Coaches in the Dark: What Can Athletic Staff Do in Eating Disorder Situations?

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Having had an eating disorder as an athlete, I’ve been hyper-aware of the signs to look for in the athletes I coach. I knew, from my eating disorder experience, that if I suspected an athlete was struggling, it was my responsibility to refer them to a mental health professional and/or a dietitian for a proper evaluation. I even started doing homework to look for available resources in our area.

But I still felt like I was in the dark. Was I following all the right steps? How did other coaches know what to do in these situations? It wasn’t until a year ago that I realized that athletic trainers—staff right within the school—have formal education and training to recognize, screen and triage signs and symptoms of eating disorders in sport. In fact, most use an eating disorder protocol to begin the evaluation process, make referrals for intervention, and guide decisions about whether and when it is safe to participate in sport.

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

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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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How Can Coaches Help Underweight Athletes Gain Weight? Q&A with Dr. Quatromoni

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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: I’m a high school coach. I have an elite runner who needs to gain weight/body fat. She is not intentionally losing weight but is very active with either running or other workouts like core and strength work. She never really slows down and on top of that just doesn’t eat enough to offset her exercise. She has seen a dietitian, but they haven’t really given her a strategy. She knows what needs to happen and her parents are working on it as well. My immediate thoughts are that she needs to record her intake and maybe that shows her just how much it is and shows ways to increase it. It could also show me how much she can run so as not to create a deficit each day.

A (Paula Quatromoni, DSc, MS, RD, LDN): It sounds to me like maybe she hasn’t seen the right dietitian who truly understands sport and the importance of a fueling strategy for an elite runner, because she reportedly came away from that interaction (was it only one session?) without one. I am betting that the RD (Registered Dietitian) she saw was not credentialed and experienced as a sports dietitian; not all registered dietitians have the additional training or qualifications to work in sports nutrition or eating disorder treatment. She needs an expert capable of designing a fueling strategy for an elite athlete. She should look for someone with the CSSD credential (Certified Specialist in Sports Dietetics) on top of the RD credential; or at least an RD who states on her practice website or is known to the local sports community as experienced working with and customizing nutrition plans for athletes.

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When a Coach Suggests Athletes “Drop a Few Pounds”: Q&A with Dr. Quatromoni

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

A coach of an adult, co-ed triathlon team sent out a training guide offering athletes advice on “top 5 ways to become a faster cyclist.” One of the “lessons”:

Lesson B: Dropping a few pounds
When it comes to biking, we can all stand to lose a few pounds.

Q: How can athletes advocate for themselves and their teammates to tell a coach they are uncomfortable with recommendations being put forth to the team about weight loss?

A (Paula Quatromoni): For several reasons, this is a dangerous message for coaches to deliver to athletes, and it is a dangerous way in which to deliver it.

First, this advice endorses the “thinner is faster” mentality. Bodyweight is not the best indicator of athletic performance, so this advice overemphasizes dieting and weight loss as solutions and oversimplifies the many factors that influence performance.

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What Coaches Can Do to Prevent Eating Disorders: Q&A with Dr. Quatromoni

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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: What can coaches do to build a healthy culture and prevent eating disorders?

A: First, I’d recommend education. There is a lot that coaches can do to educate themselves and increase awareness on the topic of eating disorders in sport. They can turn to Walden GOALS materials, Running in Silence and Running in Silence blog posts, Nancy Clark’s Sports Nutrition Guidebook, and credible websites like NEDA, etc. They can also attend lectures, events, and coaching conferences to engage in continuing education on the topic. Armed with this information, coaches can address concerns that they see on their teams in a one-on-one conversation and a referral to the AT like we were talking about in that last Q&A.

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For Coaches, Approaching an Athlete with an Eating Disorder: Q&A with Dr. Paula Quatromoni

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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 do you recommend approaching an athlete you think might have an eating disorder?

A (Paula Quatromoni): Set up a private meeting with the athlete to discuss your concerns. Never, ever, ever do this in public and do not do it without some purposeful thought and advance preparation. In other words, do not have this conversation off the cuff or in the heat of a moment when you are having any kind of emotionally charged interaction with the athlete, like after a bad sport performance or when they suffer an injury.

It is important that you know the signs and symptoms of an eating disorder and that you have objective data and personal observations that align with those warning signs. Do not act on hearsay or second-hand information that could be false or inaccurate. Make notes about your observations and your concerns so that you can stay focused on the facts when you have this conversation.

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What Can Coaches Do if An Athlete is Resistant to Eating Disorder Treatment? Q&A with Dr. Paula Quatromoni

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Ever since meeting Paula Quatromoni at the Eating Disorders in Sport Conference last August, we have been in constant communication. Paula has been especially helpful for me since I am not a professional in treating eating disorders. So as one of the leading experts in this field, it is a privilege and an honor to have Paula answer questions to help coaches better work with athletes who may have eating/weight struggles. For more Q&As with Paula, which will be coming in the future, click here.

Q: What can coaches/parents/sports programs do if an athlete is resistant to going to an eating disorder therapist or dietitian, but very clearly struggling with an eating disorder?

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