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

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?

A: There are guidelines for this in the literature now, thanks to the RED-S model (Relative Energy Deficiency in Sport). A 2016 publication from this expert group included a sample “contract” that an athletic trainer (AT) or a coach can use to require an athlete to engage in treatment for an eating disorder in order to continue to participate in sport.

The RED-S clinical assessment tool allows a sports medicine professional to determine whether or not the athlete is healthy enough to train and/or compete while engaged in treatment or if sports participation needs to be suspended. The “return-to-play” guidelines inform decisions about when it is safe for the athlete to return to sport.

In the case of a collegiate athlete, there is more control over the situation with NCAA eligibility and medical clearance to participate in sport managed by a team of sports medicine professionals (MD, AT, Nutritionist, etc) who really should be the ones doing this work and making these decisions, not the coach.

At the high school level, the proper action for the coach is to express his/her concerns to the athletic trainer and to let the AT follow proper channels of communication with the parents as a sports medicine professional. The AT should inform the parents about the observed behaviors and measurable concerns that validate their clinical judgment that their child needs to be evaluated by their pediatrician for an ED risk. The athlete needs a full workup and evaluation by their primary care doctor if an eating disorder concern is identified. If the parents refuse, the AT has the right to say, “Your child will not be cleared to participate in sports until we have clearance from the pediatrician.” The student should be off the team until their MD has evaluated the situation and provides medical clearance for sports participation.

If a contract is used in this setting, parents need to be aware and involved, and the contract should be managed by the medical professionals (the AT and/or the pediatrician), not the coach.

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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.