An Athlete on Another Team Looks Underweight–What Should I Do? Dr. Paula Quatromoni Q&A

In this Q&A series, Dr. Paula Quatromoni (DSc, RD) answers some of the biggest questions coaches and athletic staff have to better prevent and assist athletes who may be struggling with eating disorders.

Coach Question: An athlete from another team appeared underweight and was still competing this season. Parents of athletes on my team have expressed concern about a possible eating disorder. We have no idea if parents, athletic staff, or the coach of this team have intervened, but it doesn’t appear so because the athlete is still competing. Any thoughts about how to handle this? Is this a situation where I could reach out to the coach to express our concerns? The athletic director of that school? The athletic trainer?

Dr. Paula Quatromoni: I do think it’s appropriate for you as a coach to raise your concern with the coach of the other team. I would not sit back and ignore a potential red flag. However, you also cannot jump to conclusions or pass judgement.

When you do express your concern, you have to stick with what you’ve observed and what your concern is. Have you known or seen this athlete before to know that what you are seeing is a recent, significant weight loss? Keep in mind that there could be other explanations for what you are observing. Maybe this athlete has a chronic health condition that contributes to their low weight. From one observation, we don’t know if this athlete has always been low weight or if they recently experienced a dramatic weight loss. So, while it may be tempting to interpret what we see as an eating concern, we can’t be judgmental or jump to conclusions. We need more information.

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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.

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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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Questions Athletes Can Ask about Nutrition, Weight, & Mental Health in College Programs (with Dr. Paula Quatromoni)

I was asked by an athlete what questions she could ask a college coach she was considering running for. After being directed to some great questions to ask (and not ask), it sparked my own questions: How could athletes see if the college coach they want to compete for has a healthy attitude toward nutrition and weight? How could they ask about available resources should an athlete struggle or need questions answered down the road?

So of course, I went right to expert Dr. Paula Quatromoni, registered dietitian (RD) at Boston University, for advice about navigating this important and delicate topic. She pointed out that many coaches are interested in these very same questions and are actively working to identify resources and build a positive team culture around these very issues. But, like resources, attitudes and culture can vary widely from one college or university to another. So, it is best not to assume that the coach shares your philosophy or is as equally engaged on this as you might hope. One way to find out is to exercise your strong communication skills. Be prepared to ask some very direct questions.

Paula suggested asking the following:

What is the culture like on your team with regards to athletes’ nutrition, weight, and overall wellness?

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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 Can Coaches Do When Athletes are Not Fueling Properly? (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.

Read more