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.
I learned this, of course, from a sports nutritionist, Dr. Paula Quatromoni, DSc, RD, when she mentioned it in her Q&As. Because I was so surprised by this information, I have made it part of my mission to make coaches aware of this too. I also decided to investigate further.
Meeting with the Athletic Trainer
I met with our high school athletic trainer just under a year ago. I wanted to understand how much knowledge he had about eating disorders and if we did in fact have an eating disorder protocol. I found myself pleasantly surprised after talking with him. I didn’t realize he had so much information about something beyond physical injuries. And I think this is important to note—our athletic trainers aren’t just there to prevent or treat the physical injuries. They are on the front lines, working closely with athletes. This means they are in the prime position to recognize signs and symptoms of disordered eating and/or emotional distress in their athletes.
My high school athletic trainer even printed a packet of information about the eating disorder protocol for me to look over. I wish I had known about this resource a lot sooner! But now that I know, he is my “go to” for input and assistance when any concerns arise. It was a promising, encouraging conversation.
Trainings for Coaches
As I stepped into the role of head coach this year, I had to take a first-year coaching training. I appreciated the training—especially since it focused on athletes as people rather than solely on performance. We even had an athletic trainer come in to discuss injuries and concussions.
To my surprise, eating disorders were not brought into the conversation at all in that training session. It solidified my suspicion that there is a lack of information that coaches are getting about the prevalence of eating disorders/disordered eating, how to look for eating disorder risk factors beyond evaluating an individual’s body size, and the steps to take when a coach recognizes that an athlete may be experiencing an eating disorder or other mental health issue. Like concussions, eating disorders aren’t always easy to identify, especially if we don’t know what to look for. And like concussions, if eating disorders aren’t addressed, we are jeopardizing athletes’ physical and emotional well-being.
Prevention and Opening the Conversation: Other Resources
Once we have awareness and information about eating disorders, we need the proper resources and assistance. As coaches, we are not expected, nor are we trained, to play the role of therapist or dietitian. We are, however, charged with the responsibility of connecting our athletes to professionals when they need help.
Reaching out to the athletic trainer on staff is the first step. After doing this myself to gather information, I also met with our strength and conditioning coach. We discussed ways in which we could bring a dietitian to campus to speak with the student-athletes, and he successfully pulled this off. We are hoping to continue having this dietitian speak more often in the future. We began with nutrition educational sessions throughout the summer and offered one-on-one meetings for our student-athletes with the dietitian. We loved being able to refer athletes to her when any nutrition questions came up.
Dr. Quatromoni has brought up more than once that having a training in each season for the athletic staff and student-athletes would be helpful. This allows the dietitian to have an ongoing working relationship with the athletics department and it helps to build trusting relationships with student-athletes and coaches over time. It also helps to deliver new information as the needs of athletes change when they move in and out of the competitive season to the off-season and their nutritional needs change.
To find a registered dietitian (RD) to come to campus to speak about eating disorders and proper nutrition, Paula suggests this:
You can go to www.eatright.org and click on the link for Find an Expert in the top right corner. You can type in your zip code and you can also search by specialty area, so you can search for sports nutrition or eating disorder expertise. It will generate a list of local RDs in your area and their contact info and it will identify their areas of expertise.
Another strategy is to see if any of the colleges or universities near you have a Dietetics program on their campus; even better, if they have a graduate program in Nutrition. Faculty members may have the right expertise; grad students can do some education for your teams; the college’s student health services may have an RD; and/or there may be a sports RD who consults with or is employed by the university who is looking for other places to consult. Most sports RDs are not employed full time inside sport and are usually patching together a bunch of part-time jobs to consult in a bunch of different places.
Paula also mentioned that counselors in the schools are helpful for any mental health issues that may arise on the team.
The school counselor can do a basic assessment and should be trained to ask the right screening questions to make an appropriate referral to a licensed mental health professional for a full evaluation. The school counselor should/could have a list of referrals to therapists and counselors to recommend to parents. At a minimum, the counselor should have the ability to make an authoritative recommendation to parents that the child is exhibiting specific symptoms of concern and needs a full evaluation by their pediatrician; from there, the pediatrician can make the appropriate referrals to other professionals.
Who Should Be Involved in an Eating Disorder Case?
Because I’ve received many messages from coaches and parents about eating disorder issues that arise, it’s important to understand who should be involved at a school. From Dr. Quatromoni:
The AT, the school nurse, and/or the school counselor should be the school-based personnel on the case. More importantly, they need to bring awareness of the eating disorder concern to the parents and require a pediatrician to evaluate the athlete before he/she can return to sports participation.
If there is confusion about what to do or whose responsibility it is to intervene, this implies that there is no formalized eating disorder response plan or protocol at the school. This is something that these school leaders should come together to create. An eating disorder protocol is as essential as a concussion protocol, for example. Encouraging the wellness team to think about eating disorders in sport as “metabolic injuries” may facilitate this action.
I believe it’s important to know what to do, not only with a physical injury, but also with what I like to a call a “mental injury.” It’s helping me to see where we can improve as an athletic community and give coaching staff a greater awareness of what to do. Paula’s advice?
As coaches, keep pushing for training, resources, opportunities and strategies to educate and raise awareness in all of those groups in your community. It is a tireless effort that takes a village to address!
And, as a coach who had to take the concussion training this year as well, I believe it’s important that eating disorders also be a part of the conversation and trainings. With the influx of questions from coaches about these situations, it’s a clear sign that this issue challenges us hard and it challenges us often. As coaches, we cannot be left in the dark.