinterpretation and misplaced responsibility. Clear expectations and ground rules are best!

Experts Needed

First, let’s be clear about this: it is not the coach’s responsibility or within the scope of a coach’s training and expertise to monitor an athlete’s weight or food intake. This is particularly dangerous in the case of an athlete with an eating disorder because it could delay timely diagnosis and proper intervention. Anything that delays timely diagnosis and treatment of an eating disorder escalates the health risks for the athlete, increases risk of injury, and lowers the likelihood of recovery.

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Bringing Mental Health Education to Coaches and Athletes in Michigan

As many of you might know, I coach high school cross country and track in Michigan and I’m required to take trainings on the sports rules and how to spot concussions. These trainings are run by the MHSAA, which is also a member of the National Federation of State High School Associations. Of course, with my eye for mental health and eating disorders, I noticed that there were no required trainings on how to identify mental health issues in our athletes (something I’ve already witnessed in the few years of coaching).

But when I went to the Stomp Out Stigma walk a few weeks ago, I spoke with Christy Buck, CEO of the Mental Health Foundation of West Michigan, who shared the great news that there would now be an Action Plan implemented by the MHSAA to educate coaches on how to spot possible mental health issues in their athletes. It’s my greatest hope that we can get more trainings like this in all athletic/coaching programs, and I’m so thankful the MHSAA took this on, that I had to learn more and share:

Representing the Michigan Eating Disorders Alliance with Director Gail Hall just before Christy Buck told us about the Action Plan for the MHSAA

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How Should Eating Disorder Recovery Stories Be Shared? 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: How should eating disorder recovery/stories be shared in presentations? How do we share properly, avoid triggers, address concerns, and raise awareness?

A (Paula Quatromoni, DSc, MS, RD, LDN): I was recently looking for something on-line and came across some “guidelines” for eating disorder prevention talks in schools and one of the top recommendations was to not bring in an individual to tell their recovery story. I wish I could remember the source of that ‘tip,’ but clearly, I dismissed it because in my opinion, “it depends” entirely on the audience and also on the individual sharing their story.

I do not believe in making a hard and fast “no, don’t do it” declaration. At the same time, I would not give an unconditional, “do this!” recommendation either. What works for one person and in one setting may not work for another. There are never any guarantees that what we deliver in an educational session will meet everyone in the audience’s needs. One speaker may do a great job and a different speaker may not do the topic justice at all. That is true in any educational setting and the same can be said of teachers, in general. It is also true of counselors, therapists, dietitians, doctors, etc. Some patients or clients may describe their interactions with a health professional as “outstanding” or “super helpful,” but others may find their interactions to be not very therapeutic, effective or individualized to their personal needs.

What we do need to ensure is that first, we “do no harm.” So there are some important considerations and a need for heightened sensitivity when a recovery speaker is planning to address a school community.

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