Need a Dietitian, But Can’t Afford One? Q&A with Dr. 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 answers some of the biggest questions coaches and athletic staff have to better prevent and assist athletes who may be struggling with eating disorders.

What if an athlete needs a dietitian’s support but says they can’t afford one?

Dr. Paula Quatromoni: If the athlete is otherwise healthy and is seeking general nutrition advice or recommendations for performance nutrition, there are many resources, noted below.

If it is a situation of a health concern, like GI distress, food allergy or intolerance, disordered eating or an eating disorder, the athlete needs a medical evaluation and individualized treatment. The athlete should consult their doctor and be fully evaluated to determine the next steps.

If treatment is needed, the physician should help the athlete find treatment options and collaborative providers. Whatever their health insurance covers is where the athlete should start. So, get to know the details of what your specific insurance plan covers. Some, but not all, insurance plans cover outpatient nutrition services. It could be that insurance covers the medical evaluation but not a dietitian unless there is a specific diagnosis or unless a primary care doctor initiates a referral. In this case, the doctor can make a referral so that nutrition services provided by a Registered Dietitian/Nutritionist (RDN) are covered.

Eating disorder treatment requires a multidisciplinary team comprised of a doctor, a therapist, and a dietitian. A team can be assembled using outpatient providers, or a team can be provided at a higher level of care at an eating disorders specialty center. Most eating disorder treatment programs and providers help clients navigate insurance coverage for care, some treatment centers take patients regardless of ability to pay, and others set sliding-scale fees to accommodate clients from a range of socioeconomic levels. There are also non-profit organizations and private foundations that offer resources to offset eating disorder treatment expenses. Two examples are the Manna Fund (mannafund.org) and the Kirsten Haglund Foundation (kirstenhaglundfoundation.org). Project Heal (theprojectheal.org) offers programs focused on breaking down barriers to eating disorder treatment, including financial barriers, accessing treatment, and navigating insurance.

Early Intervention

We know from both research and clinical practice that if someone is experiencing an eating disorder, the greatest chance for a full recovery is associated with early intervention and treatment, so you don’t want to ignore the warning signs or delay an assessment of risk. We also know that intervention in the earlier stages of disordered eating is as medically and nutritionally necessary as treatment for an eating disorder. Early intervention can actually prevent the development of an eating disorder. If you suspect an eating disorder or another health concern, do not delay in getting an assessment and proper treatment.

Registered Dietitian Fees

Most RDNs in private practice, especially eating disorder dietitians, do offer sliding scale payment, meaning that they lower their fees to make their services affordable to people who can’t pay out-of-pocket their full consultation rate. Seeking individualized advice from an RDN is always a good strategy for an athlete. Building an ongoing relationship with a provider who you trust and can return to over time when your needs change is a good investment in your overall well-being. Most dietitians use telehealth to augment their clinical practice, making nutrition services more accessible than ever!

Additional Resources

  • General healthy eating advice for Americans can be found at the website for the U.S. Dietary Guidelines at www.choosemyplate.gov
  • When looking for athlete-specific advice, look for nutrition books, articles, and blog posts written by Registered Dietitians (using the RD or RDN credential).
  • Nancy Clark’s Sports Nutrition Guidebook, by famed sports nutritionist Nancy Clark, MS, RD, is my go-to resource for well-rounded, sound, evidence-based sports nutrition advice.  I personally think every athlete and every coach should have this on their bookshelf!
  • Another book I often recommend is Endurance Sports Nutrition by Suzanne Girard Eberle, MS, RD, CSSD.
  • For the college-age athlete, I also recommend The College Student’s Guide to Eating Well on Campus, by Ann Selkowitz Litt, MS, RD. There are chapters on healthy approaches to weight, eating disorders and sports nutrition in addition to addressing the challenges to good nutrition on a college campus.
  • On the topic of relative energy deficiency in sport (RED-S), which is sometimes accompanied by disordered eating and manifests with health concerns similar to eating disorders in sport, I recommend Finding Your Sweet Spot: How to Avoid RED-S by Optimizing Your Energy Balance, by Rebecca McConville, MS, RD, CSSD, CEDRD.
  • The NCAA (National Collegiate Athletic Association) has online materials promoting nutrition for sport on its website (ncaa.org/sport-science-institute/nutrition-sleep-and-performance).
  • So too does the Collegiate and Professional Sports Dietitians Association (CPSDA), available at sportsrd/org/downloadable-resources.
  • Follow a collegiate or professional sports RD on social media! They put out great content for their followers!
  • The Academy of Nutrition and Dietetics (www.eatright.org) has lots of resources for consumers by searchable terms, like nutrition for bone health, anemia, etc. Athletes can visit eatright.org/fitness/sports-and-performance/tips-for-athletes for more tailored advice.
  • On the eatright.org website, there is a Find a Nutrition Professional link where you can type in your zip code and search by terms like sports nutrition or eating disorders to find RDNs who have the right expertise you are looking for in your local area.
  • Online eating disorder information and resources are accessible from the National Eating Disorders Association at nationaleatingdisorders.org. Finally, most eating disorder treatment centers have treatment and recovery-focused blogs that offer great information that is relevant to athletes.
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