5 Things Coaches Should Avoid Saying to Adolescent Athletes

By: Amanda Feldman 

Amanda Feldman is a graduate student in Boston University’s Nutrition and Dietetics program pursuing her RDN credential with a special interest in sports nutrition and eating disorders. Outside of the classroom, she is a high school Varsity Softball and Cross Country coach at the Dana Hall School in Wellesley, MA, where she graduated before continuing on to play 2 years of collegiate softball at Trinity College in Hartford, CT. In her free time, Amanda is an avid long-distance runner and is passionate about sharing her love for running, athletics, and nutrition education.

Eating disorders are serious mental illnesses that come in all shapes and sizes.1 Male-identifying and female-identifying. Those in larger and smaller bodies. They can occur in runners, football players, soccer players, dancers, fencers and everything in between.

As a former athlete and a current high school coach myself, I am aware of the unique role coaches play in an adolescent athlete’s life. We act as role models, mentors, and individuals our athletes are trying to impress. In some cases, the internal pressure to impress a coach is so high our athletes will do anything and everything asked of them to get on the field, be a starter, become a captain, or earn a coach’s respect. Because of this, everything from the way coaches talk about goal setting, fueling and food, athletes’ bodies, and body changes can have a profound impact on an athlete – be that positive or negative.

Some individuals have a predisposition that puts them at a higher risk for developing an eating disorder. Eating disorders are “complex traits,” and multiple environmental and genetic factors play a role in their development.1 This includes individual’s genetics, past experiences, societal pressures, traumas, and other mental health diagnoses to name a few factors. It is hard for us to identify exactly who is at high risk for developing one, but what we do know is that adolescence is a vulnerable period,2 one in which eating disorders too commonly manifest. This is why we need to place high importance on eating disorder prevention.

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Kamila Valieva’s Tragedy is Not An Isolated Incident

Guest Post By Matt Stranberg

Matt Stranberg, MS RDN LDN CSSD CSCS is a Sports Nutrition and Exercise Science Specialist helping athletes and non-athletes improve their relationship to food and exercise. To learn more visit: https://www.mattstranbergconsulting.com/ Follow Matt on instagram: @matt_stranberg_consulting

Olympic trials have always had their fair share of controversies and dramas, dating back to the early 1900’s and the spectacle of Nazi Berlin to more recent media frenzies surrounding Simone Biles’s 2021 withdrawal. This year is no different as young Russian figure skating prodigy, Kamila Valieva was plunged into scandal following a positive drug test as well as more recent stories highlighting her series of falls in competition resulting in a media explosion exploring the cruel treatment by coaches during her heartbreaking moments of public anguish.

Many critics, including International Olympic Committee President Thomas Bach have derided Kamila’s treatment as “disturbing, cold, harsh and chilling to see.”[i] Numerous media outlets have framed this tragedy as yet another “confrontation between Russia and international institutions,”[ii] that has reignited debates regarding possible age limits for Olympic competition.[iii]

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Avoiding Eating Disorder Triggers: Athletes Can’t Talk About Food? Q&A With Dr Paula Quatromoni

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

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

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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The Professionals to Bring in for Student-Athletes With Eating Disorders (Q&A with Paula Quatromoni)

Paula Quatromoni is a senior consultant for Walden Behavioral Care, a registered dietitian, and one of the leading experts for eating disorders in athletes. She has published several papers on both clinical experiences and qualitative research on recovery experiences of athletes. Dr. Quatromoni is the Department Chair of Health Sciences and a tenured associate professor of Nutrition and Epidemiology at Boston University where she maintains an active, funded research program. In 2004, she pioneered the sports nutrition consult service for student-athletes at Boston University. Dr. Quatromoni was named a 2016 Outstanding Dietetics Educator from the Nutrition and Dietetic Educators and Preceptors (NDEP) Council. 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 will be answering 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?

Paula Quatromoni: 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)

Paula Quatromoni is a senior consultant for Walden Behavioral Care, a registered dietitian, and one of the leading experts for eating disorders in athletes. She has published several papers on both clinical experiences and qualitative research on recovery experiences of athletes. Dr. Quatromoni is the Department Chair of Health Sciences and a tenured associate professor of Nutrition and Epidemiology at Boston University where she maintains an active, funded research program. In 2004, she pioneered the sports nutrition consult service for student-athletes at Boston University. Dr. Quatromoni was named a 2016 Outstanding Dietetics Educator from the Nutrition and Dietetic Educators and Preceptors (NDEP) Council. 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 will be answering some of the biggest questions coaches and athletic staff have to better prevent and assist athletes who may be struggling with eating disorders.

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 Questions About Nutrition and Weight Should High School Athletes Ask College Coaches?

I was asked by an athlete what questions she could ask a coach she was considering running for in college. After being directed to some great questions NOT to ask, with helpful re-frames provided here: https://www.ncsasports.org/blog/2018/05/23/19-questions-college-coaches-hate/, it sparked my own questions. How can athletes assess whether the college coach they want to compete for has a healthy attitude toward nutrition and weight? How could they ask about resources available on campus or inside athletics should an athlete struggle or need guidance down the road?

So I went right to collegiate nutrition expert Paula Quatromoni for advice about navigating this important and delicate topic. She stated that often, these important questions are not asked because athletes (and parents) are focused on training and performance expectations, scholarships, the recruitment process, etc. and don’t necessarily think about the culture around food, nutrition and weight up front. Athletes may get other advice on this topic (from any source, really; not just a coach) and they should thoughtfully consider which questions are best suited to their individual circumstances and personalized needs when having conversations to evaluate a good fit with a coach, program, team or university. She suggested asking the following questions specific to nutrition and weight:

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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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